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Daytona Beach Community College

Science Department

Information Sheet

Course_____________ Section________________


Last First Middle

S.S. NUMBER:_________________________

LOCAL ADDRESS:_______________________________________________________

PHONE NUMBER:_____________________


(Check those courses that you have taken.)

High School College

Algebra _____ General Math _____

Geometry _____ Algebra _____

Trigonometry _____ Geometry _____

Physics _____ Trigonometry _____

Chemistry _____ Calculus _____

Physical Science _____

Physics _____

Chemistry _____

High School Attended:__________________________ Date Graduated:___________

College(s) Attended:______________________________________________________


What is your reason for taking this course?_____________________________________

At this time, what is your anticipated major?____________________________________

What college or university do you plan on attending after you leave DBCC?___________


Would you like your grades for the exams and your final letter grade posted in the hallway display case, by your student number, along with those of the other students in the course? ' Yes ' No

________________________________ _______________

Signature Date