First Name:        Last Name Major Nursing Dental Hygiene Radiography Open College Nursing Open College Dental Hygiene Open College Radiography Liberal Arts Other

Student ID Number Email Address:

Section you have registered for:  Bio 111 02 Bio 112 07 Bio 112 64

Have you taken A & P I:  yes no If yes, Instructor:    Grade: A B+ B C+ C D F

Have you taken A & P II: yes no IF yes, instructor:  Grade: A B+ B C+ C D F

Do you hold a degree?  yes no    If yes, degree type : AS AAS BS BA MS other   Granting Institution: 

Do you work?  yes no    If yes, where:    Number of hours per week:  less than 5 5 - 10 11 - 15 16 - 20 greater than 20

Prior to taking this course, did you take and remedial courses (010's)?  yes no

Are you a project Connections Student:  yes no If yes, please submit your documentation to me.

Are there any personal circumstances I should be made aware of?  yes no If yes, please elaborate below

Do you have any special medical circumstances that I should be aware of?  yes no If yes, please elaborate below

Please tell me one of you likes and dislikes

Tell me one thing interesting about yourself