Eton Academy Tutor Pros
Student Questionnaire Grades 6-9
STUDENT INFORMATION
Student's First Name
Last Name
Address
City
State
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
Age
Student's Gender
Male
Female
Current Grade
Current School
My favorite subjects are: (Check as many as you like)
English/Literature
Composition
Social Studies
History
Science
Computer
Geometry
Algebra
Calculus
Art
Music
Physical Ed/Sports
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Please Rate Yourself in the following areas:
(1 - Weakness 10 - Strength)
Mathematics
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
Reading
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
Literature
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
Writing/Composition
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
Social Studies/History
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
Science
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
Computers
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
Art
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
Music
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
Physical Ed/Sports
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
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Organization
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
Test Taking
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
Note taking
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
Asking for help
Please Select
1
2
3
4
5
6
7
8
9
10
Comments
In my most challenging classes, the teacher: (Check as many as you would like)
Helps me
Goes too fast
Doesn't explain the material well
Never answers my questions
Is confusing
Doesn't know that I'm struggling
Other
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Study Habits
How much time do you spend on homework?
Please Select
Less than 15 minutes per day
15-30 minutes per day
30-60 minutes per day
More than 60 minutes per day
How often do you take breaks while completing homework?
Please Select
Every 5 minutes
Every 10 minutes
Every 20 minutes
Every 30 minutes
Every 60 minutes
Doesn't take breaks
Where are you most comfortable doing your homework?
Please Select
Library
Bedroom
Den area or study area at home
Kitchen table
Friend's house
School
Other (please specify)
When do you do your homework?
Please Select
Right after school
Early evening
Late at night
At school
Other (please specify)
When doing your homework, you: (Check all that are applicable)
Listen to music with headphones
Talk on the phone
Text friends
Listen to music without headphones
Surf the Internet
Become frustrated
Daydream
Watch television
Get sleepy
Have fun
Other
Complete the following sentence
Is there any information you would like to share about yourself?
My goal is that an Eton Tutor Pro will help me by...
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