* 1. Your name:

* 2. Is it easy for you to get work done when you're by yourself?

* 3. When you do your assignments, how often are they done well?

* 4. How often is the stuff you're working on interesting to you?

* 5. How often are you writing in your planner?

* 6. How often are you distracted while working?

* 7. How often are you motivated while doing schoolwork?

* 8. How often do you have what you need (pencil, textbook, log-in information, etc.) to get your work done when you're in class and at home?

* 9. You can let us know if there is anything else we should know that may help.

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