Information Form for Students Enrolled in 

Please fill in each box.  Enter "none" instead of leaving a blank. Answers to personal questions will be held confidential.

Math Course you are signed up for including section number( i.e.. math 1111 004)

Student ID Number
Last Name: 
First Name or name you prefer to be called: 
E-mail address: 
Street Address: 
City, State, Zip Code: 
Phone numbers:
        Cell Phone: 
        Emergency number: 
Previous Math  courses (including high school): 
Previous college math courses: 
Please list your reasons for taking this course:
Please list the campus you will be taking your tests.

Select your campus







What are your future educational plans?
Are you a non-native speaker of English? (yes, no) 
        If yes, list country of origin & original language: 
Do you have any type of disability? (yes, no) 
        If yes, please specify: 
Have you ever taken an online course before? (yes, no) 
        If so, which course(s) and where? 
Type of computer you will be using (e.g., Pentium II 266 MHz, etc.): 
Speed/type of modem connection (e.g.,56k, DSL, on-campus (ethernet), etc.):
Web browser you will be using (e.g., Firefox, Internet Explorer, etc.): 
Type of spread sheet you will be using (optional): 
Have you ever participated in a chat session?
Have you ever used an online bulletin board? 
Have you ever written a web page? 
Word processing program you will be using? (e.g., MS Word 2000) 
Internet provider you will be using? (e.g., AOL, BellSouth, etc.) 
Please add any other personal comments here: (e.g., married? children? pets? hobbies? fears? aspirations?) 

By clicking on the button below to submit my information, I agree that I have received a syllabus or have received the online address
of the syllabus and am aware of the content of it.

i understand that the course will have quizzes, homework, discussions, tests, a midterm exam and a final exam.  All of these
must be completed as part of the course.

I understand that I am responsible for all of the information in this syllabus
and the web ct discussion board or email which may contain a change from the syllabus.
I agree to abide by the highest standard of academic honesty.

I fully understand that this is an online course, and that online courses may not be suitable for all students.

Online course absences are measured by failure to post to the Discussion twice or three times a weekas designated
in the discussion postings or the syllabus..

I understand that this course may take 9 or more hours per week.
I understand that the final exam must be taken on a specific date on one of the campuses in person.
Students must also take an on campus midterm exam.
I understand that I am responsible for having the necessary computer skills to participate in this course.
I understand that I am responsible for having (or having access to) the necessary computer and any other equipment or supplies
that are required in order to take this course online.
I understand that I am responsible for obtaining my own commercial internet provider.

I have taken the necessary prerequisite course:

If I am enrolled in Math 1113, then I have taken College Algebra which is a required prerequisite for Math 1113-Precalculus.
If I am enrolled in Math 2431, then I have taken Precalculus which is a required prerequisite for Math 2431-Calculus I.

By clicking below I am acknowledging that I understand all of the above and verifying that I am eligible to take the course for which I am enrolled.