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Ms. Johnson's Student Information Sheet
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* Indicates required question
Last Name
*
Your answer
First Name
*
Your answer
Preferred Name
*
Your answer
Class Period
*
1
2
3
4
Personal Email
*
Your answer
Parent/Guardian #1 first and last name
*
Your answer
Parent/Guardian #1 work phone
*
Your answer
Parent/Guardian #1 cell phone
*
Your answer
Parent/Guardian #1 email address
*
Your answer
Parent/Guardian #2 first and last name
Your answer
Parent/Guardian #2 work phone
Your answer
Parent/Guardian #2 cell phone
Your answer
Parent/Guardian #2 email address
Your answer
Extracurricular Activities
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Seating and/or health concerns?
*
Your answer
Which of the following mornings DO NOT work for you to come before/after school for help?
*
I am not available outside of school.
I am not available any mornings.
I am available all mornings.
Tuesday Morning
Wednesday Morning
Thursday Morning
Friday Morning
Required
Which of the following afternoons DO NOT work for you to come before/after school for help?
*
I am not available outside of school.
I am not available any afternoons.
I am available all afternoons.
Monday afternoon
Tuesday afternoon
Wednesday afternoon
Thursday afternoon
Friday afternoon
Required
What is your goal for this class?
*
While grade-based and numeric goals are acceptable, it is important that you also consider other types of goals as well.
Your answer
Why did you take this class? Please be honest.
*
Your answer
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