NURS 8009 Childbearing Theory
Student Information Sheet
Full Name: ________________________________________________________________________________
What do you prefer to be called? _____________________________________________________________
Pronouns:
He/Him
She/Hers
They/Them
Other: __________________________
Do you have reliable access to a computer with internet and Canvas at home?
Do you live:
on-campus?
/
Yes
/
No
off-campus
If off campus, where? ____________________ How do you get to class? ________________________
Will you be working this semester?
Yes
/
If yes, how many hours per week? _________
No
Do you plan to work overnight shifts? Yes / No
Aside from your academics or a job, do you have any responsibilities outside of school?
Do you have any special needs that you would like me to know about?
Please use this space privately share anything you would like to me to know, including anything
information that may impact or help your learning, experience, or effort in this class.
Additional Questions
General Information
Preferred method of contact: __________________________________________________________________
Pronunciation for your name: __________________________________________________________________
I am originally from (City/State/Country): _________________________________________________________
My parents/guardians are from (City/State/Country): ________________________________________________
My family currently lives in: ____________________________________________________________________
I have traveled to the following countries: _________________________________________________________
Diversity and Inclusion
Please briefly share how you identify.
 Race:
 Ethnicity:
 Gender identity:
 Sexual orientation:
 Religion:
 Socioeconomic status:
I have experience of other cultures through work, friends, neighbors, etc. Please specify all that apply and in what
way.
My first language is: ___________________________
Do you speak more than one language?
No
Yes (please share):_______________________
Have you lived in another country?
No
Yes (please share):_______________________
Do you think the Connell School of Nursing is an inclusive environment that embraces different perspectives and
cultures? Why or why not?
Access & Equity
Do you have a device such as a smartphone to bring to school?
Yes
/
No
Student Success
What tends to motivate you to do well in a class? What discourages you?
I appreciate when my instructors…______________________________________________________________
I dislike when my instructors…__________________________________________________________________
What study strategies do you use to prepare for exams?
What challenges or difficulties have you encountered with your academics? Why?
Approaches to learning (most commonly experienced): ______________________________________________
Approaches to teaching (most commonly experienced): ______________________________________________
Class Specific
A word that describes how I feel about this class in this moment: _______________________________________
Number of hours per week I believe I will be spending to study for this course: ______________
What specific questions do you hope will be addressed in the course?



_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
One current question I have about this class is:
Miscellaneous
As a nurse, what do you want to learn HOW to do?
What are the three most important things I should know about you?
 _____________________________________________________________________________
 _____________________________________________________________________________
 _____________________________________________________________________________
What are some of your extracurricular interests?