Supplement 2: Copy of First-day Questionnaire

by Irene

QUESTIONNAIRE FOR FRENCH 111  [All information will be kept confidential]

 Name  (Full name and the name by which you want to be called):  __________________________________________________________________________________                

 Tell me something that will help me remember who you are:  ___________________________________

 Local Address & Phone #:       ________________________________________________

 E-mail Address (Add **“NOTE” if different from campus e-mail):  ______________________________________

 Class Level:     ________________________________________________

 Major:              ___________________          Minor (if applicable): ___________________

Place and date of birth:            ________________________________________________

 High school attended (Name and city): _____________________________________________________

 Family info (Parents, sibs, etc.):  ________________________________________________

 Career goals:    _______________________________________________________________

 What do you like to do in your free time?  _________________________________________________

 Do you read in your spare time?  If so, what kinds of things?  ___________________________________

 What do you hope to gain from taking French 111?  _________________________________________

 What do you hope to give to this class?  _________________________________________

What are your goals for this course?  _________________________________________

Discuss the following:    How do you expect French to be taught from a Christian perspective?  Do you think this French class might be different from a similar class taught at a secular university?  If so, how? 

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What is your favorite subject and why?

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 What is your least favorite subject and why?

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 Give 3 words to describe yourself:

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How do you learn best?  How would you describe your learning style?  Visual?  Auditory? Kinesthetic?  Other?  __________________________________________________________­­­­­­­­­­­­­­

 What would a person who knows you well say that you excel in?

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 Have you had any musical training?  If so, please describe.

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 Do you recall any incident from your prior schooling where you were put down academically?  How did that make you feel?

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 Do you recall any incident from your prior schooling where you were really successful academically?  How did that make you feel?

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Describe your experience in high school with grammar instruction.

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 How did you do in your reading, writing, and literature classes?

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 How did you do in social studies?

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 Have some areas remained difficult and others not?

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 Outline any previous foreign language learning experience you have had (elementary school, high school, college)–list language and explain setting.  

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 Were there any specific things that made foreign language learning difficult for you?  Explain.

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 How would you rate your English spelling ability, on a scale of 1 (poor) to 10 (excellent)?  ___________

 How would you rate your English grammar ability, on a scale of 1 (poor) to 10 (excellent)?  __________

 How would you rate your English reading ability, on a scale of 1 (poor) to 10 (excellent)?  ___________

 How would you rate your memorization ability, on a scale of 1 (poor) to 10 (excellent)?  _____________

 How many hours per day do you study?  ____________________

  •     Do your study habits vary from subject to subject?  If so, describe.  ________________________________________________________________________________________
  •    What is difficult for you to study and why?   ________________________________________________________________________________________
  •    Do you consider yourself a good writer?  ______________  Explain:  ______________________      _______________________________________________________________________________
  •    How you would rate your (English) pronunciation?  Can people usually understand you when you speak? _______________________________________________________________________________
  •    How would you rate your ability to memorize and recall numbers, dates, names, days of the week, and months?  _______________________________________________________________________________
  •   Are you often late for appointments, deadlines, etc.?  Explain.  _______________________________________________________________________________
  •   Do you ever write things on your hand to remember them?  ______________________
  •   How would you rate your sense of direction?  ____________    How would you rate your sense of left / right or north/south and east/west?  ____________   Can you read a map upside down?   _______
  •  When you have a task that requires a lot of thought, do you avoid or delay getting started?  Explain.  _____________________________________________________________________________________
  •  Do you often fidget or squirm with your hands or feet when you have to sit down for a long time?  Explain.  _________________________________________________________________________
  •  Do you ever feel overly active and compelled to do things, like you were driven by a motor?  _________________________________________________________________________________
  •  Are you color blind?   ______________________________________________________
  •  How would you rate your sense of smell?  _______________________________________________
  •  Do you have any food allergies?  Explain.  _______________________________________________
  •  Do you have any allergies (other than food)?  Explain.  _____________________________________
  •  Do you often misplace things like keys, papers, etc.?  Explain.  ______________________________
  •   Do you ever go to get something and then forget what you went to get?  Explain.  _______________________________________________________________________________
  • Do you get mixed up when you are given 3 or more things to do in a row?  Explain.  _______________________________________________________________________________
  • Do you have trouble wrapping up the final details of a project, once the challenging parts have been done? ____
  • Do you have difficulty getting things in order when you have to do a task that requires organization?  _____
  •  Do you have any difficulty telling time unless the clock is digital?  Explain.  _______________________________________________________________________________
  • Do you use memory strategies?  Explain.  _____________________________________________ _______________________________________________________________________________
  • Do you have a relative who has (had) reading / writing problems?  Other learning difficulties?  Explain. _______________________________________________________________________________
  • Have any of your family members been identified as having a learning difficulty?  AD(H)D?   _____________  If so, who?  ____________________________
  • Are you currently taking medication for your learning difficulties?  _______ If so, what?  _________ 
  • When do you take it?  __________________      Do you find it helpful?  ____________________     
  • Are there any negative side effects?  ________________________________________________
  • Sleep patterns. 
    •  How many hours do you usually sleep per night?  ________  
    •  Regular restful sleep?  ________  If no, please explain: ____________________________
    • Hard time falling asleep?  ______    If yes, please explain: __________________________
    • Hard time getting up in the morning?  ______ If yes, please explain: __________________
    • Sleep apnea?  _________________
    • Other comments:  __________________________________________________________
  •   Are you:  ___ left-handed?            ___ right-handed?        ___ ambidextrous?
  •  Childhood “stuff”:
  • At what age did you learn to walk?  ______________    to talk?  _______________
  • Did you ever have speech therapy?  ____________  Eye-tracking therapy?  __________
  • Did you have ear infections as a child?  (If so, how severely?  Tubes?) __________________
  • How old you were when you learned to read?  ______________________ 
  • Did you enjoy reading?  Why, or why not?  ________________________________________
  • Do you remember the method by which you learned to read in school?  (Phonics?  Whole language?)  ___________________________________________________________________________
  • Were you a good speller?  ______________  Are you a good speller now?  ______________
  • Have you ever had a concussion or head injury?  _______  If so, how many times?  ________ 
  •  Do the following characteristics generally describe you (not only in an academic setting)?

      ____________ impulsive                          ____________ difficulty with concentration / focus

      ____________ spacey / daydreaming       ____________ hyperactive

      ____________ distractible                                    ____________ depressed

      ____________ procrastinator                    ____________ difficulty with organization / time

      ____________ effective study habits       ____________ addictive behaviors (Explain) 

 Are there any health issues that might impede your success in this class?   ______________________________________________________________­­­­­­­­­­­­­­

How would you describe your learning difficulties in general?   ________________________________

­­­­­­­­­ Do you have any concerns about this course?  Explain. ______________________________________­­­­­­­­­­­­­­

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