1 STUDENT INFORMATION

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1.11 What is the best way to contact you?

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1.15 Ethnicity:

2 NEEDS ANALYSIS

Do you need assistance with any of the following? (Check all that apply): 

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3EDUCATIONAL DATA

3.1 Please select your student status:

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3.4 Did you see/hear any SUSLA advertisement?

3.5 Which of the following advertisements did you see or hear? (Check all that apply)


3.6Have you ever seen SUSLA on social media (FaceBook, Instagram, etc.)?

3.7  On what Social Media site(s) did you see SUSLA advertised or mentioned? (Check all that apply)


3.8Has anyone in your family (parents, brothers and sisters) attended college?

3.9Has anyone in your family (parents, brothers and sisters) graduated from college?

3.10Do you have a personal computer?

3.11 Have you ever taken online courses?

4 CAREER PLANS

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4.2When do you expect to have accomplished your goal?

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Please rate your time management skills in the following areas: 

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Punctuality (arriving to school, work, or other activities)

 

  
 

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Finishing tasks on time (meeting deadlines)

 

  
 

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Maintaining schedules

 

  
 

4.7Are there any subjects (i.e. math, reading, science, etc.) that you need help with?

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5 SPECIAL INTERESTS

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5.8Have others told you that you were good at something?

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5.11Are you a member of any social/religious organization(s)?

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6WORK DATA

6.1Do you intend to work while attending college?

6.2On average, how many hours each week will you work?

6.3Are you interested in:

6.4Do you have dependents (children or other family members) that you care for?

7MOTIVATION FACTORS, ACADEMIC PREPAREDNESS

7.1Do you think you are prepared academically for college?

7.2Are certain courses more difficult than others?

7.3Which ones? (Please select the area of most difficulty for you)

7.4Are you confused about your choice of major or career plans?

7.5Do you feel that college is the best way to achieve your goals?

7.6Do you like to be challenged when learning something new?

8SOCIAL LIFE

8.1Do you enjoy socializing (i.e. dating, outings with friends, etc.) with others?

8.2How many hours per week do you socialize with others?

8.3Are drugs and/or alcohol involved in your social activities?

9TEST ANXIETY, LACK OF CONCENTRATION

9.1Does taking tests bother you?

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9.3Do you have difficulty finishing tests?

9.4Do you get distracted easily when studying?

9.5What appears to distract you the most when studying?

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10STUDY HABITS

10.1How many hours per day do you devote to studying?

10.2Are you able to find a quiet, comfortable place to study?

10.3Did you thoroughly read through your assignment(s)?

How often do you engage in the following behaviors? 

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Take good lecture notes in class

 

  
 

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Rewrite or reword your notes after class

 

  
 

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Review your notes before each class period

 

  
 

10.7Do you cram for exams?

10.8Do you study alone?

10.9With whom do you study?

10.10Do you think your other commitments will affect your study time?

10.11Based on your study habits, will you seek tutoring?

10.12 What other problems may interfere with your studies? (Please check all that apply.)


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