This survey is designed to help your instructor get a better sense for how you are feeling heading into this semester. We realize that all of our students are experiencing a wide variety of circumstances and we want to be as prepared as possible to anticipate and accommodate your needs.

• Name
• UVA Email Address
• Will you be on-Grounds this semester? If off-Grounds, in what time zone are you located?
• Do you have regular access to reliable wifi? What is your internet speed? (You can check your internet speed at: https://www.speedtest.net)
• What device are you going to use most to access materials for this class? (Laptop, tablet, phone, desktop, other?) What device will you use to participate in synchronous class sessions? Do you have headphones? A microphone? Do you have the technological capacity to record videos of yourself, if assigned? Please describe your equipment in detail.
• Provide a short description of your experiences and comfort level using Zoom.
• Provide a short description of your experiences and comfort level using UVA Collab.
• Provide a short description of your experiences and comfort level using Microsoft Teams.
• If audio/video is required for participation, are you experiencing anything that might make regularly appearing on camera difficult (accessibility needs, medical constraints, lack of comfortable working space, etc.)?
• Do you have any accessibility needs or concerns you feel comfortable sharing? Please provide a short description?
• Do you have any questions about the course? 
• How prepared do you feel to succeed this semester? What, if anything, would help you feel more prepared?

For another example, check out this survey from UVA Arts and Sciences.