Student Information Sheet – Fill Out in Your Own Handwriting
Name: ____________________________________ Student ID _________________
Course: ___________________________________ Section Number: ____________
Email Address: _____________________________ [It should match eCampus]
To do well in this class, you must be willing to put in time and to work. It is not a selfpaced class, although there are no set times each day that you must login or work. There
are firm due dates by which assignments and exams must be completed. No exceptions
are made to due dates; late work is not accepted. Work is always accepted early though!
Please understand that you are responsible for reading all information about the course
that your instructor has provided in eCampus, in emails, in the syllabus, and in MyLab
Math. The information could be updated periodically, and if you have questions, you need
to email your instructor!
Please understand that not having a computer or internet at any given time is not an
extenuating circumstance and that it is your responsibility to make sure your software and
hardware works well in advance of any deadlines.
I have read all the information contained on this sheet and understand that it is my
responsibility to stay in contact with my instructor.
Signature: ___________________________________
Date:____________
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Your instructor would like to know about you so that they may better help with your
success in this course. Please answer the questions below to the best of your ability. You
may skip any that you are not comfortable answering.
1.
How many hours are you taking this semester? (Circle the one that applies. If attending
several institutions, circle the total number.)
1–3
4–6
7 – 10
11 – 14
15 – 18
more than 18
Revised 6/12/20
2.
How many hours do you work at a job per week? (Circle the one that applies.)
0
1 – 10
11 – 20
21 – 30
3.
31 – 40
more than 40
How many hours per week do you feel you will study for this course? (Be as
realistic as possible.)
0
4.
1–4
5–9
more than 10
Why are you taking this course? (Check as many as apply)
____ It is a prerequisite for __________________________ (next class).
____ My transfer college/university requires this as a degree requirement
Name of college/university of transfer: ____________________________
____ Degree requirement for AA/AS
____ Prospective degree: _____________________________
____ Repeating for better grade
5.
Are you: (Check as many as apply)
____ Dual Credit (grade: 9 10 11 12)
School Name: ____________________
____ First Generation College Student
____ Transient - Home University: ____________________________________
____ Concurrent University Student
Name of University: __________________________
____ DCCCD student (other than Richland College)
Home Campus: _________________________
____ Richland College student
6.
What is your (prospective) major? (Check the option that best describes your major.)
____
Architecture
____ Business
____ Certificate (which one? ________________________)
____ Computer Science
Revised 6/12/20
____ Criminology/Criminal Justice
____ Education
____ Engineering (all)
____ Liberal Arts: History/English/Languages/Art
____ Math
____ Science (which one? __________________________)
____ Sociology/Psychology
____ Other: _________________________
7.
What is your hometown? ______________________________
8.
What is your country of origin? ______________________________
9.
How many people reside in your household? __________________
10.
What was the last math class you took? ______________________________
11.
How long ago did you take it? ______________________________
12.
How did it go? __________________
13.
What have you heard about this class? ______________________________
14.
Anything you can foresee that will interfere with your success in this class?
_________________________________________________________________________
15.
Is there anything else you would like to share with me?
Revised 6/12/20