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MCR 3UI-02 - Student Information Form
This form is a chance for me to gather some important information and get to know you a little bit. Your responses will be for the teachers use only and will not be seen by other students.
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* Indicates required question
Email
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Your email address
What is your full name (first and last)?
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Your answer
Do you have a preferred shortened name/nickname? (i.e. You are Mackenzie but prefer to be called Mack)
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Your answer
Preferred Pronoun?
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They/Them/Theirs
She/Her/Hers
He/Him/His
Other:
Who do you live with?
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Your answer
E-mail of Parent or Guardian (if known)
Your answer
What is your most favourite subject?
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Your answer
What is your least favourite subject?
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Your answer
What was the last math class you took?
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Grade 10 Academic (MPM 2DI)
Grade 11 University/College (MCF 3MI)
Grade 11 University (MCR 3UI)
Other:
What was your previous math mark? (do your best to try to remember)
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Level R (less than 50%)
Level 1 (50-60%)
Level 2 (60-70%)
Level 3 (70-80%)
Level 4 (above 80%)
Please check the option below that BEST represents your math course and learning for the 2021-2022 school year.
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I completed my previous math course in the modified semester 1 last year (2 periods per day, all morning or all afternoon)
I completed my previous math course in a normal semester (1 period per day) (semester 2 last year)
I completed my entire school year, including math, from home with the Secondary Distance Learning Program (SDLP)
Other:
Is there anything about your progress in math last year that you would like me to know? If so, please use the space below to elaborate.
Your answer
How would you rate your confidence level in math?
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Easy Peasy Lemon Squeezy
I've got it for the most part
I'm good with some things, but struggle with others
Math is usually a real struggle for me, but I am willing to try (and ask questions!)
I have a really hard time with it and struggle to find the motivation to try.
What will you need to do to be successful in math?
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Your answer
Do you have someone besides Mrs. Wagler (parent/sibling/friend) that can help you with Math, outside of school, if needed? Who is that?
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Your answer
Do you have an IEP (Individual Education Plan)?
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Yes
No
Don't know
Do you have a part-time job or volunteer somewhere? If so, where?
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Your answer
What are your extra curricular activities/interests?
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Your answer
What do you think you would you like to do after you graduate W-O? Be specific!!! (ex. university to become a marine biologist, college to become a skilled electrician, etc.)
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Your answer
Are there any medical concerns/allergies that your teacher should be made aware of? List all that apply or simply reply 'no' if there are none.
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Your answer
The last few years have been a long and trying time for many. How would you rate your mental health status at this point? If none of the options below apply to you, please use the "other" category to express how you are feeling. Please do not check 'other' and then leave the space blank.
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1 - I am not okay. I need/would like some additional support dealing with this crisis.
2 - I am having a lot of difficulty, but I am trying to deal with things on my own and do not want additional support at this time.
3 - I am having a lot of difficulty, but I am attempting to deal with the help of family/friends and do not want additional support at this time.
4 - I am okay. I have my moments (tears, stress, anxiety, worry, etc), but I am managing most of the time on my own and do not need additional supports at this time.
5 - I am okay. I have my moments (tears, stress, anxiety, worry, etc), but I am managing most of the time with support from family/friends or a professional.
6 - I am good, but I have been mostly dealing with things on my own. I do not require additional support at this time.
7 - I am good. I have been asking for and receiving support from my family, friends or a professional, so I do not need additional support at this time.
Other:
Please use this space to elaborate on your mental health status choice from the previous question, ONLY if you feel that you would like to do so.
Your answer
Is there anything that your math teacher should know about you? (preferred name, vision issues which would affect where you should sit, special considerations...).....IF NOT, then tell me something INTERESTING about you!
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Your answer
Do you have any questions or concerns right now about math class? Or school?
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Your answer
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