Whats Your Story?

This is not a test please respond to the questions honestly. Your answers will not be shared
with others, and will be used only to help improve how we learn in our team, and as a tool for
me to get to know you better.
Name: ___________________________________________________________
Preferred Name (nickname):__________________________________________
Form: __________________ Birthday: _________________________________
E-Mail:___________________________________________________________
What elementary school did you go to? _________________________________
Please circle either Yes or No for the following questions:
Do you use Facebook?
Do you use Twitter?
Do you text?

Yes / No

Yes / No

Yes / No

Do you use MSN? Yes / No

Do you use Skype?

Yes / No

About how many texts per day do you send? _________

Do you have a YouTube account?

Yes / No

Do you have an iPod or MP3 player? Yes / No

Can you bring it to class? Yes / No

Do you have access to a bicycle and a helmet? Yes / No

Take a few minutes to think about these questions and answer them honestly.
What did you do this summer? _______________________________________________________
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Do you have a job? Where do you work? _______________________________________________
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Do you have any siblings? Do you have to babysit? _______________________________________
How do you get to school? __________________________________________________________
Are you excited to be back at school? Why or why not? ___________________________________
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What do you like best about school? Why? _____________________________________________
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What do you like least about school? Why? _____________________________________________
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Do you like to read? Why or why not? __________________________________________________

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Do you like to write? Why or why not? _________________________________________________
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Do you like math? Why or why not? ___________________________________________________
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Do you like science? Why or why not? _________________________________________________
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How do you like to demonstrate your learning? Test? Project? Interview? Another way?
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What do you do outside of school? Play sports? Art? Music? Theatre? Movies? Dance? Singing?
Other things? _____________________________________________________________________
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On average, how much time per week to you spend on these activities? _______________________
Who are your friends at school? Are there any in this class? ________________________________
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Do you have teachers that you connect with at school? Who are they? ________________________
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Is there anything you are worried about for this year? ______________________________________
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If you could study anything while you were at school, what would you be most interested in studying?
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Do you prefer to write things by hand or type them out on the computer? Why? _________________
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What is your favourite thing about yourself? _____________________________________________
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What do you hope to accomplish in school this year? What are your goals? ____________________
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How can I as your teacher help you achieve your goals? ___________________________________
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Is there anything that might get in the way of you achieving your goals this year?
________________________________________________________________________________
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Take a few minutes to think about these questions about your learning style and answer them
honestly. Please circle either Yes or No for the following questions.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

I study best when it is quiet. Yes / No

I am able to ignore the noise of other people talking while I am working. Yes / No
I like to work at a table or desk. Yes / No
I like to work on the floor. Yes / No
I work hard by myself. Yes / No
I work hard for my parents or teacher. Yes / No
I will work hard on an assignment until completed, no matter what. Yes / No
Sometimes I get frustrated with my work and do not finish it. Yes / No
When my teacher gives an assignment, I like to have exact steps on how to complete it. Yes / No
When my teacher gives an assignment, I like to create my own steps on how to complete it. Yes /

No
k.
l.
m.
n.
o.
p.
q.
r.
s.
t.

I like to work by myself. Yes / No

I like to work in pairs or in groups. Yes / No
I like to have unlimited amount of time to work on an assignment. Yes / No
I like to have a certain amount of time to work on an assignment. Yes / No
I like to learn by reading about something. Yes / No
I like to learn by listening to other people tell me about things. Yes / No
I like to learn by watching how to do something or through visuals. Yes / No
I like to learn by moving and doing. Yes / No
I like to learn while sitting at my desk. Yes / No
Most things I do, I do well. Yes / No

Is there anything else you want me to know about you? ____________________________________

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Thank you for taking the time to complete this survey. I really appreciate it!
When you have completed this survey, please place it face down on the top right hand corner of your
desk.