Chem 112 Student Survey

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Chemistry

112 Student Survey


Name: _________________________________________________________________________________________________
How would you like to be addressed? _____________________________________________________________
Phone #: _________________________________________ Email: ____________________________________________
Interests or Hobbies: ________________________________________________________________________________

Where did you complete Chem102? ________________________________ Semester/ Year? ___________
Who was your Chem102 instructor? ________________________________ Grade Earned: _____________
What is the most recent Math Course you completed? __________________________________________
Semester/ Year? _____________________

Grade Earned: _______________


Why are you taking Chem112? _____________________________________________________________________
Are you planning to take Chem113? _________
What are your educational goals? __________________________________________________________________
What are your career goals? ________________________________________________________________________

What is your course schedule this semester?
Class




Units




Instructor





Do you work? ____________

If so, how many hours per week? ____________

Do you have parents or children for whom you are the primary caregiver? ___________________
How many hours per week do you plan to devote to studying chemistry? _____________________
What grade do you expect to earn in this course? ____________
What do you expect from the instructor of this course to help you succeed? __________________
_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

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