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				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				completely comfortable
	5.	How comfortable are you with using a sound level meter?
			not at all familiar				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”?