Student Information Survey

First Name:
Last Name:
What name would you like to be called by?
Course:
Gender:
Racial/Ethnic Catergory:
ID:
Phone:
Email:
Web Address: http://www.
Grade posting name:
GPA:
College Rank:	Freshman Sophomore Junior	Senior Graduate
Expected Graduation Date:
Do you have reservations about being called upon in class?	Yes No
Is there anyone in class you would prefer not to work with?
Do you have any learning disabilities or special needs of which I should be aware?	Yes, No
Why are you taking this course?	Part of your major Part of your minor Other,
What do you hope to get out of this class?
Finish this statement by circling one of the following responses: I'm in the ____________ of all students in my major at this college.
top 10% top 25% top 50% bottom 50% bottom 25% bottom 10%
How many hours do you plan on putting into this class?
Comments:

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