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1. Why are you learning English? (check one)
___ Business
___ School
___ Travel
___ Meeting English speakers
___ Personal Interest
___ Other (explain):___________________
2. What do you need the most practice with?
Number in order: (1)Most (7)Least
___ Reading
___ Writing
___ Pronunciation
___ Vocabulary
___ Grammar
___ Listening
___ Speaking
3. What subjects do you enjoy discussing? (check all that apply)
___ Politics
___ Travel
___ Music
___ Economics
___ Customs
___ Health
___ Science
___ Nature
___ Trends
4. How do you learn English best?
Number in order: (1)Learn Best (5)Learn worst
___ Listening to the teacher
___ Practice outside of class
___ Speaking in groups
___ Writing essays
___ Reading English stories
5. What exercises do you think are most helpful to you?
Number in order: (1)Most helpful (7)Least helpful
___ Memorizing vocabulary
___ Using the Internet
___ Memorizing grammar
___ Talking to native speakers
___ Reading to the class
___ Practicing pronunciation
___ Watching English television
6. What is easiest for you in English?
(example: For me, English is easiest when....)
7. What is most difficult for you in English?
(example: For me, English is most difficult when....)
8. Do you enjoy reading in your native language?
(example: In my native language, I read....)
9. Are you interested in television or the Internet?
(example: I am interested in....)
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