MED 307 Data Sheet

First Name Last Name

Local Address

Preferred Email

Telephone Number

Semester Fall Spring Summer

Year 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Do You Own A Computer? yes no

What kind? Windows Based MacIntosh Both

What Type of Internet Access do you have at home?

Dial Up High Speed DSL or Cable (i.e. Verizon) None

Number of hours in MAT courses you have completed to date.