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Use this questionnaire by cutting and pasting it into your own document  Then, you can modify it to meet your own particular needs and the maturity level of the students you are interviewing.

Name _________________________________________   School _______________________________

Nickname _____________________________________    Birthday ______________________________

What people have influenced you most? Why? _______________________________________________

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What teachers have influenced you most? Why?______________________________________________

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What advice would you give to other students? _______________________________________________

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List your favorites:

Favorite book __________________________________________________________________________

Favorite music _________________________________________________________________________

Favorite movie _________________________________________________________________________

Favorite television program _______________________________________________________________