Personal Information Sheet

                                     

                                       Personal Information Form

 STATUS – PROFESSION        Firefighter        Administrator        Engineer  Policeman    singer    Coach        Staff        Studen   Teacher      

SECTION 1

Name__________________________________________________Nickname_____________________________                                         (Last, First, Middle Initial)                                                                                 Age   _________        Home phone_______________________________            Cell phone __________________ Fax:                                                                                                Address                                                                                            City______________________________                 Mailing Address (E – mail)  ________________________________            Fotolog _______________________ Class you belong to ___________________   (+ )Likes: _____________________                                                   (-)Dislikes: _________________________                                                                                                          Future profession ______________________               Favourite computer program  ___________________ Favourite singers/bands ____________________      Favourite TV program _________________  Mother’s name ____________________ Profession ________________________ Father’s name _____________________Profession ________________________ How many bothers or sisters have you got? __________________________ Best friend’s name ________________________ Allergies ______________________________   Do you have a Pc at home?       Yes             No Do you belong to the “Dual” system?     Yes          No

EMERGENCY CONTACT INFORMATION –  Person we’d call   In case of an accident  Contact Name__________________________________________________      Relationship____________________________ (brother, mother, sister, uncle, grandfather)                            Contact Address_______________________________                                      City__________________    Phone Number_______________________

 

SECTION 2

DEMOGRAPHIC INFORMATION   Birth Date _____/_____/_____           Ethnic Background:                                                                      Sex:                 Month    Day     Year                   White        Asian or Pacific Islander                                    Male (M)                                                                 Black        American Indian or Alaskan Native                  Female (F)                                                                 Hispanic       Chilean citizen                            Marital Status                                    Yes                                            Married     Divorced  Legally Separated  Widowed                               No                                         Single             with a girlfriend         with a boyfriend

      I acknowledge the information provided is correct: _________________________________ /____/____/____/                                                                                                         Student Signature                                      Date  

At the back of the page you should write a paragraph including, background information, family, things would like to

do in the English class, English class expectation, common things you used to do in your English classes last year.