Name _________________________________________________________

First name you like to be called ____________________________

E-mail address: ___________________________________________

Major ______________________________

Minor _____________________________ Class rank ______________________

Why are you taking this class? _______________________________________________

________________________________________________________________________

________________________________________________________________________

Extracurricular activities (feel free to include work, family, etc.) ____________________

________________________________________________________________________

Career Goals _____________________________________________________________

Mass media or other communication industry work experience (or volunteer, intern exp.)

________________________________________________________________________

Communication Courses you’ve taken: __________________ __________________

____________________ ___________________ ________________________

The following information will be kept confidential and be used only if an administrative need arises:

Local Mailing Address: ____________________________________________________

_________________________________________________ Zip ____________

Local phone numbers (include work numbers if you don’t mind being called at work):

_____________________ _____________________ _____________________

If you have any special concerns or other information you wish to share, please use the back of this form. Thanks.