Getting to Know You Survey

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Hello, students! After you have read our course syllabus, please take a few moments to complete this form. Your responses will come directly to me and will be kept confidential. I will use the information you provide to support your success this semester. Thanks so much for your time!

Required questions are marked with an asterisk (*).

This survey by Michelle Pacansky-Brock is shared in the Public Domain, which means you are free to re-use and adapt it as you'd like without attribution.

First Name *

What would you like me to call you?

Last Name *

Your Pronouns *

she/her/hers

he/him/his

they/them/theirs

Other:

Which of the following describes you? *

Select all that apply.

This is my first semester of college.

I am the first in my family to attend college.

This is my first time taking an online class.

I work more than 20 hours per week.

I am a caretaker for at least one person.

Other:

Required

I may leave you feedback in voice or video this semester. How does that sound to you? *

That sounds great to me!

Thanks for asking. I would prefer written feedback.

In one word, describe how you are feeling about this class. *

What is the one thing that is most likely to interfere with your success in this class? *

At this time, what is your academic goal? *

What is one characteristic of a great online class? *

Is there anything you'd like to share or ask me at this point?

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