One Inch Graph Paper Template Page 21
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38STUDENT CENSUS
Name______________________________________________________
First
Middle
Last
Date of Birth__________________________ Age___________________
month
day
year
What country were you born in ? ________________________
________________________________________
Address
Street
___________________________________________________________
City
State
Zip Code
Telephone Number___________________________
Number of people who live at this address ___________
Number of brothers __________ Number of sisters ______________
Hair color _________________ Eye color___________________
Check one:
right-handed
left-handed
Circle the grades attended at this school
K
1
2
3
How do you usually come to school? (Check one)
car
bus
walk
bicycle
other__________
Circle your favorite subject. reading math science social studies
What is your favorite activity? (Check one)
playing
watching TV
reading
other________
Classroom Strategies Blackline Master
IV - 1
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