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. ______________________________________