CEP Class Needs Analysis

Monday, February 10th 2014

Name: __________________________________________
Telephone/Mobile phone number: ________________________
e-mail: __________________________________________

Welcome to the class! It would be nice to know more about you so we could help each
other make the most out of the classes.

I. Student Background (Please check the box that best describe you.)
1. What is your mother tongue?
Arabic French German Italian Korean Japanese Portuguese
Russian Spanish Thai Turkish Vietnamese Other:
_____________________

2. What is your education level?

elementary school middle school high school university Masters PhD
life

3. How long have you learned English for?

less than 1 year 1-3 years 3-5 years 5-10 years more than 10 years

4. In what kind of setting did you learn English?

Academic (in school)
Life (from work, friends, watching TV etc.)

Other: ___________________________________

5. How long have you been in the US?

less than 6 months 6 months-1 year 1-3 years 3-5 years more than 5 years

6. What other country/countries have you lived in?

________________________________________________________________________

7. How many hours of English do you speak outside the class everyday?
less than 1 hour 1-3 hours 3-6hours more than 6 hours

8. How much time do you have to study English outside the class everyday?
less than 1 hour 1-3 hours 3-6hours more than 6 hours

9. What do you like to do in your free time?

10. What skill do you think you should improve most?
________________________________________________________________________

II. Learning Expectations

1. Which skill would you like to learn more about? What exactly would you like to
learn about that skill? (0=not so much; 5=very much!)
Speaking
0
1
2
3
4
5
Detail: _______________________________________________
Listening
0
1
2
3
4
5
Detail: _______________________________________________
Writing
0
1
2
3
4
5
Detail: _______________________________________________
Reading
0
1
2
3
4
5
Detail: _______________________________________________
Grammar
0
1
2
3
4
5
Detail: _______________________________________________
Vocabulary
0
1
2
3
4
5
Detail: _______________________________________________
Pronunciation
0
1
2
3
4
5
Detail: _______________________________________________
2. Which content area of English would you like to learn more about?
Daily/
Social conversation

Grammar explanation

Completing a task

(shopping,
mailing a letter,
banking,
seeing a doctor etc.)

Work

Giving a presentation

e-mailing

Telephone

Travelling

3. What other area or activity would you like to learn more about in class?
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4. Why did you decide to attend this class?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
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5. What would you like to achieve in the coming 10 weeks?
_____________________________________________________________________
_____________________________________________________________________
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