Questionnaire Checklist – Survey Form 8. Are you a full time or part time student?

Yes No

9. How long have you studied English for? __________

Name (Optional): _________________________________ 10. When did you first start learning English?

Age: __________________ Sex: Male Female Primary School Secondary School

College Others, specify: ____________

SA A D SD
PART I 11. Did you stop studying English? If yes, why and how 4 3 2 1
1. Do you feel quite sure of yourself
1. When did you start learning English? long? when speaking in the English class?
2. Don’t you worry about making
Elementary High School Yes. _________________ No
mistakes in the English class?
College Others, specify: ______________ 12. How old were you when you took English again? 3. Do you tremble when you know
that you are going to be called on in
2. Do you like English lessons? ______________________________________________ the English class?
4. Is it frightening when you don't
Yes No Sometimes 13. Have you ever visited an English-speaking country? understand what the teacher is
saying in the English class.
3. Do you study English after class? Yes No
5. Does it bother you to take more
Yes No Sometimes 14. Where did you go and for how long? English classes?
6. During English class, do you find
4. How often do you speak English in your daily life? ______________________________________________ yourself thinking about things that
have nothing to do with the course?
1-2 hours a day 5-6 hours a day 15. Why are you taking English? 7. Do you keep thinking that the
other students are better at
3-4 hours a day More than 6 hours a day University Requirement Interest in Languages languages than you?
8. Are you usually at ease during tests
4-5 hours a day Almost never Others, specify: ______________________________
in English classes?
5. Parents’/Guardian’s Highest Educational Attainment? PART II 9. Do you panic when I you have to
speak without preparation in the
Elementary High School The following statements concern the situations of foreign English class?
language speaking anxiety. There is no right or wrong 10. Are you worried about the
College Others, specify: ______________ answers. Rate how many these statements reflect how consequences of failing the English
you feel or think personally. Select the choice class?
6. Do you have any relatives who speaks English in corresponding to the degree of your agreement or
disagreement.
your family? If yes, specify your answer
LEGEND:
Yes. ____________ No
4 = Strongly Agree 2 = Disagree
7. Do you talk to them in English?
3 = Agree 1 = Strongly Disagree
Yes No

SA
4 3
11. Can you understand why some
people get so upset over foreign
language classes?
12. In English class, Do you get so
nervous when you forget things you
know?
13. It is embarrassing to volunteer
answering questions in English?
14. Wouldn’t you feel nervous
speaking English with native
speakers?
15. Do you get upset when you don't
understand what the teacher is
correcting?
16. Do you feel anxious even if I you
are well prepared for the English
class?
17. Do you often feel like not going
to your English class?
18. Are you afraid that your
language teacher is ready to correct
every mistake you make?
19. Are you confident when you
speak in English class?
20. Can you feel your heart
pounding when you are going to be
called on in class?
SA A D SD
4 3 2 1
21. The more I study for an English test,
the more confused I get.
A D SD 22. Don’t you feel nervous to prepare
2 1 very well for the English class?
23. Do you always feel that the other
students speak English better than you
do?
24. Are you conscious about speaking
English in front of other students?
25. Are you worried about getting behind
when language class moves so quickly?
26. Do you feel more tense and nervous
in your English class than in any other
class?
27. Do you get nervous when you are
speaking in your English class?
28. When you are on your way to English
class, do you feel very sure and relaxed?
29. Do you get nervous when you don't
understand every word of the language
teacher?
30. Are you overwhelmed by the number
of rules one has to learn to speak
English?
31. Are you afraid that the other
students will laugh at you when you
speak English?
32. Would you probably feel
comfortable around native speakers of
English?
33. Do you get nervous when the
instructor asks questions that you haven't
prepared?