Your Name:
Grade Level:

Welcome to GREAT!

You have been invited to participate in the exciting GREAT! project. Please help us to get to know more about your interests and experiences by filling out the form below. THIS IS NOT A TEST! Don't worry if you aren't sure -- there are no wrong answers. By the end of all the workshops, you will know about all of the things listed below.

A. Please tell us a little bit about yourself. (Fill in the Blanks):

1. What are your interests or hobbies (things you like to do)?

2. Describe something that makes you unique or special:

3. What is your FAVORITE subject in school?

4. What subject do you like LEAST in school?

5. What kind of job do you want to do when you are out of school?

6. What do you like to do on the computer?

B. What is your level of experience with technology?

1. Please rate your skill level. (Check one for each item):

Never Used Beginner Intermediate Advanced Don't
Know
Send an email
Receive an email
Use the calculator
Have a "real time" conversation (Chat)
Use a CD-ROM
Work on a Database/Spreadsheet
Play a game
Write a computer program
Send photographs on the Internet
Alter photographs in PhotoShop
Download music or sound
Edit sound
Edit video
Use multimedia software
Use wordprocessing software
Make a graph or a drawing
Use virtual reality software
Make my own web page
Make a PowerPoint presentation
Use an external hard drive or "zip" drive
Use a scanner
Use a desktop publishing program

2. Name the person who has helped you the MOST to learn about the computer
(Check one ONLY):

Check one ONLY v
My Dad
My Mom
My Sister
My Brother
A Girl Friend
A Boy Friend
A Teacher
I Learned All By Myself
Other:

C. Where do you use computers? (Check one ONLY)

1. Do you have access to a computer at home? (Check one): Yes No

2. Do you have Internet access at home? (Check one): Yes No

3. Where do you access computers the MOST? (Check one):

Check one ONLY v
Home
School
Public Library
After School Center/Community Center
At a Friend or Relative's House

D. What do you think about math, science and technology?

1. Please say if you agree or disagree with the following statements about technology.
(Check one for each item):

Strongly Agree Agree No Opinion Disagree Strongly Disagree
I like working on the computer.
My friends think it is important to be good at math and science.
Boys like to use computers more than girls do.
Kids who like science are usually nerds or geeks.
Boys do better than girls in science.
If I had a big problem to solve, I'd miss a party to solve it.
I am good at math.
I am good at science.
I like a challenge.
Girls understand computers better than boys.
I like to work in a team.
Math is an interesting subject.
Science is only for smart kids.
Girls are afraid of science.
Math is not that important outside of school.

2. Please say if you agree or disagree with the following statements about technology.
(Check one for each item):

Strongly Agree Agree No Opinion Disagree Strongly Disagree
I think that using technology is important for getting a job.
My family wants me to get good grades in science.
Boys like science more than girls do.
I would like to use technology more often.
I like sports.
Science is important in every day life.
I plan to go to college.
I am good at talking in front of a group.
My family pushes me to get good grades in math.

E. Who is a scientist?

Imagine a scientist at work. Imagine what the scientist looks like, the scientist's clothes and the things the scientist works with. What do you see? Try to draw it. Add words to explain your drawing.