English as a Second Language (ESL) Class - Spring 2015

Student Needs Analysis Questionnaire (Advanced-3)

This questionnaire is designed to acquire information of the student including language background, learning goal and
experience as a language learner. The information will help the instructor appropriately focus on relevant skills, which supports
consistent learning progress. Please be honest in answering the questions and provide detailed information where applicable.
Part One Personal/Language Background
Student Name _________________________________________
Nationality __________________

Native Language ___________________

Language (s) other than English ______________________________

Highest Educational Level ________________ Major _________________________________
Country _______________________________________
Was English a major language for instructions at your institution?
____Yes

____No

If not, what language _____________________________

When did you come to the United States? ______________________
How many years have you studied English?
____ 1-2 years
____ 2-5 years
____ 5-10 years
____ more than 10 years
Approximately, what is the percentage (%) of your daily English usage?

________ %

How many hours do you have for studying or reviewing English lesson outside the class during the week?

________ hour (s)

Part Two - Self-Evaluation/Language Learning Style

Direction: For each item, please circle the number on the rating scale that corresponds to your situation/evaluation.
Language Skills
Please rate the following skills based on your overall perception of the difficulty.
1 = Extremely Difficult

2 = Difficult

3 = Average

Skill

4 = Easy

5 = Extremely Easy

Your perception of the skill

Reading

Writing

Speaking

Listening

Grammar/Structure

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What is/are the skill (s) that you want to improve the most in this course? Why?
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Part Three - Classroom/Teacher Expectation
Classroom Expectation
1 = Strongly Disagree

2 = Disagree

3 = Not Certain/No Opinion

4 = Agree

5 = Strongly Agree
Rating Scale

Situations

I prefer working in small groups during the lesson.

I love working in pairs.
I like to sit and listen to the teacher without too much practice during the lesson.
I feel confident whenever I produce language in the classroom e.g. during the
exercise
I am nervous when I have to speak in front of the class e.g. during presentation,
reporting the activities

Teacher Expectation
Rating Scale
Situations

I expect the teacher to provide feedback on my work including progress in my

language learning.
I want the evaluation criteria of the course to be informed clearly to all students.

I prefer learning with teachers who know the students individually.

I highly value the teachers guidance regarding my language goals.

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Part Four Technology/Internet Usage

Do you have Internet access either at work or at home?

____Yes

____ No

If yes, approximately how many hours per day do you use the Internet? __________ hour (s)
Which one (s) of these do you have? (Select all that apply)
____ Computer (Desktop)
____ Notebook Computer
____ Smartphone
____ Tablet/I-Pad
____ Other (s), please specify ______________________
Please rank your selection (s) above based on your usage frequency. (1 is the highest, 3 is the lowest)
1. _______________ 2. _______________ 3. _______________
How would you rate yourself on the ability to use general mobile/Internet applications?
____ Very Competent
____ Competent
____ Average
____ Limited
____ Very Limited
What was your first impression when you arrived in New York City?
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Is there anything else you would like the teacher to know more about you?
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Thank you. Have fun with the class!

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