Student Information Form



Student Information

Please fill out all of the following data and click the "Submit" button when you are finished. Fields marked with a blue asterisk (*) are required.

Note that javascript must be enabled in your browser.

Data About You

First name: *      Last name: *

What name do you want me to call you in class?

Alias (code name) for posted grades:
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. (Don't stress about what to pick--you can change it any time you want by just telling me.)

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:      Cell phone: (optional)      Email:


Parent/Guardian Contact Information

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

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

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

Photo Permission

If I take a picture of a lab or activity that includes you, may I use the picture (without your name) in a post on my blog (

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?


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


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


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 blue asterisk (*) are required. If you leave any of these blank, you will get an error message when you try to submit the page. If this happens, use your Back button and fill in the field with the error.



URI of this page:
Last updated: 22 Dec 2016 by Mr. Bigler
Date of access (today's date): 27 Jul 2017

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