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.