DL Student Focus Group Application Form

DISTANCE LEARNING STUDENT FOCUS GROUP APPLICATION FORM

Please complete the form below and click Submit at the bottom.

First Name:	Last Name:
Primary Email:	Secondary Email:
Major:	Home Campus:	TP/SS RV GT
Phone Number:	MC ID #:

1. Are you currently enrolled in a class on WebCT?
      Yes
      No

2. Is this your first time enrolling in an online course at Montgomery College?
      Yes (If you answer Yes, skip to Question 3)
      No (If you answer No, proceed to Question 2)

3. How many online courses have you previously taken at Montgomery College?
      1-4 5-8 more than 8

4. How many online courses have you taken at other colleges/universities?
      0 (none) 1-4 5-8 more than 8

5. What are the total number of college credits you have earned?
      1-9 10-20 21-30 31-40 41-50 more than 50

6. What are the total number of online course credits you have earned?
      1-9 10-20 21-30 31-40 41-50 more than 50

7. How did you hear about this DL Student Focus Group?

8. Please explain your interests in joining this DL Student Focus Group.

Please make sure the information above is accurate before clicking on the "Submit this Form" button below.