Technology 101 Survey

Childs name: _______________

Parent/Guardian name: _____________________
Directions: For each technology listed, place a check mark in the second and third
columns if this resource is available to you.
Next, rate yourself on your experience and comfort levels with each one of the
technologies listed, using the following scale:
4 Very experienced
3 Experienced

4 Very comfortable
3 Comfortable using this

2 Somewhat experienced

2 Somewhat comfortable using this

1 No experience

1 Not comfortable using this

technology
technology
technology

Available at Available at Experience

school
home
Level
Computer
Internet
Access

E-mail
Installing
Software
Word
Processing
Software

iPad
Instant
Messaging

Comfort
Level