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Who Are You?

Last Name, First Name ____________________________________________________


Name _________________________

English

Mailing Address: _______________________________________________________________


Grade ________________
City:

__________________________________________________
Birthday______________________

ZIP

Code

________________

What are the names of your parents/guardians that you live with?
FEMALE:
MALE:
____________________________________________ ____________________________________________
___
______
Relationship:
__________________________________________

Relationship:
__________________________________________

Daytime
Phone: Daytime
Phone:
________________________________________
________________________________________
Email:
Email:
____________________________________________ ____________________________________________
_______
_______
What are the names and ages of the other people that you live with?
NAME: _________________________________________________
_____________________

AGE:

NAME: _________________________________________________
_____________________

AGE:

NAME: _________________________________________________
_____________________

AGE:

NAME: _________________________________________________
_____________________

AGE:

NAME: _________________________________________________
_____________________

AGE:

NAME: _________________________________________________
_____________________

AGE:

What are the names of any parent(s) that do not live with you, but are important to you?
FEMALE: _________________________________________________________________
____________________________

PHONE:

MALE: ____________________________________________________________________
____________________________

PHONE:

Who
was
your
English/ESL
teacher
__________________________________________________________________

last

School:
_____________________________________________________
______________ Final Exam: _________
How
many
years
have
you
been
______________________________________________________________

Average
studying

year?
Grades:
English?

(This gives me an idea of what to expect from you please be honest! I can look this up.)
Favorite Subject _________________________________________
Least Favorite Subject
_________________________________
What are some activities/topics that you liked learning about last year?

What are some activities/topics that you didnt like learning about last year?

Where do you prefer to sit in the classroom? Circle please.


Front
Near the Window?

Middle
Y

Back
/

Is there anything important that I should know about you?


(Example: Medical conditions, learning disabilities, family issues, etc.)

What are your interests/hobbies and/or what sports do you play?

Do you play a musical instrument? Which one?

What time do you get home from school? What do you do when you get home?

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