Name

Your answers to the questions on this survey are confidential. We will use your name and uca in order to add you to the SciTech Student Forum (located in the Learning Technology Center institution in Vista.) We will use the other demographic information to track usage of the Student Forum.

Last Name: First Name:

Enter your campus UCA (as used for Vista or email):

How did you hear about this sign-up form?: Group announcement in Vista Instructor Poster Friend other (Specify)

What is your age?: 17 or under 18 19 20 21 22 23-25 26-29 30-34 35-39 40-49 50-59 60 and above

What is your major?: Architectural Eng Tech Biology Chemistry Civil Eng Tech Computer Science Computer Security Electronics Eng Tech Forensic Science Graphics Technology Mathematics Math Education Mech Eng Tech Science Education Safety/Environmental Eng Tech Tech Education other (Specify)

How many years of college have you completed so far? 0 1 2 3 4 5 6 7-8 9-11 12 or more

How many hours per week do you work for pay? 0 1-5 6-10 11-15 16-20 21-25 26-30 31 or more

Which features are you interested in using in the SciTech Student Forum in Vista (select all that apply)?

Tutoring   yes      no

Mentoring   yes      no

Jobs   yes      no

Graduate Schools   yes      no

Advising   yes      no

Scholarships   yes      no

Program Info   yes      no

Research/Internships   yes      no

Student Clubs   yes      no

other (Specify)

Tutoring	yes	no
Mentoring	yes	no
Jobs	yes	no
Graduate Schools	yes	no
Advising	yes	no
Scholarships	yes	no
Program Info	yes	no
Research/Internships	yes	no
Student Clubs	yes	no
other (Specify)