Fall 2014 Course Questionnaire

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. What is your current class level?*
    Senior
    Junior
    Sophomore
    Freshman


  1. In terms of Academics, I consider myself*
    Way above averarge (A+)
    Above average (A to B+)
    Average (B to C+)
    Below average (C to D)
    Way below average (D to F)


  1. Do you receive or plan to apply for "free lunch?"*
    Yes
    No


  1. Have you taken Spanish before? *
    Yes
    No


  1. If yes, how long ago did you take it?*
    Last semester
    2 semesters ago
    3 or more semesters ago
    more than 2 years ago


  1. What grade did you make the last time you took Spanish (if you took it)?
    A
    B
    C
    D
    F


  1. Do you or your family speak Spanish at home?*
    Yes (fluently)
    Yes (a good bit)
    Yes (only a little)
    No (not at all)


  1. Have you ever traveled outside the United States?*
    Yes
    No


  1. If so, where have you traveled?


  1. I enjoy high school...
    Most of the time
    Some of the time
    Rarely


  1. Please go to the following website and take the survey. At the end, select your top three learning styles. http://www.edutopia.org/multiple-intelligences-learning-styles-quiz
    Linguistic intelligence ("word smart"):
    Logical-mathematical intelligence ("number/reasoning smart")
    Spatial intelligence ("picture smart")
    Bodily-Kinesthetic intelligence ("body smart")
    Musical intelligence ("music smart")
    Interpersonal intelligence ("people smart")
    Intrapersonal intelligence ("self smart")
    Naturalist intelligence ("nature smart")


  1. The type of music I listen to (you can choose multiple answers)
    Rap & Hip Hop
    Rock
    Country
    Classical
    Jazz
    Electronic
    Heavy Metal
    Alternative
    Disco
    Pop
    Rhythm and Blues
    Classic Rock
    Oldies
    Christian Music
    Bluegrass
    Musicals and Showtunes
    Indie
    Instrumental


  1. How do you get to school? (you can choose more than one)
    Take the bus
    Drive my own car
    Drive with someone else
    Walk
    Ride a bike


  1. In the last two semesters I have been written up (discipline referral)...
    A lot (more than 6 times a semester)
    Frequently (3-5 times a semester)
    Rarely (1-2 times a semester)
    Never


  1. How would you describe yourself? Is there anything unique I should know about you?*


  1. I live with...
    My mom and dad
    My mom
    My dad
    My guardian
    Split custody between mom and dad


  1. What is your parent's/guardians' name(s)?


  1. Tell me about your personal interests (hobbies, what you like to do with your free time).


  1. What is the name of your coach, guidance counselor, or tutor this semester?


  1. I participate in extracurricular (after school) activities.
    Yes
    No


  1. If yes, I participate in
    Football
    Basketball
    Soccer
    Baseball
    Softball
    Band
    Chorus
    Drama
    Volleyball
    Wrestling
    Yearbook
    Strings
    Track
    Clubs
    Cheerleading
    Dance
    Lacross
    Beta Club
    FBLA
    Other


  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
    Condo


  1. Do you have a cell phone?
    Yes
    No


  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 have a smart phone with internet or applications?
    Yes
    No
    Maybe


  1. How much time do you normally spend on school-work per day?
    less than 1 hour
    1-2 hours
    2-3 hours
    more than 3 hours


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


  1. What is your favorite television show(s)?


  1. What grade would be acceptable to you in this course?
    A
    B
    C
    D


  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


  1. Do you use Facebook?
    Yes
    No


  1. On average, how many hours a day do you spend on your cell phone?
    0
    30 mins to 1 hour
    1-2 hours
    3-4 hours


  1. I am nervous to speak up in front of a class...
    yes
    no
    a little


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


  1. I think it is okay to have free time in class.
    Very rarely.
    A little every day.
    All of the time.


  1. I had --- for my previous Spanish class.
    Ms. Hachen
    Mrs. Sims.
    Señor Figuero
    Sr. Johnson
    Mrs. Davis
    Mrs. Sain
    Other


  1. Is there anyone in this class that you know you DO NOT work well with?


  1. What is your gender?*
    Male
    Female


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


  1. Is this your second time taking this course at this school (as in you did not pass it and you are taking it again)?
    Yes
    No


  1. What name do you want me to call you?


  1. What does your mom (female guardian) do for a living?


  1. What does your dad (male guardian) do for a living?


  1. Is your mom (female guardian) employed right now?
    Yes
    No


  1. Is your dad (male guardian) employed right now?
    Yes
    No


  1. Have you ever been arrested?
    Yes
    No


  1. Do your parents care if you use profanity at home?
    Yes
    No


  1. Do your parents speak Spanish?
    Yes
    No


  1. Do you have texting capabilities with your phone?
    Yes
    No


  1. Do you have internet access with your phone?
    Yes
    No


  1. What do you expect to be doing in 10 years?


  1. Have you ever been in ISS?
    Yes
    No


  1. If yes, what was it for?


  1. What block are you taking this course?
    1st
    2nd
    3rd
    4th


  1. Have you ever been in a physical altercation/fight at school in the last 2 years?
    Yes
    No


  1. I want to make a --- in this course.
    A
    B
    C
    D


  1. I have to make an --- in this course (for my parents).
    A
    B or higher
    C or higher
    D or higher


  1. I have experienced bullying at this school
    Yes
    No


  1. I have seen bullying of others in this school...
    On a daily basis
    Weekly
    Once a month
    Never


  1. If I could change anything about high school I would change ...


  1. Do you stay up past 12 midnight most nights of the week?
    Yes
    No





Señor Johnson
Spanish Teacher
Nation Ford High School
SC