Student Development Survey Forms
Part I & Part II

Dear SEEK Student,

We have placed TWO FORMS online for you to fill out and submit. The information you provide will be kept STRICTLY CONFIDENTIAL! Your information will help us to better assist you as we plan appropriate services and activities that support your academic success at Lehman College.

Below is form # 1 (Student Development Survey Form - I). Please read the questions and provide an answer. The questions with an asterisk (*) are required; therefore, please make sure that you provide an answer for those. Upon completing the form please click on the "Submit" button below.

If you do not answer a question that is required you will receive an error message identifying which question was left blank. If you get such an error message simply click on your brower's back button to return to the form and continue filling it out; otherwsie, you will receive a submission confirmation and will be linked with form # 2 (Student Development Suvey Form - II). The total time to complete both forms on average is about 20 minutes. If you encounter problems, have questions or require assistance, please send an email to: seek.learning@lehman.cuny.edu or call us at (718) 960-7979. Thank you for your attention and cooperation; we greatly appreciate it!

Student Development Survey Form - I
CUNYFirst EMPLID Number:
Please provide your CUNYFirst EMPLID Number;
if you do not know your number you can log-in to
CUNYFirst using the link on the right in order to find out
CUNYFirst Login
*First Name:
*Last Name:
*Address:
Apartment #:
*City:
*State:
*Zip:
*Cell_Phone:
Home_Phone:
*Primary_Email:
Gender:
Date of Birth:
Place of Birth:
Ethnicity:
If other, please specify:
*Citizenship Status:
If other, please specify:
First language spoken:
Number of years of studying English:
Number of years living in the United States:
Language(s) spoken primarily in your home:
*Current Living Arrangements:
If other, please specify:
Please indicate who currently resides with you: (Please check all that apply)
Mother:
Father:
Step Mother:
Step Father:
Grandmother:
Grandfather:
Aunt:
Uncle:
Cousin:
Sister:
Please indicate the age(s) of your sister(s):
Brother:
Please indicate the age(s) of your brother(s):
Please specify if you reside with someone else not listed above:
Do you expect your living arrangements
to change while you are in college?
*What is your current financial status?
*Do you expect your financial status
to change while you are in college?
If yes, please explain:
*Is it necessary for you to contribute
financially to your family's household?
*Have you ever been hospitalized?
If yes, please provide brief details of your
hospitalization (i.e. for what, when & where?):
*Are you currently on any medication
or have been in the past?
If yes, please provide brief details of your
medications (i.e. name, dosage, etc.):
*Are you now or have ever been treated
by a medical professional for anything?
*Are you now or have ever
received counseling support?
If yes, please provide brief details of your
counseling (i.e. for what, when & where?):
*Are you the first in your
family to attend college?