Technology Integration Questionnaire 4/15/24, 7:04 PM

Technology Integration Questionnaire

Use this form to begin the coaching process with your Instructional Technology Coach. This form will
not be complete at the time of submission. It will not be completed until the end of our coaching.

Part 1: Background Information

1. Name

2. Email Address

3. What grade do you teach?

4. How do you already incorporate technology in your everyday instruction?

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5. What tools do you use to gather and observe data?

6. What is the student engagement like in your classroom? Are students actively participating in
your current lessons? Explain.

Part 2: Coaching
Here you will give me some information to help me plan our coaching sessions. They will be based on one
speciDc lesson that you would like to teach.

7. Lesson Subject

8. Lesson Standard(s)

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9. What time do you teach this particular subject each day? Is there a specific day that works better
than others.

10. How long is this unit?

11. Student Levels: Please list the number of students you have in each category (Beginning,
Developing, Proficient, Distinguished)

Part 3: Implementation
Using the tools and strategies from our coaching sessions go ahead and teach your lesson. I will be
observing this lesson so that we can reJect on it at a later time. Please be sure to save all data (exit tickets,
formative assessments, independent practice, etc).

Part 4: Observation
After observing your lesson we will schedule a time to meet to reJect with one another.

Part 5: Reflection

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12. What are your thoughts after receiving coaching and implementing your lesson? Please feel
free to share all thought both positive and negative about this process. I am open to all
feedback.

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Forms

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Technology Integration Questionnaire 4/15/24, 7:04 PM

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