Course Name:




Course Number:




Section Number:





  1. Identification Number: ______________________________


  1. Please indicate your intended major:


_____ Computer Sciences/Mathematics


_____ Engineering (of any type)


_____ Natural or Physical Sciences (Biology, Chemistry, Physics, etc.)


_____ Education


_____ Commerce or Business related majors


_____ Humanities, Liberal Arts (English, History, etc.)


_____ Social Sciences (Psychology, Sociology, Social Work, etc.)


_____ Undecided


_____ Other. Please, specify: ______________________________


  1. Please indicate the student status that best describes you:


_____ Freshman


_____ Sophomore, or Junior or Senior (circle one)


_____ Transfer student


_____ Other. Please, specify: ______________________________





  1. Please indicate the enrollment status that best describes you:


_____ Full-time


_____ Part-time (more than one course)


_____ Single course-taker


  1. For the current semester, when are your courses scheduled mainly:


_____ Daytime


_____ Evening


_____ Other


6.      Please indicate how many full years of mathematics you took during grades 9-12:

_____ 1 year


_____ 2 years


_____ 3 years


_____ 4 years


  1. Please provide the following information on the last mathematics course you have taken prior to this course:



_____ 0-1 year ago


_____ 2-3 years ago


_____ 4-10 years ago


_____ More than 10 years ago


·        Where was that course taken?


_____ Public high school


_____ Private high school


_____ Community college


_____ Four-year college or university


_____ Other. Please, specify: _____________________________


·        Final letter grade in that course: _______________



  1. Is this the first time you are taking this course?


__________ Yes                                 __________ No


  1. If you answered NO in question 8, please indicate why:


_____ Failed the course the first time.


_____ Dropped the course due to a failing grade.


_____ Dropped the course for other reasons.


_____ Did not fail the course, but I am repeating it for other reasons.


10.  How many hours per week do you anticipate you will be working in a job during this semester?

_____ 0-10 hours


_____ 11-20 hours


_____ 21-30 hours


_____ 31-39 hours


_____ Full-time (40 hours or more)










  1. How often did you use the following types of technology in this course?








often employed


in this




Type of technology



No at



but not






a) Calculators: graphing, computational, etc.






b) Email: one-on-one communication, online discussion groups, etc.






c) Internet: World Wide Web, downloadable software, etc.






d) Data Probes: Calculator-Based Laboratories (CBL’s) or Microcomputer-Based Laboratories (MBL’s), motion detectors and other sensors






e) Computer Algebra Systems (CAS): Mathematica, etc.







f) Spreadsheets: Excel







g) Other software packages: word processing, presentation graphics, etc.







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