PERSONAL DATA FORM

Today’s Date: _______________

Name: _____________________________________________________________

Last First Middle Initial

School: ____________________________________________________________

Home Address:

___________________________________________________________________

Number Street Apartment Number

___________________________________________________________________

City or Town State Postal Code

Telephone: _________________ ________________

Home Cell

For emergencies, call: _______________________ ________________

Name Telephone Number

Birth Date: ____________________ Age: _______________

Month/Day/Year

Signature of Student: ________________________________________

The student completed this form: (Circle one)

Alone With assistance

Signature of person helping student provide information: ___________________

ASSESSMENT SURVEY

1. In your language, are reading and writing easy or difficult for you? ______________

2. How did you learn to read and write? (Circle one.) school family tutor

3. Years of education: (Circle last year completed.) 5 6 7 8 9 10 11 12 13 14 15 16

(elementary) (secondary) (university)

4. Other education: _______________________________________________________

5. Other languages you speak: ______________________________________________

6. Other languages you read or write: ________________________________________

7. What type of materials do you like to read in your language? ___________________

8. What do you write in your language? (Circle one.)

letters stories lists notes other

9. Have you studied English before? __________ Where? _______________________

10. How long have you studied English? ______________________________________

11. Describe your ability in English: (Circle the best description.)

Understanding is . . . always difficult sometimes difficult never difficult

Speaking is . . . always difficult sometimes difficult never difficult

Reading is . . . always difficult sometimes difficult never difficult

Writing is . . . always difficult sometimes difficult never difficult

12. Why do you want to learn English? ________________________________________

13. What is the most important thing you want to learn? __________________________

________________________________________________________________________

14. Do you have any questions about this program? ______________________________

________________________________________________________________________

The student completed this form: (Circle one.) Alone With assistance

Signature of person helping student provide information: ___________________

Name: _____________________________________________ Date: ______________

PLACEMENT TEST

Directions: Circle the correct letter.

1. These are your books, _____ they? 4. A lot of rice is grown in Asia.

a. isn’t The sentence is mostly about _____.

b. aren’t a. why people grow rice

c. weren’t b. how people grow rice

2. I told the teacher _____ I had seen. c. where people grow rice

a. what 5. I asked a woman when I could catch the

Broadway bus. She said, “The Broadway bus
b. which
arrives at six o’clock.”
c. where
The Broadway bus_____.
3. We talked about _____ new words.
a. will arrive in the future
a. learn
b. has already arrived
b. learned
c. won't be arriving
c. learning
6. I would travel to Hawaii if I _____ a lot of 13. “Do you think it will rain?”
money in the lottery.
The speaker wants to know about _____.
a. get
a. the weather now
b. won
b. the weather in the past
c. will
c. the weather in the future
7. This is the dress _____ my grandmother
14. She doesn’t want _____ coffee.
made.
a. any
a. whom
b. some
b. where
c. many
c. which
Name:
8. “Carl would rather not go to the party.”
_____________________________________
The speaker means _____. ________ Date: ______________

a. Carl really wants to go. 15. “Stephanie will regret her decision sooner
or later.”
b. Carl doesn’t want to go.
The speaker means Stephanie _____.
c. Carl wishes he could go.
a. might make a decision soon.
9. Sara _____ to Los Angeles in 2005.
b. could be happier later.
a. moved
c. is definitely going to be sorry.
b. moving
16. All of the food _____ on the table.
c. has moved
a. is
10. If I have enough time, I _____ help you
with your homework. b. am

a. am c. are

b. will 17. “We ran out of milk.”

c. would The speaker means we have _____.

11. Right now, it _____. a. no milk

a. rain b. some milk

b. rains c. a lot of milk

c. is raining 18. Robert _____ his keys in the living room.

12. This pen is _____ same as that one. a. find

a. as b. found

b. not c. founded

c. the
19. Don and Nancy _____ the house a. The family sat down.
yesterday.
b. Everyone ate.
a. cleaned
c. Larry arrived.
b. cleaning
26. The laundry was _____ by my sister.
c. cleaner
a. do
20. Leah said, “I’m bored with this book. Let’s
b. done
watch TV.”
c. doing
Why did Leah want to watch TV?
27. I won’t play basketball with Pete because
a. The TV wasn’t interesting.
he never _____ the rules.
b. Leah wasn’t interesting.
a. attends
c. The book wasn’t interesting.
b. follows
21. We _____ to have a test next Friday.
c. targets
a. are going
28. The teacher is writing the answers on the
b. may going board.

c. will going The sentence is about _____.

22. “You lost the tennis match, didn’t you?” a. the past

The speaker thinks you _____. b. the present

a. didn’t lose the match c. the future

b. probably lost the match Name:

_____________________________________
c. will most likely lose the match
________ Date: ______________
23. Dave and Chris _____ very early tomorrow
29. Greg is taller than Samuel.
morning.
Which sentence could be true?
a. will leaving
a. Greg is 181 cm tall, and Samuel is 176 cm
b. are leaving
tall.
c. have left
b. Greg is 176 cm tall, and Samuel is 181 cm
24. _____ a new language is never easy. tall.

a. Learn c. Greg is 181 cm tall, and Samuel is 181 cm

tall.
b. Learned
30. Hana got 89% on the test. John got 96%
c. Learning on the test. Rita got 78% on the test.
25. When Larry arrived, the family sat down to John got _____ score on the test.
eat.
a. the higher
Which event happened first?
b. the highest
c. the most high a. Who

31. Before you travel by train, you need to b. What

buy a _____.
c. Where
a. travel agent
38. Bill’s class, which meets at 11:00, has 28
b. reservation students in it.

c. ticket Bill has _____.

32. A _____ is a kind of vegetable. a. one class

a. strawberry b. at least two classes

b. wheat c. three or more classes

c. carrot 39. Patty and Lou went to India.

33. “The airplane is crowded.” The sentence means _____.

The speaker means the airplane is _____. a. Only Patty went.

a. quite new b. They both went.

b. too full c. Lou went alone.

c. very late 40. What time _____ the class begin?

34. People usually touch something with their a. does

_____.
b. was
a. eyes
c. is
b. noses
41. The children _____ in the classroom.
c. fingers
a. is
35. Melanie said to Grace, “The blue
b. am
dictionary is mine.”
c. are
Melanie means the dictionary belongs to
_____. 42. “The situation has really gotten out of
hand.”
a. Melanie
The speaker means the situation is _____.
b. Grace
a. not easy to understand
c. Melanie and Grace
b. not under control
36. There _____ two lamps in the bedroom.
c. not beneficial
a. is
43. My father enjoys _____ golf.
b. are
a. plays
c. was
b. playing
37. _____ he goes is not my problem.
c. to play
44. The class hasn’t ended _____. c. Mark and Alex both know the answer.

a. yet LISTENING TEST

b. now 51. The speaker is talking about _____.

c. already a. the past

45. If you cope with something, you _____ b. the present

with it.
c. the future
a. play
52. Which food will Mario NOT eat?
b. deal
a. cheese
c. tend
b. steak
46. Remember to send _____ an email.
c. onions
a. her
53. Who wrote the paper?
b. she
a. Mary
c. hers
b. Kathy
47. Adele exercises _____ healthy.
c. Mary and Kathy
a. to be
54. Which sentence is true?
b. was
a. The weather was colder yesterday.
c. are
b. The weather is warmer today.
48. Could you please tell me _____?
c. The weather was warmer yesterday.
a. where is the Grand Hotel
55. The speaker is talking about _____.
b. is where the Grand Hotel
a. the past
c. where the Grand Hotel is
b. the present
49. “Can you give me a hand?”
c. the future
The speaker wants _____.
56. Which sentence could be true?
a. help
a. Ron weighs 69 kg, and Taylor weighs 76 kg.
b. praise
b. Ron weighs 76 kg, and Taylor weighs 69 kg.
c. money
c. Ron weighs 69 kg, and Taylor weighs 69 kg.
50. Neither Mark nor Alex knows the answer.
57. The speaker is talking about _____.
The sentence means _____.
a. the past
a. Mark doesn’t know the answer, and Alex
b. the present
doesn’t know the answer.
c. the future
b. Mark knows the answer, but Alex doesn’t
know it. 58. The speaker thinks you can't _____ Lisa.
a. hear 66. Which happened first?

b. trust a. I arrived.

c. match b. I saw the band.

59. The speaker plans to buy _____. c. The band started playing.

a. one thing 67. The speaker is talking about _____.

b. two things a. one person

c. three things b. at least two people

60. This is a _____. c. three or more people

a. refusal 68. The speaker’s grandfather is _____.

b. complaint a. dead

c. compliment b. blind

61. Which sentence is true? c. alive

a. The speaker has no money. 69. How much water does Tom want?

b. The speaker has some money. a. none

c. The speaker will give you money. b. a small amount

62. The speaker is probably _____. c. a large amount

a. at a travel agency 70. The speaker is going to _____.

b. at a doctor’s office a. spend some money at the bank

c. at a restaurant b. put some money in the bank

63. The speaker is talking about _____. c. get some money from the bank

a. why the woman spoke

b. when the woman spoke

c. how the woman spoke

64. The speaker thinks _____.

a. scuba diving is dangerous

b. you’re not going scuba diving

c. scuba diving is usually safe

65. You should send a fax to _____.

a. a man

b. a woman

c. two people
Name: _____________________________________________ Date: ______________

WRITING PLACEMENT TEST

Choose ONE of these topics and write about it.

• Write about your house or apartment. How many rooms are there? What are they? What is your
favorite room? Why?

• Write about a person you know very well. Who is this person? What does he/she look like?
Why is he/she important to you?

• Write about your neighborhood. What does it look like? What is in your neighborhood? Is it
quiet or noisy?

What things do you like your neighborhood? What things do you not like your neighborhood?
• Write about something you bought recently. What did you buy? Where did you buy it? How
much did it cost? Why did you buy it?

• Imagine that a waiter in a restaurant was very rude to you and your friends. Write a letter to
the manager of the restaurant and complain. Tell the manager what happened, why you are
upset, and what he/she should do to make you happy again.