New Chemistry Student Intake Form

Welcome to Your New Chemistry Course!
Please complete the questionnaire to help us optimize your learning experience.

about you

Full name (for the purpose of this exercise):

First Name:

Last Name:

Preferred Name / Nickname:

Preferred pronoun:

Email:

Phone number with area code:

^*Please provide a number for texting, if possible, or a number to call in case of emergency or unforseen circumstances

Student ID:

None

High-school chemistry

Some college chemistry

Completed a college chemistry course