St. Edmund Campion S.S. - O. Ocampo
IDC 3O - Grade 11 Open, African-Canadian History
Name:__________________________
Age: ____ Birthdate: ________________
Address: __________________________________
(number and street)
________________
(postal code)
Home Phone Number: ____________________ Email:______________________
Parent/Guardian Contact Number: _______________________________________
Please read and answer the following questions using full and complete sentences.
Provide as much detail as possible. Attach another piece of paper if the space
provided is not enough. Be honest and genuine in your responses.
1. What have you heard about this course?
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2. What have you heard about this teacher?
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3. What do you remember about History from Grade 10? Please List:
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4. Why did you choose to take this course? Explain.
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5. What is your Ethnic background/heritage?
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6. Was last year in History a successful year for you? YES or NO (circle one)
7. What level did you take last year in History? Essential/Applied/Academic
(circle one).
8. Approximately, what was your final grade in the course (circle one)?
Failed
50-59%
60-69%
70-79%
+80%
9. Write a brief paragraph explaining why or why not last year was a successful
year for you.
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10.
What do you hope to learn about this year during the course?
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11.
To be a successful student this semester, I plan to:
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12.
Do you have a part-time job? If so, where and how many hours do you
work in a week?
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13.
Do you participate in any extra-curricular activities (i.e. sports teams,
school clubs, music, community groups, etc)? Please list:
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14.
Tell me something interesting about yourself:
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Date: _____________ Student Signature: ________________________________