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Student Questionnaire
Please answer each question as accurately as possible.
If a question does not apply to you place N/A in the text box
Type names and addresses using proper capitalization for post office
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* Indicates required question
Class
*
MT-1a - 1st year, 1st class of the day / MT-1b 1st year, 2nd class of the day / MT-2 - 2nd year / MT-3 - 3rd year
MT-1a
MT-1b
MT-2
MT-3
Auto 1a
Auto 1b
Auto 2
Auto 3
Fire and Rescue 1
Fire and Rescue 2
Required
Grade Level:
*
9
10
11
12
Required
High School:
*
Adams Central
Bellmont
Bluffton
Jay County
Norwell
South Adams
Southern Wells
Other:
Required
First Name:
*
Your answer
Middle Initial:
*
Your answer
Last Name:
*
Your answer
Address:
*
Your answer
City:
*
Your answer
State:
*
Your answer
Zip Code:
*
Your answer
My Home Phone / Parents' Phone #:
*
Your answer
My Cell Phone #:
*
Your answer
Birthdate:
*
Please follow this format: 00/00/0000
Your answer
T-Shirt Size
*
Adult Sizes
Small
Medium
Large
X-Large
2X-Large
3X-Large
4X-Large
Other:
Required
My E-Mail Address:
Your answer
My School E-Mail Address:
*
Your answer
Father's Name:
(First and Last Name)
Your answer
Father's Email
Your answer
Father's Phone Number:
Your answer
Father's Workplace / Occupation
Your answer
Mother's Name:
(First and Last Name)
Your answer
Mother's Email
Your answer
Mother's Phone Number:
Your answer
Mother's Workplace / Occupation
Your answer
My Favorite Hobbies are:
*
Your answer
Extracurricular Activities:
Your answer
Current Employer:
Your answer
Current Job Title / Responsibilites
Your answer
Favorite Magazine(s) and/or Book(s)
*
Your answer
Favorite TV show(s) / Movie(s)
*
Your answer
Favorite Video Game or other activities
*
Your answer
If I could make any project or learn any skill this school year, it would be.....
*
Your answer
My goals for the next 5 years:
*
Your answer
What skills, talents, personality traits, etc sets me apart from others
*
Your answer
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