Student Self Assessment

First Name *

Last Name *

Mainestreet ID

Pronounciation

Preferred Pronouns *

Military Affiliation *

Military Affiliation Other...

Are you currently employed? *

Employer *

How many hours do you work each week? *

Do you commute to school? *

How many hours do you spend commuting to school each week? *

Do you have child or family care responsibilities? *

How many hours a week do you dedicate to care responsibilities? *

Are you involved in any clubs or organizations? *

Please list them. *

How many hours a week do you participate in these clubs/organizations? *

Is financial aid adequate to meet your needs? *

What is your financial aid gap? *

Do you have textbooks for this semester? *

Yes

No

Did you earn/Are you earning grades that correspond to your abilities? *

How often do you ask for help? *

Have you ever used tutoring services? *

Yes

No

Are you interested in learning more about any of the following? *

What skills would you like to improve upon? *

Are you interested in having a mentor in your field of study *

Yes

No

Type of Mentor *

Do you have a Graduation Plan? *

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