Community Language Program Student Name:

Fall 2018

Student Questionnaire
I. Tell me about yourself:

1. Where are you from (city/country)? ______________________________________________

2. What is your native language? __________________________________________________

3. What other languages do you speak? _____________________________________________

4. How long have you lived in the N.Y.? ____________________________________________

5. How long have you been studying English? Where?

_______________________________________________________________________

_______________________________________________________________________

6. Other fun fact(s) about yourself:

______________________________________________________________________________

______________________________________________________________________________

_____________________________________________________________________________

II. Tell me about your English use:

1. Where did you speak English this week and to whom? (E.g., at work with my co-worker)

2. What did you write in English this week? (E.g., a text message, an email, an essay, etc.)

3. What did you read in English this week? (E.g., a novel, a newspaper online)
Community Language Program Student Name:
Fall 2018

4. Typically, how long do you use English every day (hours)?

5. How many hours per week can you study English outside school?

III. Why are you studying English?

First, circle your reason/s for studying English. You can circle more than one. Then, circle one
number from 1 to 5 to show how important the chosen reason is for you. After, write a reason
why one might be very or not important to you.

1= Not important 5=Very important

Pass TOEFL exam 1 2 3 4 5

Why?_________________________________________________________________________

Attend school/university in English 1 2 3 4 5

Why?_________________________________________________________________________

Participate in meetings/discussions 1 2 3 4 5
Why?_________________________________________________________________________

Give presentations 1 2 3 4 5
Why?_________________________________________________________________________

Communicate in every day life 1 2 3 4 5

Why?_________________________________________________________________________

Improve my professional qualifications 1 2 3 4 5

Why?_________________________________________________________________________

Get a higher salary 1 2 3 4 5

Why?_________________________________________________________________________
Other Reason (s):
________________________________________________________________________

IV. What else do you want me to know about your English language study plans?

Let’s have a great semester!