PERSONAL INFORMATION Prefix Mr. Mrs. Ms. Reverand Minister Deacon Deaconess Trustee *First Name Middle Name *Last Name Suffix Sr. Jr. MD PhD DMin Household Status Head of House Spouse Child Spouse's Information First Name Last Name Suffix Sr. Jr. MD PhD DMin Parent(s) information, if same address Mother's First Name Mother's Last Name Suffix Sr. Jr. MD PhD DMin Father's First Name Father's Last Name Suffix Sr. Jr. MD PhD DMin Home Address *Street *City *State *Zip Code Mailing Address (if different from above) Street City State Zip Code Home Phone Fax Cell phone/Pager # E-mail address Date of Birth Gender Female Male Marital Status Married Single Widow Divorced Languages Written Oral Written Oral Written Oral PROFESSIONAL INFORMATION Employer Occupation City Work Phone Work Fax Work E-mail (optional) EDUCATION Current School Name City School type Preschool Elementary Jr. High/Middle School High School College Other Grade Level If College graduate or business school: Degree: School: Special Training: Certifications: TECHNOLOGY BACKGROUND Check all that applies Computer Usage *Do you currently own a computer? Yes No *How often do you use your computer?   Daily Weekly Monthly   *Where do you use a computer Home School Work Operating System *I am familiar with the start menu Yes No *I know how to use the find function Yes No *I know how to format a diskette Yes No *I know how to install a program Yes No *I know how to change the date and time Yes No *I know how to change the mouse settings Yes No *I know how to create a folder Yes No Applications *I know how to use Microsoft Word Yes No *I know how to use Microsoft Excel Yes No *I know how to use Microsoft Power Point Yes No Programming *I know how to create program code Yes No *I know how to compile a program Yes No *I know how to debug a program Yes No Networking *I know how to configure a switch Yes No *I know how to install and test cabling Yes No *I know how to install & configure a network printer Yes No *I know how to create a network user account Yes No *I know how to set permissions for a network user account Yes No *I know how to allocate quotas on a network server Yes No COMMENTS