Last name	First name	class period

	[please circle one of the answers to each question]
Do you have easy access to a computer, outside of school?	Yes	no
Do you have easy access to the Internet, outside of school?	Yes	no
Do you or your family have an email address? 	Yes	no
	If yes, then your email address is:		
	your family email address is:		
Your family telephone numbers:		
					
What plans do you have for after high school?

As far as school goes, what do you consider your strength?