Last Name __ _E~rk ________ First Name--~"' Grade l l Per __?.

__
1. Name the last math class you took __ .£.r..ic,....._l:Ut
2. When did you take that class? (Last year, summer school?)_L..0..)t_-4-~"'·
- r_ _ __
3. What grades did you receive? (A, B, C, D, F) 1'1 Semester~-- 2• d Semester _A_
4. What was the teacher's name? __rt:,..:. l'..\.1
5. Rate that class from 1-5 (5 being best); 1 2 3 '°4) 5
·- ------
6. What grade do you expect in this class? © B C D F
7. What will you have to do to earn th\s grade? I ,.,.,11 \11<:l~G m :'Jtvcl..,,d_ __
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8. W hat else are you involved in besides school? (Music, sports, drama, church, U.S.B.,
hobbies, video games, streaming, etc.)
_ __,c~clc,L_ __ ~ ~ o s:>! J i. C..W, IY'IJOIVCP( ,v , LJ<1C/(,w oV1 ol t> ) Bvol~ YI
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- - - ~ ~ ~ l : : J . ~___1____ £il~ ---~Lra.;J--U-~~~--~-lw_O
t. _.____________

9. Who are your on-campus coaches, advisors, etc,? (If any)_...l:!.~r_ _w

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.1 ~- - - - -
10. Are you fluent in any other language? @ NO Which one(s)? ....M=a.'"=~"'~"'-------
11. Do you have any difficulty speaking or understanding English? YES
12. Who is your Grade Level Coordinator? t-tr:,. Dv1e.n':'o:>
13. J o\r,.., ( IC)
Please list all your siblings with t heir ages. ~ t?,,:m,hu
- - ~l£1±1.~__..:ia,.±&~--A~bl~~-_(J2)_ ________________
14. Circle the names of any of your siblings that had me as a teacher.
15. What is your school AND personal Email address?
Personal: S3"'"' f?"'.-1<. os~ 0 d ""'...,; \.
School:311~~ ~ ""'vv.~J. or
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16. What is your birth date OS / __ j:J.__/ 2-{F>=f

17. How many days do you EXPECT to be absent this semester? YJ Ol"I !::,

18. Are you currently taking any other math classes? YES (Course: _ _ _ _ _ _ -,-@
19. List your phone numbers
Home phone # (_~j_)-11.1!> - r'?H Mobile phone # ( i 6"1) 'f<,:, Z. - "l':> Ofo

20. List your parent(s) names, mobile phone number, and email address
Mother R,c,.,c.,\<i e.., I p"'yl<. Father 'Q01vd e,( P"'rK
Phone (~)__h_"t Q - rn:=r
Email: o{0 .,. 1c-l po-Ylc. "1 €2 1v15..,. c" ""'

21. Are you employed? YES @) (if yes, Where? _ _ _ _ _ _ _ _ _ __

22. Do you have any special needs? (hearing, vision, other) YES @ (if yes, what?
22. Each of you have your own unique talents. What are you able to do better than the
average pe~son? (I.e. State level trombone player, blue chip football player, top I% of
players In a video game, fearless In public speaking, bouldering at a competitive level,
etc.)

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23. Use this space to tell me anything else that you can a~out yourself.

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24. Class Schedule - List your dally schedule here, include teacher name, course, and room.

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