|
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? |
___ |
|
