HIS 104 Student Information Form
Please answer the following questions. Your answers will remain private and are used only by the instructor for reference during the semester. Contact Dr. Rose with any questions at
What is your name? (First and Last)
you may include a nickname here
What is your major/minor?
Primary Email Address
Tackk Account Name
Please register for a free Tackk account (
) if you do not already have one.
Name one or two skills you would like to focus on this semester
What are your future plans?
Do you have any learning considerations?
This information will be kept private. You may also email me or make an appointment to discuss your specific needs before the first assignment. You may also email me or come to my office hours to discuss your needs.
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