Initial Assessment Form

Initial assessment form


Personal data










Interests


  • English 
    Spanish 
    Portuguese 

  • Corporate Group 
    Private Group 
    Individual 

  • Conversation 
    Writing 
    Accent Reduction 
    TOEFL Preparation 
    TOEIC Preparation 



  • Commercial Correspondence 
    Management 
    Business 
    Financial 
    General Conversation 



Important information






  • Yes 
    No 

  • Yes 
    No 









  • Yes 
    No 





  • DVD player and TV 
    PC with DVD & speakers 

  • Windows 7 
    Windows 8 
    Windows 10 









  • Yes 
    No 

Individual needs survey

Please indicate the importance of each of the items below by checking one of the boxes below from 0-2 (“0″ being not important for your needs, “1″ being somewhat important, and “2″ being very important for your language goals).

I need to improve the following skills

  • 0 
    1 
    2 
  • 0 
    1 
    2 
  • 0 
    1 
    2 
  • 0 
    1 
    2 

I need to use the “target” language for the following

Rate the importance from 0 to 2 and pick 3 you consider the most imporant

  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 
  • 0 
    1 
    2 
    MI 

LEARNING PREFERENCES (mark all that apply):


  • Memorization of expressions 
    Conversation 
    Listening to dialogues/texts 
    Reading 
    Repeating what you hear 
    Studying grammar 
    Written exercises 
    Role-play 

  • Immediately after an error 
    Later, at the end of an activity 

  • Video materials 
    Audio materials 
    Print materials 





How did you hear about CCLS?


  •  Internet

     Flyer/Brochure

     Yellow Pages

     Friend/ Family/ CCLS student