WHO ARE YOU????

2004-2005 School Year Entry Survey Form

Please complete the following form so I have a better sense of who you are as an individual and can thus tailor my classes to try and accommodate your needs and wants. When you are done, please click on the submit button. Thanks!.

Your name:

Street Address:

City/Town:

State:

Zip Code:

Phone Number:

Email Address:

Parents/Guardians:

Parent/Guardian Email Address:

Birthday:

How would you best define your learning style?

I am a visual learner. I learn best with PowerPoint Presentations and Handouts.
I am an auditory learner. I learn best with lectures.
I am a hands-on learner. I learn best by doing projects/giving presentations.
I am a combination of learning styles. Please specify which ones below.

Learning Styles:

How many hours (on average) do you spend on homework a week?

How long (on average) do you spend studying for a test or a quiz?

How would you best define your test taking skills?

I study hard and I am confident when I sit down to take a test.
I get very anxious and nervous. My mind draws a blank the minute I see the test.
It depends.

What kind of test questions do you prefer? Check as many as apply.

Multiple Choice
True/False
Fill in the Blank
Short Answer/Identifications
Essays

How do you work best?

Alone
With a partner
In small groups
In large groups

What would you like to do? Check as many as apply.

Long Projects (may require outside work at home)
In-Class Activities
Videos
Computer Work (i.e. creating PowerPoint Presentations, doing simulations)
Lectures/Notes
Daily Homework Assignments
Weekly Homework Assignments

What grade do you hope to earn in this class?

What topics are you interested in learning?

What clubs/activities/sports are you involved in?

Are there any special needs/concerns I should be aware of?

Anything else you would like to share?

Ask me a question?

Your name:
Street Address:
City/Town:	State:	Zip Code:
Phone Number:
Email Address:
Parents/Guardians:
Parent/Guardian Email Address:
Birthday: