Name: _______________________________

Date: _____________________
Period: __________

Student Questionnaire and Information Sheet

Answer the following questions:
1. What grade are you in?

___________________

2. How many brothers and sisters do you have?

3. Do you take the bus to school?

___________________

___________________

4. Do you bring your own lunch to school? ___________________

5. What language do you speak at home?

___________________

6. Who do you know, other than a teacher, who has gone to college? ________________
7. What are your educational goals after high school?
After high school I will probably ______________________________________.
8. What do you see yourself doing in the next 5-10 years?
I see myself ______________________________________________________.
9. Who are your friends in this class? ______________________________________
10. What are you are most proud of?
I am most proud of _________________________________________________.
11. What do you enjoy doing in your free time? _________________________________
12. What has your experience with Resource been like?___________________________
13. What is your favorite thing about school? ___________________________________
14. What is your least favorite thing about school? _______________________________
15. What was your favorite class last year? Why?

___________________

16. What school clubs and organizations do you belong to? ___________________
17. What sports do you play? _______________________________________________
18. What do you want me to know about you?___________________________________

In the space below (fill up the entire space!), draw a self-portrait (that's a
picture of you!). Include items that are important to you (books, pets, car
keys, a photograph, your X-Box, etc.).