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STUDENT SURVEY

Name

Period

Date

Name you prefer to be


called if different than legal
name
Personal
Information

Birthday
School you attended last
year/Did you take Spanish
before? How many years?
First and Last Name
Relationship to You

Parent/Guardian
Information

Home Phone Number


Work Phone Number
Cell Phone Number
Email Address

As you answer the next group of questions, please be specific and use complete sentences.
Name one person you look up to and explain why.

What is the one thing you like the most about yourself? Dont be bashful.

What excites you about learning Spanish?

What intimidates you learning Spanish?

What are your hopes/plans for the future? If I were to run into you five or ten years from
now, where would you be and what would you be doing?

Check all that apply.


I learn best when...
I hear a teacher explain it
verbally
I hear a classmate explain it
verbally
I read a written explanation
I see diagrams or drawings
I do a hands on activity
I see lots of different
examples
I can see how it relates to
something I already know
I can ask lots of questions

What are three words your friends or family


would use to describe you?

the room is silent


there is music playing
I am working alone
I am working with a partner
I am working with a group
the teacher is talking only to me
Other :
_____________________________
_____________________________
_____________________________

What are three words YOU would use to


describe yourself?

Favorites
School
subject

Snack or treat

Book

Singer/Group

Movie

Activity/Sport

Television
show
Do you have internet access?
(Check all that apply)

__Home

Superhero or
cartoon
character
__Library

__School

__Cell/Smart Phone
__Other:
___________________________
Thank you for filling out this survey. I am so excited to have you in class! I know your unique talents
and interests will enrich everyones learning this year.