ECI 646 - Distance Education: Student Information Form

Please fill out the following form as completely as possible. This data will help Dr. Hollenbeck configure the clss as closely as possible to your needs.
First Name
Last Name
Student ID (optional)
Department of Major
Primary Email Address
Web Address (if applicable)
Contact Phone (place where you will get a message)
Course Goals What do you want to accomplish in this course?
Course Hopes What do you hope will or will not happen.
Do you have home and/or work access to a computer?	Yes No
What brand is the computer?
What operating system is it?	Windows Macintosh UNIX
What kind of Internet connction? (leave blank if none)	Select 14,400 Modem or less 19,200 Modem 28,800 Modem 33,600 Modem 56,000 Modem Cable Modem DSL T1 and above
What kinds of computer(s) can you use?	Windows Macintosh UNIX
What kind of computer to your prefer?	Select Windows Macintosh UNIX
Have you taken an educational technology course before?	Yes No
Please rate your computer skills for each specialty 1=very weak 5=very strong
General Computing	1	2	3	4	5
Word Processing	1	2	3	4	5
Database	1	2	3	4	5
Spreadsheet	1	2	3	4	5
Presentation (i.e. PowerPoint)	1	2	3	4	5
Graphics	1	2	3	4	5
Browsing the World Wide Web	1	2	3	4	5
Making a Web page using an editor	1	2	3	4	5
Coding a Web page using HTML	1	2	3	4	5
Advanced Web skills such as JavaScript and CSS	1	2	3	4	5
Hypermedia experience (i.e. HyperStudio)	1	2	3	4	5
Macromedia Director	1	2	3	4	5
Video	1	2	3	4	5
Computer Conferencing	1	2	3	4	5
Other Comments:

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