Student Information Sheet for Chem 111A at Fullerton College


Please complete the information sheet below and click on the Submit button when you are finished.  Thanks!
Student Information Form
Name
Email
Major
Have you taken Chem 107 at Fullerton College? Yes No

If you took Chem 107, when?

Did you take the proficiency exam?  Yes No

If you did take the exam, did you Pass? Yes No


Please list all Chemistry Courses you have taken in high school and college.  Include where you took the course, when your took the course, whether it included a lab, and the grade you received. 

Please list all math courses you have taken in high school and college.  Please include where you took the course, when your took the course, whether it included a lab, and the grade you received. 

Please list all science courses you have taken in high school and college.  Please include where you took the course, when your took the course, whether it included a lab, and the grade you received. 

Why are you taking Chem 111A?

What do you anticipate will be your biggest challenge in taking this course?

Do you have any questions for the instructor at this time?