Here is the needs assessment questionnaire from Boon, A. 2005. Tell me what you want, what you really, really want! Modern English Teacher 14, 4: 41-52.

1. NEEDS QUESTIONNAIRE:<br />1.Personal Details:<br />Name:____________________Date:______________________<br />Do you currently use English in your job? YES/NO<br />If ‘ YES ’ - Give details: __________________________________________________________<br />______________________________________________________________________________<br />______________________________________________________________________________<br />2. Previous Experiences:<br />Have you taken an English class before? YES/NO<br />If ‘ YES ’ : <br />What did you like about the class? __________________________________________________<br />______________________________________________________________________________<br />______________________________________________________________________________<br />What didn’t you like about the class? ________________________________________________<br />______________________________________________________________________________<br />______________________________________________________________________________<br />3.Learning Preferences:<br />How do you like learning English?Please circle your answers:<br />a] I like to work individually / in pairs / in one group in class.<br />b] I like to learn from coursebooks / listening tapes / handouts / authentic materials. <br />c] I like to learn by listening and talking to the teacher / listening and talking to other students / copying from the whiteboard / reading and making notes / solving problems / role-playing /playing games / repeating what I hear / memorizing / <br />OTHERS: (Please specify): ____________________________________. <br />d] I like the teacher to correct my mistakes immediately, in front of the class / at the end of the task, in front of the class / in private.<br />4.This Course:<br />a] What balance would you like between job-related English and general English in this course?<br />Job-related ____%General ____%Total 100%<br />b] What are you interested in doing in class? (Please circle)<br />Area High Priority- - - - - - - - - - - - - - - - Low Priority <br />Describing and Explaining*54321<br />Grammar54321<br />Listening54321<br />Meetings & Discussions54321<br />Presentation Skills54321<br />Pronunciation54321<br />Social Communication54321<br />Telephone Language54321<br />Travel English54321<br />Vocabulary Building54321<br />Writing**54321<br />* Instructions, Processes, Product descriptions, etc.<br />** E-mail, memos, reports, business letters<br />c] How much homework are you prepared to do per week? _____ hour(s)<br />d] What kind of homework do you want to do? Please check areas you are interested in working on?<br />AreaV<br />Grammar____<br />Listening____<br />Reading____<br />Vocabulary____<br />Writing____<br />Other: (_____________)____<br />5. Your Goal for this Course:<br />How would you like your English to have improved by the end of the course?<br />(From Boon, A. 2005. Tell me what you want, what you really, really want! Modern <br />English Teacher 14, 4: 41-52)<br />