Name
Last
First
Middle
Nickname
E-mail
Address
Social
Security Number
Mailing
Address
Street
Apt
#
PO
Box
City
State
Zip
Telephone Numbers
Home
Work
Cellular
Pager
Employment
Company
Position
Number
of hours work per week
Days
and hours you work
Age
Marital
Status
Please Select One
Single
Married
Separated
Divorced
Widowed
Children
Number of
Ages of
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.)
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.
Semester
Schedule
Please
provide your school schedule for the semester. List each course
that you are taking, the faculty person teaching the course, and
indicate if the course is an Internet course, classroom interactive,
or self-paced. If the course is held in a classroom at Odessa
College, indicate the days and times it meets as well as the building
and room number.