Level: I4

Needs Analysis
Please take a few minutes to do the following survey. This is to help us know
you better. This is NOT a test.
Name / Nickname: _________________________________________________
Where you are from (city/country): ___________________________________
Nationality: _______________________________________________________
Email: ____________________________________________________________
Phone: ____________________________________________________________
Professional Details
1.What is your professional background/work experience?

General Questions
2.How long have you been in the USA? ____________________________
3. What is your native language? ____________________________
4. Do you know any other languages? If yes, what are they?
____________________________
5. How long and where have you studied English? ____________________________
6. What are your English goals? Rank your top 3 goals below from most important (1) to
least important (3):
____ get a job
____ get a better job
____ improve speaking
____ improve reading
____ improve grammar
____ improve conversation skills
____ improve writing
____ learn about American culture
____ for TOEFL, IELTS, GRE or other test
____ other: _______________________________________________
7. What do you think you are good at in English? Rank your skills from best (1) to worst
(6):
____ reading
____ writing
____ listening
____ speaking
____ grammar
____ pronunciation
____other:______________________________________________________________
1

Level: I4
8. Which activities are most helpful to you in learning English? (check all that apply)
reading
watching TV
pronunciation drills
grammar exercises
games
field trips
conversation
other: _________________________________________________________
9. What do you usually read in English? How often?
10. What is the last book you read for pleasure (in any language)?
11. Are you a fast reader in English?

Yes / No

12. What do you usually write in English? How often?

13. What topics are interesting to you? (check all that apply)
American culture
food/cooking
technology
sports
jobs/work
cultural differences
global issues/politics
pop culture (music, movies, fashion, etc.)
other: ____________________________
14. Which of the following do you have at home? (check all that apply)
computer (laptop or desktop)
iPad or tablet computer

smartphone

15. Which websites and software are you familiar with? (check all that apply)
Google
Amazon
Microsoft Word
Blogger
Facebook
Twitter
Microsoft Power Point
other: ________________________________________________________________
16. Approximately how many hours per day are you willing and able to dedicate to English
study outside of the classroom (homework. practice, etc)?
less than 0.5 hour 0.5 hour
1 hour
1.5 hour
2 hours
3 hours
4 hours
more than 4 hours
17. How much of your day is spent in English (approximate percentage)?
less than 10% 10%-20% 20%-40% 40%-60% 60%-80% more than 80%
18. Do you have any questions for the teachers?

Level: I4
19. I would like to know more about you! Please write 1-2 sentences to answer the following
questions:
a. Why did you come to New York?

b. What do you like best about New York?

c. What do you like least about New York?