Class Survey

What name do you want me to call you: _______________________             

current grade level (i.e. 9 - 12):  ______

Do you have a computer at home ? _____             Do you have Internet access from home ? _____   

List your most recent math and science course, semester grades (A - F), and teacher's name:

Math course name: __________________	semester grades: ________	teacher's name:  ____________
Science course name:  ________________	semester grades:  ________	teacher's name:  _____________

tell me about yourself (optional; e.g. interests, reason you enrolled in the class; etc.)

List your class schedule: include period, class, teacher, and room number: