1. Name:
2. Phone Number:
3. E-mail Address:
4. I would describe my ability to use the Internet as: (circle one) Excellent Very Good Good Fair Poor
5. I have access to the Internet at: (circle one) Home Work Friend or Family member’s house No access except school/library
6. Major/Planned course of study:
7. Occupation:
8. Favorite Book(s):
9. Favorite Movie(s):
10. Newspapers/Magazines you regularly read:
11. Special interests, skills, hobbies:
12. Previous writing courses:
13. Strengths:
14. Weaknesses:
15. Please tell me anything else that you think is important for me to know.
16. Password: