Name________________________________________
Class________________________
1. Who is your legal guardian (who do you live with?). Please circle one from the list below.
Mom and Dad
Mom
Dad
Grandmother
Grandfather
2. Legal guardian’s phone number(s). ________________________________________________________
________________________________________________________________________________________
3. Legal guardian’s email. _________________________________________________________________
4. My mailing address is ____________________________________________________________________
________________________________________________________________________________________
5. Before an exam (please circle one from the list below) ….
(A) I always study.
(B) I never study.
(C) I study sometimes.
6. Do you have a quiet place at home to study?
(A) Yes.
(B) No.
7. How many people live with you at your house/apartment? _________________________________
8. The main reason I come to school is to ……
(A) Hang out with friends.
(B) My parents make me go. (C) I think it’s important for my future
9. What grade would you like to receive in this class? _______________________
10. What grade do you think you will end up receiving in this class? ___________________________
11. Science is …..
(A) Fun.
(B) Boring. (C) Interesting.
(D) Dangerous.
12. I spend _____ hrs every day on video games
I spend _____ hrs every day using my phone
13. My parents/guardian tells me that education is important to my success in life…
(A) “All the time”.
(B) “Sometimes”.
(C ) “Hardly ever tells me”