STUDENT ENROLLMENT DATA FORM

Student background information often aids in providing
direction and focus for the course material. By inputting
this information directly you help eliminate the loss of time.

Under University policy, all students have the right to deny even those with legitimate
educational interests access to any personal information regarding themselves. Additionally,
some students may have concerns regarding the security of providing such information via
electronic means. Click here for an explanation of your rights and appropriate safeguards
for transmitting these data. If you are uncomfortable with completing and transmitting the
form below, bring a written request for a waver of this requirement to class.
Year:  

Quarter Enrolled: FALL WINTER SPRING SUMMER 

  Class Enrolled in: MT336 MT498 MT582 MT630 MT631 
  
Student Name:  
     (Type your name as you want to have it appear on your name plate) 

Local Mailing Address:  

E-Mail Address:  
                                   (You must provide your e-mail address) 

INTERNET home page:  
               (Provide the complete URL if you have an active homepage) 
  
Undergraduate Degree 

Month & Year Degree was/is Awarded/Anticipated:   

Degree & Major:  

University & College: 
   
Current and Recent Work Experience: 

 

Your Expectations for this Class: 

   
Please Provide a 4-Digit Code for the Posting of Your Grades:    
  (It is your responsibility to maintain the confidentiality of this code) 
To submit the form, click here:  

To clear the form, click here:    

Thank you for your time
and your assistance.

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