Student Orientation Form

By completing AND submitting the following information, you are finishing orientation.
Failure to submit this form may result in your being dropped from the course.
This information is held in confidence. It's purpose is to assist me in
keeping contact with you to help you successfully complete this class.

Section Number:

Today's date (Month/Day/Year Format):

Last Name:

First Name:

Middle Name:

ACC ID:

Street Address (Include Apt Number):

City:

State:

Zip Code:

Home Telephone Number:

Work Telephone Number:

email address:

	No	Yes
I have access to the Internet from home.
I have a computer with a modem at home.
I have access to a FAX machine.
If you answered yes, what is your FAX number?
I have read the orientation materials and understand my responsibilities.
If necessary, may I call you at work?

What is your major? Hours of college completed

Why are you taking this course?

Thank you! You have completed the online orientation when you have submitted this information!