Questionnaire to complete before beginning the SSEP Online Course

Before you start the SSEP online course, please fill in the questionnaire below.

Your answers will help us to assess your progress and to further improve the course for future students.

All responses submitted to this questionnaire will be treated as strictly confidential and will not be passed on to any third parties.

If you prefer to remain anonymous, please just enter your initials into the name box (and please use the same initials on any subsequent feedback questionnaires) This questionnaire takes about 10 minutes to complete

There are 20 questions in all. They are to collect some general background information about you and your stuttering.

After filling in the questionnaire, don’t forget to press the Submit button, otherwise we will not receive it!

Name


A red asterisk (*) indicates required questions.


  1. In what year where you born?*


  1. Your gender?
    male
    female


  1. What is the highest level of educational qualification you have?
    (If your qualifications differ from those listed, please highlight the nearest match)
    GCSE (USA-High School Diploma) - approx age 16
    'A' level (USA- APs) - approx age 18
    Diploma (USA-Associate degree)
    First Degree
    Post-graduate degree


  1. is English your first language?*
    yes
    no


  1. are you bilingual (or more)?*
    yes
    no


  1. What country do you currently live in?*


  1. In your everyday life, what language do you speak most of the time?*


  1. What is (or was) your main occupation*


  1. Approximately how old (in years) were you when you started stuttering?*


  1. Have you ever had any of the following conditions that affect speech and communication?
    (please select any that apply or, if none apply, move on to the next question).
    Dyslexia
    Dyspraxia
    Dysarthria
    lisping
    Hearing impairment
    Cluttering
    Tourette's
    Cleft lip or palate
    Social Anxiety
    Word-finding difficulties
    Spasmodic dysphonia


  1. Have you ever had any other conditions (i.e., other than those listed above) that have affected your speech and communication? If so, please give details


  1. Have any of your family (brothers, sisters, parents or children) ever stuttered? If so, please give details


  1. Have any of your family (brothers, sisters, parents or children) ever had any other conditions (apart from stuttering) that have affected their speech and communication abilities? If so, please give details


  1. Have you ever experienced any significant remission from your stuttering (either spontaneous or following therapy)?
    (i.e., when it more or less completely disappeared).
    If so, please give details.*


  1. If there is anything else that you feel we need to know about your stuttering and/or your general health?


  1. Have you ever had any therapy for stuttering?*
    Yes
    No


  1. If yes, then please give very brief details (not more than 100 words)


  1. Are there any particular words or situations you go out of your way to avoid?
    If yes, then please give very brief details
    (not more than 100 words)


  1. Would you be willing to complete a 15 minute questionnaire to enable us to assess the severity of your stuttering and the extent to which it impacts upon your life?
    If so, please make sure to provide your email address, and we will send you a link to the questionnaire.
    After six months, we will then send you a second such questionnaire so that we can gauge the extent to which this online course has benefitted you.
    *
    Yes
    No


  1. Your email address?