This is an interest inventory that leads the way to differentiation. Students are asked several questions that can be used to differentiate by resource and by product.
I use this inventory to group students in my science class to learn about lab safety during the first week of school. I have an article, a video, discussion questions, search topics, and a small experiment all set up, and place students in the appropriate station based on their response to the survey.
I like to have students complete this inventory at the start of every quarter. Sometimes on the back I will have them write a short journal and then give them all back on the last day of school so they can see how their answers change.