Student Questionnaire
  Contact Information
     
Name (*)  
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Age  
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Year in School  
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School Address  
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Address  
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Email (*)  
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Phone  
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Birthday  
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Place of Birth  
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Major/Area of Study  
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Family Profile
Family members (include pets too)

Name   Age

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Class Schedule/Availability

What days in general do you have open? (*)








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Information About You

What interests you about the POTF Program?

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What, if any, are your expectations?

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What do you do for fun? Any interests or hobbies?

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What are your pet peeves/things that make you uncomfortable?

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What would make it difficult for you to relate to your family?

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Do you have transportation?

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Please include a brief paragraph about your religious/spiritual beliefs.

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