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* 1. Please enter your student ID number and your Full Name (this information is collected for data analysis only and will be kept confidential.)

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* 2. Is this your first enrollment as a student at FPCC?

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* 3. Check the response that best describes your student status.

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* 4. Do you have access to a desktop or laptop computer to complete courses online?

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* 5. Internet is required to complete your FPCC courses online. Do you have reliable and consistent internet or Wi-Fi access?

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* 6. Please check your age group below

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* 7. Check the response that describes your current family.

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* 8. Are you responsible for an elderly family member in your home?

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* 9. Did your mother or father attend college, university or post-secondary vocational school?

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* 10. Did either your mother of father receive a Bachelor degree or above BEFORE you turned 18 years of age?

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* 11. What is your current employment status?

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* 12. Do you have a physical disability that is NOT corrected by prescription lenses, hearing aid or other devices?

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* 13. Educational Barriers. Does any of the following apply to you?

Limited English Proficiency. Do you have an imperfect ability to listen, think, speak, read, write, spell or to do mathematical calculations? Includes such conditions as perceptual handicaps, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasics.

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* 14. Economically Disadvantaged. Does any of the following apply to you according to the following definition?

A student whose family income is at or below the national poverty level, a student (or parents) who is unemployed, on public assistance, or under state guardianship or is institutionalized and who requires special services, or programs, in order to succeed in a vocational program."

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* 15. Displaced Homemaker. Does any of the following apply to you?

An individual who has worked primarily without remuneration (paid/compensation) to care for a home and family, and for that reason, has diminished marketable skills; or has been dependent on the income of another family member but is no longer supported by the income; or is a parent whose youngest dependent child will become ineligible to receive assistance under the Social Security Act; and is unemployed and is experiencing difficulty in obtaining or upgrading employment.

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* 16. What was your educational status when you first enrolled at FPCC

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* 17. What is your current financial aid status?

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* 18. What is your academic or vocational program?

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* 19. Are you a Veteran?

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* 20. Please check the Native American languages you speak.

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* 21. If you speak a Native Language, what is your degree of proficiency?

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* 22. Have you ever participated in a Head Start Program as a student or parent volunteer?

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* 23. How has COVID-19 impacted your life? (Check all that apply)

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