Sample Personal Information Form

Please use the "Tab" key, mouse, or cursor keys to move from item to item. Do not press the Enter Key until you are done filling in this form!

First Name:

Last Name:

Complete Postal Mailing Address:

Phone Number:

Email Address:

Other Courses This Term:

Expected CLIS Graduation Date:
December 2003
May 2004
August 2004
December 2004
2005
2006
Unknown / Not Sure

Current Employment:

Management/Work Experience:

Primary Career Interest After Graduation:

Public Library
Academic Library
Special Library
School Library Media
Technology / Systems
Business
Government
Other
Unknown / Not Sure

What do you most want to learn in this course?

Online Discussion Time Availability

The only set time each week you will need to spend on this course will be when you go online to discuss concepts and case studies with other students in the class. I will do my best to place you in a discussion group at the time most convenient to you. To help me do that, please complete the form below by indicating your 5 most convenient times and any times you are unavailable. Place a 1 in the time slot box representing the time most convenient for you. Place a 2 in the time slot box next most convenient. Then indicate your convenient times 3-5. Place an N in any time slots you are absolutely unavailable so I will be sure not to assign you during those times. I'll assume any slots you leave blank are acceptable to you. Note: the actual online discussions will require only about an hour of your time each week.

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
Early Morning (8 - 10 a.m.)
Late Morning (10 a.m. - 12 noon)
Early Afternoon (12 noon - 2 p.m.)
Mid Afternoon (2 - 4 p.m.)
Late Afternoon (4 - 6 p.m.)
Early Evening (6 - 8 p.m.)
Late Evening (8 - 10 p.m.)