Personal Information

First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Zip:
Home Phone:
Mobile Phone:
Email Address:
Preferred method of communication: Email
Phone
Mail
Not selected
Sex: Male Female Not selected
Date of Birth: / / (YYYY)
Ethnicity: White
Native American
Hispanic/Latino
African American
Asian/Pacifi Islander
Other
Not selected
Education: High School GED
Not Selected
High School:
HS Name:
HS State:
Year of Graduation: (YYYY)

GED:
Month:
Year: (YYYY)
How did you learn about Phoenix College?
Would you like more information about Phoenix College?

Yes
No
Not selected

Educational Goals

What is your primary reason for attending this college?

Prepare for employment
Improve my skills at my present job
Learn new skills for a better job
Prepare for career change
For my personal interest or self-improvement
Transfer to another college
Not Selected

Orientation Questions

1. How did you learn about the online orientation? (select all that apply)
Advisor/Counselor
Class Schedule
Teacher 		PC Web Site
Recruitment & Retention Office
Friend
2. If you find yourself in academic difficulty, what would you do?
(select all that apply)
Seek Tutoring
Drop Class
Talk to Advisor/Counselor 		Talk with Instructor
Other, specify
3. Who in your life motivates you the most to be successful in college?
(select all that apply)
Myself
Relative
Friend 		Advisor/Counselor
Parent(s)
Other, specify
4. Are you enrolled in any programs at Phoenix College? (select all that apply)
Athletics
Honors
Project Success 		President Scholar
PC Support
Other, specify
5. Please answer the following questions:
Yes No    
Are you more informed about campus resources and assistance available to you as a result of this orientation?
Has this orientation helped motivate you to be successful in college?
Would you recommend that we continue this online orientation?
Would you use campus resources as a result of this online orientation?
6. What other information would be helpful to have on this online orientation?
7. We would like your comments on your online orientation experience:


 

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Updated August 23, 2006 12:51 PM