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Name
:
I am ___ years old.
9
10
11
12
13
14
15
Do you own a pet?
Yes
No
If you said yes to question #1. Please introduce your pet to me.
If you said no, tell me about a pet you might like to have someday.
What is your favorite color?
Red
Orange
Yellow
Green
Blue
Purple
Pink
Black
Gold
Silver
Other
Rank the following by personal enjoyment.
1
2
3
4
5
6
7
8
9
10
Reading
Listening to Music
Games
Dancing
Watching TV
Sports
Movies
Socializing with Friends
Shopping
Surfing the Internet
I feel comfortable on the computer and know how to use technology.
1
2
3
4
5
Strongly agree
Strongly disagree
What are your favorite ice cream sundae ingredients. Check all that apply.
Vanilla ice cream
Chocolate ice cream
Strawberry ice cream
Bananas
Strawberry topping
Pineapple topping
Buterscotch topping
Caramel topping
Hot Fudge topping
Cherries
Nuts
Whip Cream
Marshmallows
Oreos
Brownies
Candy Bars
Other
Pick a favorite game/activity from the following choices.
Scrabble
Life
Monopoly
Checkers
Chess
Clue
Apples to Apples
Blink
Tag
Yahtzee
Boggle
Sorry
Marbles
Cards
Tic Tac Toe
Hangman
Marco Polo
Horse
Chinese Checkers
Majong
Operation
Mouse Trap
Scattegories
Bunco
Balderdash
Pictionary
Suduko
Crossword Puzzles
Cribbage
Parchessi
What is your favorite food?
What is your favorite subject in school?
Math
Language Arts
Science
Social Studies
Art
Educational Technology
PE
Skills for Success
Spanish
Ms. French
Title I Math Class
ACA
AZ
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