STUDENT INFORMATION*
1. Grade: (Circle one) 9 10 11 12 2. Name:____________________________
3. Student I.D. Number: ___________ 4. Phone Number:____________________
5. Email: _______________________________________________________________
Parent’s Email: ________________________________________________________
6. Birthday: ___________________ 7. Class you do best in: ________________
8. Address: Street: ______________________________________________________
City: ____________________________ Zip: _______________________
9. Legal Guardian: (Circle one) Parents, Mother, Father, Older Sibling, Relative, Friend
Name: ______________________________ Name: ________________________
Work Phone: _________________________ Work Phone:___________________
10. Schedule: Lunch(s) (Circle all that apply) A B C D
Period Subject Teacher
1 __________________________ _______________________________
2 __________________________ _______________________________
3 __________________________ _______________________________
4 __________________________ _______________________________
5 A __________________________ ________________________________
5 B __________________________ ________________________________
6 __________________________ ________________________________
7 __________________________ ________________________________
11. Name of the last science class you took: ___________________________________
Grade (Circle one) A B C F
12. Extracurricular activities (Present and/or future)
_________________________________ ____________________________________
_________________________________ ____________________________________ (OVER)
(OVER)
13. Question or issue that you would like to discuss or know more about: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
14. Complete this sentence in 50 words or more: This year I expect my science teacher to_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
15. Complete this sentence in 50 words or more: This year I expect to ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
16. List three people that you admire and briefly state why:
____________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________
17. What technology do you possess? (For example, iphone, ipad, laptop)
___________________________ ______________________ ______________________
__________________________ ______________________ ______________________
18. What technology are you comfortable using?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________