The document appears to be a data collection form that collects basic personal information such as name, gender, age, education level, and occupation. It also contains a sample English proficiency test with 20 multiple choice questions testing vocabulary, grammar, and comprehension. The questions cover topics such as daily activities, food, housing, transportation, sports, education, and personal preferences.

1. Sampel:
Lembar Pengumpulan Data
Nama :
Jenis Kelamin :
Usia :
Posisisi :
Pendidikan Terahir : SMA Sederajat D III S1
1). I always …. a lot of mistakes when I speak English 10). He was terribly….when he heard the news of his
A.Make C. Do friend’s accident
B. Made D. Doing A. Upset C. Happily
B. Noisy D. Confused
2). We always try not to….. a noise after ten o’clock at 11). I …. At Intakha
night A. Sleep C. Study
A. Made C. Become B. Work D. Lunch
B. Make D. Do 12). …. Apple on the table
A. Is C. An
3). If I ….my home work everyday, my English will get B. The D. Am
better 13). This…. My book
A. Doing C. Make A. Am C. Will
B. Do D.Made B. Is D. Buy
14). I never…coffee
4). My feet are feeling … after that run A. Eat C. Drink
A. Broke C.Light B. Watch D. Get
B. Sore D.Broken 15). Bad driving…..many accidents
A. Due to C. Because
5). I love the smell of…bread B. Causes D. Happen
A. Bad C. Aromatic 16). My parents ….in a very small flat
B. Fresh D. Special A. Go To C. Live
B. From D. Buy
6) .This milk smells…. I’ll open another bottle
A. Horrible C. Full 17). The Olympic games….every four years
B. Fried D.Bad A. Take a place C. Will
B. At D. happen
7). That painting looks like a….
A. Draw C.Money 18). Many used to keep ….in her garden until they
B. Photo D. Paint started to get out
A. Nails C. Flowers
8). I did’nt know who was telling the truth, I felt B. Car D. Chickens
totally….. 19). Our students study both…. And literature in their
A. Happy C. Proud English degree
B. Confused D. Pleasant A. Spoke C. Economy
B. language D. Physic
9). This rainy weather has gone on for so long. I feel 20). I’ve had…. Of green vegetables ever since I was a
really …with it child
A. Push- up C. Sit-up A. Dislike C. Get
B. Fed-up D. Looking for B. Interesting D. Sell
C by Yohana & Iga3911.2011 Page 1