1. West Hills College Coalinga Student Learning Self-Assessment Survey

Please provide us with honest information about yourself to assist our counselors in identifying the services that best meet your needs. Your answers will remain confidential and will not be shared with instructors or staff without your approval.

* 1. Student Identification Number (ID#)

* 2. First Name

* 3. Last Name

* 4. Course Name

* 5. Instructor Name

* 6. I have eye strain; words get blurry or move when I read.

* 7. I think that I may have some problems with hearing.

* 8. I have documented disability that may be causing some problems with my learning.

* 9. I have had a stroke, head injury, seizure, or other serious medical condition in my past that may be causing some learning problems.

* 10. I am taking medications that make me feel sleepy or forgetful.

* 11. I have recently experienced a major change such as a move, death, or divorce.

* 12. I attended Special Education classes or a Resource Room in grade school.

* 13. I was absent from high school or grade school often.

* 14. I have trouble understanding in class due to limited English.

* 15. I have trouble managing time.

* 16. I have trouble studying.

* 17. I have trouble understanding computers.

* 18. I have trouble with typing.

* 19. I had limited schooling or did not finish high school.

* 20. I have challenges speaking English.

* 21. I have trouble listening.

* 22. I have trouble writing.

* 23. Is English your primary language?

* 24. How many languages do you speak?

* 25. I utilize the library services often.

* 26. I utilize the tutorial department often.