CHM ______ - ______
Student Information Survey
Term: _____________
Please Write Legibly!! (especially email address) (All info is optional; I promise I’ll keep it to myself!)
Email Address:
Do you typically check it every day?
Have you updated myOakton with this address?
Name:
Daytime Telephone:
I have access at home to:
Evening Telephone:
Have you used Oakton computers before?
Ethnicity:
Age:
Native Language:
a computer
the web
neither
Y
N
Gender:
Hobbies or interests?:
My last chemistry course w/C or better was
My last math course w/C or better was (name/#)
____________________________, taken at
_________________________________, taken at
________________________ in_______ (year).
It was _________________.
(First word that comes to mind?)
__________________________ in:
Fall, Spr, Summer
of _________ (year).
I am taking this course because:
College goals (program? major? field of interest?):
If employed, average work hours per week:
Level of obligation to family responsibilities:
part-time
I am looking forward to this course
Please explain your rating:
Lowest grade I would be satisfied with in this
course:____________
I think I will probably earn a(n) ____________.
Disagree
1
2
full-time
none
3
4
Agree
5
List the other courses you are enrolled in either at
Oakton or another college (include meeting times):
Course w/ Number
Meeting days
Times
What, if any, fears do you have about taking this
course?
I am good at & enjoy explaining things to others.
I enjoy analyzing & solving problems.
I use the EE (or EXP) button on my calculator.
Disagree
1
1
1
1
2
2
2
2
3
3
3
3
4
4
4
4
Agree
5
5
5
5
I can make a plot in Excel (or other software).
How many hours you expect or plan to spend on this course outside of class each week. PLEASE DO NOT
LEAVE THIS BLANK. Just make a rough estimate if you wish; it can be a range of hours, but please use
numbers (i.e., not “a lot”).
How much time would you consider to be an “excessive” amount of time to spend on this course in a week?