It would help me to know you better and be able to direct this course to more nearly meet the needs and desires of the majority of the class if you would share some personal information with me. Whatever you share will be held in strictest confidence: FOR MY EYES ONLY. Please give only the information you feel comfortable in sharing with me.

Name: _______________________________________________________________________ Seat No: _______________

What do you prefer to be called?________________________________________________________________________

Mailing Address: _______________________________________________________________________________________

Daytime Phone: ___________________ Evening Phone: ______________________ Cell/Pager?:___________________

Email address (please print carefully or email to me)  _____________________________________________________

Single _____ Married _____ Divorced _____ Widowed? _____ How many years? _______________

Children: Boys/Girls/Ages? _____________________________________________________________

Where do you work? __________________________________________________________________________________

What type work do you do? ____________________________________________________________________________

What is your religious affiliation or preference? __________________________________________________________

In addition to getting a good grade and required credit,
what is the most important thing you want to get from this course? Any special interests?

Other than not being "preached at," having your religion "bashed," or being pressured to change religions,
what is the main thing you DO NOT want from this class? Any special concerns or fears?

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