The 8-part Questionnaire for Adult ESL Students

This questionnaire was designed to help understand your feelings, desires and needs for English and
to help you achieve your goals.

Please answer the questions as honestly as possible with as much detail as possible as well.

1. My feelings towards English

Answer the following questions about your past and present feelings towards English.

I usually feel ~ when I speak English because…

I usually feel ~ when I study English because…

I felt ~ when I started learning English because…

I hope to feel ~ about English because…

Example:

I usually feel nervous when I speak English because I think I make so many mistakes and I speak very
slowly. Sometimes I think people think I’m not smart when I speak English!

2. History of English

Please briefly explain your history with English.

This can include when you started to study, how you have learned, what resources you use to study
and when you have used English in your life.

Example:

I first started to learn English in high school about 7 years ago and a little bit in university but I
haven’t spoken it too much since then. I only spoke English when I traveled outside of my home
country on vacation, which was only one time when I went to the United States. Now I have a new
job where I have a conference call in English every month.

3. Present challenges (retos actuals)

Please write about any challenges that you may have with English.

These could be about your abilities, your feelings or anything you feel that is holding you back.

What do you want or need to improve?

I presently have challenges with…

Example:
I presently have challenges with listening to people from foreign countries speaking English like
India, China and other places. Their accents are difficult for me to understand. I also struggle with
staying motivated because I get discouraged easily.

4. Present strengths (los puntos fuertes del presente)

Please write about what you believe are your strengths in English. These could be about your
abilities, your attitudes or anything you feel that helps you learn English.

My present strengths include…

Example:

My present strengths include being optimistic and interested in learning. I am also good at reading
quickly since I watch many TV shows with subtitles in English.

5. Specific goals and deadlines (objetivos y plazos)

Please write down three goals you hope to achieve with your English and a deadline for each one of
them.

Be sure to make these goals specific, achievable and measurable.

A specific goal will have details that make it clear what exactly you want to do.

An achievable goal is a goal that is very realistic to complete, given the amount of time and effort
required.

A measurable goal is one with a specific deadline and achievement. This way you will know exactly
when you have completed your goal!

Examples:

1. I want to watch an entire movie in English without subtitles and understand it by the end of next
month.
2. I want to make fewer than 5 mistakes at my next presentation by the end of next week.
3. I want to study for 10 minutes every morning (total of 300 minutes) by this time next month.

6. Definitions

Write your own definitions to these words or expressions. Try to write what the words mean to you.
Do not use a dictionary to define them.

Fluent:

Good English Speaker:

Proficient:

Conversational English:

Speaking Well:
Advanced Level English:

Intermediate Level English:

7. S.L.R.W. Importance Scale

Write down how important each category is to you and your English on a scale from 0-100 but make
sure that all the numbers add up to 100. Then below, write down why you wrote down those
numbers.

(S) Speaking _________

(L) Listening _________
(R) Reading _________
(W) Writing _________

Examples:

(S) Speaking 50%

(L) Listening 30%
(R) Reading 15%
(W) Writing 5%

I want to learn English for traveling and meeting people in different places so it’s important for me to
practice speaking and listening. Reading may be important for understanding signs and notices. I
don’t imagine I would use writing very often.

8. I will be content when… because…

Fill in the blanks and write what it will take to make you content and why that will make you
content. You can write anything you would like.

I will be content when ~ because…

Examples:

I will be content when I no longer feel nervous or anxious when I speak English because it always
makes me feel bad and I don’t want to feel bad anymore.

I will be content when I can express myself in English without thinking of the words I want to say or
pausing because it’s my dream to speak English as good as I speak my own language.