Student Information Form - Mr. Benner
Please complete this form so I can gather some basic information about you and your interests.
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Which class are you taking with Mr. Benner this semester? *
Which class period do you have Mr. Benner?
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Student Contact Information
Student First Name *
Preferred Name
This is the first name you go by or would like to be called.
Student Last Name *
Grade Level *
Student Safety Information
List any allergies that you have. *
There are a variety of materials we will use during this course.  I want to make sure you are not allergic to any of them.  (Write "none" if you don't know of anything that you are allergic to.)
List any medical conditions you have that I should be aware of. *
(Write "none" if you don't have any.)
Student History, Background, & Interests
This is where I get to find out what you think about science, what you're involved in outside of school, and what you're interested in.
Science Courses I Have Already Taken: *
Please check all courses you have successfully completed.
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What sports/clubs do you participate in at school? *
Write "none" if you do not participate in any sports/clubs.
Do you have a job? *
When I think about science, my first thoughts include... *
My favorite type of science is:
I've heard this class is...
I'm most looking forward to learning about...
When I grow up I want to... *
Name someone you admire and tell me why.
What is something you want me to know about you?
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This form was created inside of Randolph County School System.