STUDENT QUESTIONNAIRE - Listening and Speaking D (Fall 2010)


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  1. What is your last name?

  1. What is your first name?

  1. What name do you want everyone to call you in class?

  1. Telephone number (please indicate whether it is your home or cell number)

  1. E-mail address

  1. Where are you from? (Please indicate city and country)

  1. What language(s) do you speak at home?

  1. How long have you lived in the U.S.?

  1. Have you ever been in a country where English is the main language?

  1. If you answered "Yes" to Question #9 above, please indicate where.

  1. Do you work?

  1. If you answered "Yes" to Question #11 above, please indicate what you do.

  1. How many hours do you work per week?

  1. Is this your first semester/summer session at Mission College?

  1. Have you attended any other college(s) or English language programs?

  1. If you answered "Yes" to Question #15, please indicate where and the type of program.

  1. What are your educational goals? Please check all that apply.
    AA/AS degree (from Mission College)
    Vocational Certificate
    Transfer to 4 year university
    Personal growth

  1. If you are planning to get a degree or certificate at Mission College or to continue to a 4 year university, what is your major?

  1. What other classes are you taking this semester? (List all)

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

  1. What do you want to learn in this class?

  1. Is there anything that you would like to add? If yes, please write here.

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