Student Questionnaire

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Last Name *

First Name *

Class Period *

5/8

Name of person I can contact to brag (say good things) about you when you are doing well in my class? In other words, who is your parent/guardian? *

What is your parent/guardian's email? *

What is your parent/guardian's phone/cell number? *

When is your birthday? *

YYYY

What is your CPS email? *

What do you do for fun? *

What type of music do you listen to? *

What are your strengths in school? *

What do you struggle with in school? *

What do you know about this class, think you know about it, or want to know about it? *

Do you like science? *

Yes

I don't know

Other:

Are you open minded to liking science? *

Yes

I don't know

Other:

What is a positive experience you had with science? *

Yes

I don't know

Other:

What is a negative experience you had with science? *

Yes

I don't know

Other:

What do I need to know about you in order to help you do well in this class? *

Feel free to share something (appropriate for school), about yourself, that you may want me to know. *

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