Vital Signs of Learning (Middle/High School)

Student Information

This survey allows you to provide information about your educational background, preferences, and skills in order to better serve your learning needs.

Your honest responses about the kinds of learning situations that work best or have been more difficult for you can be useful for monitoring and adjusting school experiences in ways that can help you succeed.

All 20 questions require an answer in order to provide the most complete feedback report, but if you choose, you can enter a question mark (?) for any question you do not want to answer and move on to the next question.

Question Title

* 1. Please provide the student information requested below

First Name: *

Last Name: *

School Name: *

Guide Teacher - Last Name: *

Gender Identification: M, F, Bi

Best email address:

Best Phone #:

Question Title

* 2. Gender Identification:

Female

Male

Other

Question Title

* 3. Grade Level:

Question Title

* 4. Mark the core subjects you are currently taking

English/Lang. Arts (e.g. reading, writing)

Social Studies (e.g. history, geography)

Science (e.g. biology, nature, animals)

Math (e.g. general math, algebra)

Music/Art/Publications

Health/PE

Other (please specify)