This survey was developed by the LEAD (The Learning through Evaluation, Adaptation and Dissemination) 
Center at the University of Wisconsin, Madison for "New Traditions Systemic Reform Project.

Chemistry 103
End-of-Semester Survey


Chemistry Course Survey Consent Form for Students

The Learning through Evaluation, Adaptation and Dissemination (LEAD) Center is conducting a survey of 
some of the Chemistry DepartmentÕs undergraduate courses.  The survey is designed to assist faculty in 
understanding the effects of course innovations on studentsÕ learning experiences and may lead to 
improvements in the teaching of chemistry nationwide.

We are asking students who are enrolled in the participating lectures  to complete a brief survey about their 
learning experiences in the course.  The survey should take about ten minutes to complete.  In order to 
correlate responses with demographic data and measures of achievement we are asking you to write your 
Student I.D. number on the survey.

All student responses will be held strictly confidential.  The LEAD Center will generalize about student 
responses so as to obscure the identity of any particular students before reporting any survey findings.  The 
LEAD Center may publish papers based on the results of this survey, but these materials will contain no 
information that would identify particular students.

Participation is completely voluntary. (Students choosing not to participate may simply return a blank 
survey).  Refusal to participate will have no effect on your grade. There are no formal benefits or risks 
associated with participation. 

Any questions you have you may ask now, or you may call Dr. Susan Millar, Director, LEAD Center, at 265-
5943.

I have read the above and give my consent to participate in the study.


Signature ____________________________________	Date ____________

STUDENT I.D. Number ______________________

(Please write your I.D. both here and fill in it in on the upper left corner of the 
ÒbubbleÓ sheet)


The LEAD Center wishes to thank you for participating in this national study of how students learn in 
college chemistry courses.  The questions in the survey are intended to help LEAD Center researchers 
understand your experiences in the chemistry course in which this survey is being administered.  Your 
thoughtful responses to the questions in this survey will enable us to help faculty across the nation improve 
chemistry education.

Copies of this consent form can be obtained at the LEAD Center room 427, 1402 University Ave.

Please fill in your responses using a no. 2 pencil on the separate bubble sheet.
BACKGROUND:
1) semesters of high school chemistry:	0	1	2	3	over 3 ( fill in  bubble 4 )
2) semesters of high school math: 	0	1	2	3	4	5	6	7	8

For each group of factors below please fill in a number on the bubble sheet to indicate the relative impact of 
each factor on your LEARNING overall in this course.
	relative impact on your LEARNING overall

PEOPLE
not applicable
negative


neutral


positive

3)
professor
0
1
2
3
4
5
6
7

4)
TA/lab instructor
0
1
2
3
4
5
6
7

5)
friends/informal groups
0
1
2
3
4
5
6
7

6)
course organized groups
0
1
2
3
4
5
6
7

7)
Chem Learning Center
0
1
2
3
4
5
6
7

	 relative impact on your LEARNING overall

ACTIVITIES/ MATERIALS









8)
      lecture-- overall
0
1
2
3
4
5
6
7

9)
                -- concept tests
0
1
2
3
4
5
6
7

10)
                -- demonstrations
0
1
2
3
4
5
6
7

11)
                -- exams
0
1
2
3
4
5
6
7

12)
                -- quizzes
0
1
2
3
4
5
6
7

13)
         labs-- overall
0
1
2
3
4
5
6
7

14)
               -- UW-ChemScape
0
1
2
3
4
5
6
7

15)
               -- lab manual
0
1
2
3
4
5
6
7

16)
discussion-- overall
0
1
2
3
4
5
6
7

17)
                -- Challenge Problems
0
1
2
3
4
5
6
7

18)
                -- homework/exercises
0
1
2
3
4
5
6
7

19)
        other-- Chem You Can Do
0
1
2
3
4
5
6
7

20)
                -- the textbook
0
1
2
3
4
5
6
7

21)
                --weekly computer exercises
0
1
2
3
4
5
6
7

22)
                --special computer assignments
0
1
2
3
4
5
6
7


For each group of factors below please fill in a number on the bubble sheet to indicate the relative impact of each factor on 
your CONFIDENCE  in your ability to understand and do chemistry.
	relative impact on  your CONFIDENCE

PEOPLE
not applicable
negative


neutral


positive

23)
professor
0
1
2
3
4
5
6
7

24)
TA/lab instructor
0
1
2
3
4
5
6
7

25)
friends/informal groups
0
1
2
3
4
5
6
7

26)
course organized groups
0
1
2
3
4
5
6
7

27)
Chem Learning Center
0
1
2
3
4
5
6
7

	relative impact on  your CONFIDENCE

ACTIVITIES/ MATERIALS









28)
      lecture-- overall
0
1
2
3
4
5
6
7

29)
                -- concept tests
0
1
2
3
4
5
6
7

30)
                -- demonstrations
0
1
2
3
4
5
6
7

31)
                -- exams
0
1
2
3
4
5
6
7

32)
                -- quizzes
0
1
2
3
4
5
6
7

33)
         labs-- overall
0
1
2
3
4
5
6
7

34)
               -- UW-ChemScape
0
1
2
3
4
5
6
7

35)
               -- lab manual
0
1
2
3
4
5
6
7

36)
discussion-- overall
0
1
2
3
4
5
6
7

37)
                -- Challenge Problems
0
1
2
3
4
5
6
7

38)
                -- homework/exercises
0
1
2
3
4
5
6
7

39)
        other-- Chem You Can Do
0
1
2
3
4
5
6
7

40)
                -- the textbook
0
1
2
3
4
5
6
7

41)
                --weekly computer exercises
0
1
2
3
4
5
6
7

42)
                --special computer assignments
0
1
2
3
4
5
6
7


Please compare your INTEREST levels in the areas below BEFORE and AFTER taking this course.
(Fill in a number on the bubble sheet for each row.)
	interest level
INTEREST IN...


low




high

science in general...............................
43)
before
0
1
2
3
4
5


44)
after
0
1
2
3
4
5

chemistry in general..........ÉÉÉÉ..
45)
before
0
1
2
3
4
5


46)
after
0
1
2
3
4
5

taking more chemistry........................
47)
before
0
1
2
3
4
5


48)
after
0
1
2
3
4
5

pursuing a chemistry-related major....
49)
before
0
1
2
3
4
5


50)
after
0
1
2
3
4
5

pursuing a science-related field .........
51)
before
0
1
2
3
4
5


52)
after
0
1
2
3
4
5

working with others to learn science... 
53)
before
0
1
2
3
4
5


54)
after
0
1
2
3
4
5


Please assess your  CONFIDENCE  levels in the areas below AFTER attending this course.  (Fill in the 
appropriate number on the bubble sheet).


CONFIDENCE IN YOUR ABILITY TO...

confidence 
level




low




high

55)
understand key concepts of chemistry
0
1
2
3
4
5

56)
solve chemistry problems
0
1
2
3
4
5

57)
understand the chemistry of lab experiments
0
1
2
3
4
5

58)
perform lab experiments
0
1
2
3
4
5

59)
visualize key concepts of chemistry
0
1
2
3
4
5

60)
apply your knowledge of chemistry 
to the real world

0

1

2

3

4

5

61)
understand other areas of science
0
1
2
3
4
5

62)
succeed in this chemistry course
0
1
2
3
4
5

63)
succeed in a chemistry-related discipline
0
1
2
3
4
5


64)
What grade do you expect in this course?           ForÉ
C
BC
B
AB
A
other


                                                                  Fill inÉ
0
1
2
3
4
5


Please rate the relative importance of each of the factors below in terms how you might approach solving a difficult 
chemistry problem: (Fill in the appropriate number on the bubble sheet.)



not very
important
very
important
not
applicable

65)
working on your own
0
1
2
3
4
5
6

66)
doing similar homework problems
0
1
2
3
4
5
6

67)
reading sample problems in the text
0
1
2
3
4
5
6

68)
reading explanations in the text
0
1
2
3
4
5
6

69)
asking your instructor (out of class)
0
1
2
3
4
5
6

70)
asking your instructor (during class)
0
1
2
3
4
5
6

71)
working in course organized groups (during class)
0
1
2
3
4
5
6

72)
working in course organized groups (out of class)
0
1
2
3
4
5
6

73)
working with friends/informal groups 
0
1
2
3
4
5
6



Please rate the relative importance of each of the factors below in terms of helping you to grasp difficult 
concepts in chemistry: (Fill in the appropriate number on the bubble sheet.)



not very
important
very
important
not
applicable

74)
lab experiments
0
1
2
3
4
5
6

75)
working on your own
0
1
2
3
4
5
6

76)
doing homework problems
0
1
2
3
4
5
6

77)
reading sample problems in the text
0
1
2
3
4
5
6

78)
reading explanations in the text
0
1
2
3
4
5
6

79)
asking your instructor (out of class)
0
1
2
3
4
5
6

80)
asking your instructor (during class)
0
1
2
3
4
5
6

81)
working in course organized groups (during class)
0
1
2
3
4
5
6

82)
working in course organized groups (out of class)
0
1
2
3
4
5
6

83)
working with friends/informal groups 
0
1
2
3
4
5
6


For each statement please fill in one number on the bubble sheet which best represents your view.


LAB EXPERIMENTS
strongly
disagree




strongly
agree

84)
The labs helped me understand important concepts in this course.
0
1
2
3
4
5

85)
The labs were an effective way to learn laboratory procedures.
0
1
2
3
4
5

86)
The labs related well to the lecture material.
0
1
2
3
4
5

87)
My TA was effective in helping me learn from the labs.
0
1
2
3
4
5

88)
My lab partners were effective in helping me learn from the labs.
0
1
2
3
4
5

89)
I understood the chemistry concepts behind the labs before I did 
them.
0
1
2
3
4
5

90)
Eventually, I understood  the chemistry behind the labs.
0
1
2
3
4
5

91)
Often, enough time was not allowed for labs.
0
1
2
3
4
5

92)
Usually, everyone in my lab group contributed about equally.
0
1
2
3
4
5

93)
I would have learned more if I had done the labs on my own.
0
1
2
3
4
5

94)
I was an effective contributor to my lab group.
0
1
2
3
4
5

95)
While doing the lab, I sometimes thought about the concepts the lab 
illustrated.

0

1

2

3

4

5



CHALLENGE PROBLEMS

strongly 
disagree




strongly
agree

96)
The Challenge Problems were an effective way to learn key 
chemistry concepts.
0
1
2
3
4
5

97)
Often, enough time was not allowed for Challenge Problems.
0
1
2
3
4
5

98)
My TA was effective in helping me learn from the Challenge 
Problems.
0
1
2
3
4
5

99)
Often, the Challenge Problems were so hard they were a waste of 
time.
0
1
2
3
4
5

100)
Doing the Challenge Problems increased my confidence 
that I could succeed in this course.
0
1
2
3
4
5

101)
My group was effective in helping me learn from the Challenge 
Problems.
0
1
2
3
4
5

102)
Usually, everyone in my Challenge Problem group contributed 
    about equally.
0
1
2
3
4
5

103)
I would have learned more if I had done the 
  Challenge Problems on my own.
0
1
2
3
4
5

104)
While doing the Challenge Problems, I sometimes felt that my 
group was dominated by one or two people.
0
1
2
3
4
5

105)
I was an effective contributor to my Challenge Problem group.
0
1
2
3
4
5



GENERAL:  (Fill in the appropriate response)

106)
I am confident that I learned the material in Chem 103 well enough 
to be prepared for Chem 104
0
1
2
3
4
5

107)
I am confident that I am prepared for Chem 104 , regardless of who 
teaches it
0
1
2
3
4
5


108)
I am planning to take Chem 104
forÉ
no
yes






fill inÉ
0
1





109)
average hours each week 
spent on this course:
forÉ
0-5 hr.
5-10 hr.
10-15 hr.
15-20 hr.
over 20 hr.



fill inÉ
0
1
2
3
4




definitely 
not recommend
definitely 
recommend

110)
Would you recommend this course to a 
friend?
0
1
2
3
4
5



THANK YOU !
3