Language Use Questionnaire Participant Code : __________ Date : __________

I. General Information,
1.1 Name: ______________________ 1.2 Age/D.O.B:______ 1.3. Gender: M / F 1.4 Marital Status: _____________ 1.5 Occupation: ______________ 1.6 Contact Address and Telephone/ E-Mail ID: __________________________________

1.7 Which hand do you prefer to use mostly? RIGHT / LEFT 1.8 Do you have significant medical problems? (If Yes, Pease Specify). YES / NO

II Language Profile: 2.1 State your Native Language ( if you grew up with more then one language then please

specify) _________________________________________________________________ 2.2 List all the other languages you can communicate in. ________________________________________________________________________

2.3 Language Exposure History. Place of Stay Years of Residence Languages Exposed to

2.4 Mention the age at which you were exposed to each language and how you have learnt it. Language Age first exposed to the language Speaking Reading Writing Mode of Learning Instruction / Interaction

2.5 List all the language skills you know in order of most proficient to least proficient. Rate your ability on the following aspects in each language. Please rate according to the following scale (write down the number in the table): 1 Poor 2 Fair 3 Functional 4 Good 5 Excellent

Language

Reading

Writing

Speaking

Listening

2.6 Education (Mention the place studied, year passed and the medium of instruction in appropriate boxes) Level Primary / Secondary High-School Under-Graduate Post-Graduate Place Year Medium of Instruction

2.7 Do you know any foreign languages? (If yes, please specify) YES / NO

2.8 If you have taken a standardized test of proficiency for languages other than your native language (e.g., TOEFL or Test of English as a Foreign Language), please indicate the scores you received for each. Language ______________ ______________ ______________ Scores ___________ ___________ ___________ Name of the Test ____________________ ____________________ ____________________

III. Language Proficiency ( Self Rating)

3.1 Please rate your proficiency of each language against each activity On a scale of 1 to 5, where 1 = Cannot do; 2= Do it with great difficulty; 3 = Do it with moderate difficulty; 4 = Can do it, not very well 5= Do it very easily and very well Please look at the rating scale each time circle the appropriate number for the language that you use most of the time. Specify the language you are rating (e.g. Telugu, Hindi etc) in the top boxes Languages S.No ACTIVITY

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Say the days of a week Name the months in a year Count up to hundred Name common fruits / vegetables Help someone write a letter Tell a story Understand conversations Read popular and academic texts Translate from and to English Understand proverbs

IV. Language Use Frequency and Choice

4.1 Indicate using the rating scale below, the frequency with which you use the languages you know.

1 Never

2 Rarely

3 Sometimes

4 Mostly

5 Almost always

Telug Item No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Language use context u While playing Participate in debates Talking to sibling Writing letter to close friend Ask directions in an unfamiliar street Making grocery lists Understood proverbs / idioms Talking to children at home Brothers/sisters talking to you While neighbors talking to you Making train enquires Friends talking to you Filling forms ( bank, travel booking etc.) When stressed out Parents talking to you Talking to parents Operating an ATM machine Talk about academic matters Name common fruits/ vegetables Watching movies Talking to pets Watching TV programs Describe yourself in an interview Language in places of worship Talk to auto / taxi driver While arguing with friend Read a pamphlet / handbill Teachers talking to you Writing official letters While talking to your teachers Hindi English

31 Reading newspapers 32 When worried / Frightened 33 Reading magazines