ZQuest Learner Survey
2012-2013
Child’s Name __________________________________________ Birth Date: ________________________________
Parent/Guardian Name(1) __________________________ Parent/Guardian Name(2)_______________________
School and Grade Attended in 2011-12 School Year: __________________________________________________
Dear Parent/Guardian,
It is important for us to have a basic understanding of your child so that we can do our best to personalize
and individualize his/her learning experience. To help us get to know your child, please fill out this
questionnaire and return it with your enrollment form. Thank you!
Please list some of your child’s hobbies/interests:
___________________________________
___________________________________
___________________________________
___________________________________
Which academic area is your child most interested in:
____________________________________________________________________________________
Does your child have any behavioral challenges?
YES
NO
If YES, Explain: ___________________________________________________________________________________
Write one sentence decribing what goal(s) you have for your child’s future:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
How would you and your family like to get involved in Z Quest community?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Would you be interested in online learning opportunites for your child?
YES
NO
Explain: __________________________________________________________________________________________
Is there anything else that you would like us to know about your child? _________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
To be filled out by student (Grades 4 – 8):
Group 1
____ 1. I like to read when I have free time.
____ 2. I like to read a report rather than be told what’s in it.
____ 3. I understand something best when I read it.
____ 4. I remember what I read better than I remember what I hear.
____ 5. I would rather read a newspaper than watch the news on TV.
_______ Total number of check marks in Group 1
Group 2
____ 1. I take notes when I read to better understand the material.
____ 2. I take lecture notes to help me remember the material.
____ 3. I like to recopy my lecture notes as a way of better understanding the material.
____ 4. I make fewer mistakes when I write than when I speak.
____ 5. I find the best way to keep track of my schedule is to write it down.
_______ Total number of check marks in Group 2
Group 3
____ 1. I like to listen to people discuss things.
____ 2. I learn more when I watch the news than when I read about it.
____ 3. I usually remember what I hear.
____ 4. I would rather watch a TV show or movie based on a book than read the book itself.
____ 5. I learn better by listening to a lecture than by taking notes from a textbook.
_______ Total number of check marks in Group 3
Group 4
____ 1. I remember things better when I say them out loud.
____ 2. I talk to myself when I try to solve problems.
____ 3. I communicate better on the telephone than I do in writing.
____ 4. I learn best when I study with other people.
____ 5. I understand material better when I read it out loud.
_______ Total number of check marks in Group 4
Group 5
____ 1. I can “see” words in my mind’s eye when I need to spell them.
____ 2. I picture what I read.
____ 3. I can remember something by “seeing” it in my mind.
____ 4. I remember what the pages look like in books I’ve read.
____ 5. I remember people’s faces better than I remember their names.
_______ Total number of check marks in Group 5
Group 6
____ 1. I like to make models of things.
____ 2. I would rather do experiments than read about them.
____ 3. I learn better by handling objects.
____ 4. I find it hard to sit still when I study.
____ 5. I pace and move around a lot when I’m trying to think through a problem.
_______ Total number of check marks in Group 6
To be fill out by parent (Grades K-3):
What is your child’s favorite subject to learn in school? (check all that apply)
Reading/Literature
Writing
Science
Art
Geography
History
Music
Math
Physical Education
Technology
Language (Spanish)
What does your child enjoy most about school? What does your child enjoy least about school?
__________________________________________________________________________________________________
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What does your child like to do in their free time? ____________________________________________________
__________________________________________________________________________________________________
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How much time does your child spend watching TV each week? _________ playing video games?________
How much time does your child spend on the computer each week? ________
What does your child like doing on the computer? _____________________________________________
What should a teacher know about your child that will help him/her learn best in school?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
My child is a self starter.
YES
NO
My child is intellectually curious.
YES
NO
My child is academically motivated.
YES
NO
My child manages time well.
YES
NO
My child has good organizational skills.
YES
NO
My child works well independently.
YES
NO
My child works well in groups.
YES
NO