Name _____________________________________ Age ______ Phone number ___________________

Home city/state/country ________________________ Pronouns you go by (he/she/they/ze, etc.) ________________

Your honest responses to the following questions will help me in our work together this semester.
PLEASE CONTINUE ON THE OTHER SIDE OF THE PAGE IF NECESSARY

1a. If you’re not from the U.S., how long have you been in the U.S.? ______________
b. Has your family lived in many different places (for military service, other employment)? _________
c. Language and/or language spoken at home: _________________

2a. How many semesters have you completed at Berklee? ________

b. If you did not come to Berklee directly from high school, what did you do in the time in between?
For example, did you attend college? did you work? what sort of work was it?

3. Interests or hobbies in addition to music:

4. Responsibilities and obligations outside of school:

5. What aspects of identity, if any, have you been thinking about and exploring already?

6. Continue on the other side, if needed: If there is anything else you'd like me to know about you, please include that
here. Some examples: Concerns you have about the class; disabilities that might affect your work (this would be
very helpful for me to know for our work together); other information you want me to know.

– There are questions on the reverse side, as well as more space to complete your answers from this side –
 EVERYONE, PLEASE FILL OUT YOUR PREFERENCES
 We won’t be able to cover all the topics listed below, so I’d like to know your preferences. Please indicate your
interest in our class exploring each of the topics listed below.
 IN ADDITION, PLEASE CIRCLE the three (3) topics you are most interested in focusing on as a class.
 If there are additional topics concerning identity that you’d like us to cover, please include them here.

Not
Interested Neutral Other comments
interested
Body: in what ways is our body important to our
identity?
Class: in what ways does our socio-economic
class shape our identity?
(Cross-)Cultural Issues: how are our habits/
personalities/preferences shaped by culture?
Family: in what ways does our family shape our
identity and our perceptions of reality?
Gender: in what ways is our gender identity
important?
Nationality: in what ways does our nationality
shape our identity and worldviews?
Race/Ethnicity: in what ways is our racial/
fethnic identity important?
Religion: in what ways is our religion and our
(lack of) relationship to it important?
Sexuality: (1) sexual orientation and (2) humans
as sexual beings: in what ways is sexuality
important to our identity?
Social Psychology: how do we define ourselves
and others in relation to groups?
Other

Other

– CONTINUATION OF YOUR RESPONSES FROM THE OTHER SIDE –