STUDENT INFORMATION FORM

This form will gather information so that Dr. Bowman will know you better and to ascertain the level of access you have to a computer. It also makes sure you know how to get to our course webpage.

Your Name:

Your Email Address:
Confirm Email Address:

----------------
The three questions below are asked in order to enable Dr. Bowman to understand each student's situation more clearly.

Where do you live?
  Lezhë (city)
  Lezha District
  Outside of Lezha District

With whom do you live?
  Parents
  Parents and Other Brothers and/or Sisters
  Grandparents
  Other Family or Friends

With what religion do you most closely identify?
  Muslim
  Roman Catholic
  Orthodox Chriistian
  Evangelical Christian 
  Another Religion
  None

----------------

In which grade are you at Lezha Academic Center?
  12
  11
  10

Where is the computer you are using to fill in this form?
     If 'Other', briefly explain:

Do you have Internet access at your home?
  Usually
  Sometimes
  Never

Any Questions or Other Comments?

By submitting your comment, you give permission for Dr. Bowman to respond to you via email. No other use of your name or email address will occur except to respond to any question you raised.