Student Survey/Information Sheet

Name: ______________________________ Birthday: ____________________

Address: _____________________________ Home Phone number: ______________

_____________________________ Cell number: ______________

Email Address: ____________________________

Mom’s Name: ___________________________

Dad’s Name: ___________________________

Do you have any siblings (brothers or sisters?) Yes No

Interesting Facts about Me

Do you have any siblings (brothers or sisters?) yes no

List their names and ages. Name Age

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Do you have any pets? yes no

Type of Animal Name

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Favorite…

Color: _____________________________________________________________

Singer/ Musical Artist: ________________________________________________

Movie: ____________________________________________________________

Book/ Genre/ Magazine: _______________________________________________

Game: _____________________________________________________________

Hobby: ____________________________________________________________

Food: _____________________________________________________________

Candy: ____________________________________________________________

TV Show: __________________________________________________________

Actor/ Actress: _____________________________________________________

Athlete: ___________________________________________________________

School Subject: _____________________________________________________

Sport: ____________________________________________________________

Flavor of ice cream: __________________________________________________

Thing to do in your free time: ___________________________________________

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Tell me three things you are good at: ______________________________________

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If I had one wish, it would be… __________________________________________

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If I had a million dollars, I would… _______________________________________

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After I graduate, I want to… ___________________________________________

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Tell me what one of your teachers did last year that you liked: ___________________

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Who is your hero? ___________________________________________________

Draw what you think would be the “perfect” day for you.

Something you want to know about Mrs. Howard or Mrs. Heider is:

Teacher: (circle one) Mrs. Howard Mrs. Heider

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