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 blue 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.

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Data About You

Fill in your First and Last names the way you actually use them.

First Name:  
* [Required]
Pronunciation:
  • Enter the name that you want me to call you in class. This can be your given name, your chosen name, a (school-appropriate) nickname, etc.
  • Please indicate how to pronounce your name if you think it would be helpful.
Last Name(s):  
* [Required]
Pronunciation:
  • Enter the last name(s) you want me to use for you. If you have more than one last name but you use only one of them, enter that name here. If you have two last names and you want me to use both, enter both.
  • Please indicate how to pronounce your name if you think it would be helpful.
If there are accented letters in any of your names that you are unable to type, please describe them here:

Which class are you in?:     * [Required]

Advisory room:      Class of: * [Required]      Student ID #:

Guidance counselor * [Required]


Personal Information

Gender:  Other (if not listed):

Pronouns: * [Required] Other (if not listed):

Is there anything I should know about using these pronouns in class, with your caretaker (parent/guardian/etc.), or anyplace else?

Date of birth: ,

Primary language: * [Required]

If you selected a language other than English above, do you speak English reasonably proficiently? yes    no


Your Contact Information

School Email: * [Required]

Personal Email:
Please double-check that you have typed your email address(es) correctly!

Preferred email address: * [Required]

Phone number: (optional)
Please enter phone numbers with no spaces, dashes or anything else, as shown. Otherwise the form will give you an error.

Address:




Caretaker (Parent/Guardian/etc.) Contact Information

You live with:* [Required]    Other (please specify):
  Name Phone Email Primary Language Speaks English?
Caretaker #1 * [Required] Other (if not listed): yes    no

Caretaker #2 Other (if not listed): yes    no


Photo Permission

I often take pictures of students taking part in experiments or activities. If I take a picture of a lab or activity that you appear in, may I include the picture (without your name) in things that might be seen by other people, such as a blog post?

yes      show me the picture and ask      no, never

Regardless of the above, if I think you might object to a particular picture, regardless of whether or not I might consider showing it to anyone else, I will either delete it or show it to you first and ask you about it.


Cold-Calling

How do you feel about being cold-called on in class? (This is when the teacher chooses you to answer a question instead of asking for a volunteer.)

* [Required]

Previous Math/Science Classes

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


Accomplishments

Please tell me something that you're particularly proud of.

Concerns

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

Accommodations

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

Family Members who Took Mr. Bigler's Physics or Chemistry Classes

If any of your relatives (brother, sister, cousin, etc.) graduated in 2012 or later and took one of my classes, please tell me their name and either when they took my class or when they graduated. (If you don't know, your best guess is fine.)

Your Superpower(s)

What superpower(s) do you have or wish you had?

What else should Mr. Bigler know?

What other things would it be good for me to 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 you get an error message, find and fill in the missing information, and resubmit.

Note that using the "back" button will not work in Microsoft Internet Explorer and Microsoft Edge, because these browsers reset the form when you go back.

Would you like to receive a copy of the email message generated by this form? yes      no
Note: This will be sent to your school email and it will work only if your email address is correct at the top of this from.



 

 


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Last updated: 7 Sep 2024 by Mr. Bigler
Date of access (today's date): 21 Dec 2024
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