More About You

To be completed after the ELSA Inventory
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Name: 


A red asterisk (*) indicates required questions.

  1. I am a *


  1. I am (select all that apply) **
    American Indian or Alaska Native alone
    Asian alone
    Black or African-American alone
    Native Havaiian or other Pacific Islander alone
    White alone
    Mixed race
    Some other race alone


  1. I am currently ____ years old. *


  1. I am currently in the ____ grade. *


  1. The place where I live (mostly) is *


  1. I'm involved in these leadership activities and programs *(select all that apply)*
    I'm not involved in any leadership activities/programs.
    Community group (Girl Scouts/Boy Scouts; Boys/Girls Club; 4-H; camp)
    Volunteering
    Youth group at my place of worship
    Babysitting
    Music and fine arts activities (outside of school)
    Athletics (in or out of school)
    School group (Chess Club; Model UN; Do Something; etc)
    Serve as a mentor/tutor


  1. Please elaborate on question #6 about the specific community group, volunteering, music/art activity, athletic activity, school group(s) you participate in. In other words if you checked athletics in Question #6, write down here which sports you participate in and if they are school/community affiliated or both.*





Mrs. Case
Gifted Resource Teacher
Fairfield Middle School
VA