Name
:
Status
: Student (English Academic / Non English Academic / senior/ junior/ elementary school)
Teachers
Employers
Parents
Others (_________________________________)
Instance
:
Part A
In what situation is English (or would English be) useful for you?
Please check the appropriate column
Put this sign in what situation would English be useful for you.
Num
Questionnaire
Very useful
Useful
Not useful
A1.
Buying ticket plane
A2.
Go to abroad
A3.
Watching Hollywood movies
A4.
Teaching or learning something in school
A5.
Communicating with friends
A6.
Buying something in Indomart
A7.
Guiding tourist in Tourism places
A8.
Listening music
A9.
Reading instruction in cosmetic product
A10.
Visiting Bali
A11.
Reading the Jakarta Post
A12.
Chatting with foreigner in Yahoo Messenger
A13.
Singing a song
A14.
Reading your lesson
A15.
Asking friends studying together
A16.
Learning English in class
A17.
Speaking to your lecturer
A18.
Making passport
A19.
Taking vacation in Australia
A20.
Doing national examination
A21.
Continuing study in University
A22.
Doing Job interview
A23.
Receiving email
A24.
Knowing popular idol
A25.
Watching sport news in television
A26.
Connecting with facebook
A27.
Searching something in google
A28.
Using English with family members
A29.
Operating computer
Others
Please Explain:
Part B
From the list above please choose five that are the most important for you. Write the number below
Part C
If you already speak English, please indicate your present level of ability in English
C1. Basic (lower): very limited vocabulary, grammar, and pronunciation heavily influenced by mother tongue.
C2. Basic (upper): wrong pronunciation, short conversation on a few predictable topics; survival level knowledge of vocabulary, grammar, and idiom
C3. Intermediate (lower): communicate with English fluently but different topics, though still some difficulty with vocabulary, idiom, grammar and pronunciation
C4. Intermediate (upper): can manage comfortably in familiar situations and with familiar topics, though still some difficulty with vocabulary, idioms, grammar, and pronunciation.
C5. Advanced: able to converse fluently and naturally on most topics; little difficulty with vocabulary, idioms, grammar, and pronunciation.
Please put this sign in box that indicating your present level of ability in English
C1. Basic (lower)
C2. Basic (upper)
C3. Intermediate (lower)
C4. Intermediate (upper)
C5. Advanced
C6. If you have studied English, please indicate under what circumstances.
I studied English in Formal education (elementary, junior high school, senior high school and university)
I took English course
I studied with a private tutor
Other
C7. If you attended (English course, formal education and other), please indicate the length and frequency of them.
Example:
Num
Activities
Frequency
1
Formal education
6
weeks
3
hours
per
1
week
Num
Activities
Frequency
1
Formal education
weeks
hours
per
week
2
English course
3
A private tutor
4
Other
____________
____________
C8. How useful was the formal education? (Please circle your choice.)
Very useful
Somewhat useful
Not useful
C9. How useful was the English course? (Please circle your choice.)
Very useful
Somewhat useful
Not useful
C10. How useful was the private tutoring? (Please circle your choice.)
Very useful
Somewhat useful
Not useful
C11. How useful was the …………………..? (Please circle your choice.)
Very useful
Somewhat useful
Not useful
C12. If you have used one or more textbooks, please indicate the name of each text and how are useful or otherwise it was:
Name of textbook
Very useful
useful
Not useful
1
Metode cepat menguasai bahasa inggris
2
______________________
3
______________________
4
______________________
5
______________________
C13. To what would you attribute your present level of ability in English?
Very useful
useful
Not useful
1
I attended a useful course
2
I studied in formal education
3
I studied with a private tutor
4
I enjoy studying English
5
I need English for my job
6
Other
________________________
C14. What activities or experiences were most helpful in your study of English? Please elaborate.
Part D
If you have studied English before, but have since stopped studying English, please complete part D below by checking the appropriate box
I have studied English before, but I stopped because of the following reason(s):
Situations
Very true
Somewhat true
Not true
D1
I didn't have time to study English again
D2
I felt that I was not making any progress
D3
There is no opportunities to use English in outside the classroom
D4
The lesson were not useful because:
Difficult to communicate with English
Pronunciation problem
Many vocabulary that difficult to memorize
D5
The teacher did not know how to teach English
D6
I did not like the teaching methods used
D7
The materials were:
Uninteresting
Irrelevant to my needs
Too easy
_________________________
_________________________
D8
Other:
_________________________________________
_________________________________________
_________________________________________
Part E
Have you ever used the following activities in studying English? If you indicate yes, how useful were they?
Num
Activities
Very useful
Useful
Not useful
E1
Practicing conversation from a book or internet
E2
Free conversation with native speakers
E3
Free conversation with other learners of English
E4
Memorizing bilingual vocabulary lists.
E5
Studying English textbook at boarding house / home
E6
Studying the grammar of English
E7
Studying English Pronunciation
E8
Using MP3 at boarding house / home
E9
Speaking English without making mistakes in grammar or pronunciation
E10
Translating English text from newspaper or others
E11
Using dictionary
E12
Asking friends to fix your pronunciation
Other:
_____________________________________________
_____________________________________________
_____________________________________________
Part F
In class or with a tutor, I would like my teacher to:
Num
Activities
No
A little
Good
Best
F1
Practice before explaining new grammar points
F2
Correct my mistakes of grammar
F3
Correct my mistakes of diction
F4
Correct my mistakes of pronunciation
F5
Use Indonesian language and English
Part G
What are your feelings about English as a language?
Situations
Very true
Somewhat true
Not true
G1
English is a language with a rich vocabulary
G2
English is a very difficult language
G3
English is a language where pronunciation is very important
G5
English is a language with a lot of grammar
G6
English is a beautiful language
G7
English is a amazing language to learn
G8
English is a boring language to learn
