Sample Needs Assessment Forms Page 3
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4eSOL LeArner needS ASSeSSMenT
This portion should be filled out at registration
Name:
Date:
Level:
Term:
1. When did you come to the U.S.?
2. How long will you be living in the U.S.?
3. Where did you hear about our program?
4. What is your main reason for coming to the United States?
❏
Work
❏❑
Study
❏❑
Family
❏❑
tourism
❏
❏
5. Are you currently employed?
Yes
No
If YES, what is your job and where do you work?
6. I am a:
❏❑
Faculty member
❏❑
Graduate student
❏❑
❏❑
researcher
Staff member with (college or university)
7. Did you work in your home country?
❏❑
Yes
❏
No
If YES, what was your job?
8. Where have you studied English before?
9. For how long did you study English?
10. How do you need to use English?
11. In what neighborhood do you live?
SOURCE: The Greater Homewood Community Corporation
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MCAEL TEAChEr TooLkiT
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Parent category: Business