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| The following needs assessment survey, accompanied by a personal welcome message, will be sent via private E-mail to each new person who has requested to join the Lingo-L mailing list. The survey is designed to obtain background information about the people who have asked to join the list. This information will help me introduce new members to the list, prepare specific materials for distribution to everyone, and manage the list in a more efficient manner. Participants will be asked to return the survey form directly to me rather than to the list at large. |
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| Name:
________________________________________________________________________ |
| *Age: ______________ *Gender: _______________ *Birthdate: _______________ |
| E-mail address:
________________________________________________________________________ |
| Nationality or country of origin:
________________________________________________________________________ |
| Currently employed? Yes: ____ No: ____ Currently a student? Yes: ____ No: ____ |
| Highest educational level attained:
________________________________________________________________________ |
| Native or first language learned:
________________________________________________________________________ |
| Other languages studied:
________________________________________________________________________ |
| How proficient is your written English?
Very good: _______ Adequate: _______ I Get By: _______ |
| Where do you receive your e-mail?
Home: _______ Work: _______ School: _______ Other: _______ |
| What E-mail program are you using?
________________________________________________________________________ |
| What kind of Internet connection do you have?
T1/T3: _______ Modem: _______ Other: _______ |
| Do you have access to the Worldwide Web (WWW)? Yes: ____ No: ____ |
| Are you familiar with listserv protocols (subscribing, unsubscribing,
submitting messages,
and so on)? Yes: ____ No: ____ I could use some help: ____ |
| Why do you want to join the Lingo-L list?
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ |
| What would you like to learn from this list?
________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ |
| Note: Starred items are voluntary. You do not have to answer these questions. I would like to know your birthdate, however, so that I can send you a special greeting on your day. |
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| © 1998 E.V.A. Co.
Designed and maintained by Editing & Visual Arts Co. |
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