Student Information Form

Student Information Form

Name:

School:

School Phone:

Email Address:

Home Phone:

Home Address:
Home Address:

It is my wish to facilitate communicate among students in this class. I would like to make a directory of the students in this class and post the information on our website. The information I wish to include is your name, school, home phone, and email address.

Please check box.

	I give my permission for the instructor to post the designated information.
	I give my permission for the instructor to post all information EXCEPT my home phone and address.
	I DO NOT give my permission for the instructor to post the designated information.

On the back of this paper, please write responses to the following:

Considering your own work experiences, graduate education thus far, and course description, list your competencies in terms of strengths and areas you wish this course to personally address for you. Make 2 columns "Strengths" and "Personal Learning Goals."