This document contains a 20 question survey collecting personal information from a student including their full name, birthday, grade, contact information, extracurricular activities, goals for the school year, study habits, computer usage, and classroom preferences.

2. Birthday____________________________________

3. Grade_____________________

4. Address_________________________________________________________________________________________________________________________________________

5. Home Phone Number__________________________________

6. Parent/guardian names & preferred language_______________________________________________________________

7. _____________________________________________________________________

8. Parent/guardians cell phone numbers________________________________________

9. Your email address______________________________________________________

10. Your cell phone number__________________________________________________

11. Sport teams/ clubs/ activities that you participate in______________________________

12. _______________________________________________________________________

13. What do you like to do on your own time?_______________________________________

14. What are your goals for this school year?________________________________________

15. What’s your favorite color?________________________

16. Do you think mostly in words (audio) or pictures?________________________

17. When you do your school work, do you often listen to music (if so what type of music)?_____

18. ______________________________________________________________

19. Do you often quote movies that you have seen?________________________

20. How much time do you usually spend on the computer?__________________________

21. Do you have to sit in the front of the classroom for any reason?_____________________

22. Do you like to participate and speak in front of the class?___________________________

23. Is there anything about yourself that you think that I should know?_____________________

24. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________