O’Brien Sp16
Autobiographical Survey
Note: You may leave a slot blank if you prefer to not share the requested info.
My name is ________________________________________. I go by ___________________ (preferred name)
I am __________ years old. I live in ____________________________________________________________.
You can reach me at _____________________________________ (phone number). The best time to call me is
_________________________. My non-NWACC e-mail address is ___________________________________.
I am ________________________ (married, unmarried). I have ______________________________ (children)
and ______________________________________ (pets). I am employed ____________ hours a week as a(n)
____________________________________________________________________. Someday I want to be a(n)
____________________________________________________________________________. I am majoring in
___________________________. I am taking __________ credit hours this semester. My other classes include
__________________________________________________________________________________________
When I’m not working, going to classes, or studying, I spend most of my time _____________________________
__________________________________________________________________________________________.
Something unique and interesting about me is _____________________________________________________
__________________________________________________________________________________________
Something you should know about me is _________________________________________________________
__________________________________________________________________________________________
The last math class I took was _____________________________________________________. I took it in the
____________________ (fall, spring, summer) of ______________ (year). I made a(n) _____________ (grade).
I really _________________________ (loved, liked, disliked, hated) the class because _____________________
__________________________________________________________________________________________
This semester I think I will make a(n) _______________ (grade) because _______________________________
__________________________________________________________________________________________.