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Name: ____________________________________________

Address: __________________________________________

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Telephone Number: _________________________________

Cell Phone: ________________________________________

Email Address: _____________________________________

Do you have Internet access at home? YES NO

What is your learning style?

VISUAL AUDITORY

TACTILE OTHER/COMBINATION

Do you prefer tests with 20-25 Questions


25-30 Questions
30-50 Questions

Number in order of preference (1-favorite 4-least favorite)

___ Multiple Choice


___ Fill in the Blank
___ Open Ended
___ Matching

Do you prefer group, partner, or individual projects/assignments?


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What healthcare specialty interests you? __________________________________

What made you choose the health science career track?


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