Student Profile Sheet by 0DsvQh87

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									                                          Student Profile Survey
                                               Confidential

Last Name: ____________________________________ First Name: ____________________________________

Birthday: ___________________ Pronunciation guide for name (if necessary): ____________________________

Do you have a computer at home?        YES       NO          Do you have internet access at home?   YES         NO

Any siblings? What ages? ______________________________________________________________________

What language do you speak at home?_____________________________________________________________

Activities / Interests: ___________________________________________________________________________

____________________________________________________________________________________________

Feelings about science (check all that apply):
         Science is fun.                            I have not liked science in the past.
         Science has been easy for me.              I have struggled with science in the past.
         Science is an important subject to learn.  I am nervous about science this year.
         Other ______________________________________________________________

Rate yourself academically on a scale of 1-5: (5 being a high strength of yours)

        Following verbal directions              1       2         3      4        5

        Following written directions             1       2         3      4        5

        Completing assignments                   1       2         3      4        5

        Asking for help when needed              1       2         3      4        5

        Organization                             1       2         3      4        5

        Classroom discussion                     1       2         3      4        5

        Remembering information                  1       2         3      4        5

        Test taking                              1       2         3      4        5

        Problem solving                          1       2         3      4        5

Which of the above categories would you like to improve on the most this year? ___________________________

Things that have been done in the past that have helped you learn: (check all that apply)
         Class website                                                             I have had a tutor
         Practice tests                                                            I take notes
         I use my agenda / planner to keep me organized                            Teacher notes handouts
         The teacher taught me one-on-one                                          I worked in small groups
         The teacher has been available before or after school                     Homework practice
         The teacher showed me how to organize my materials                        My friend(s) help me
         The teacher taught me good study strategies
         Breaking the project or assignment into smaller pieces
         Other ______________________________________________________________
When I get off task – the best way to get me back on task is: (check all that apply)
        I normally am on task – so it won’t be a problem
        Ask me directly to stop
        Walk towards me
        Have me work by myself either in the hall or on the side of the room
        Remind me about how my behavior affects others
        Contact my parents
        Other ______________________________________________________________

When I don’t turn in work – the best way to get me to turn in work the next time is: (check all that apply)
        I always turn in my work so don’t worry about it
        Have me write it in my planner
        Send me an email
        Contact my parents
        Give me a verbal reminder
        Other ______________________________________________________________

Things that motivate me are: (check all that apply)
         Grades                                        Recognition of my accomplishments
         Candy / Food                                  Getting into college
         My parents                                    Doing fun activities
         Getting a good job in the future              My friends
         Learning new and exciting things              Getting privileges at home (cell phone, etc)
         Other _________________________________________________________

I would be successful in this class if…______________________________________________________________

        ______________________________________________________________________________________

Anything else you would like me to know about you?
       ______________________________________________________________________________________

        ______________________________________________________________________________________

								
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