BEGINNING OF SEMESTER SURVEY FOR PHYSICS-107(TV)

developed by
The Learning through Evaluation, Adaptation and Dissemination (LEAD) Center
University of Wisconsin-Madison

PHYSICS-107(TV) SURVEY CONSENT FORM FOR STUDENTS

The LEAD Center is conducting a survey of students enrolled in Physics 107-TV. The survey is designed to assist Professor Durand in understanding the effects of this course and the effect of the television medium on students' learning experiences. The feedback you provide will lead to improvements in the structure and content of this course. In addition to this survey, we will be looking at the final course grades and comparing the grades between live and Internet (First Class) discussion sections.

We are asking students who are enrolled in Professor Durand's lectures to complete a brief survey about their background and their expectations for this course. At the end of the semester there will be a second, follow-up survey about your experiences in the course which you will also need to complete. In order to match your responses on the first survey with your responses on the second survey, we are asking you to write your Student I.D. # on each survey.

All student responses will be held strictly confidential. The LEAD Center will generalize about student responses so as to obscure the identity of any particular students before reporting any survey findings. The LEAD Center or Professor Durand may publish papers based on the results of this survey, but these materials will contain no information that would identify particular students. Participation is completely voluntary. Refusal to participate will have no effect on your grade. There are no formal benefits or risks associated with participation.

If you have any questions you may call Dr. Julie Foertsch, LEAD Center, at 265-6368 or email her at foertsch@engr.wisc.edu.


NAME
STUDENT I.D. NUMBER

1) your gender:

2) U.S. ethnic code:

3) college rank:

4) intended major:

5) Semesters of high school science courses completed (enter the number of semesters of each):

6) Semesters of high school math courses completed (enter the number of semesters of each):

7) Is this the first science or math course you have taken at UW-Madison?

8) Is this the first video course you have taken?

9) How far do you live from campus?

10) How many hours per week will you be working at a paid job this semester?

11) Do you expect to have child care responsibilities this semester that will sometimes conflict with classes?

12) Are you a returning adult student?

13) How did you LEARN ABOUT this course? (check all that apply):

14) Why did you DECIDE TO ENROLL in this course? (Check all that apply in the square boxes, and put a check in the round circle by your main reason):


Please place a check below the number that indicates your current interest level in the areas below:

Interest in…
(Interest level: 0=Low, 5=High)
0
1
2
3
4
5
understanding the principles of physics 15)
being able to understand advances in science 16)
pursuing a career that requires an understanding of science 17)
using the Internet as a learning tool 18)
working in groups to complete class assignments 19)
taking courses by video 20)


Please place a check below the number that represents your current confidence level in the areas below:

Confidence in your ability to...
(Confidence level: 0=Low, 5=High)
0
1
2
3
4
5
understand physics concepts 21)
write about physics concepts 22)
explain physics concepts by drawing diagrams 23)
explain physics concepts aloud 24)
solve problems using formulas 25)
succeed in a university science course 26)
succeed in a university math course 27)
use the Internet to retrieve information 28)
use the Internet to communicate with others 29)

Please place a check below the number that represents your degree of agreement with these statements:

(Degree of agreement: 0=Low, 5=High)
0
1
2
3
4
5
Working in groups has benefits over working individually. 30)
I can learn more by working with others than I can by working alone. 31)
Working in groups is often frustrating. 32)
Some people in a group always end up doing all the work, while others hardly do anything. 33)
On science homework, I prefer working in teams over working individually. 34)


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