Name Telephone E-mail

School Address City Zip

Home Address City Zip

1. What year are you at the university? What is your major? Special interest within major?

2. Tell a little about yourself...your interests, hobbies. Help me to get to know you.

3. Describe your experience working with children.

4. What are some of your future professional goals?

5. What would you most like to learn in this class?

6. What (if anything) worries you about this class?

7. How can I be of greatest help to you? (Try to be specific.)

8. Anything special you would like me to know about you?