1. Please create your personal code in the space below by entering the first letter of your first name plus the first letter of your last name plus the first letter of the month you were born plus the date. For example if my name is Dwayne Johnson and my birthday is September 12 my code would be DJS12 
2. Please type today's date in the space below. 
3. This Boys and Girls Club is located at 
4. Race / ethnicity
5. What grade are you currently attending?
6. Gender  
7. I use a computer at home:
8. I use a computer at school: 
9. How long have you been a member of this Boys and Girls club?
10. I usually attend the Boys and Girls club:
11. My favorite things to do at the Boys and Girls club are: 
12. I concentrate hard in mathematics
13. I try to answer questions the teacher asks.
14. If I make mistakes, I work until I have corrected them.
15. If I can't do a problem, I keep trying different ideas.
16. I am good at using computers.
17. I am good at using things like VCR's, DVD's, MP3's and cell phones. 
18. I can fix a lot of computer problems.
19. I can master any computer program needed for school.
20. I have a mathematical mind.
21. I can get good results in mathematics.
22. I know I can handle difficulties in mathematics.
23. I am confident with mathematics.
24. I am interested to learn new things in mathematics.
25. In  mathematics you get rewards for your effort.
26. Learning mathematics is enjoyable.
27. I get a sense of satisfaction when I solve mathematics problems.
28. I like using computers for mathematics.
29. Using computers in mathematics is worth the extra effort.
30. Mathematics is more interesting when using computers.
31. Computers help me learn mathematics better.
32.  My favorite subjects in school are:
33. My least favorite subject in school is:
34. The name of my school is
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