UB Orientation: Center for Academic Development Services (EOP First Year Students) Data Form

Last Name:

First Name:

UB Person Number:*

Street Address:

City:

State:

Zip:

Phone (day):

Phone (night):

E-mail:*

The best time to reach you by phone on weekdays is:

Your sex is:

Male

Female

Your age is:

Have any of the following members of your family attended/or graduated from college?

	Mother	Father	Sister	Brother	Grandparent
Attended:
Graduated:

Your father's occupation:

Your mother's occupation:

Your parents' combined family taxable income per year ranges from:

Less than $25,000

$25,000 to $49,000

$50,000 to $75,000

$75,000 or greater

Please indicate the category which best describes your race or ethnicity:

Black

Puerto Rican

Hispanic

Native American

Asian/Pacific Islander

White

Unknown

Other

During your first semester at UB you will be living:

In the campus residence halls

Off campus near the university

At home with your family

Unsure

Do you have a documented disability?

Yes

No

Do you think you may have a disability although it has not yet been documented?

Yes

No

Please check any of the following statements that apply to you:

You have been out of high school for two or more years

You will be employed full time while attending college

You can only attend classes in the evening

Please choose one of the following regarding your intended major: (Please refer to the list of majors)

(Please see the UB Undergraduate Catalog Academic Programs Listing for more information about UB majors.)

My intended major is:

I am undecided about a major.

(Note: If you have received a letter of acceptance into the School of Engineering and are undecided about which Engineering program you would like, please type “Engineering - General” in the space above.)

Math Skills:

Please indicate the math areas in which you feel you have a proficiency level of mastery (master means you feel you can do 90% or more of problems you encounter). Check all that apply:

Calculus

Pre-Calculus

Advanced Algebra

Intermediate Algebra

Beginning Algebra

Trigonometry

Geometry

The high school math courses you have/or will have completed upon entry to college are:

Course Name and Level:

Grade Received:

Course Name and Level:

Grade Received:

Course Name and Level:

Grade Received:

Course Name and Level:

Grade Received:

Computer Skills:

Please rate your proficiency in the following computer operation or software programs: 1 = Very Strong, 2 = Strong, 3 = Average, 4 = Below Average, 5 = Poor, 6 = Very Poor

Word Processing	12 3456
Database (i.e. Access)	12 3456
Internet	12 3456
Library Databases	12 3456
E-mail	12 3456
Spread Sheet	12 3456
Presentation (i.e. PowerPoint)	12 3456
Windows	12 3456
Programming Language (please list)	12 3456
Browsers (i.e. Explorer/Navigator)	12 3456
Other	12 3456

Writing Skills:

Please rate your proficiency in these areas using: 1 = Very Strong, 2 = Strong, 3 = Average, 4 = Below Average, 5 = Poor, 6 = Very Poor

Spelling	123456
Punctuation	123456
Paragraph Structure	123456
Grammar	123456
Sentence Structure	123456
Footnoting	123456
Citing References	123456

Is English your first language?

Yes

No

Language Skills:

The high school second-language courses you have/or will have completed upon entry to college:

Course Name and Level:

Grade Received:

Course Name and Level:

Grade Received:

Advanced Placement:

The Advanced Placement exams you have/or will have completed upon entry to college:

Course Name:

Score (if known):

Course Name:

Score (if known):

College Level Credit You Have Earned:**

College or University:

Dept. and # (e.g., ENG 101):

Title

Credit Hours

Grade

College or University:

Dept. and # (e.g., ENG 101):

Title

Credit Hours

Grade

**NOTE: If you have credit from a 2 or 4 year institution you must contact that school and have them send UB (Office of Admissions) an OFFICIAL transcript. If you have courses in progress now, you must have an official transcript sent once you have earned grades in those courses.

Study Skills:

Please rate yourself in the following study skills using: 1 = Very Strong, 2 = Strong, 3 = Average, 4 = Below Average, 5 = Poor, 6 = Very Poor

Reading Textbooks	123456
Classroom Note Taking	123456
Time Management	123456
Following Direction	123456
Attention Span	123456
Test Taking - Multiple Choice	123456
Test Taking - Essay	123456
Listening	123456
Essay Writing	123456
Working In Groups	123456
Public Speaking	123456
Long-Term Memory	123456

Undergraduate Academies

UB’s Undergraduate Academies are communities of common interests that focus on three broad issues and connect students with faculty and staff for a distinctive undergraduate experience in and out-of-the classroom. Review the UB Academies Web site and indicate below if you would like to participate this fall.

Civic Engagement Academy: I am interested in serving the community by participating in community engagement programs and exploring civic responsibility.

Global Perspectives Academy: I am interested in learning more about our interconnected world and discussing how societies interact with one another across the globe.

Research Exploration Academy: I am interested in learning about scholarly research, research opportunities for UB undergraduates, and developing research-related skills.

UB Orientation

Center for Academic Development Services (EOP First Year Students) Data Form

Have any of the following members of your family attended/or graduated from college?

Your parents' combined family taxable income per year ranges from:

Please indicate the category which best describes your race or ethnicity:

During your first semester at UB you will be living:

Do you have a documented disability?

Do you think you may have a disability although it has not yet been documented?

Please check any of the following statements that apply to you:

Please choose one of the following regarding your intended major: (Please refer to the list of majors)

Math Skills:

The high school math courses you have/or will have completed upon entry to college are:

Computer Skills:

Writing Skills:

Is English your first language?

Language Skills:

Advanced Placement:

College Level Credit You Have Earned:**

Study Skills:

Undergraduate Academies

Please list any other questions you may have about academic planning and/or completing your fall course schedule: