The person appears to be a/an Middle Eastern Male, approximately 10 to 19 years old.
Sure! Here’s a simple survey template you can use: 

1. How would you rate your understanding of the topic discussed in class? (1 = Poor, 5 = Excellent)
2. What aspects of the topic did you find most interesting?
3. Do you think we should explore this topic further? (Yes/No)
4. Any additional comments or suggestions?

Feel free to modify the questions to better fit your needs!
To create an effective survey, consider including questions that assess satisfaction, usability, and overall experience. Here’s a sample question you can use: 'On a scale of 1 to 5, how satisfied are you with the product/service? 1 = Very Unsatisfied, 2 = Unsatisfied, 3 = Neutral, 4 = Satisfied, 5 = Very Satisfied.' Additionally, you might want to include open-ended questions to gather more detailed feedback.