Student Information

Please fill out this form completely and press the submit button.

Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

Date of Birth
Sex Male Female

Classification:

Freshman
Sophomore
Junior
Senior

Parent information:

Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail

What subject do you feel you perform best in:

Why did you choose this science class?

The environment is important to me.
I heard it was fun.
I heard it was easy.
Seems easier than other sciences.
I like Mr. Dehnisch.
Will look good on my transcript.

Which of my classes are you taking?

Regular Environmental Science
AP Environmental Science

What section are you in this fall?

1A
3A
4A
1B
3B
4B

What topic(s) in this class do you think will interest you most?

What are you goals and/or expectations for this class?

Created by Michael Dehnisch.
Copyright © 1999. All rights reserved.
Revised: October 06, 2001