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Questionnaire

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English as a Second Language

Title
Name
Section A : Choose Your Focus (Tiles)
Pick the ONE area you need most right now.
Section B: Quick Check (Yes/No)
1. I understand my boss clearly when instructions are given.
2. I can explain my health concerns to a doctor without help.
3. I feel comfortable calling schools, offices, or businesses.
4. I understand appointment times, deadlines, and schedules.
5. I can complete forms (work, school, medical) without stress.
6. I speak English confidently without fear of embarrassment.
7. I feel ready to apply for a better job or promotion.
8. I feel unsure or anxious about using smartphones, computers, or the internet for everyday tasks.
9. I want guidance on what books to read to grow my career, improve my thinking, and learn from successful people’s experiences.
10. Knowing Spanish will help me improve my career opportunities and everyday life, and I want to learn it from the beginning.
Section C: About You
1. What is your English level today?
2. Your preferred support

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