Collect basic information about students, their interests, and their learning styles at the beginning of a school year.
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.
Name you like to be called (if different)
Date of birth
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
I have a cell phone.
I have a smart phone.
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?
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?
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).
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?
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...
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?
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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