STUDENT INFORMATION FORM

This form will gather information so that Dr. Bowman will know you and your mathematical background better and to ascertain the level of access you have to a computer. Even if you have filled one of these out last year, please do so this year again and make certain all of the info is correct. Thanks.

Your Name:

Your Email Address:
Confirm Email Address:

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

What mathematics courses have you completed? (Check all that apply.)
  Gen. Math. 7, 8, or 9
  Algebra I
  Algebra II
  Geometry
  Trigonometry

What mathematics courses are you presently enrolled in? (Check all that apply.)
  Gen. Math. 7, 8, or 9
  Algebra I
  Algebra II
  Geometry
  Trigonometry
  Pre-calculus
  None

Any Questions or Other Comments?

----------------
The three questions below are optional and any answers will be held in strict privacy by Dr. Bowman. They are asked in order to enable him 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

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

By submitting your comment, you give permission for Dr. Bowman to respond to you via email and to use any of this information in the pursuit of education at Lezha Academic Center. No other use of your name or email address will occur except to respond to any question you raised.