This is a modification of the 20 question survey created by Tomei. (Tomei, Lawrence A. (2002). The Technology Facade: Overcoming Barriers to Effective Instructional Technology. Boston, MA: Allyn & Bacon.) Any linked text goes to further explanation of what terms means or the item requires.

Print out and complete the survey. The dark blue cells indicate locations where scores should not be placed.
 

2. Are the library and computer lab computers in your school....?
 

	Points Available	Points Awarded
Locked during unsupervised periods such as recess, study halls, lunch, and before and after school	0	.
Available before and/or after school	3	.
Available when there are no classes scheduled	5	.
Open during recess, study halls, lunch, and before and after school	7	.
Your score (7 possible)	===>	7
Optional comments:

3. Are the classroom computer facilities in your school adequate?
 

	Points Available	Points Awarded
All classrooms have at least one computer connected to the Internet.	2	2
In classrooms, a computer and its display screen are located in a central location allowing small group and large group use as appropriate. For example, in classrooms that teach using small groups, the computer screen is located at the table where small groups meet and is used regularly in instructional activities. This same monitor can be easily turned to show a full screen picture to a larger group.	2	1
Each teacher has the resources to engage the entire class in computer activity that supports instruction within their regular classroom and regularly does so, not just during the class's time in the computer lab. There are several ways in which this might be implemented. Each classroom could have a projection system enabling the classroom teacher to project the computer display to a large screen, thereby enabling whole class instruction OR each student has a handheld computer OR each student has a laptop or desktop computer.	2	1
There is a computer lab with a trained computer educator and classes have regular scheduled times in which to use this facility.	1	.5
Your score (7 possible)	===>	4.5
Optional comments:

4. Do classroom teachers use technology for...? Rate each separately.
 

	Points Available					Points Awarded
	Never	Seldom	Occasionally	Increasingly	Routinely
Grading	0	1	2	3	4	3
Lesson preparation	0	1	2	3	4	3
In-class assignments	0	1	2	3	4	3
Out-of-class assignments	0	1	2	3	4	0
Professional development	0	1	2	3	4	3
Your score (20 possible)	===>	===>	===>	===>	===>	12
Optional comments:	*Dependant upon school

5. Is the computer teacher expected to have lesson plans with specific student learning objectives related to state technology competencies? Select one.
 

	Points Available	Points Awarded
Computer instruction is not based on lesson plans	0	.
Lesson plans are not used. There are general goals for instruction, but no specific learning objectives.	3	.
Lesson plans contain generic technological competencies and general learning objectives	5	.
Detailed lesson plans are used that reflect the state's specific technological competencies expected of each student	7	.
Your score (7 possible)	===>	5
Optional comments:  Integration with classroom curriculum is highly emphasized.

6. Does the software found on your computers reflect current classroom curriculum needs? Select one.
 

	Points Available	Points Awarded
Computer software is available, but its selection was not based on teacher input and seldom reflects actual classroom content	1	.
Computer software was recently purchased but is not readily available for teachers and students to use	3	.
Computer software selection was based on teacher input and its use on current curriculum objectives	5	.
Computer software versions are current, software selection is based on teacher input, and the software is routinely used by teachers and students	7	.
Your score (7 possible)	===>	7
Optional comments:

8. Do teachers participate on the Technology Committee and its subordinate teams? Identify all that apply.
 

	Points Available	Points Awarded
Teachers do not participate as full voting members on the Technology Committee	0
There is a Hardware/Software Acquisition Team subcommittee on which teachers participate	3
There is a Technology Budget Preparation Team subcommittee on which teachers participate	3
There is an Instructional Technology Curriculum Team subcommittee on which teachers participate	5	5
There is a Strategic Technology Planning Team subcommittee on which teachers participate	5
Your score (16 possible)	===>	5
Optional comments:

9. Do parents, community leaders, alumni, and students participate on the Technology Committee and its subordinate teams?
Identify all that apply.
 

	Points Available	Points Awarded
They do not participate as full voting members on the Technology Committee	0
They participate as members of the Hardware/Software Acquisition Team subcommittee.	3
They participate as members of the Technology Budget Preparation Team subcommittees.	3
They participate as members of the Instructional Technology Curriculum Team subcommittee.	5
They participate as members of the Strategic Technology Planning Team subcommittee.	5
Your score (16 possible)	===>	0
Optional comments:

10. Does your school provide direct access to the following technology professionals? Identify all that apply.
 

	Points Available	Points Awarded
None of these professionals are employed at our school.	0
Computer teacher (part time/full time)	3/5	3
Computer technician (part time/ full time)	1/3	3
Network administrator (Full time only)	3	3
full time technology coordinator or masters degree instructional technology specialist (077 certified)	4/7	4
Your score (18 possible)	===>	13
Optional comments: *Ratings based on district situation.

11. How is technology funded in your school? Select one.
 

	Points Available	Points Awarded
Technology is funded with year-end fallout money.	1	.
Technology is included in the operating budget under a miscellaneous account.	3	.
Technology is included in the general operating budget	5	.
Technology is its own specific, recurring line item in the annual budget.	7	.
Your score (7 possible)	===>	5
Optional comments:

12. Has your school implemented a recognition program for teachers who develop technology-based instructional materials? Select one.
 

	Points Available	Points Awarded
There is no remuneration or recognition program to recognize excellence in instructional technology.	0	.
Excellence in instructional technology is recognized in school newsletters, bulletins, and school board reports.	1	.
A formal awards program recognizes teachers who develop excellent instructional technology programs.	5	.
Teachers receive compensatory time, monetary compensation, or other specific remuneration for developing technology-based programs.	7	.
Your score (7 possible)	===>	0
Optional comments:

13. Is there a technology plan for the school? Select one.
 

	Points Available	Points Awarded
No technology plan exists in our school.	0	.
The school is working under a general district-wide plan, but a local building plan does not exist.	1	.
The school is working on an informal strategy for technology, but a formal plan has not been prepared.	3	.
Yes, but it is serious need of revision or has not been revised in the previous 2 years.	5	.
Yes, and it is revised on a regularly scheduled basis at least annually.	7	.
Your score (7 possible)	===>	7
Optional comments: A three year revision was just submitted.

14. Does your school's Technology Plan contain the following? Identify all that apply.
 

	Points Available	Points Awarded
No technology plan exists in our school.	0
Vision/mission statement	1	1
Demographic review of teachers, students, and community	1	1
Technology-related purchasing procedures	1	1
Periodic and on-call maintenance for instructional technologies used for classroom teaching	1	1
Security plan regarding physical threats, human threats, and Internet threats to technology	1	1
Formation and operation of a viable technology committee with diverse membership	2	1
Impact of technology integration on the curriculum	2	2
The uses of technology for lifelong learning, special needs learners, and exceptional learners	2	2
A comprehensive facility plan for installation and periodic upgrades	2
A formal plan for continuous evaluation, both formal and informal	3	2
Your score (16 possible)	===>	12
Optional comments:

15. Rate the computers in your school computer lab and classrooms. Identify all that apply.
 

	Points Available	Points Awarded
Most of the machines are less than 3 years old.	1
Most of the machines are CD or DVD capable.	1	1
Most of the machines are connected to networked or stand-alone printers.	1	1
Most of the machines are connected to the Internet.	2	2
Your score (5 possible)	===>	4
Optional comments: All elementary schools will be re-equipped with new Dell terminal stations this summer.

17. Technologies are currently used to increase parent-student-school communication. This would include phone based systems such as automated telephone calling systems for homework and grades and web based online gradebooks with secure parent passwords to see only their child's grades, etc. (For further explanation and examples, see: Lunt's article, SchoolMessenger, MainBrainSchool, ParentConnect.)
 

	Points Available	Points Awarded
Automated telephone calling systems are used by all teachers.	1
email accounts provided to all teachers and used in parent communication.	1	.5
A building web site which provides for quick data entry of calendar changes, emergency information and has features that allow automated broadcast of email and text messaging to cell phones.	1	.5
Classroom level web pages that are part of the building web site that report at least homework assignments, along with other classroom information.	3	1
Live and canned video over the web is periodically used to show classroom and school activities.	1
Your score (7 possible)	===>	2
Optional comments:

18. When using technology based lessons in the classrooms, students.....? (Identify all that apply.)
 

	Points Available	Points Awarded
learn and use an increasingly wider range of options from the information pyramid as they advance through the grade levels Look stage.	3	3
learn and use an increasingly wider of options for technology based composition found on both desktop computers and on the Internet as they advance through the grade levels (e.g., word processing, spreadsheets, graphing calculators, online calculators, databases, paint-draw, photograph, animation, video editors, computer programming, music, animation, 3D) Evoke stage link.	3	2
learn and use an increasingly wider range of options for technology based interaction as they advance through the grade levels (e.g., email, email attachments, chat, newsgroups, listservs, fax, audio or video conferencing). Assess stage link.	3	1
learn and use an increasingly wider range of options for publishing or sharing finished compositions (electronic slideshows (e.g., Powerpoint), newsletters, web site design, audio, video). Publish stage link.	3	2
see and use classroom-teacher developed supporting materials for technology-based lessons which include text-based (e.g., handouts, study guides and workbooks), and/or visual based (overheads, slideshows such as Powerpoint), and/or web based online course pages?	3	1
Your score (15 possible)	===>	9
Optional comments:

19. Describe what typically happens when classroom teachers wish to use technology resources to present a lesson. Select one.
 

	Points Available	Points Awarded
The computer labs or technology resources are often unavailable.	0	.
The technology teacher or coordinator must present the lesson.	1	.
Technology must be transported into the classroom.	3	.
Computer labs or technology resources are available for scheduling without significant delays or classrooms have good resources (handheld computers, laptops or desktops) for whole class student activity.	5	.
Your score (5 possible)	===>	1
Optional comments:

20. How do students* in the computer classroom/laboratory describe their experience? Select one.   *This question is restricted to students and their teachers in grades 4 and above.
 

	Points Available	Points Awarded
Play time or game time	0	.
Unstructured, not sure of expected learning outcomes	1	.
Applicable to what they are covering in class	5	.
Appropriate for current classes and important for required/anticipated future skills	7	.
Your score (7 possible)	===>	7
Optional comments: Most lab time is spent with instructional software (PET) in Reading and Math.

The circle ranking column asks for a ranking of the areas with the area receiving the highest percentage getting a one and so forth. This helps to identify the area in greatest need of development.