PERSONAL INFORMATION

Name: _______________________________________

How / when do you use English in your job, home, and among friends? (please tick the frequency
for each)

Never Once/year Once/6 months Once/month Once/week Every Day

Email Nhfgh Hd Bjfg
Phone
Social
networking
Meetings
Presentations
Other

Why do you want to learn English? (please circle all that apply)

Work Travel Friends/ Family / Partner Film/TV/Music Internet/Gaming

Areas to focus on ___________________________________________________________________

How would you rate your ability in English for the following skills? (1 being poor, 5 being excellent)

Reading 1 2 3 4 5

Writing 1 2 3 4 5

Speaking 1 2 3 4 5

Listening 1 2 3 4 5

Which areas of English do you find most difficult?

Reading Writing Speaking Listening Grammar

Pronunciation

Which do you prefer?

To speak slowly and very accurately ___ To speak more quickly but making quite a few mistakes ___

What are your hobbies and interests? __________________________________________________

_________________________________________________________________________________

Who was your favourite teacher (for any subject at any time) and why? ______________________

__________________________________________________________________________________

Please write 3 goals you have for the future:

__________________________________________________________________________________
__________________________________________________________________________________

__________________________________________________________________________________

Do you want homework? Yes No

Thank you for your time!