English as a Second Language (ESL) - Teachers College, Columbia University

Level: Intermediate 2 (I2) Summer 2015

Student Needs Analysis Questionnaire
This questionnaire is designed to acquire information of the student including language
background, learning goal and experience as a language learner. The information will help the instructor
appropriately focus on helping improve relevant skills, which supports consistent learning progress.
Please be honest in answering the questions and provide detailed information whenever possible.
Part I : Personal Background
Student Name _________________________________________
Nationality __________________

Native Language ___________________

Language (s) other than English __________________________________________________

Highest Level of Education (Please check one) Major of study ________________________________
High School/Vocational School

Masters Degree

Bachelors Degree

Doctoral or higher

Was English a major language for instructions at your institution?

Yes

No

If not, what language _____________________________

When did you come to the United States? ____________________________
How many years have you studied English (approximately)? __________ year (s)
Part II : Self-Evaluation - Language Skills
Language Skills
Rate the following skills based on your present ability.
1 = Very Weak 2 = Weak

3 = Moderate/Acceptable 4 = Competent 5 = Very Competent

Skill

Your present ability

Reading

Writing

Speaking

Listening

Grammar/Structure

What is/are the skill (s) you want to improve the most in this course? Please provide reason.
_____________________________________________________________________________________
_____________________________________________________________________________________

Language Styles and Preferences

For the following items, place a check mark (/) in the cell that best describes your styles and preferences.
1 = Strongly Disagree 2 = Disagree 3 = Not Certain/No Opinion 4 = Agree 5 = Strongly Agree

Situations

Rating Scale
1

I am skilled at organizing ideas and expressing them in writing.

I best express my ideas or opinions through writing.
I read a lot to help enhance my writing skills (word choice,
development of ideas etc.)
I know how to use transition words to develop coherence among
paragraphs in my writing.
After writing is completed, I perform either self- or peer-editing
during the final stages.
I am happy to share my writing with others to learn any areas that I
can further improve in future writing.

Part III : Classroom Work Styles/Teacher Expectation

Classroom Work Styles
For the following items, place a check mark (/) in the cell that best describes your situations.
1 = Strongly Disagree 2 = Disagree 3 = Not Certain/No Opinion 4 = Agree 5 = Strongly Agree

Situations
I prefer working with other students in completing classroom
activities and assignments.
I learn more and produce better work in groups than working alone.
I like a lecture-style class without hands-on practice.
I feel confident whenever I produce language in the classroom e.g.
during the exercise
I prefer learning language in meaningful contexts.

Rating Scale
1

Teacher Expectation
For the following items, place a check mark (/) in the cell that best describes your situations.
1 = Strongly Disagree 2 = Disagree 3 = Not Certain/No Opinion 4 = Agree 5 = Strongly Agree

Rating Scale

Situations

I expect the teacher to provide feedback on my work including

progress in my language learning.
I want the evaluation criteria of the course to be informed clearly to
all students.
I prefer learning with teachers who know the students individually.
I highly value the teachers guidance to support achievement of my
language goals.
I hope the teacher will assign a lot of pair and/or group work during
this course.
Part IV : Miscellaneous
Do you have Internet access either at work or at home?

Yes

No

If yes, approximately how many hours per day do you use the Internet? __________ hour (s)
Which one (s) of these do you have? (Select all that apply.)
Computer (Desktop)

Smartphone

Notebook Computer

Tablet/I-Pad

Other(s), please specify _____________________________

Please rank your selection (s) above based on usage frequency. (1 is the highest, 3 is the lowest)
1. _______________ 2. _______________ 3. _______________
Will you be able to use these tools to help you learn English both in and outside of class?
Yes

No

How would you rate yourself on the ability to use general mobile/Internet applications?
Very Competent
Competent

Average
Limited

Very Limited
Please feel free to provide any further information you would like to share with me in the space below.
_____________________________________________________________________________________

Thank you. Have a pleasant semester.