Student Information Form

This form is designed to help me to get to know you better so please fill it out as completely as possible. I will expect you to type the information in before you leave class today or you will have to redo the whole form again at another time.


         

       

Name: 


  1. Choose your Period 


  1. Today's Date is... (Type date out like the following example for the date 08/16/2005)


  1. Enter Last Name, First Name and Middle Initial ( Be sure to capitalize the first letter in your Last name, First Name and Middle Initial)


  1. Street Address


  1. Home Phone


  1. Zip Code


  1. Mother's Full Name (If no mother, leave blank.)


  1. Mother's Work Phone Number (If no mother work phone, leave blank.)


  1. Father's Full Name (If no father, leave blank.)


  1. Father's Work Phone Number (If no father work phone, leave blank.)


  1. Who I live with (Please provide full name and relationship to you, i.e. grandparent, aunt/uncle, etc.)


  1. Guardian's Work Phone Number. (If it does not apply, do not fill out.)


  1. Hobbies I am interested in (Computer games, stamp collecting, sports, skateboarding, etc. are examples.)


  1. Board and card games I like to play (Monopoly, Battleship, Stratego, Risk, Chess, Checkers, hearts, canasta, etc. are examples)


  1. Computer and electronic games that I like to play (3D-Action, strategy, computer board games(chess/checkers), etc. are examples) Be specific and let me know which games you like!


  1. Names and types of pet(s) in my home. ( Example: Dog named Pluto, Cat named Sylvester, Canary named Tweety, etc.)


  1. I have a Macintosh Computer at home.
    Yes
    No


  1. My Macintosh computer has which type of operating system, i.e. OS 8, OS 9, OS 9.22, OS X Panther, OS X Tiger, etc.) (Leave blank if you do not have a Macintosh computer.)


  1. I have a Microsoft Windows Computer at home.
    Yes
    No


  1. My Pentium PC computer has which type of operating system, i.e. Windows 98, Windows 2000 Professional, Windows XP Home, Windows XP Professional. (Leave blank if you do not have a PC that runs Windows.)


  1. If you have an internet connection at home, please write your email address below.


  1. Tell me what you would like to learn in a class and how you would work to achieve this skill and knowledge.


  1. My computer has a CD-ROM in it.
    Yes
    No


  1. I have internet access at home.
    Yes
    No


  1. I have a digital input device that connects to my computer at home, i.e. Quick Cam, iSight, DigiCam, Camcorder,
    Yes
    No


  1. My favorite core class in school is 


  1. My least favorite core class in school is 


  1. My favorite elective class in school is 


  1. Do you participate in an after school school activity or sport?
    Yes
    No


  1. What type of afterschool activity do you participate in? (Football, basketball, cheerleader, film club, Dell TechKnow, etc. are examples.)


  1. The thing I enjoy most is


  1. My goal in life if to become a ______________ because


  1. My best talent is


  1. One thing I worry about is


  1. What do you want to learn in this course?


  1. Write a paragraph about your family. Tell me things you think think are interesting or that you would want me to know about you and your family. (Paragraph has three or more sentences.)





Mr. W
James Weldon Johnson Middle School
Jacksonville, FL