Welcome to Science 20!

Name (first and last): ______________________________________________________________

Is there a name you prefer to go by? __________________________________________

Age: _____________ Grade: _____________ Birthday: ____________________________

What are your pronouns? Circle your answer.

He/Him She/Her They/Them Other: ________________________

or I’d prefer not to say

Is English your first language? Circle your answer.

YES NO: ___________________________

Can you speak, read, or write in another language? Circle your answer.

NO YES: __________________________________________________________

Do you have any allergies or sensitivities to certain scents? Circle your answer.

NO YES: __________________________________________________________

How do you learn best? Circle your answer(s) below.

Reading and Writing Visuals

Ex. reading powerpoint slides or texts, taking notes, Ex. photos or images, graphs or tables, videos, color
writing things out. coding, drawing.

Auditory Physical
Ex. listening to lectures, participating in in class Ex. using my hands, working with materials (ie.labs),
discussions, audiotapes, podcasts, music. moving my body, role playing.

In school my:

Favourite subject is ______________________________________________.

Least favourite subject is ________________________________________.

Rank the following activities/hobbies based on how much you would enjoy doing
them.
1 = I enjoy the most 6= I enjoy the least

Art RANK Being Social RANK Entertainment RANK

Drawing, painting, Hanging out with Watching TV, movies,
sculpting, crafting family, friends, YouTube, TikTok,
etc. animals etc. playing video games
etc.

Music RANK Reading RANK Sports RANK

Listening to music or Reading books, Playing or watching
playing an comics, articles etc. sports.
instrument.

Are you, or do you plan to be, a part of any teams, clubs or organizations at
school? Circle your answer.
NO YES: __________________________________________________________

__________________________________________________________

Are you a part of any teams, clubs or organizations outside of school that you
would like to share with me? Circle your answer.
NO YES: __________________________________________________________

__________________________________________________________

In regards to COVID, please circle the following that applies to you.

1. In class, I prefer to wear my mask all of the time.

2. In class, I prefer to wear my mask most of the time, unless socially
distanced.
3. In class, I prefer to wear my mask mainly during group or partner work.
4. I’d rather not say.
How do you usually get to school in the morning? Circle your answer(s).

The bus I drive myself Someone else drives me

I walk Bike, skateboard, Other: ____________________

rollerblade etc.
____________________________

Please indicate your preference for where you would prefer to sit in the
classroom. Please note this does not guarantee where you will sit!
1 =Most preferred 3 =Least preferred.
Front ______
Middle ______
Back ______

If there is a specific reason for your preference of seating please let me know on
the line below. Ex. To see the board or poor hearing.

__________________________________________________________________________________________

In Science 20 I would like to learn...(optional)

__________________________________________________________________________________________

__________________________________________________________________________________________

Is there anything else you would like me to know? (optional)

__________________________________________________________________________________________

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