Print Environmental Survey

Print this form and ask students to complete. Make notes of each preference.

 Name______________________ Date___________ Period_________

DIRECTIONS: In the space mark (T) true, (F) false, or (0) if neither one applies.

NOISE:

_____ 1. I prefer to work with music playing.

_____ 2. I concentrate best in a quiet room.

LIGHT:

_____ 3. When I work, I like all the lights on.

_____ 4. I work best when the lights are low.

TEMPERATURE:

_____ 5. When I need to concentrate, I prefer a cool room.

_____ 6. I like to study in a warm room.

STRUCTURE: FORMAL OR INFORMAL:

_____ 7. I sit at a desk or kitchen table to do homework.

_____ 8. I can think better lying down than sitting.

_____ 9. I study best sitting on a soft chair, sofa, or bed.

INTERACTION: WITH PEERS OR ALONE:

_____10. I study or work best when I am alone.

_____11. I study or work best with one other person.

_____12. I study or work best in a group of 3 or 4 people.

_____13. I am at my best in a large group of people.

LEARNING STYLES:

____14. The things I remember best are the things that I hear.

____15. The things I remember best are the things that I read.

____16. The things I remember best are those I have seen on TV.

____17. If I do each step of a job, I always remember how to do it.

INTAKE:

_____18. Eating something would distract me when I'm working.

_____19. I like to snack when I am studying.

TIME OF DAY:

_____20. I get better grades in my morning classes.

_____21. My easiest classes are usually in the afternoon.

_____22. I can remember things best when I study in the evening.

MOBILITY:

_____23. I enjoy tasks that allow me to take breaks.

_____24. I constantly change positions in my chair.

_____25. I can sit in one place for a long time.

MOTIVATION:

_____26. I like to plan how I am going to get a job done.

_____27. I feel better when my teacher or boss tells me how to do the job.

_____28. If I've done a job right, I like to be told so.

_____29. I work better when it's for a grade.

_____30. No one has to tell me when I've done a good job.

NOTE: This instrument was created by Anne Pemberton for use with certain students at Nottoway HS, Virginia. The instrument was developed using categories and questions developed by Rita and Ken Dunn on their Learning Styles Inventory. This instrument is NOT designed to be used independently by students, but is intended to be used in conjunction with a discussion of each of the categories and how the student can accomodate him/herself within the classroom. "Scoring" is done by reading the entries in each category and writing the preference in space to the right of the category. Categories with more than two choices may have more than one true response. Read, and if its unclear, ask the student for an expanded explanation of their answers to the questions. Ideally, students should have a copy of their completed and scored survey as well as a copy kept for later reference.

NEW!!!

Educational Synthesis Forums provides a place for discussion of all areas of education. Login and join the talk or make suggestions. Come back often to read and discuss the critical issues of the 21st century.

Page created September 20, 2006. Anne Pemberton. Updated Fri, September 4, 2009 . AP.

Return to: