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Strengths Based Needs Assessment Social Supports/Family/Friends: Family makeup i.e. siblings/birth order, what was it like growing up in your family?
Student Needs Assessment
Name: _______________________________
Date: ________________________________
e-mail address: ________________________
Phone: ______________________________
Country of origin: ______________________ Languages spoken: ___________________________________________________________ General Information: __________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Current Language Skills: (0=I can’t do this at all, 5=I’m very good at this) Skill
How good am I?
How often do I do this?
Speaking
0
1
2
3
4
5
Never
Rarely
Sometimes
Often
Listening
0
1
2
3
4
5
Never
Rarely
Sometimes
Often
Writing
0
1
2
3
4
5
Never
Rarely
Sometimes
Often
Reading
0
1
2
3
4
5
Never
Rarely
Sometimes
Often
How do you use your English?
What opportunities do you have to practice your English?
Why do you want to improve your English?
What’s the most important reason for improving your English?
Student: _____________________________
How much time do you want to spend in class on each of these English skills? (0=no time, 4=all of my time) Speaking Listening Writing Reading comprehension Grammar Vocabulary development Pronunciation Business communication skills (emails, meetings, small talk, presentations, other) Other
0 0 0 0 0 0 0 0
1 1 1 1 1 1 1 1
2 2 2 2 2 2 2 2
3 3 3 3 3 3 3 3
4 4 4 4 4 4 4 4
0
1
2
3
4
Previous English study (when, how long, where, what):
A. What did you like best about your previous study?
B. What did you like least?
C. What is your favorite way to learn English?
What is the most difficult thing for you about English?
What is your educational background?
What is your profession?
What do you do when you are not working? (hobbies, family, personal interests)
What else would you like me to know about you?
Do you want and/or have time for homework? If so, how much time do you have?
