Needs and Interests Survey

The purpose of this survey is to learn about you so that we can better meet your needs, interests, and expectations. Please answer every question. There are no right or wrong answers. Your answers just help us learn which of our courses would fit you best, and also what new courses we should consider developing.
Name: 


A red asterisk (*) indicates required questions.

  1. Please state your full name.*


  1. Do you have another name you prefer to be called?


  1. What is your email address?*


  1. If we need to call you, what is the best time for us to call? Please include the time zone you are in.*


  1. What language is your first language or mother tongue?*


  1. List any other languages you can speak and if you speak them at the beginning, intermediate or advanced level.


  1. What country are you living in at the present time?*


  1. How long have you studied English? *


  1. Please look at the box below. Then number the choices according to your preferences. For example, 1 = first choice. Do not put a number next to options you are not interested in.

    Option 1
    Option 2
    Option 3
    Option 4
    Option 5
    Option 6
    Option 7
    Option 8
    Option 9
    Option 10


  1. Number the choices below according to your preferences. Do not put a number next to options you are not interested in.

    Option 1
    Option 2
    Option 3
    Option 4
    Option 5
    Option 6
    Option 7
    Option 8
    Option 9
    Option 10
    Option 11
    Option 12
    Option 13
    Option 14
    Option 15


  1. Please look at the box below. Then number the choices according to your preferences. For example, 1 = first choice. Do not put a number next to options you are not interested in.

    Option 1
    Option 2
    Option 3
    Option 4
    Option 5
    Option 6
    Option 7
    Option 8
    Option 9
    Option 10
    Option 11
    Option 12
    Option 13
    Option 14
    Option 15


  1. Rank the following English skills according to which skills you are strongest at:
        1 2 3 4
    Listening  
    Speaking  
    Reading  
    Writing  


  1. Rank the following English skills according to which skills you are most interested in working on:
        1 2 3 4
    Listening  
    Speaking  
    Reading  
    Writing  


  1. Where do you speak English now? Please check all answers that describe you.*
    Nowhere
    Everywhere
    In restaurants
    On vacations
    At parties
    At work
    On the phone


  1. If you are employed now, what is your job?


  1. If you are in college or have finished college, what is or was your major field of study?


  1. What do you like to do most when you have free time?





Barbara Novelli
Owner of SLESL.net
SLESL: Second Life for English as a Second Language
Shaver Lake, CA