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 Name Last 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: