Survey

Supplemental Instruction

If you would like to be considered as a SI leader in the Supplemental Instruction Program, please print out this survey. Return your completed survey to BEP 230.

Name	_____________________________________
#	_____________________________________
Street Address	_____________________________________ __________________________________________
City	_____________________________________
State	_____________________________________
Zip	_____________________________________
Phone	__________________________ (day)
	__________________________ (eve)
E-mail	_____________________________________
Classification	________ Freshman
	________ 2nd semester Freshman
	________ Sophomore
	________ Junior
	________ Senior
GPA	__________________

Check all that apply	________ I am not interested in becoming an SI Leader
	________ I am interested in being the SI Leader for the following course(s):
	1. __________________________________ taught by ___________________________ during ____________________ semester.
	2. __________________________________ taught by ___________________________ during ____________________ semester.

Please note: Priority will be given to those students who have been recommended by the course professor.

Supplemental Instruction

BEP 230

NORTHERN KENTUCKY UNIVERSITY

Highland Heights, KY 41099

Phone: (859) 572-5182

E-mail: Jenkinssmith@nku.edu

This website last revised on 07/24/2003