First name Middle initial (optional) Last name
Extra (for example, "Jr", if used) Nickname (optional)
Student ID Number (new version, starts with "P")

Which of these course are you taking (check one or two boxes only):
AGS 3340: Computers, the Internet, and Society (Undergraduate version)
ISP 5990:  Computers, the Internet, and Society (Graduate version)
AGS 3360: eCommerce: Using the Web to Find and Service Customers (Undergraduate version)
ISP 5500: eCommerce: Using the Web to Find and Service Customers (Graduate version)

Street address
City State (e.g. MI) Zip
Daytime telephone number (include area code):
Evening telephone number (include area code):
Email address
Other contact information:
(optional, e.g. second email address, cell phone, pager, FAX - {describe})

Which Web Browser do you use (e.g. Netscape Navigator or Internet Explorer)?
Browser Name:
Version Number:

What email software do you use (e.g. Eudora, Netscape, AOL, Internet Explorer, etc.)?
Email Software:
Version Number:

Do you want to be able to get on-line grade reports for this course (including all work turned in and/or missing at the time, and projected grade) from the course web site?
Yes (If yes, give yourself a password here. Remember it!)
No

Counting this time, how many times have you submitted this form?