Student Needs Assessment

Complete the Questions below and submit/mail/fax/deliver to the instructor:

Student's Name

Student's Mailing Address

City

State

Zip Code

Home Phone

Day Phone

Fax Number

(Student's Primary Email Address)

(Student's UACN Email Address if applicable)

(Student's Web Page URL if applicable)

What Course(s) are you enrolled in? * check as many as apply *

CIOS 100 - Computers For Absolute Beginners
CIOS 145 - Internet Concepts and Applications
CIOS 293a - Advanced Internet: Sitka
CIOS 293b - Advanced Internet: Sitka
CIOS 246a - Advanced Internet I: Fairbanks
CIOS 246b - Advanced Internet II: Fairbanks
CIOS 246c - Advanced Internet III: Fairbanks
CIOS 153 - Web Publishing Concepts and Applications- HTML I
CIOS 255a - Web Publishing Concepts and Applications- HTML II
CIOS 255b - Web Publishing Concepts and Applications- HTML III
CIOS 171 - Web Programming I
CIOS 271 - Web Programming II
CIOS 100/250 - Computer Applications Certification
CE S041 - Web Page Making

What date did you register?


Month	Day	Year

What type of computer will you be working on for this course?
Win 3.x Win 95 Win 98 Win NT Apple/Mac Other

How will you be accessing the Internet?
Home Computer Work Computer School/College Other

Are you already connected to an Internet Service Provider? (ISP)?

Yes

If yes, who is your ISP? (example: PTI, UACN, SEAKNet, AlaskaNet)
If no, do you wish information on how to connect your computer to the University of Alaska Computer Network (UACN) ISP?

Yes
No
What Internet communication programs are on the computer's hard disk drive (if you know?)
Do you have manuals available on operating the computer and it's communication software and hardware?

Yes
No
What type of modem or connection are you using and what is it's speed? (if you know)
Do you already know how to use your communication program?

Yes
No
Have you ever used electronic email before?

Yes
No
Do you already have a UACN electronic email account?

Yes
No
If yes, what is your email address?
If no, do you wish a temporary UACN email address?

Yes
No
What type/size disk drive will you be using for this course?

MAC 3.x Disk
IBM 3.x Disk
IBM 5.x Disk
IOmega Zip Disk
What would you like to accomplish in this course? (how can this course help meet your personal or professional needs?)
Self-directed learning does not mean learning in isolation. We encourage you to learn with a buddy, even if that person is not taking the course. This buddy can be at the same level of skill or can be a more experienced computer user. Do you have a buddy?

Yes
No
If yes, Who? (if not, the instructor will introduce you to an online buddy)
Describe your previous experience using a personal computer.
Assess your current skill level using your computer. 1 = you are a "newbie" brand new to computers, 10 = you are very experienced and very comfortable with your computer.

One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
(optional) Send a small picture so that the instructor and computer lab staff can put your name with your face. Is it alright if the Instructor puts your photo on your student status page for other students to view?

Yes
No
(optional) Write a biographical sketch of yourself: what you do, where you live, your family situation, anything that would help the instructor and other students understand your background and specific learning needs. Is it alright if the Instructor puts your biography on your student status page for other students to view?

Yes
No

Online Users:
Please click here when form is complete:

- OR -

Offline Users:
Choose one of the following to Submit an offline form:

Snail Mail:
Elaine Craddick-Patt
Computer Department
University of Alaska - SE, Sitka Campus
1322 Seward Avenue
Sitka, Alaska 99835
Fax:
University Fax Number: 907-747-3552
Hand Delivery:
The University is located on Japonski Island, 1322 Seward Avenue.
The Instructors drop mail-box is located on the second floor, in the computer lab.
The Instructors on-campus lab hours are located online at:
- http://www.shuilongs.com/inssch.html

SLC

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