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Foundation Coalition
Active Cooperative Learning

Sample Registration Form (Purdue University)

Last Name: ________________   First Name: ________________

Hometown (State): _____

Local Telephone: __________________   GPA: _____

E-mail Address: ________________________

Semester Standing: ___________________   Major: ___________

Other related courses completed:



How would you rate your computer skills on a scale of 1 to 5 with 5 meaning that you can do most anything you want on a computer:

              1                 2                 3                 4                 5                
Do you work part time? Hours per week: ____________

Extra-curricular activities? Hours per week: ___________

Why did you decide to take this course?



What do you expect to learn from it?



What do you want to be when you grow up?



What are the most important things I need to know about you as student and colleague?

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