CEP, Summer A 2016

Intermediate 2

What are your needs?

Please answer the following questions. This questionnaire will help me get to know you and your
specific needs in improving your English.
Name:
Email address:

Personal Information
1.

What is your first (native) language?

2.

Do you speak any other languages besides English?

3.

How long have you been living in the U.S.? How long do you plan to stay?

Background Information
1. How many years have you studied English (formally/informally)? Where have you
studied?

2. Which language skills do you feel most comfortable with (listening, reading, writing,
speaking)?

3. Which skills would you like to improve the most?

4. Outside of class, where do you write and speak English?

CEP, Summer A 2016

Intermediate 2

5. Why do you want to study English? What are you goals? What are your English needs?

6. What do you like to do in your free time (personal interests, hobbies)?

7. Is there anything else you would like me to know about your language learning
experience?