ESL Survey 2013

1.What type of study or work are you doing now?

Other (please describe your type of study):

3.What do you consider your first/mother language?

4.Which English skills (if any) would you like help with? (Please mark as many as needed.)

Other (Please Specify):

5.Please mark any of the following sentences that match your thinking or feeling:

"My English is too limited outside of my specialized field; I need to learn other parts of English."

"I would like to attend discussion groups on current topics (public policy, arts, philosophy, religion, economics) in 'advanced' English."

"My school provides all of the English help that I need."

"I think I could perform better in my studies if I had more help with my English."

"I feel sort of left out in the social scene at my school because of my English ability."

"I would like more chances to use my English with native speakers."

"I need practice listening to lectures, taking notes, and using those notes to answer questions."

"I would be interested in watching video movies with native speakers, pausing part-way through to ask questions and discuss what's happening."

Other (Please write your opinion here):

6.Is there anything else you'd like to share about your needs and interests, which could help us in planning courses that would be useful for you?

7.During which of the following summer sessions would you be interested in studying English? For each one, please also click on the arrow to show which time would be best for you.

Best Time(s)

June 3-14

June 17-28

July 15-26

July 29-Aug 9

Aug 12-23

8.Which English language class size(s) would you prefer and be willing to pay for? {Please click whichever one(s) are true for you.}

10.Could you get to the Straight Up Cafe, at 795 Main Street., Worcester, for classes?

Yes

No

I'm not sure

11.Do you remember any particular past English book(s) you've used in the past? If so, please give as much information about them as you can remember here, including whether you think you are past that level or whether you would still want to work from those books.

13.If you want us to tell you about any English courses that we plan, please put whatever contact details that you want to here. (We will not give these details to anyone else.)

First Name:

Family Name:

E-Mail Address:

Street Address:

City:

State:

Zip Code:

Telephone Number:

14.If you want us to tell you about any other events that we plan (day trips, holiday events, conferences, etc.), please put whatever contact details that you want to here. (We will not give these details to anyone else.)