NEEDS ANALYSIS – NAXI

PERSONAL INFORMATION

Name: _______________________________________ Date _______________________________

Phone Number: __________________ Email address: _____________________________________

Company & Address: (if classes will take place at office): ___________________________________

_________________________________________________________________________________

Job Title / Position: _____________________________ Responsibilities (eg. Giving presentations,

contacting clients, travelling abroad): ___________________________________________________

__________________________________________________________________________________

How / when do you use English in your job? (please tick the frequency for each)

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

month
Email
Phone
Social Media
Meetings
Reports
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

Grammar 1 2 3 4 5

Pronunciation 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 ___

EDUCATION

Highest level of education: ___________________________________________________________

Field of Study: _______________________________________________ When? ________________

Method of Study: Online / Academic Institution __________________________________________

If Academic Institution, which one? ____________________________________________________

Other Languages From when until when? Where Certification

OTHER INFORMATION

Medical Conditions / Learning Disabilities (please specify condition and details): ________________

__________________________________________________________________________________

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!