SU12 Math 215 SLA Registration Form Default Section Question Title * 1. Please provide some information about yourself: First Name: Last Name: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Zip Code: Franklin Email: Phone Number: Question Title * 2. Math 215 Instructor's Name Anthony VanderHorst Charles Peselnick Clayton Rothenbush Cynthia Cannizzo Heather Houchard Klaus Fricke Mark Marino Mary Hemby Michelle Wilson Ronnie Catipon Ronnie Kerlee Thomas Foltz Todd Hoff Wendy Neaville Other (please specify) Question Title * 3. I am taking the Math 215 class Online Face-to-face Question Title * 4. What day does your class meet? (If applicable) Monday Tuesday Wednesday Thursday Friday Saturday Question Title * 5. Did you take Math 150 at Franklin University? Yes No Question Title * 6. Have you ever registered for Math 215 at Franklin prior to this term? Yes No Question Title * 7. How long has it been since you took a Math class? 0-2 years 3-5 years 6-10 years 10+ years Question Title * 8. How comfortable do you feel going into this class? Very uncomfortable Somewhat uncomfortable Somewhat comfortable Very comfortable Question Title * 9. SLA Participant Agreement SLA program is completely voluntary, however, once you register, you agree to the following:-Regular participation. Students may not miss more than three consecutive sessions, otherwise, you may lose your place in the program. -Class attendance. SLA is not a substitute for class. Students are expected to attend class regularly. Should you miss a class, please make arrangements to "flex" into another section or talk to your instructor for make-up instructions. -Active participation. Students are expected to prepare for SLA by completing homework problems, preparing questions and participating in the discussion. -Instructor notification. Your instructor will be notified of your participation in the SLA program. -Adherence to the Franklin University Student Code of Conduct I agree I do not agree Question Title * 10. Please select a day to attend Structured Learning Assistance for the entire term. Once you register for a specific section, it may not be possible to change sections. Wednesdays from 8-10 p.m. on FranklinLive! (online) Thursdays from 8-10 p.m. on FranklinLive (online) 100% of survey complete. Done