1. Sex
Male (1)
Female (2)
2. Year of birth
19 __ __
3. Circle the number which best describes your living arrangements this semester:
Live in residence on campus (1)
Live off Campus
Live Alone (2)
Live with parent(s)(3)
Live with other relative(s)(4)
Live with spouse or partner (with or without children)(5)
Live with other students or friends (6)
Single parent with dependent children (7)
Other (please specify) (8)
4. Do you have any dependent children?
No (1)
Yes (2)
How many children under age 6?__________
How many aged 6-11?__________
How many aged 12 and over?__________
5. Do you register through:
Campion (1)
Luther (2)
SIFC (3)
A University of Regina Faculty (4)
6. Which Faculty are you in?
Administration (1)
Arts (2)
Education (3)
Engineering (4)
Entrance Program (5)
Extension or ESL (6)
Fine Arts (7)
Graduate Studies (8)
Physical Activity Studies (9)
Science (10)
Social Work/Human Justice (11)
Special/Interim Student (12)
Other (please specify)__________ (13)
7. What is your major or your program? (e.g. Music, Biology, Educational Psychology, Human Justice, Electrical Engineering, Pre-Admin, Pre-Med).
__________
8. What degree (certificate, diploma) are you currently working on? (e.g. B.A., B.Ed. B. Sc. Honours)
__________
9. What year did you start working on this degree (certificate, diploma)?
_________
10. What year do you anticipate obtaining this degree (certificate, diploma)?
_________
11. How many credit hours are you registered in this semester? Note: A normal class is 3 credit hours.
___________ credit hours
12. Which year of university are you in?
1st year or less than 30 total credit hours (1)
2nd year or between 31 and 60 total credit hours (2)
3rd year or between 61 and 90 total credit hours (3)
4th year or between 91 and 120 total credit hours (4)
5th year plus or more than 120 total credit hours (5)
