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I.D. NUMBER:

E-MAIL:

COHORT NUMBER:

SECTION I
1. I am enrolled at:
a. TSBVI
b. TTU
c. SFA

2. Current Semester:
a. Fall
b. Spring
c. Summer

3. Current Year:
a. 2000
b. 2001
c. 2002
d. 2003

4. Age:
a. under 22
b. 22-29 yrs.
c. 30-39 yrs.
d. 40-49 yrs.
e. 50 or older

5.Ethnicity:
a. African-American
b. Asian/Pacific Islander
c. Hispanic
d. Native American
e. White (non-Hispanic)

6.What geographic area
are you from?
a. in state
b. out of state
c. urban
d. rural

SECTION II

1.How did you find out about the Visual Impairment Preparation Program?

a. Professional Colleagues
b. Educational Service Center
c. Professors
d. University department
e. Other students
f. Brochure or advertisement
g. Other (explain)

2.How many years have you taught?
a. none
b. 1-3 years
c. 4-6 years
d. 7-10 years
e. Over 10 years

3.What are your teaching specialties?

a. General Education K-6
    How long?
    1.none
    2.1-3 years
    3.4-6 years
    4.7-10 years
    5.Over 10 years
 b.Secondary 7-12
    How long?
    1.none
    2.1-3 years
    3.4-6 years
    4.7-10 years
    5.Over 10 years
 c. Special Education
    How long?
    1.none
    2.1-3 years
    3.4-6 years
    4.7-10 years
    5.Over 10 years

d.Physical Education
    How long?
    1.none
    2.1-3 years
    3.4-6 years
    4.7-10 years
    5.Over 10 years
e.Other
    How long?
    1.none
    2.1-3 years
    3.4-6 years
    4.7-10 years
    5.Over 10 years

4.I was assigned a mentor before the end of my 1st semester of vision-related courses.

a.Yes
b.No
If no, when was the mentor assigned?

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