* 1. What is your name?

* 2. What is your age?

* 3. What school do you attend?

* 4. What grade are you in?

* 5. What is your gender?

* 6. What is your ethnicity? (Please select all that apply.)

* 7. What are your favorite subjects in school?

* 8. What are your favorite hobbies?

* 9. List one word to best describe your personality.

* 10. What are 3 strengths you have?

* 11. Check the activity you are most interested in:

* 12. What are 3 goals you have for the future?

Thanks for your time. We hope you enjoy the upcoming STEPS class.

T