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Student Interest Survey

Total questions: 28

Worksheet time: 1hrs 15mins

Name
Class
Date
1.

What is your first and last name?

4 lines
2.

Do you have another name you'd like your teacher to refer to you with?

4 lines
3.

Do you have any pets? If so, what kind? How many? Share anything special you'd like about them.

4 lines
4.

What sports do you play? Do you play for a team or just for fun? Where do you play these sports? If none, just type "N/A"

4 lines
5.

What is your FAVORITE school subject? Why?

4 lines
6.

What is your LEAST Favorite subject? Why?

4 lines
7.

If you had the chance to be part of a Robotics team that competes on weekends with other students from other schools wuoudl you be interested?

4 lines
8.

Have you ever build robots before?

4 lines
9.

Have you ever created a program to make a robot move?

a)

Yes

b)

No

10.

Where did you go to school last year?

4 lines
11.

Do you have any brothers or sisters that attend HOMS? If so, what grade are they in?

4 lines
12.

What is your favorite movie you recently watched?

4 lines
13.

What indoors games do you like to play?

4 lines
14.

Tell Mrs. DuBois about one thing you are super proud of about yourself.

4 lines
15.

Are you going to join any school clubs this year? If so, which ones?

4 lines
16.

If you could plan one field trip to anywhere with your classmates, where would you take us? Why?

4 lines
17.

If you could choose one problem at school what would you pick? Explain why. Tell how you might begin to solve it?

4 lines
18.

What is one thing you think Mrs. DuBois should know about you?

4 lines
19.

Where do you most like to sit in class? Why?

4 lines
20.

Do you prefer to work alone? With a partner? or with a group? Pick one and explain why you chose this option.

4 lines
21.

Explain why it's important to be kind to others in life.

4 lines
22.

Draw what it looks like to be respectful to your classmates and teacher.

23.

Which reward would you rather. Choose 1.

a)

Spin the wheel for a small treat

b)

a popsicle

c)

sit by a friend

d)

Free time to do homework

24.

Finish the sentence with ONE word. TECHNOLOGY IS...

2 lines
25.

Do you participate in any afterschool programs; like Karate, dance, gymnastics, basketball, football, swim, vocal lessons, etc...

4 lines
26.

Which social media platform do you like to use? Chose as many as apply to you.

a)

Instagram

b)

Snapchat

c)

Chatrooms

d)

None of the following

e)

I don't use any social platforms

27.

Do you have your own cell phone?

a)

Yes

b)

No

28.

What is one question you'd like to know about this class.

4 lines