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all about you

Note: if you have a default email account in your browser settings, then fill out the following form and submit it. If not, click here and submit the excel document.

*Required Information

*first name:

*last name:

nickname:

*student id number:

email address:

which chemistry class are you enrolled in?

 organic   qualitative   quantitative 

which textbook are you using?

*what is your book number?

what condition is your book in?

 new   excellent   good   fair   poor 

list all of the problems in your book:

*Choose a password to check your grades online:

*Verify your password:

*street address:

*city:

state:

*postal code:

 - 

*home telephone number:

 - 

birthdate:

/ /

What is your favorite subject in school?

 Fine Arts
 Foreign Language
 Language Arts
 Mathematics

 Physical Education
 Science
 Social Studies
 Other

*tell me more about yourself:

PLEASE NOTE: If you do not want to periodically receive emails about class, select "no" below.

 yes   no

Page maintained by: Stephen A. Roe
Last update: Tuesday, October 3, 2006 2:40 PM