Student Information Form

Midlands Technical College
CPT 242 - Student Information Form

Instructions: You must complete the form online and then submit it online by clicking the "Submit" button at the bottom of the page.

Please provide the following information:

Name
Course	(use drop-down arrow to select)
Section	(use drop-down arrow to select)
Phone Number 1	(format: 803-555-1234)
Phone Number 2	(format: 803-555-1234)
Email Address
Major
Expected Graduation Date	(ex. May 2009)
Have you taken CPT 101?	(use drop-down arrow to select)
Have you taken CPT 104 or CPT 170?	(use drop-down arrow to select)
Have you taken MAT 100 or MAT 039?	(use drop-down arrow to select)
Do you have a computer at home?	(use drop-down arrow to select)

Reasons for taking this course: (Please be brief) [Limit 5 lines]

Level of Experience working with Databases (including Access, Oracle, SQL Server, etc.):
[Limit 5 lines]

Comments: [Limit 10 lines]

Midlands Technical College
IST Department