Asset-Based Questionnaire - Student Enrollment◻ Newcomer◻ Transferring Schools◻FromMiddle School◻ Returning to NYC

Student information
Student Name: ________________________________
OSIS __________________

Home country _____________________

Date of birth: _______________ Age: ______ Intake date: ____/____/2023

Languages Spoken at Home ________________________ Medical Needs:

YESNO (if Yes complete medical information)

Purpose/ Utility:
The purpose of this questionnaire is to help us determine a student’s strength and better predict what academic or socio emotional supports the student willneed. This questionnaire helps identify:● The students’ educational background as well as their feelings towards school, themselves and their community.
● Understanding the student and their background allows the educators to actively engage students.
● The interview is ideally conducted by a counselor who will share pertinent information with the teacher team but maintain the appropriate measures ofconfidentiality for the student and family.
● While the questions should be mainly answered by the student, it is encouraged to have the family member present so that they can fill in any gaps ofinformation that the student may not be able to answer.
Tell Me Who You Are as a PERSON:

Suggested Questions● Write one word that describes you as a person. Why do you describe yourself thisway?
● If you really knew who I am you would know that I……..
● If you could have lunch with a famous person, who would it be? Why?
● What school activities would you like to participate in?

● How was your life different now compared to when you were in your home country?
● Tell us about your experiences going from Middle School to High School?
● Tell us about any work experience. (Paid jobs, helping out at home, or volunteering)● If you were to win a million dollars today, what would you do with the money?

Tell Me Who You Are as a STUDENT:

Suggested Questions:❖ What subject is the best? Why is it the best?
❖ What is your most difficult subject? Why is it difficult?
❖ What do you think you need to be successful in a NYC High School?
❖ Was there a time in your life that you had to miss school for an extended period oftime (except for March 2020-2021)? If yes, why did this happen and how did thisaffect you?
❖ How familiar are you with Technology? What is your favorite social media platform?
Why?

Indicate how each statement best describes you.
Aspects
I care about doing well in school

Mostly True

Sometimes True

Not True

I try my best in school each day.

Mostly True

Sometimes True

Not True

I do my homework.

Mostly True

Sometimes True

Not True

I understand things by reading them.

Mostly True

Sometimes True

Not TrueI get along well with my teachers.

Mostly True

Sometimes True

Not True

I take good notes in class.

Mostly True

Sometimes True

Not True

I am good at taking tests.

Mostly True

Sometimes True

Not True

I am good at giving presentations.

Mostly True

Sometimes True

Not True

I am happy with my grades

Mostly True

Sometimes True

Not True

I enjoy working in groups

Mostly True

Sometimes True

Not True

Tell Me Who You Are as a FAMILY MEMBER:

Questions (*optional)➢ Do you have siblings? If so, how many? Are you the oldest? Middle ? Youngest? Onlychild?
➢ Before you came here, who did you live with? ( This may be a question we need to dig forSEL) Ie: How was your relationship with your parents or guardian ?
➢ Are you still living with them? If not,how does it feel to no longer be living with them?
Who are you living with now? Name all the people in the household. How are they
related to you?
➢ What are the best parts of your new living situation? What are some things you’d like tochange?
➢ Who do you wish you could get along better with?
➢Home Country / Educational Background*If you could cook a meal for your family what would you make them?

Questions➢ How was school for you in your Home Country? Is it the same or different from school inNYC? Or Do you think it will be the same or different from your former school? Explainin detail.
➢ What was the schedule of your school day ? Tell me about it from the minute you got
there until you left.
➢ When did you arrive in the United States? What have you been doing since youarrived?

➢ What was a topic in school that you really enjoyed? Was there something inschool that you struggled with? Why do you think this class was difficult? Haveyou ever received additional support for academics?
➢ What language were your classes taught in?
➢ Have you ever studied English in your Home Country? What grades did you
study in English? How many years were you studying English for? How many
hours per week?
➢ How do you feel about school? Is it something you enjoyed or wanted to avoid?
Explain in detail.
➢ If school was something you avoided, can you explain why?
If YES which◻ NO➢ Did you repeat any grades? ◻ YES➢ Was there ever a time you had to miss school?
❏ If yes, for how long? Tell us about it.
❏ Why did you stop attending? Give as much information as possible.

Other Comments (i.e. medical, trauma, IEPs)