Cultural Capital Survey

Tell me a little about yourself.
Name: 


  1. Languages you speak (other than English). Why do you speak it?


  1. Countries in which you've visited/lived: For how long? How old were you?


  1. Types of books you read: (click all that apply)
    nonfiction
    science fiction
    fantasy
    poetry
    biography
    mystery
    romance
    history
    adventure
    comics


  1. Other books? Explain:


  1. How many hours do you read per day or per week?


  1. Do you have a computer at home?
    Yes
    No


  1. Do you share it with others in the home?
    Yes
    No


  1. If you have a job, what school nights do you work? (click all that apply)
    Monday
    Tuesday
    Wednesday
    Thursday


  1. How many hours do you work, in general?


  1. Where do you work, or what type of work do you do?


  1. What are your plans for after high school? College? Work? Other?


  1. What do you like to do?


  1. What do you hate to do?


  1. What would you like to find out about me or my Spanish class?


  1. Answer the next set of questions by answering yes or no about yourself.

    I like to sit at a table or desk to do my work.
    Yes
    No


  1. I like to work on the floor.
    Yes
    No


  1. I like to learn by talking to others.
    Yes
    No


  1. I like to learn by looking at pictures and reading things.
    Yes
    No


  1. I like to learn by moving or doing things.
    Yes
    No


  1. I like to learn by hearing things.
    Yes
    No


  1. I work hard for myself.
    Yes
    No


  1. I work hard to please my parents or my teacher.
    Yes
    No


  1. I work on something until it's done, no matter what.
    Yes
    No


  1. I work on something until I'm frustrated, and then I quit.
    Yes
    No


  1. I like to work by myself.
    Yes
    No


  1. I like to work with a partner or in a group.
    Yes
    No


  1. I like to have things broken down into specific steps on how to do an assignment.
    Yes
    No


  1. I like to create my own plan for how to do an assignment.
    Yes
    No


  1. I like to have a specific amount of time to finish my work.
    Yes
    No


  1. I like to have unlimited time to do my work.
    Yes
    No


  1. I like to work where it's quiet.
    Yes
    No


  1. I like to have music or background noise where I work.
    Yes
    No


  1. I am most awake and alert in the morning.
    Yes
    No


  1. I am most awake and alert in the afternoon.
    Yes
    No


  1. Rate these activites based on how much you enjoy doing them to show what you have learned.

            1 2 3 4 5      
      Debate Strongly agree  Strongly disagree  
      Write a brochure Strongly agree  Strongly disagree  
      Write a poem Strongly agree  Strongly disagree  
      Create a slogan/motto Strongly agree  Strongly disagree  
      Make a speech Strongly agree  Strongly disagree  
      Write a journal Strongly agree  Strongly disagree  
      Tell a story Strongly agree  Strongly disagree  
      Make an audio tape/CD/MP3 Strongly agree  Strongly disagree  
      Write a story Strongly agree  Strongly disagree  
      Design a checklist Strongly agree  Strongly disagree  
      Write a research paper Strongly agree  Strongly disagree  
      Write a summary Strongly agree  Strongly disagree  
      Write a fairy tale or legend Strongly agree  Strongly disagree  
      Take part in a mock trial Strongly agree  Strongly disagree  
      Write a conversation or dialogue Strongly agree  Strongly disagree  
      Design a puzzle Strongly agree  Strongly disagree  
      Create an analogy Strongly agree  Strongly disagree  
      Make an outline Strongly agree  Strongly disagree  
      Develop a theory Strongly agree  Strongly disagree  
      Make a daigram Strongly agree  Strongly disagree  
      Invent a code Strongly agree  Strongly disagree  
      Draw a time line Strongly agree  Strongly disagree  
      Make a storyboard Strongly agree  Strongly disagree  
      Record dates or information Strongly agree  Strongly disagree  
      Draw a caricature Strongly agree  Strongly disagree  
      Analyze a trend Strongly agree  Strongly disagree  
      Make a flowchart Strongly agree  Strongly disagree  
      Design an opinion poll or a survey Strongly agree  Strongly disagree  
      Evaluate or rate something Strongly agree  Strongly disagree  
      Design a computer game, program or graphic Strongly agree  Strongly disagree  
      Draw a picture Strongly agree  Strongly disagree  
      Make a mobile Strongly agree  Strongly disagree  
      Build a model Strongly agree  Strongly disagree  
      Make a poster Strongly agree  Strongly disagree  
      Design a Web site Strongly agree  Strongly disagree  
      Make a collage Strongly agree  Strongly disagree  
      Create a cartoon Strongly agree  Strongly disagree  
      Take photographs Strongly agree  Strongly disagree  
      Make a sculpture Strongly agree  Strongly disagree  
      Create a board game Strongly agree  Strongly disagree  
      Make a map Strongly agree  Strongly disagree  
      Design a postcard Strongly agree  Strongly disagree  
      Design a greeting card Strongly agree  Strongly disagree  
      Design a set for a play Strongly agree  Strongly disagree  
      Make visual aids: pictures, props Strongly agree  Strongly disagree  
      Perform a skit Strongly agree  Strongly disagree  
      Make a video Strongly agree  Strongly disagree  
      Do pantomime Strongly agree  Strongly disagree  
      Construct a model Strongly agree  Strongly disagree  
      Dance Strongly agree  Strongly disagree  
      Do a parody or spoof Strongly agree  Strongly disagree  
      Perform in a play Strongly agree  Strongly disagree  
      Develop an invention Strongly agree  Strongly disagree  
      Dramatize a story or poem Strongly agree  Strongly disagree  
      Write a song Strongly agree  Strongly disagree  
      Improvise music Strongly agree  Strongly disagree  
      Perform a song Strongly agree  Strongly disagree  
      Sing in a group Strongly agree  Strongly disagree  
      Play a musical instrument Strongly agree  Strongly disagree  
      Write a rap Strongly agree  Strongly disagree  
      Perform a rap Strongly agree  Strongly disagree  
      Perform music Strongly agree  Strongly disagree  
      Compose lyrics Strongly agree  Strongly disagree  
      Perform in a musical Strongly agree  Strongly disagree  
      Participate in a group activity Strongly agree  Strongly disagree  
      Participate in a discussion Strongly agree  Strongly disagree  
      Conduct an interview Strongly agree  Strongly disagree  
      Paraphrase ideas of others Strongly agree  Strongly disagree  
      Debate personal thoughts or perspectives Strongly agree  Strongly disagree  
      Build a group consensus Strongly agree  Strongly disagree  
      Plan a campaign for an idea or issue Strongly agree  Strongly disagree  
      Do a volunteer project Strongly agree  Strongly disagree  
      Organize an event or activity Strongly agree  Strongly disagree  
      Counsel your peers Strongly agree  Strongly disagree  
      Keep a journal Strongly agree  Strongly disagree  
      Identify your beliefs about an issue Strongly agree  Strongly disagree  
      Summarize your ideas and beliefs Strongly agree  Strongly disagree  
      Present your own perspective, view point or belief Strongly agree  Strongly disagree  
      Set personal goals Strongly agree  Strongly disagree  
      Develop support for a personal opinion Strongly agree  Strongly disagree  
      Classify objects Strongly agree  Strongly disagree  
      Solve a problem Strongly agree  Strongly disagree  
      Explore a topic or theme Strongly agree  Strongly disagree  
      Create a collection Strongly agree  Strongly disagree  
      Participate in a simulation Strongly agree  Strongly disagree  
      Construct a display of objects Strongly agree  Strongly disagree  
      Make comparisons Strongly agree  Strongly disagree  
      Conduct an observation Strongly agree  Strongly disagree  
      Identify a problem Strongly agree  Strongly disagree  





Señor Mitchell
Bethlehem Central Senior High School
Delmar, NY