ALL ABOUT YOU FORM

First

MIDDLE

ALL ABOUT YOU

Student Statement — to be completed by the student. Please print clearly.

First

Last

ADDRESS

CITY

ZIP CODE

PHONE NUMBER

EMAIL

AGE

DATE OF BIRTH

FACEBOOK

NAME OF PARENT(S) OR GUARDIAN

ETHNIC BACKGROUND

ARE YOU ATTENDING SCHOOL? IF YES, WHAT SCHOOL?

YES

NO NO

WHAT GRADE ARE YOU IN?

WHAT IS YOUR AVERAGE GRADE? (EXAMPLE: A, B, C...)

IF NOT IN SCHOOL. PLEASE EXPLAIN.

DO YOU LIKE SCHOOL? PLEASE EXPLAIN.

YES

NO

SOMETIMES SOMETIMES

WHAT SUBJECTS DO YOU LIKE BEST?

WHAT DO YOU WANT TO DO WHEN YOU GRADUATE?

ARE YOU ENROLLED IN AFTER-SCHOOL ACTIVITIES IN YOUR AREA?

YES

NO NO

WHICH ONES?

WHAT DAYS AND TIMES DO YOU GO TO THESE ACTIVITIES?

DO YOU ENROLL IN LOCAL SUMMER PROGRAMS?

YES

NO NO

WHICH ONES? WHAT DAYS AND TIMES DO YOU GO TO THESE ACTIVITIES?

WHAT DO YOU LIKE ABOUT YOURSELF?

IF YOU COULD HAVE THREE WISHES, WHAT WOULD THEY BE?

IS THERE ANYTHING THAT YOU WOULD LIKE TO CHANGE ABOUT YOURSELF?

WHAT ARE YOUR LIKES AND DISLIKES ABOUT YOUR COMMUNITY?

ARE YOU A PERFORMING STARS' MEMBER?

YES

NO NO

ARE YOU A PERFORMING STARS' MEMBER?

YES

NO NO

IF NO, HAVE YOU EVER BEEN INVOLVED IN PERFORMING STARS ACTIVITIES? PLEASE EXPLAIN:

IF YES, WHAT TRAINING CLASSES ARE YOU INVOLVED IN?

IF YOU ARE NOT A MEMBER OF PERFORMING STARS, WHY DO YOU WANT TO JOIN?

HOW DID YOU FIND OUT ABOUT PERFORMING STARS?

IF YOU HAVE BEEN INVOLVED WITH PERFORMING STARS, WHAT DO YOU LIKE BEST ABOUT THE PROGRAM?

IF YOU COULD CHANGE ANYTHING YOU WANT ABOUT PERFORMING STARS, WHAT WOULD IT BE?

DO YOU PLAY A MUSICAL INSTRUMENT?

YES

NO NO

IF YES, WHAT INSTRUMENT(S)?

DO YOU DANCE?

YES

NO NO

IF YES, WHAT KIND OF DANCE?

DO YOU SING?

YES

NO NO

DO YOU LIKE ACTING?

YES

NO NO

DO YOU LIKE TO DRAW?

YES

NO NO

IF YOU HAD A CHOICE TO BE IN A CLASS, WHAT WOULD IT BE? FROM THE ACTIVITIES BELOW LIST YOUR FIRST, SECOND AND THIRD CHOICE OF WHAT YOU WOULD LIKE TO DO: DANCE: BALLET, TAP, MODERN, JAZZ, SPANISH, AFRICAN FOLK, HIP-HOP, OTHER MUSICAL INSTRUMENTS: PIANO, GUITAR, WIND INSTRUMENT, PERCUSSION, STRINGS, OTHER OTHER ACTIVITIES: DRILL TEAM, BATON TWIRLING, ACTING, CHOIR/CHORUS, ART/DRAWING, GYMNASTICS, PHOTOGRAPHY, OTHER

Thank you for your time and thoughts

Felecia Gaston
Executive Director, Performing Stars (11/11/18)

African American/Black	Caucasian	Hispanic	East Indian	Asian Pacific Islander
Native American Indian	African	Latino	Other

BASEBALL	FOOTBALL	SOCCER	MANZANITA CHILDREN CENTER
HANNAH PROJECT	BRIDGE THE GAP	GIRL SCOUTS	BOYS & GIRLS CLUB
OTHER

TAP	BALLET	FOLK	JAZZ
MODERN	STREET	HIP HOP