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Student Demographics
Please answer the following questions providing me with demographic information about yourself.
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* Indicates required question
Your First and Last Name
*
Your answer
Preferred name if not your first name
Your answer
Your preferred pronouns
*
she/her
he/him
they/them
Other:
Your email address
*
Provide an email address that you check regularly, either school or personal.
Your answer
Parent/Guardian Name(s)
*
Your answer
Your Home Address
*
Your answer
Home Phone (or Parent Cell Phone if no land line)
*
Your answer
Parent email (if applicable)
Your answer
Your semester schedule
*
Your answer
What period are you in my class?
*
1st
2nd
3rd
4th
Do you have reliable internet at home?
*
Yes
No
Available, but not reliable
Do you have a printer at home or easily accessible?
*
Yes
No
Other:
How comfortable are you with using technology to complete schoolwork at home?
*
Not comfortable at all (I need extra support)
1
2
3
4
5
Very comfortable (I can use tech with ease on my own)
How comfortable are you with using video conferencing tools (like Microsoft Teams)?
*
Not comfortable at all (I need extra support)
1
2
3
4
5
Very comfortable (I can use video conferencing tools with ease on my own)
Is there any important information I need to know right away?
(Other accessibility issues I didn't address, IEP/504 modifications, health issues, concerns, etc.)
Your answer
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