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 5 points toward your participation grade and is due the first week of classes!

If you have problems with this form, then email your instructor with the requested information prior to the due date.

First Name:
Last Name:
Email address:
Contact phone number:	Make sure you have only numbers, NO dash between numbers!
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