[UNIVERSITY/SCHOOL NAME] is very interested in your feedback. Please take this short 5 minute survey to share your candid opinions.

	Please rate each of the following on a 1-5 scale, where (1) is "Very Dissatisfied" and (5) is "Very Satisfied." Use N/A for those that are "Not Applicable"

	1. GOVERNANCE:
	Very Dissatisfied   Neutral   Very Satisfied N/A Clarity of institution's goals/mission 1 2 3 4 5 N/A Communications from/with department leadership 1 2 3 4 5 N/A Communications from/with college leadership 1 2 3 4 5 N/A Ability to influence decisions in department 1 2 3 4 5 N/A Ability to influence decisions at institution 1 2 3 4 5 N/A

	2. RESOURCES:
	Very Dissatisfied   Neutral   Very Satisfied N/A Adequacy of financial resources for instruction 1 2 3 4 5 N/A Adequacy of physical resources for instruction 1 2 3 4 5 N/A Adequacy of support services for instruction 1 2 3 4 5 N/A Adequacy of technological & multimedia instructional resources 1 2 3 4 5 N/A

	3. PROFESSIONAL DEVELOPMENT:
	Very Dissatisfied   Neutral   Very Satisfied N/A Recognition/appreciation of good teaching 1 2 3 4 5 N/A Opportunities for research in discipline 1 2 3 4 5 N/A Recognition of research accomplishments 1 2 3 4 5 N/A Opportunities for professional development 1 2 3 4 5 N/A Opportunities for school involvement outside discipline 1 2 3 4 5 N/A

	4. INSTITUTIONAL CLIMATE:
	Very Dissatisfied   Neutral   Very Satisfied N/A Collegiality among faculty members in your department 1 2 3 4 5 N/A Inter-department collegiality among faculty members 1 2 3 4 5 N/A Reputation of our institution 1 2 3 4 5 N/A Reputation of your department/discipline 1 2 3 4 5 N/A Reputation of our students 1 2 3 4 5 N/A

	5. FINANCIAL REWARDS:
	Very Dissatisfied   Neutral   Very Satisfied N/A Adequate financial rewards for good teaching 1 2 3 4 5 N/A Compensation for faculty 1 2 3 4 5 N/A Fringe benefit package for faculty 1 2 3 4 5 N/A Your compensation and fringe benefits 1 2 3 4 5 N/A

	6. STUDENTS:
	Very Dissatisfied   Neutral   Very Satisfied N/A Student ability & motivation 1 2 3 4 5 N/A Opportunities for interaction with students outside classroom 1 2 3 4 5 N/A Encouragement of inter-disciplinary initiatives 1 2 3 4 5 N/A