Last Name: First Name:

Student ID:

Synonym:

Telephone Numbers:
Home:
Work:
Other:
E-mail Address:

Issues I should be aware of:

Reasons for taking this course:
Personal Interest
Required by degree, my degree program is
Work Related, Please explain in comments section
Recommended by:
Other Please explain in comments section

Please indicate the following:
Hours working per week
Number of credit hours enrolled in this semester
Number of computer courses taken at ACC
Highest Degree Earned

What computer courses have you already completed?


What computer of computer related work experience do you have?


Comments: