General Information
This questionnaire is completely confidential. Please fill it out with as much information as you feel comfortable sharing. Just do your best to answer each question in whatever way makes sense. Knowing you better will help me teach you better!
Full Name
First Name
Last Name
Name you like to be called (if different)
Class period
period 1
period 2
period 3
period 4
period 5
period 6
Date of birth
Please select a month
January
February
March
April
May
June
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Month
Please select a day
1
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Day
Please select a year
2026
2025
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2022
2021
2020
2019
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Year
Place of birth
Email
example@example.com
Phone Number (Optional)
Please enter a valid phone number.
Format: (000) 000-0000.
I check my email...
4+ days per week
1-3 days per week
at least once a month
almost never
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Parents' or guardians' Name
First Name
Last Name
Their Email Address for Monthly Newsletter
example@example.com
Do you have any siblings? What ages? Do they live with you?
Are there any other people who live in your household?
What language(s) do you speak at home?
Are you religious? If so, what religion do you practice? How important are your religious beliefs to your daily life?
Are you new to XX School District? If so, where did you go to school before?
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Activities and Interests
What do you usually do after school?
What are some of your interests?
What are some of the things you're best at?
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What do you like to read? (Name some books, comics, etc.)
What do you like to watch? (Name some movies, TV shows, etc.)
What games do you like to play? (Name video games, board games, sports, or anything else).
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Full Name
First Name
Last Name
What do you imagine yourself doing 5 years from now?
What do you imagine yourself doing 10 years from now?
Imagine you knew you were going to be stranded for the rest of your life on a desert island, with no hope of escape, but with all your basic needs met (food, water, shelter, etc.). What 5 things and/or people would you bring with you, and why?
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Your Learning Style
NOTE: This section isn’t about telling me what you think I want to hear. Please describe your actual learning style as well as you can. You’re allowed to have your own style and opinions!
How do you describe yourself as a student?
Do you like school? Why or why not?
Do you like Social Studies and/or history? Why or why not?
What would you really like to learn about in World Studies?
How do you learn best?
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How do you feel about working in groups? Do you generally take the lead, follow, check out, worry about having to do too much, or bringing the group down, or do you just feel happy to be working in a group, or what?
If you got a B on a big test, how would you feel? How (if it all) would it affect your studying behavior?
Is there anything that could make this class especially difficult for you?
Can you think of a way I can help you with this?
Is there anything else you'd like me to know?
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