Course Questionnaire - (Block 3 Part 2 F10)

Please fill out the following questionnaire so I can get to know you better. Please be honest and keep in mind that I will not share any sensitive information with the class.


         

       

Name: 


A red asterisk (*) indicates required questions.

  1. My favorite role model is... because...


  1. Where are you from originally?
    SC
    NC
    GA
    Other (in the USA)
    Other (outside the USA)


  1. I live in a...
    House
    Apartment
    Town House


  1. What is your race (you can choose more than one response)
    African American
    White
    Asian
    Amerindian (indigenous peoples of the Americas are the pre-Columbian inhabitants of North, Central, and South America, their descendants, and many ethnic groups)
    Other


  1. What type of internet connection to you have at home?
    High Speed (Cable or DSL)
    Dial up
    None


  1. If you don't have internet access, do you know someone who would let you use theirs?
    Yes
    No
    Maybe


  1. Did you know the media center has computers available in the morning and after school until 4:15 p.m.?
    Yes
    No


  1. Do you have a cell phone?
    Yes
    No


  1. How much time do you normally spend on school-work per week?
    less than 1 hour
    1-3 hours
    3-5 hours
    more than 5 hours per week


  1. Who do you know that speaks Spanish?
    Friends
    Family
    Family and Friends
    Only Acquaintances
    No one


  1. Who is your favorite musical group, singer, performer?


  1. What is your favorite television show?


  1. What grade do your parent(s) or guardian(s) expect you to make in this course?
    A
    B
    C
    D
    F


  1. If you get into trouble in class or at school, what is it that you usually have problems with (even if it's not for a referral)? (you can choose more than one answer)
    Talking out of turn
    Not listening
    Fighting or arguing with other students
    Dress code
    Cell phone use
    Talking back or arguing with teachers
    Not doing work
    Not having materials
    Not paying attention
    Sleeping in class
    Inappropriate Language
    Cutting class
    Drug use
    Being too loud
    Being late
    Not wearing ID


  1. Do you belong to Facebook, MySpace, or other social net-working sites?
    Yes
    No


  1. How many hours a day do you spend on the internet?
    0
    0-1
    2-3
    3-4
    4 or more


  1. Put in order what you spend the most time on in terms of electronics. 1 being the highest)
        1 2 3 4 5 6
    Television  
    Internet  
    Cell Phone or Telephone  
    Video Games  
    Mp3 or Ipods  
    Texting  


  1. What is your email address?


  1. What is your personality like?
    Extroverted
    Introverted
    A mix of both types


  1. I am afraid to learn Spanish...
    yes
    no
    a little


  1. Would you be willing to volunteer in class?
    yes
    no


  1. Do you think discipline referrals help students improve behavior?
    Yes
    No
    Sometimes


  1. Who is your favorite teacher at this school and why?


  1. I think it is okay to have free time in school.
    Very rarely.
    From time to time.
    Everyday.


  1. I like having fun in class.
    Vary rarely.
    Sometimes.
    All of the time.


  1. It is very important to me what my classmates think of me.
    Yes.
    No.


  1. Who are you friends with already in this class?


  1. Is there anyone in this class that you know you CANNOT work with?


  1. What is your gender?*
    Male
    Female


  1. Do you like to read?
    Yes
    No
    Sometimes


  1. How would you describe your home life (you can choose more than one answer)?
    Happy
    Stressful
    Fun
    Frustrating
    Scary


  1. Is this your second time taking this course at this school?
    Yes
    No


  1. How many Spanish words do you know?
    almost none
    a few (less than 20)
    a handful (20-50)
    a good bit (50+)





Señor Johnson
Spanish Teacher
Nation Ford High School
SC