<p> MICROBIOLOGY STUDENT DATA SHEET</p><p>The following information about you and your academic background will be used to help us to better understand your needs. All information will be treated with confidentiality.</p><p>Name:______Lab sec: ______Semester: ______</p><p>Address:______</p><p>Phone #:______e-mail address:______</p><p>Student ID#:______</p><p>Emergency Contact Person and Phone #:______</p><p>1. Academic preparation</p><p>Check Classes taken When Grade Comments? courses earned taken Introductory chemistry Chem 101 Additional chemistry Please list</p><p>Anatomy (Bio 260) or A&P first semester (250) Physiology (Bio 261) or A&P second semester (Bio 251) Introductory biology (Bio 100, 102) Core biology 200-level courses Algebra (Math 090,095,102) English (Eng. 101,102) Other (Medical Terminology/ Health/etc.) </p><p>2. Have you ever been enrolled in Microbiology before this semester? Yes ___ No ____ If yes, please explain the circumstances (when, where, why you are repeating) ______</p><p>3. What is your current course load? Total number of units_____ List courses: ______</p><p>Continued on back 4. Academic skills self assessment:</p><p>Excellent Good Average Weak Very Bad Reading speed Reading comprehension Writing skills (grammar/ spelling)</p><p>Verbal Communication Math Problem solving Note taking skills Memorization of facts Comprehension of complex or abstract ideas Test taking skills Stress management Time management Ability to work in teams</p><p>5. Do you have any difficulties that could effect your ability to function in the course?</p><p>Yes No Difficulty Comments: any special assistance the instructor can provide? Vision Hearing Movement Learning Medical (any condition that weakens immune response)</p><p>Psychological Financial Job Transportation Family Other</p><p>6. What is your career goal? (Why are you taking this class)? ______</p><p>Professor’s comments: ______</p><p>Discussed with student: ______</p>