You are on page 1of 4

Appendix B

FACULTY

QUESTIONNAIRE FOR INDIVIDUAL STAFF MEMBERS

(This information for each staff member should be gathered and submitted to
the evaluating team before it proceeds to fill out the survey form for Faculty)

NAME Pearl Angeli Q. Canada DEPARTMENT College of Teacher Education

RANK ___________________ SCHOOL JOSE MARIA COLLEGE

A. ACADEMIC AND PROFESSIONAL PREPARATION

Educational Field of
Degrees Date
Institution Specialization

Special Training

B. EDUCATIONAL AND PROFESSIONAL TRAINING

1. Teaching Experience

Designation Institution Dates No. of Years


2. Professional Experience (other than teaching)

Designation Institution Dates No. of Years

C. WEEKLY SCHEDULE

Indicate in the table below, classes and activities regularly assigned or


carried out in each period.

Wednes Thursda Saturda


Time Room Monday Tuesday Friday
day y y

COMMENTS
D. PROFESSIONAL ACTIVITIES

1. Membership in Professional Organizations

___________________________ ____________________________

2. Professional Reading

List below the professional BOOKS which you have read within the last six
months, and the professional PERIODICALS you regularly read.

3. In-Service Courses

Indicate courses taken during the past THREE YEARS or NOW being taken.
DO NOT include courses taken BEFORE beginning to teach.

4. Indicate research activities and/or publications completed in the past five


years.