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     \rfoot{\begin{tabular}{@{}l}\small\textsl{Continued on the other side \ldots}\\\ \end{tabular}}
     \afterpage{
                \rfoot{\begin{tabular}{@{}l}Page 2 of 2\\\ \end{tabular}}
                \lhead{\tiny{CONFIDENTIAL\linebreak when completed}\\}
                \chead{\textsc{Csci}\,\oldstylenums{6606} \textsc{student intake questionnaire} {\footnotesize (cont.)}\\\small \when}
                \rhead{\tiny{CONFIDENTIAL\linebreak when completed}\\}
                \cfoot{\begin{tabular}{@{}l@{}l}
                       \textsf{Dal ID\#} & \rule{\mystuID}{\s}\\
                       & \footnotesize\textsf{\textcolor{gray}{(if page is not double-sided)}}
                       \end{tabular}}

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\begin{document}
  \vspace*{-3\baselineskip}

  \begin{center}
    \textsc{%
      {\Large{\textit{Confidential} Student Intake Questionnaire}}
      \\\medskip
   }
   For CSCI\,6606 (Winter 2015/16)
  \end{center}

  \bigskip\bigskip

  \noindent\begin{boxedminipage}{1\textwidth}
  \raisebox{0.05\baselineskip}[0pt]%
             {\colorbox{white}{\large{\textsf{Dalhousie's official record}\,}}}
  \vspace{-0.75\baselineskip}
  \begin{tabbing}
     ~{\small \textsf{So your professor can identify you in Dalhousie's Student Records}}\\\\
     1.\hspace{0.7em}\=Official X \=\=\namefill ~X  \=2.~Major/Conc.xx\=\kill
     1.\>Official\\
     \>Name  \>\namefill
     \>\raisebox{-.6\baselineskip}[0pt][0pt]{
                {\footnotesize \sffamily \textcolor{gray}{Given name(s)}}}
          \hspace{20ex}%
       \raisebox{-.6\baselineskip}[0pt][0pt]{
                {\footnotesize \sffamily \textcolor{gray}{Family name}}}\\\\\\

     2.\>Dal ID\# \>\>\fillin\\
       \>\>\raisebox{1.15\baselineskip}[0pt][0pt]{\large\sffamily B0}
  \end{tabbing}
 \end{boxedminipage}

  \bigskip\bigskip

 \begin{boxedminipage}{\textwidth}
  \raisebox{0.05\baselineskip}[0pt]%
             {\colorbox{white}{\large\textsf{Your identity\,}}}
  \vspace{-0.75\baselineskip}
  \begin{tabbing}
     ~{\small \textsf{How you want to be addressed in class and e-mail}}\\\\
     1.~\hspace{0.7em}\=Preferred XX \=\=\namefill ~XXX  \=2.~Major/Conc.xx\=\kill
     3.\>Preferred \\
       \>Name \> \namefill
     \\ \\

     4.\>Preferred  \> \chkbx\,he/him     
                       \hspace{3em}
                       \chkbx\,she/her 
                       \hspace{3em}
                       \chkbx\,they/them
                    \\
       \>Pronouns
                    \\ \>\>
                       \chkbx\,\rule{19em}{\s}
     \\
  \end{tabbing}  
 \end{boxedminipage}

 \bigskip\bigskip

 \begin{boxedminipage}{\textwidth}
  \raisebox{0.05\baselineskip}[0pt]%
             {\colorbox{white}{\large\textsf{Your academic goals and preparation\,}}}
  \begin{tabbing}
%     ~~{\small \textsf{How you want to be addressed in class and e-mail}}\\\\
%     1.\=Preferred XX \=\=\namefill ~XXX  \=2.~Major/Conc.xx\=\kill

     5.\hspace{0.7em} \= Please indicate what you are working on\\\\
        \> \chkbx\,Master's project \hspace{2em} \=
           \chkbx\,Master's thesis  \hspace{2em} \=
          \chkbx\,PhD thesis        \hspace{2em} \=
          \chkbx\,undecided \\\\
        \>\chkbx\,\footnotesize \sffamily {\textcolor{gray}{(other)}
                            \textcolor{black}{\fillin\fillin}}\\\\

     6. \> How long have you been in graduate school?\\\\
        \> \chkbx\,this is my first year
           \hspace{5ex} \chkbx\,\textcolor{black}{\rule{2.5em}{\s}}\ years
        \\\\

     7. \> Have you taken any courses in research methods (for credit)?\\
        \> If so, at which university and from which professor(s)?\\ \\ 
  \end{tabbing}  
 \end{boxedminipage}
 \enlargethispage{5\baselineskip}
  \bigskip 

  \noindent
    \begin{tabular}{@{\hspace*{\fboxrule}\hspace*{\fboxsep}}ll}
     8. &
        How many hours a week (outside of lectures) do you \emph{plan} to
        devote to this course?\\
        & {\small\textsf{A number please, not `as many as it takes'}}
     \\\\
     \end{tabular}

\newpage
  \noindent
    \begin{tabular}{@{}p{1.109em}l}
    ~~9. & Please tell me about your background:\\
        & What is your area of interest?
          Is it primarily in research or application?\\
        & \emph{Or} what is the working title of your thesis/proposal?
    \end{tabular}

    \vfill

  \noindent
    \begin{tabular}{@{}p{1.109em}l}
    10. & How do your particular interests relate to this course?\\
        & What do you expect to learn by taking this course?\\
        & How do you expect to improve yourself by taking this course?
    \end{tabular}

    \vfill

  \noindent
    \begin{tabular}{@{}p{1.109em}l}
    11. & \emph{If} there is anything else you think the professor should know about you,
          \tabularnewline
        & please use the space below to provide the necessary specifics.\\
        & \small \chkbx\,\textsf{\slshape This space intentionally left blank}
    \end{tabular}

    \vfill
\end{document}
