OPIc Background Survey

Your response to this Background Survey will be

used to generate an individualized test.
H
ENGLIS
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Please read the questions carefully and make DREAM
your selections as instructed.

1. Do you work? Check one

a. Full time
b. Part time
c. Do not work (If you checked “don’t work”, go to question 5) --answer

2. Where do you work? Check one

a. Outside the home

b. At home
c. Do not work

3. How many different companies have you worked for in your career? Check
one

a. 1
b. 2-3
c. 4+
d. Do not work

4. Are you a manager who supervises other people? Check one

a. Yes
b. No
c. Do not work

5. Are you currently a student? Check one

a. Yes, I am studying full time--- answer

b. Yes, I am studying part time
c. No

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6. Where do you live? Check one H

ENGLIS
a. I am single and live alone in a house or apartment
b. I am married and live only with my spouse (and my children if any) in
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a house or apartment
c. I am single and live with other members (parents, grandparents,
siblings, etc) in a house or apartment
d. I am married and live with other family members in a house or
apartment
e. I live with friends or non-family members in house or apartment
f. I live in my own in a boarding house
g. I share a room with others in a boarding house
h. I live in my own room in a student dormitory
i. I share a room with others in a student dormitory

7. What activities do you do? Check at least six.

a. Go shopping-
b. Restaurants
c. Movies
d. Clubs--
e. Theater--
f. Concerts--
g. Museum—--
h. Parks--
i. Camping--
j. Professional sports--
k. Watch your children play sports--
l. Coach sports--
m. play games by yourself (Cards, video games)--
n. play games with adults (Cards, billiards, board games)--
o. Play games with children--
p. Visit with and/or friends--
q. Study a language--
r. Take a class
s. Teach a class
t. Help your children with school assignments
u. Do household chores
v. Do home improvement projects
w. Maintain your car
x. Go to the doctor/dentist
y. Go to church
z. Go to beauty salon/barber

8. What interests or hobbies do you enjoy? Check at least three.

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 OPIc Background Survey
a. Watch TV and or DVDs
b. Chat on the phone
c. Surf the internet
d. Read--
e. Read to children
f. Listen to music H
g. Play a musical instrument ENGLIS
h. Sing alone
i. Sing with a group
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j. Take dance class/lessons
k. Go out dancing
l. Write creatively (letters, short stories, poetry)
m. Draw, paint
n. Sew, embroider
o. Knit, crochet
p. Cook
q. Garden
r. Have pets

9. What sports or physical activities do you participate in? Check at least one

a. Play basketball--
b. Play baseball/softball--
c. Play soccer—
d. Play football--
e. Play rugby--
f. Play ice hockey
g. Play field hockey
h. Play cricket
i. Play golf
j. Play volleyball
k. Play tennis
l. Play badminton
m. Play table tennis
n. Swim
o. Bike
p. Scuba dive/snorkel
q. Waterski
r. Ice skate
s. Inline skate
t. Horseback ride
u. Jog
v. Walk
w. Do yoga
x. Go hiking/trekking
y. Go fishing
z. Go biking
aa. Go boating
bb.Go to a health club
cc. Exercise
dd.Do not participate in sports or physical activities

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 OPIc Background Survey
10.What types of vacation or travel do you do? Check at least one.

a. Travel for business domestically

b. Travel for business internationally
c. Stay at home for vacation
d. Take vacation domestically H
e. Take vacation internationally ENGLIS
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