1. About Me
Your name, where you live, and how to reach you.
The name people call you at school.
Just one letter. Leave it empty if you do not have one.
Your family name.
Write it like 04/15/2008.
The street you live on, with the number.
Only if you live in an apartment.
You can write MA or Massachusetts.
Five numbers.
The number where someone can reach you.
Your own email address.
2. My School
Where you go to school and who helps you there.
The name of your school.
Like 10th grade.
Your main teacher's name.
The room number where your class is.
The adult who checks in with you at school.
3. Emergency Contact
The first person we call if you need help.
Who should we call in an emergency?
Like mother, father, aunt, grandparent.
The best number to reach them.
Only if you know it. You can leave this empty.
4. Second Emergency Contact
Someone else we can call if the first person is not there.
Who should we call in an emergency?
Like mother, father, aunt, grandparent.
The best number to reach them.
Only if you know it. You can leave this empty.
5. Sign It
A form is not finished until you sign and date it.
Write your full name here, the way you sign it.
Today's date, like 07/28/2026.
6. Read It Over
This is what your teacher will get. You can read it, or have it read to you.
7. Check It and Send It
Check your form, then send it to your teacher.
Gmail will open in a new tab with your form already written and addressed to your teacher. Read it one more time, then press Send. Nothing you type is saved on this page — when you close it, it is gone.
Not using Gmail?
Open it in my mail app instead
✓ Copied. You can paste it anywhere.