1. Have you ever lived in an English speaking country?
  No
  Yes, for less than six months.
  Yes, from six months to one year.
  Yes, from 1-2 years.
  For more than 2 years.

2. I have studied English for ___ at school or other institutions.
  Less than 1 year
  1-2 years
  3-4 years
  5-6 years
  7 or more years

3. My age is
  10-11 years old
  12-13 years old
  14-15 years old
  16-17 years old
  18 years or older

4. Besides studying English at school, I (check all that apply)
  Have a private tutor.
  Study on my own time.
  Participate in an English club.
  Read English language books.
  Watch English language movies and television shows.
Other:

5. I want to study writing because... (check all that apply)
  I want to express myself clearly.
  I want to express myself creatively.
  I want to get better grades in school.
  I need to write essays for school admissions.
  I want to write well for standardized tests.

6. I also want to improve... (check all that apply)
  My English language listening ability
  My English language reading ability
  My English language speaking ability

7. In my native language, I like to write... (check all that apply)
  personal essays
  fiction
  poetry
  newspaper articles
  academic papers

8. The part of writing that frustrates me most is/are... (check all that apply)
  Generating ideas
  Organizing ideas
  Finding the words to express ideas
  Grammar
  Spelling

9. I learn best when
  Working one-on-one
  Working in small groups

10. One day, I hope to... (check all that apply)
  Write a blog
  Write for a newspaper
  Write a novel
  Write a nonfiction book
  Write a book in another genre (poetry, comic book, etc.)


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