1. What are your principal reasons for attending this workshop? [check all that apply]
	General interest
	To improve my own classroom teaching
	My department is involved in a campus-wide assessment effort
	Assessment is part of my institution's accreditation requirements
	My department is involved in a formal assessment effort of its own
2. How would you describe your department's current involvement with assessment? [check one]
	No systematic effort
	Plans, but just getting started
	Assessment in a few areas for at least a year or so
	Assessment is done regularly on multiple aspects of our program
3. How would you rate your own familiarity with assessment concepts and techniques? [check one]
	Very familiar
	Somewhat familiar
	Not very familiar
	Not at all familiar
4. Does your department currently have an assessment committee or similar body charged with developing and overseeing assessment? [check one]
	Yes
	No, but we have plans for one
	No, and no plans
5. What about your institution? [check one]
	Yes
	No, but we have plans for one
	No, and no plans
6. Which of the following aspects of your department: a. Would your department like to assess regularly? [check all that apply]
	Major in mathematics
	Service courses in math-intensive disciplines
	General service courses
	Remedial/developmental courses
	Placement and Advising
	Other (please specify):______________________________________________
b. Would your administration like you to assess regularly? [check all that apply]
	Major in mathematics
	Service courses in math-intensive disciplines
	General service courses
	Remedial/developmental courses
	Placement and Advising
	Other (please specify):______________________________________________
c. Are you actually assessing regularly? [check all that apply]
	Major in mathematics
	Service courses in math-intensive disciplines
	General service courses
	Remedial/developmental courses
	Placement and Advising
	Other (please specify):______________________________________________
About You…
7. Type of Institution you are from: [check one]
	Community College
	Four-Year Comprehensive College or University
	Liberal Arts College
	Research University
8. Current role/position at your institution [check all that apply]:
	Full-time faculty
	Part-time faculty
	Department Chair
	Member of Campus Assessment Committee or Task Force
	Member of Departmental Assessment Committee or Task Force
	Member of Faculty Senate or Other Governance Body
	Involved in Campus Accreditation Self-Study
9. Approximate Number of Years Teaching Mathematics: _____________________