CEP, Summer A

What are your needs?

Please answer the following questions. This questionnaire is for the teacher to get to know you and your specific
needs in improving your English
Name:
Personal Information
1.

Where are you from?

2.

What is your first (native) language?

3.

Do you speak any other languages besides English?

4.

How long have you been living in the U.S.? How long do you plan to stay?

Background Information
1. How many years have you studied English (formally/informally)? Where have you studied?

2. Which language skills do you feel most comfortable with (listening, reading, writing, speaking)?

3. Which skills would you like to improve the most? (listening, reading, writing, speaking, grammar,
vocabulary, pronunciation)

4. What do you usually read in English (newspaper, internet, books, etc)?

5. Outside of class, do you write and speak English, and where?

6. Why do you want to study English? What are you goals? What are your English needs (English for
travel, telephoning, giving Presentations, e-mailing, daily English conversation)?

CEP, Summer A

7. Is there anything else you would like me to know about your language learning experience? (What do you
like about learning English? What dont you like about learning English?)

How important is it to you to focus on the following

Listening

Speaking

Writing

Reading

Grammar

Vocabulary

Pronunciation

Write a short paragraph to tell me more about you.

CEP, Summer A