Questionnaire1 - DOC by SGOVhy96

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									ESL099.8487 Fall 2010 II              Rick Shur, Instructor            Student Questionnaire

What is your family (last) name?

What is your first name (you official first name that LaGuardia College has for you)?

What name do you want for me and your classmates to call you when we talk to you?

What are the LAST FOUR DIGITS of your Social Security number?

What is your neighborhood (if you live in Queens) or your borough if you don’t live in Queens?

What is your best phone number that I should use to contact you in an emergency?

What is your e-mail address that you I should use to contact you?

In what year did you come to the United States?

What is your home country?

What is your home town or city?

What is your native language?

What languages can you speak or understand in addition to English and your native language, if any?

What is your date of birth? [Please write it out in this format: February 19, 1975.]

What kind of Internet connection do you use at home? (none, telephone, DSL, cable, wireless)

Have you taken any classes in the Immersion Program at this college (CLIP)?

Have you taken any ESL097 courses at this college?

Have you taken any ESL098 or ESR 098 courses at this college?

If you have taken ESL099 or ESR099 before this class, how many times have you taken ESL099 before this
one?

Do you have to work at a job before you come to class (which days, or M-F) ?

Do you have to work at a job on Saturday or Sunday (which day, or both) ?

Do you live with one or more parents (father/mother) here in New York?

Do you have a spouse (partner, husband, wife) that you have to take care of?

Do you have children that you have to take care of (if so, give genders and ages)?

Do you have pets that you have to take care of (please be specific)?

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