Student Information Form

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Student Information

Please fill out all of the following data and click the "Submit" button when you are finished.

The fields that have a green asterisk (*) are required. If you leave any of these blank, you will get an error when you try to submit the page. If this happens, user your browser's "Back" button, fill in the missing information, and resubmit.

Note that javascript must be enabled in your browser.

Data About You

First name: *      Last name: *
Please format your name the way you like it to appear, and inculde any accents. Here are some common ones so you can copy and paste:
à á ä ç è é ë ì í ï ñ ò ó ö ø ù ú û ü

If you have a nickname you want me to use, enter it here:

Alias (code name) for use on grade sheet:
Grades are posted in the classroom. Your grades will be listed under your student ID number and this alias so you can find them more easily. (I can edit your alias in TAC/HAC any time you want--just let me know. If you leave this blank, your grades will be listed only under your student ID number.)

Which class are you in?:*
Physics 1 (D block)       Physics 1 (F block)       AP Physics 1 (B block)       AP Physics 1 (G block)       AP Physics 2 (C block)

Homeroom:      Class of:*      Student ID #:

Personal Information

Gender:      Date of birth: ,

Primary language: * Other (if not listed):


Home phone:      Your cell phone: (optional)      Email:

Address:




Parent/Guardian Contact Information

You live with:     both parents      mother      father      grandparent(s)      other:
Guardian Name(s) Home Phone Work Phone Cell Phone Email
Address

Guardian's primary language: * Other (if not listed):

If other than English, does your guardian speak/understand English? yes     no


Photo Permission

I have a photo blog at www.mrbigler.com/blog. If I take a picture of a lab or activity that you appear in, may I include the picture (without your name)?

Note that I review the pictures before uploading them. I won't upload a picture if I think someone in it would object to the way they look.

yes      no


Previous Math/Science Classes

Please list your most recent math and science classes and your final grades in both (to the best of your recollection). This will give me an idea of where your strengths are and where you might need help.


Time Commitments

Please list anything besides academics that will be making demands on your time (sports, jobs, activities, family obligations, etc.). Please mention which days of the week are affected, if relevant.

Please fill in the following table with the approximate number of hours you spend on each type of activity in a typical week. If you use the TAB key to move from one cell to the next, your browser will calculate the total number of hours as you type.

Activity Hours per Week
School (7:55-2:30 Monday-Friday)
Homework (usually 1-2 hours/week per class; 4-6 hours/week per AP class)
Extra-curricular activities at school (sports, clubs, drama, band/orchestra, etc.)
Activities outside of school (sports, church, youth groups, music lessons, etc.)
Job and/or child care/family responsibilities (typical week)

Time Commitments: hours/week.

How often are you stressed because of your schedule?


Accomplishments

Please tell me anything you're particularly proud of and would like me to know.

Concerns

Please tell me what you're most worried/concerned about when you take physics.

Accommodations

Are there any accommodations (such as extra time, help with organizing, etc.) that you feel you need in order to be successful? Please list everything that you think you need, regardless of whether or not you have an IEP or section 504 plan.

Anything else a teacher should know?

Please describe anything else you think I should know in order to help you be successful.

The fields that have a green asterisk (*) are required. If you leave any of these blank, you will get an error message when you try to submit the page.

If you get an error message, use your browser's Back button, find and fill in the missing information, and resubmit.

Note that if you are using Internet Explorer, the browser is usually set to "Show friendly HTTP error messages." This means that instead of the helpful error message that actually tells you which field you left out, you will get Internet Explorer's useless generic "The page could not be found" error. If this happens, your "Back" button will still do the right thing.



 

 


URI of this page: http://www.mrbigler.com/documents/info-form.shtml
Last updated: 8 Sep 2017 by Mr. Bigler
Date of access (today's date): 23 Nov 2017

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