Helen Keller Survey - 2012-2013

A pre-reading survey to see what kids know about Hellen Keller before reading.


         

       

Name: 


A red asterisk (*) indicates required questions.

  1. Have you heard of Helen Keller before?*
    Yes
    No


  1. How much do you think you know about Helen Keller already?*
    I think I know everything about her!
    I could tell you at least 10 facts about her.
    I recognize her name and know 2 or 3 facts about her.
    I think I have heard about her, but can't remember where.
    I have not heard of her, but can't wait to learn more!


  1. Do you think Helen Keller lived in the past or is living now?*
    She lived in the past.
    She is living now.


  1. Tell one thing or fact that you already know about Helen Keller. It can be VERY simple.*


  1. Write one question you have about Helen Keller.*


  1. Do you think Helen Keller was blind?*
    Yes
    No


  1. Do you think Helen Keller was deaf?*
    Yes
    No


  1. Have you ever met someone who is blind or deaf before?*
    Yes
    No


  1. Do you think it is possible for someone who is both deaf and blind to speak and go to college?*
    Yes
    No


  1. What does "deaf" mean?*
    A person cannot hear.
    A person cannot smell.
    A person cannot talk.
    A person cannot see.


  1. What does "blind" mean?*
    A person cannot hear.
    A person cannot smell.
    A person cannot talk.
    A person cannot see.


  1. Do you like learning about history and people who lived in the past?
    Yes
    Kind of
    Not really
    Not at all


  1. How many senses do human's have?*
    2
    3
    4
    5
    6


  1. Which of the following are part of our senses? (Pick all that are true. More than one is OK.)*
    speaking
    tasting
    moving
    touching
    walking
    smelling
    seeing
    breathing
    hearing
    sleeping