QUARTER? SECTION?

NAME? STUDENT IDENTIFICATION NUMBER?

E-MAIL? PHONE I CAN REACH YOU AT?

PLACE OF EMPLOYMENT? JOB TITLE? FULL OR PART-TIME?

DEPENDENTS (LIKE CHILDREN)?

CITY YOU LIVE IN?

COMMUTE TO CSUSB IN MILES? IN MINUTES?

HIGHEST DEGREE EARNED? IN WHAT?

HIGH SCHOOLS, COMMUNITY COLLEGES, UNIVERSITIES YOU’VE PAST ATTENDED?

AMOUNT AND TITLES OF CSUSB COURSES THIS QUARTER?

ADVISOR? PROGRAM OR OPTION? HOW FAR INTO THE PROGRAM?