Learner Questionnaire - Printer-Friendly Version

LEARNER QUESTIONNAIRE

Questions in bold face throughout the questionnaire are for Non-native Speakers of English only.

1. Where were you born? __________________________________________________________

2. (If not born in U.S.) How old were you when you came to the USA? ____________________

3. What was the first language you spoke as a child? __________________________________

3a. (If other than English) Do you still speak this language? yes / no

4. What is the highest school grade you completed not including adult education? __________

4a. Why did you leave school?______________________________________________________

5. In what town or city, state (country) was that school?_______________________________

6. (If not born in the U.S.) Did you attend school in (native country)? yes / no

7. (If yes to #8) How many years? __________________________________________________

8. (If yes to #8) In what language were you taught? ___________________________________

9. Can you read (native language)? yes / no

10. Can you write (native language)? yes / no

11. Can you read and write English? yes / no / a little

11a. How old were you when you learned to read and write English? ________________

12. Where did you learn to read and write English? (home, school)?________________

13. How many schools did you attend as a child? ______________________________________

14. Did you ever repeat a grade? yes / no. (If yes) Which grade(s)? ______________________

15. Do you remember ever having trouble with reading as a child yes / no

16. (If yes) In which grade did you first have trouble? ____first grade; ____ second or third grades; ____ fourth or fifth grades; ____ sixth, seventh or eighth grades; ____high school

17. When you were a child did you ever participate in any of the following programs; if you did, please describe when and where.

___Individual Tutoring____________________________________at home______in school______

___Chapter I or Title I ____________________________________________________________

___Resource Room_______________________________________________________________

___Special Classes________________________________________________________________

___Core Evaluation_______________________________________________________________

___Special education_____________________________________________________________

18. What made you decide to take adult education classes?_____________________________

_______________________________________________________________________________

19. What do you plan to do after you complete your adult education classes?_______________

_______________________________________________________________________________

20. About how many hours a week do you read for pleasure (in English)? ___less than 1;
___1-3; ___4-6; ___more than 6

21. About how many hours a week do you read for pleasure in (native language)?
___less than 1; ___1-3; ___4-6; ___more than 6

22. What do you find hard about reading? Which of the following problems seem to apply to you when you read?

English		Native Language
___	I can't read or pronounce the long, hard words.	___
___	I can't understand most of the hard words.	___
___	Sometimes I don't understand what I read.	___
___	I forget a lot of what I read right afterwards.	___
___	I forget a lot of what I read a few days later.	___
___	I read very slowly.	___
___	Other problems?________________________	___
___	Spelling problems?	___