Student's Name *
Student's Name
Date of Birth *
Date of Birth
Student's Address *
Student's Address
Student's Phone *
Student's Phone
Do you use social networking sites? If so, which ones? *
Check all that apply.
1 being "I prefer to smile and nod, but prefer to avoid social gatherings 10 being "I can talk to anybody, anywhere, anytime and am the life of the party!"
Include hobbies, interests, community involvement, or just places you enjoy in your free time.