Mu s: KS.

03

TRNG I HC CNG NGH THNG TIN V TRUYN THNG

KHOA CNG NGH IN T V TRUYN THNG
PHIU KHO ST
HOT NG CHNG TRNH "M MM CNG NGH"
Knh tha Qu v!
Phiu kho st ny nhm mc ch gip chng ti nm bt thc t v nng cao cht lng
trong hot ng khoa hc "m mm cng ngh". Nhng ng gp, chia s ca Qu v s l c s
quan trng cho vic nh gi, thit k v xy dng chng trnh ph hp vi chng trnh o to
theo nh hng hc i i vi hnh, l thuyt gn lin vi thc tin. Xin Qu v vui lng c
thng tin phiu kho st v tr li mt s cu hi di y.
Nhng kin chn thnh ca Qu v s gp phn quan trng trong s thnh cng ca
chng trnh. Xin chn thnh cm n !
A. THNG TIN CHUNG
H v tn:.............................................................................Ngy sinh:...............................................
Lp:......................................................................................Trng: ....................................................
in thoi:.................................................................Email:..................................................................
H v tn ph huynh: .. in thoi: .
B. BNG CU HI KHO ST ( ngh qu v nh du vo mc la chn)
1.

2.

3.

4.

6.

Bn tng tham gia bao nhiu hot ng giao lu v Khoa hc cng ngh no trong qu
trnh hp tp ti trng THPT ca mnh:
< 5 ln
5 - 10 ln
> 10 ln
Cha bao gi tham gia
Bn tng tri nghim cc sn phm v Khoa hc cng ngh no sau y:
iu khin t, my bay t xa
Bt/tt bng bng iu khin t xa
Cc h thng camera gim st
Cc sn phm khc:
Nhng kh khn trong qu trnh tip cn Khoa hc cng ngh ca bn:
Cha c nhiu hot ng thit thc Cha c nhiu k nng v kin thc
Trang thit b cha y
kin khc: ..........................................
Bn c ng vi vic cn xy dng thm nhiu chng trnh "m mm cng ngh" theo
hng gn lin thc tin:
ng
Khng ng
Bn c cho rng cn c trang thit b phc v cho nhng hot ng v Khoa hc cng
ngh ca bn thn bn:
ng
Khng ng
kin b sung: ..........................................................................................................................
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Ngy .. thng .. nm 20.....
NGI CUNG CP THNG TIN