Name
Last
First
Middle
Nickname
E-mail
Address
Odessa College ID Number
Mailing
Address
Street
Apt
#
PO
Box
City
State
Zip
Telephone
Numbers
Home
Work
Cellular
Pager
Contact
Times
Please
provide the best times to contact you by phone.
Please indicate which number would be best to
call if you have listed more than one above.
Enrollment
Status
Did you enroll in this course at
another institution (as a VCT student)?
Yes
No
Employment
Company
Position
Number
of hours work per week
Days
and hours you work
Age
Education
College
major or vocation
Total
college hours to date?
Are
you presently attending another school at this
time?
Please Select One
No, only enrolled at Odessa
College
Yes, High School
Student
Yes, Community College
Student
Yes, University Student
Yes, Vocational Student
If
yes, school name :
Why
are you taking this course?
Please Select One
Required For Major
Elective Course
Personal Interest
List
any college degrees or personal certifications
Previous
jobs and careers
Computer & Internet
Skills
How
would you rate your computer skills?
Please Select One
New user, I can turn the
computer on and off.
Limited user, I can send
e-mails and print documents.
Moderate user, I can
save documents and send e-mail attachments.
Frequent user, I am
comfortable with most everything.
=========================================================
How
would you rate your Internet skills?
Please Select One
New user, I have never used
the Internet.
Limited user, I can follow
Internet links on a page or in an e-mail.
Moderate user, I can
follow links and use search engines.
Frequent user, I can
find most anything with a search engine.
=========================================================
How
would you rate your word processing skills?
Please Select One
New user, I will need specific
step-by-step help.
Limited user, I can type
up a document and print it.
Moderate user, I can
save, edit and attach documents to e-mails.
Frequent user, I am
comfortable using software for this course.
=========================================================
Which
word processing software do you use? (Word, Notepad,
etc.)
Why
are you taking this class as a web course,
rather than a traditional on campus course?
Quick
Bio
Briefly
tell me a bit about yourself. The major activities
in your life, hobbies, personal and professional
goals, anything unusual and interesting about
yourself.