My Interview
Student’s name: _________________________________________________________________
Grade:_______________ Date: ________________________________
What is your name? How old are you?
Who do you live with?
What is your dad’s name?
What is your mom’s name?
Do you have any brothers or sisters? ________ How many? __________
What are their names?
_______________________________________________________________
What do you Play( ) Do homework( ) Watch TV( )
do at home? Use the tablet or cellphone( ) Other _______________________
Who do you
Mom( play ) Siblings( ) Other Family( ) Friends( )
) Dad(
with?
Alone( )
What makes you What makes you What makes you How do you feel
scared? sad? happy? in your house?
Cartoons ( ) Mom ( )
What do you Soap Operas ( ) Dad ( )
Who do you Siblings ( )
watch on TV? Movies ( ) watch TV with? Grandparents ( )
YouTube ( )
Alone ( )
Other ( ) Other ( )
Do you have Friends? Yes ( ) No ( ) What are their names? _____________________
Do your parents work? Mom: _____ Dad: _____ Who takes care of you? ___________
_________________
Student’s Signature