First Name: 

Last Name: 

Date (dd/mm/yy): 

Birthday:  Month January February March April     Day:  1 2 3 10     Year:  1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Do you have a computer at home:  Yes   No

Check the software/computer capabilities that you have on your computer at home:

If you have an email address, enter it here: 

If you have a website, enter the address here: 

List your interests, hobbies and what you're most proud of

Thank you for taking this survey.  I am looking forward to having you in class this year.