Student Questionnaire

Note: this is not for marks, but the information provided is useful to help me get to know you
and how you learn. If something does not make sense, please ask!
1. What is your name? _________________________________________________________________
2. What is your preferred pronoun?
He / Him / His She / Her / Hers Other: ______________________________
3. Please circle any/all statements that apply to you. In the line beside the statement tell me how you cope with
this issue.
a. I am excited to learn about science. _____________________________________________________
b. I generally feel prepared for most tests. __________________________________________________
c. I tend to be disorganized. _____________________________________________________________
d. I tend to procrastinate. _______________________________________________________________
e. I am a perfectionist. _________________________________________________________________
f. I tend to miss a lot of school. __________________________________________________________
g. I dont know how to take notes very well. ________________________________________________
h. I dont know how to study very well. ___________________________________________________
i. I am uncomfortable when plans change. _________________________________________________
j. I have a fear of public speaking. ________________________________________________________
k. I find it difficult to work alone. ________________________________________________________
l. I find it difficult to in groups. __________________________________________________________
m. Math is difficult for me. _____________________________________________________________
n. Reading/writing is difficult for me. _____________________________________________________

If there is any other information you would like to tell me before this course starts, please describe it below.
__________________________________________________________________________________________

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4. What is your favourite subject in school? ______________________________________________________
5. What is your least favourite subject in school? __________________________________________________
6. Does school make your feel successful? _______________________________________________________
7. What in your life makes you feel successful? ___________________________________________________
8. What do you hope to accomplish in this course? _________________________________________________
9. Do you like to listen to music while you study/ do work? __________________________________________
10. Please list some of your favourite (school appropriate) songs to listen to:
1. _____________________________________________________
2. _____________________________________________________
3. _____________________________________________________
4. _____________________________________________________
5. _____________________________________________________

Thank you for completing this little survey!

If you put this page in the corner of your desk, I will know that you are
finished.

Feel free to doodle a silly picture in the space below.