1. Why I’m Here Form Media Purpose
Student Name: ____________________________ Date: _______________
Responsible teacher: _______________________ Arrival time: _________
Estimated time needed in media center: _______ Departure time: ______
Nature of Assignment: __________________________________________________________
_____________________________________________________________________________
Request help from Media Specialist? YES or NO
If yes, nature of help needed: __________________________________________________
Should this student be using the computer? YES or NO
Should this student be interacting with other students? YES or NO
Should this student be working with or without certain materials? YES or NO
If so, explain: _________________________________________________________________
Special Comments: _____________________________________________________________