If you are registered for LIS 405 in the Summer 2004 semester, please enter the information requested below. I will use it to prepare a class list with some of the information that you provide. Some of it will duplicate what you have provided on the short bios attached to the course but perhaps some information will be new. I ask for your address and phone number but I will list only your city and state on the class list. If you prefer other information to be private as well, please check this box and I will contact you before creating the list so that you can view your entry and edit it. If you have questions, please email me at Evelyn Daniel .

Hit the Send key at the bottom of the page when you have finished entering. If you wish to start over, hit RESTART.

Name:

First Name:
Nickname:
Last Name:

Address:

Email Address:
Street Address:
City/Town:		State:

Telephone:
(Day): (Night):

Work:
Place of Work (if any):
Nature of Work (What do you do?):
Prior Experience relevant to this course:

Education:
I am a LEEP Fridays only on-campus other student. I am in the M.S. C.A.S. Ph.D. other program.

Prior Education (Degrees - subject and school):

Future Plans:
Career Aspirations (type of work and kind of organization):

Personal Interests:
What is one, or some, of your interests outside of school?

What is one interesting fact about you that you would be willing to share with the rest of the class? (e.g., a hobby, an experience, an aspiration, a quality, a pet, etc.):

Thank you for providing this information.

Revised 5/21/2004