Pertly Themes

Please complete the survey before starting a training unit.

For the first part (Demographics):
Before starting, we need to collect a little bit of information about the people taking the FHI training. Your personal information will be kept confidential. Only aggregate data will be reported.

  Demographics
       
  1. Name:
  2. Email:
  3. Phone: ( ) - ext
  4. Mailing address:
Street
City
State
Zip code
  5. Ages of individuals you work with (check all that apply) Birth-2 Middle school
Pre-school High school
Elementary Adult
  6. Role (check all that apply): Deaf Ed Teacher
Itinerant Deaf Ed Teacher
 
Vision Teacher
Itinerant Vision Teacher
Q&M Specialist
 
Special Education Teacher
Severe Disabilities Teacher
Regular Education Classroom Teacher
 
Speech Pathologist
Audiologist
 
State AI Consultant
State Vision Consultant
State Deafblind Project Personnel
National Deafblind Project Personnel
 
Other (specify)
 
  7. How long have you been in your current career (not necessarily your current position)? Less than 1 year
11-15 years
1-5 years 16-20 years
6-10 years More than 20 years
  8. How many individuals have you worked with for whom a traditional hearing test was not effective? None
11-15
1-5 16-20
6-10 21 or more
  9. Are you a current employee or student of Texas Tech University? Yes No
       
 

For the second part (Prior experience):
Next, we want to know how much you already know about some of the information that will be covered in the training.

   
  Prior experience
       
  1. Have you ever heard the term “functional hearing”? Yes No      
               
      not at all familiar arrow completely familiar
  2. How familiar are you with the concept of “functional hearing”?
  3. How familiar are you with the need for a functional hearing inventory?
  4. Have you ever used a sound level meter? Yes No      
               
      not at all comfortable arrow completely comfortable
  5. How comfortable are you with using a sound level meter?
               
      not at all familiar arrow completely familiar
  6. When referring to response to sounds, how familiar are you with “Awareness/Reflexive”?
  7. When referring to response to sounds, how familiar are you with “Attending”?
  8. When referring to response to sounds, how familiar are you with “Localizing”?
  9. When referring to response to sounds, how familiar are you with “Discriminating”?
  10. When referring to response to sounds, how familiar are you with “Recognizing”?
  11. When referring to response to sounds, how familiar are you with “Comprehending”?