Distance Learning Need Assesment Form
Dear Students of the Physics Department,
Due to the ongoing epidemic, all courses have to be conducted through distance learning. Unfortunately, not all of our students have the necessary equipment for easy access to distance learning. To help our students that might need support to access synchronized courses and online learning materials,, the faculty of arts and sciences has initiated a fundraising campaign.
In this context, to determine the students who are in need, we have created this request form. If you are in need please fill out this form to inform us. If you know someone who might be in need, please let him/her know about this form. Although it is not possible to foresee the extent of support to be gathered, we will do our best to meet the needs of as many of our students as possible.
All the information you provide will be kept confidential within the scope of personal data security.
Stay well and stay healthy,
Office of the Physics Department Chair
* Required
Email address
*
Your email
Student ID
*
Your answer
Name
*
Your answer
Surname
*
Your answer
Phone Number
*
Please enter a phone number that we can use to contact you.
Your answer
City
*
The city in which you will be during distance learning.
Your answer
Full Address (The address that we should use if we need to send you any equipment.)
Your answer
Need
*
Do you need any of the following for distance learning? (check all that applies)
Computer
Smart Phone/Tablet
Internet quota for my cellular phone
Internet quota for home internet
Other:
Required
Comments
Any other comments you would like to make
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
