Student Interest Survey             Name _______________________

Please answer these questions to the best of your ability.   You may skip answers you find to be uncomfortable.

1.  What is your favorite book from childhood? ___________________________________

__________________________________________________________________________

2.  What is the farthest point you've traveled away from home? _____________________

__________________________________________________________________________

3.  What is a recent movie you enjoyed, and what did you like about it? ______________

__________________________________________________________________________

4.  What is your favorite place to be and why? ___________________________________

__________________________________________________________________________

__________________________________________________________________________

5.  What is your favorite food? ________________________________________________

__________________________________________________________________________

6.  What is your favorite kind of music? _________________________________________

7.  What is your favorite sport? _______________________________________________

8.  To what organizations / teams / clubs do you belong? __________________________

__________________________________________________________________________

9.  Name someone you admire and tell why. _____________________________________

__________________________________________________________________________

10.  What are two common activities you do after getting home from school. __________

__________________________________________________________________________

11.  What is a responsibility you have? _________________________________________

__________________________________________________________________________

12.  What wish do you have for someone else? ___________________________________

__________________________________________________________________________

13.  What do you want to do for a career? _______________________________________

__________________________________________________________________________

14.  What is something about which you daydream? ______________________________

__________________________________________________________________________

15.  What is something about which you are curious? _____________________________

__________________________________________________________________________

16.  What would the title of a book about your life be? ____________________________

__________________________________________________________________________

17.  If you could go back two years ago, what advice would you give yourself? _________

__________________________________________________________________________

__________________________________________________________________________

18.  Describe yourself as a friend. ______________________________________________

__________________________________________________________________________

__________________________________________________________________________

19. Describe your best friend. _________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Student Information Sheet

This survey is based on information from Day One And Beyond, by Rick Wormeli.