Potential Student Survey



The Department of Geosciences offers courses in a variety of formats.  You can help us by taking a few minutes to respond to the brief survey that follows.

  1. Surname :

  2. First Name :

  3. I work approximately ______ hours per week

  4. I am interested in pursuing:

  5. in :

  6. I prefer to take courses :

  7. I can take courses at 4:00 PM Two Days a Week :

  8. I would prefer courses meeting one night per week for 3 Hours :

  9. I prefer to take courses at :

  10. I am really interested in courses in (please specify) :

  11. E-Mail Address :

  12. Employer :

  13. Address :

  14. City :

  15. State :

  16. Postal Code :

  17. Country :

  18. Telephone Number :

  19. Please add any other material that may help us help you. Include any information (financial needs, visa status, application forms, etc) that you would like to have sent to you at the above address.

    To submit your responses, press this button:

    To reset the form, press this button:

  20. Since January 30, 1999