CEP 2015Spring I4

Name:

Needs Analysis

Please take a few minutes to do the following survey. This is to help us know you better. This
is NOT a test.

I. Personal Information
1. Preferred Name (The name you want to be called in class): ___________________________
2. Where are you from (city/country)? _____________________________________________
3. What is your native language? __________________________________________________
4. What other languages do you speak? _____________________________________________
5. What is highest education level you have received? Your major?
___________________________________________________________________________
6. How long have you lived in the U.S.? ____________________________________________
7. How long have you been studying English/where?
___________________________________________________________________________
II. Communication/Skills
8. What is/are the main goal(s) for you to learn English?
Get a job/ get a better job
Test(s) preparation (TOEFL, IELTS,GRE)
Academic Needs
Business Needs
Daily Life Needs (Shopping, making friends, opening an account in a bank)
Other(s) -please be specific: _____________
9. What particular aspect(s) are you good at?
Reading
Listening
Speaking
Writing
Pronunciation
Grammar
Other(s) -please be specific: _____________
10. What particular aspect(s) do you want to improve?
Reading
Listening
Speaking
Writing
Pronunciation
Grammar
Other(s) -please be specific: _____________
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CEP 2015Spring I4

Name:

IIIOther Things
11. Do you have Internet access either at work or at home? If yes, do you prefer doing homework
using computer?

12. Approximately how many hours per week are you willing and able to dedicate to English
study outside of the classroom?

13. How much of your day is spent in English (approximate percentage %)?

14. Tell us more about yourself (at least one small paragraph).