Student Information Form

Student Information Form
Please answer all questions as accurately and honestly as possible. Your answers will be kept confidential.
Full Name:*

First NameLast Name
E-mail:*
Grade Level:*
Previous Math Teacher:*
What was the last math course you took?*
Approximately what was your final letter grade in your last math class?*
Not counting TSA, how many study halls do you have? (If you have a study hall for only half a year, use .5.)*
On a typical school night, how many hours of sleep do you get?*
My home/family situation is...*

...always conducive to completing my homework. (~100%)...usually conducive to completing my homework. (~75%)...sometimes conducive to completing my homework. (~50%)...rarely conducive to completing my homework. (~25%)...never conducive to completing my homework. (~0%)I prefer not to answer.
Check all that apply:*

I am assigned to or plan to utilize the ASC.I will usually be available during the support block.I am usually available after school or could easily arrange to be.None of the above.
Check all that apply:*

I play a fall sport.I play a winter sport.I play a spring sport.I am in drama.I am in band/chorus.I have an after-school job.I participate in another extracurricular activity that may frequently take me out of class or make me unavailable after school.I participate in another extracurricular activity, but it should not often take me out of class or make me unavailable after school.I do not participate in any extracurricular activities.I have family obligations or medical appointments that may frequently take me out of class, take me out of class for extended periods, or make me unavailable after school.I do not anticipate being taken out of class frequently or for an extended period of time.
Check all that apply:*

I have unlimited internet access at home.I have limited internet access at home.I can access the internet during a study hall, during support block, and/or after school.I can easily access the internet elsewhere (e.g. at a neighbor's house or at the town library).I do not have access to the internet at all.
What areas of math are you good at? What areas of math do you need to work on?*
Describe your strengths and weaknesses as a student.*
What are your post-graduation plans?*
Tell me anything else that you think I should know about you or your situation.
Should be Empty: