Web Based Course Student Information Form

Please fill out the form below to tell us about yourself.

*your information (required)**
*Your Name:
*Email:
*Phone:	(Use xxx-xxx-xxxx format)
Organization:		Years with Organization:
Title:
In 2 years I would like to:
In 10 years I would like to:
*Word Processing Program:		Other:
Rate your current level of ability in the following:
*Internet search ability:
*Overall computer skills:
*Grant research experience:
*Grant writing experience:
Describe current funding situation:
Describe Current program evaluation situation:

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