Student Questionnaire
Collect basic information about students, their interests, and their learning styles at the beginning of a school year.
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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! –Ms. S.
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
January
February
March
April
May
June
July
August
September
October
November
December
Month
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Place of birth
E-mail address that you actually use
I check my email...
4+ days per week
1-3 days per week
at least once a month
almost never
I have a cell phone.
Yes
No
I have a smart phone.
Yes
No
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Parents' or guardians' names
Their email address(es) for monthly newsletter
Do you live at more than one place? If so, which is the best for contacting you and your parent or guardian?
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 Issaquah 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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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
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?
How much do you...
very much
somewhat
a bit
not at all
care about what happens in the world?
have informed opinions about the news?
feel like an engaged and informed world citizen?
feel hopeful about the world's future?
feel like you have any power over the world's future?
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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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