Contact Information Survey
This survey asks you to provide contact information that will enable communication between you, me, and your family.
* Required
List your full name (first last)
*
no nicknames
List Your Address
*
house number and street; city, state zip code
List your home phone number
*
mark if unlisted; no one will access this information except your teacher
List your mobile (cell phone) number
*
easier for me to speak with you first before your parents
List your mother's/female guardian's name
*
begin with title (Miss, Mrs. Ms. Dr. Atty.); if you share parent/step parents, please list both indicating who is primary = reside with most of the time and secondary = reside with shared time
List your father's/male guardian's name with title
titles may include Mr. Atty. Dr. (use what applies)
With whom do you reside (live)?
*
mother
father
mother and father
mother and friend
father and friend
guardian (please list full name)
shared living with birth parents and step parents
Other: please explain
Whom should I contact first?
*
please give name (with title) land phone number
What is the best time to call your primary contact?
*
What are your hobbies? interests?
*
please list non-school things here
What are your school-related activities?
*
please list all activities that you intend to pursue this year
Do you work after-school?
*
please list where you work and approximately how many hours a week? per day?
What are the best ways to contact you? Please include an after-school option (so you could be checking 2 options).
before or after class
homeroom
before school
mobile phone
Skype
Private message via Facebook
Private message via Twitter
Private message via Plurk
Email
do not contact me first; contact my parents
Other: please list appropriate information
What is your homeroom?
*
Please list parents' emails; please identify mother, father, and/or guardians/step parents
*