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About You
First Name  
Last Name  
Grade  Kindergarten First Grade Second Grade
Homeroom  
Birthday Month   Day   Year                          
Favorite Subject(s)

You may check more than one but, no more than 3.

 Spelling Writing Reading
Math Science Social Studies
Art Music Physical Education
Computers    
What do you like about this subject?

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My Family
Who do you live with?  Mom Dad Grandma Grandpa Aunt Uncle Other
What is your guardian's name? Mr. Ms. Miss. Mrs.
  First Name    Last Name   
Guardian's Phone #   (Do not include dashes)
Do you have siblings? brother(s) sister(s) only child
   

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Reading Survey
Do you like reading?  yes no maybe
Do you like being read to?  yes no maybe
What is your favorite story?  
Who is your favorite author?  
What do you enjoy reading?

(Check all that apply.)

 Audio Books
Fables		 Periodicals -magazines & newspapers
Ongoing chapter books		 Poetry
Picture books
Short Stories
 
What themes do you enjoy reading about?

(Check all that apply.)

 About the 
    world 
Adventure
Animals
Fantasy
 		 Learning something new
Other Kids My Age
Realistic Fiction
Space
Sports

 

 Super Heroes
Vacations
What I want to be
    when I grow up
What type of story (genre) do you enjoy reading?

(You may select up to three.)

 Autobiography Biography
Fairly Tales
Fantasy
 		 Fiction
Folk Tales
Historical Fiction
Myths
Non-Fiction
           		Poetry
Realistic Fiction
Science Fiction
Tall Tales

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