First
Day
Student
Survey
Student Survey
Please answer the following questions so I can
learn more about you as a student. Thank you!
Name:
Birthday:
Who do you primarily live with?:
parent
Grade:
guardian
other
I make frequent calls home, both good and bad. I need the contact information of the
parent, guardian, or other adult I will be speaking with.
Name:
Phone number:
Best time to call:
Email address (optional):
Do you have internet access at home?
Yes
No
What is your favorite learning style in class? (please circle all that apply)
Lecture
Worksheets
Reading from the textbook
Videos
Hands-on activities
Individual Research
Other:
Where do you see yourself in 5 years?
Please list any extracurricular sports or clubs you participate in.
What are your top 3 interests?
Any other important information about you (accommodations, allergies, etc.)
Acknowledgements
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