ABOUT YOU!!

1.

My name:

2.

My address (including zip code):

3.

My parent/caregivers name(s):

4.

My parent/caregivers home phone number:

5.

My parent/caregivers cell phone number:

6.

My parent/caregivers work phone number

11.
is:

The person I would most like to meet (dead or alive)

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because
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7.

My greatest talent is:

8.

My cultural and/or ethnic background is

9.

Language(s) other than English that I speak:

10.

My goal for this year is:

13. If I could have the answer to any question in the

world, that question would be
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14. Are there any special needs or concerns we should

know about?

12. An issue I feel strongly about is:

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_________________________________________________________________________________

_________________________________________________________________________________

because
_________________________________________________________________________________

15. Please write down anything else you would like us to

know about you.

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