Student Information Form

A&P Basics Student Information Form

Please fill out the following form and submit it via email to your instructor by clicking on the submit button.
You may get a warning message stating that it is an email form and is not secure. Click OK.
If you do not compete the required fields you will also get an error message, so please complete the form accurately.
Remember, this form is worth an extra 5 points toward your participation grade and is due the first week of classes!

NOTE: If you are using AOL, you will have to type the information into the body of an email
as AOL has their own internet access and will not process the form correctly.
If you feel this form was not sent properly, you may still email the information in the body of an email and send it to your instructor prior to the due date and time indicated on the lecture addendum.

First Name:
Last Name:
Email address:
Contact phone number:	Send to instructor, only if necessary
Number of courses you are currently taking (this semester only) Please include this course	one two three four five or more
Why are you taking this course?
Do you also work ?	yes no