1.

Personal information
Name: Date:
Nationality: Job:
Age: Sex: M/F Level of English:
2. Learning history
a. Do you like learning languages?
b. How many languages do you speak?
c. Why are you learning English?
d. How long have you been learning English?
e. Have you studied in groups and one-to-one?
f. Are you also studying in a group class at the moment? Y/N
3. Learning style
a. What do you like doing in lessons?
b. What do you not like doing in lessons?
4. Needs analysis
a. Requirements for the course:


b. Please rate your strength in the following skills:

Reading
Weakness
1

2

3

4
Strength
5
Writing 1 2 3 4 5
Speaking 1 2 3 4 5
Listening 1 2 3 4 5
Grammar 1 2 3 4 5
Pronunciation 1 2 3 4 5
Vocabulary 1 2 3 4 5
c. From the skills (in b.), please show how much time you would like to spend on
these skills on your course.

d. Topics of interest (e.g. news, fashion, business)

e. Would you like to go on trips with your teacher? Y/N
5. Personal Aspirations
Please give a little more information about yourself and what you are doing now in
your life and what you would like to do in the future: