S P E E C H H I S T O R Y
Instructions: This form contains an analysis of needs in communication so that you can begin aneffective speech communication program this semester. Complete the form by answering all thequestions honestly.Student’s Name ______________________________________Date ____________________________ Year _____________Section __________________________ I.
What is your father’s first language?__________________________________________ Your mother’s? ____________________In what province were you reared? _______________________ _______________ What languages or dialects have you been exposed to? _________________________ II.
What English subjects have you taken up? _____________________________________ Write only those which you passed. ________________________________________________________ _____________________________________________________________________________________ Have you had private lessons in speech? ____________________________________________________ III.
Have you made reports in other classes before you enrolled in thisclass? _______________________________________________________________________________ How many times have you spoken before an audience? ________________________________________ Have you participated in speech contests? ___________________________________________________ In debating? _______________ Have you ever been a salesman, a leader, an officer in an organization, or a person engaged in meeting and influencing people? (Specify) __________________________________ _______________________________ In what situations do you speak best?_______________________ _____________________________________________________________________________________ In which most poorly? __________________________________________________________________ Do you wish to participate in the school’s extracurricular speech activities? ________________________ IV.
Have you participated in oral reading contests? (Specify) ______________ _____________________________________________________________________________________ Have you participated in other activities as a reader? __________________________________________ Do you wish to participate in oral reading recitals? ____________________________________________ Have you taken part in stage presentations? (Specify) _________________________________________ _____________________________________________________________________________________ Do you wish to participate in dramatics? ____________________________________________________ V.
Do you stutter? _____________ Do you lisp? ______________ Have you ever had adeformity of mouth, nose, or throat that interfered with your speech? (Specify) _____________________ _____________________________________________________________________________________ Do you often have to repeat to get people to understand you? __________ Underline any of the followingsounds with which you have difficulty: p, b, m, wh, w, f, v, th (soft), th (hard), t, d, n, s, z, sh, zh, ch, j, l ,r, k, g, ng, y. Has any teacher helped you with these sounds?_______ Does your voice carry well?______ Do you think you have a weak voice? ________ Do you think the pitch of your voice is too high, too low,or just right? (Specify) ________ Are you able to control or change your voice at will? _______________