CHEMISTRY: MR.

LALIBERTE Class Period:

Name: Nickname:

Name(s) of Guardians or Parents Relationship Daytime Phone #

_____________________________________ ______________ __________________

_____________________________________ ______________ __________________

What types of activities are you involved in during the school year?

What possible career paths are you considering for the future?

Is there anything special that I should know about you? (For example, do you
need to sit up front? Is there someone in class that you cannot work with?
504 plan?)

Indicate how much you agree with these statements by circling the appropriate
number. Choose [1] for strongly agree, [2] for somewhat agree, [3] for no or
neutral opinion, [4] for somewhat disagree, and [5] for strongly disagree.

a) I'm interested in learning explanations about nature. [1] [2] [3] [4] [5]
b) I want to improve my math and thinking skills. [1] [2] [3] [4] [5]
c) I am good at memorizing things. [1] [2] [3] [4] [5]
d) I am good at understanding concepts. [1] [2] [3] [4] [5]
e) I completed all or nearly all of my homework last year. [1] [2] [3] [4] [5]

Name of Chemistry Text Book #

Laliberte, 8/25/08