QUESTIONNAIRE FOR MR. DIZON

Fill Out the Form to Get a Better Understanding of the Student
Student Name:
Grade: 9th 10th 11th 12th
Parent(s) Guardian(s) Names:
Phone Number:
Email Address:

Class Schedule:

........1st Period................2nd Period.

....... 3rd Period................ 4th Period.

.       5th Period................ 6th Period.

 7th Period.
Computer Class(es) Taken:
School Club(s):
School Sport(s):
Activities - Outside of School
Sports
Hobbies
Do you own a computer? Yes No
Do you own a laptop computer? Yes No
Do you own a cell phone? Yes No
Do you own a digital camera? Yes No
Do you own a graphic calculator? Yes No
Do you own a Nintendo DS? Yes No
Do you own a Nintendo Wii? Yes No
Do you own a XBox? Yes No
Do you own a Playstation? Yes No
Do you own a flash drive? Yes No
Do you own a IPOD? Yes No
Do you own a MP3 player? Yes No
Do you have Internet access at home? Yes No
Favorite T.V. Show:
Favorite Food :
Your Music Style:

Alternative
Country
Hard/Metal
Jazz / Blues
R & B
Rap
Rock
Other

What do you expect to learn from this class?
What grade do you expect to earn in this class? A B C D F
List anything that I need to know about you so I can HELP you be suceessful in my class: