Language lessons
Please fill in the form below. This should take approximately 5-10 minutes to complete
Groupnumber
Target Language
Dutch
French
Contact Information
Student Name
*
First Name
Last Name
E-mail
*
Phone Number
-
Area Code
Phone Number
About you
Pls tell me a bit more about yourself (If possible in the target language)
What country are you from, how long are you living in Holland (Belgium) What did you study? Do you have children? What kind of work are you doing?
List any languages you know and your fluency in each. (1 = low fluency, 5 = native speaker fluency)
*
ex. Arabic(4), French (2), English (5)
What is your current fluency in target language? (0 = nothing, 5 = native speaker fluency)
*
Rows
0
1
2
3
4
5
Reading
Writing
Listening
Speaking
Overall
Please describe any previous classes or tutoring sessions you have completed in this language.
Please include details. (total length of time studying this language)
Language Goals and Learning Style
What learning styles or resources work best for you?
(topic conversation, songs, pictures, games, etc.) If none, leave blank.
What is the general reason(s) you are interested in learning this language?
(work, business, school, immigration, travel, conversation, personal interest)
In what context do you need the target language?
example: social contacs, work: talking to clients ....
What are 3 specific language goals you would like to work towards in your sessions with me?
*
(travel basics, sentence fundamentals, increased vocabulary, refined pronunciation, listening comprehension, giving presentations, answering emails, conversation skills, etc.)
How many hours of homework / practice are you able to do each week?
*
Please Select
none
30 minutes
1-2 hours
2 hours
more than 2 hours
will vary
Homework is a great way to keep the language active between practice.
Is there any other useful or relevant information about you or your learning style?
If no, leave blank.
Thank you for taking the time to fill this out.
!
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