ECI 647 - Online Learning: Student Information Form

Please fill out the following form as completely as possible. This data will help Dr. Hollenbeck configure the class as closely as possible to your needs.
First Name
Last Name
Student ID (optional)
Department of Major
Primary Email Address (The one you check regularly)
Web Address (if you have one)
Contact Phone (place where you are most likely to get a message)
Do you have home and/or work access to a computer?	Yes No
What brand is your most used computer?
What operating system does it run?	Windows Macintosh UNIX
What kind of Internet connection? (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 authoring (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
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