Information Sheet & Survey for Mr. Chaillot's Classes

1 Last Name, first name:
prefer:

2 Date of birth:
Fr -- So -- Jr -- Sr -- M -- F

3 Mailing Address:
phone(s):

4 Email address:
Homepage:

5 Parents' names & your hometown:
work # (M) _______________________ (D) ________________________

6 Extra info if needed:(name of spouse, dog, any connection)

7 Topics I know about:

8 Topics I need to know more about:

9 Topics I feel strongly about:

10 Topics I am curious about:

11 Pet Peeves:

12 What I love the most about my life right now:

13 What I love the least about my life right now:

14 What I hope for the most right now:

15 What I fear the most right now:

16 My top priority "new school year resolution" I intend to keep:

17 Main goal in my life right now:

18 What job I'd love to have someday:

19 These professions are in my family (Dad Mom GrandParents Aunts Uncles Cousins):

20 My hobbies and interests:

21 What I spend most of my money on:

22 How I spend most of my FREE Time:

23 What I love most about school:
Least:

24 Famous people I'd love to meet:

25 World locations I'd like to visit one day:

26 Favorite foods:

27 Favorite musical artist(s):
song:

28 Favorite color:
Animal:
Flower: