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ESL Agent Student Survey

To help ESL Agent find the best program for you, please answer all of the following:

I. Personal Information

First Name:
Last Name:

Gender:
Male
Female

Email Address:

Date of Birth:
  Month Day Year

Country:
Profession/Studies:

II. Knowledge of English

None/very little (Beginner)
Some (Elementary)
Good (Low Intermediate)
Very good (High Intermediate)
Excellent (Advanced)

III. Location and Type of School

A.
In which state(s) would you prefer to study?
Please specify:

B. In which type of environment would you like to study?

Major City
Small city or town
University Campus
Rural Area
No Preference

C. What size school would you prefer?

Very Small (under 50 students)
Small (50-100 students)
Medium (100-200 students)
Large (200-300 students)
Very Large (300+ students)

IV. Classes

A. What is most important for you in your studies?

(please check all that apply)
Speaking
Listening
Grammar
Vocabulary
Reading
Writing
Other:

B. How many students maximum would you like in your classes?
1 (private lessons)
6 or under
7-10
11-15
16-20
21-30

C. Which type of classroom learning environment
would you prefer?

Formal
Informal

D. What specialized English course(s) would like to take?
Business English
Legal English
Medical English
Teacher Training
Other (please specify):

E. For which English tests would you like to study?

TOEFL
TOEIC
IELTS
BEC
FCE
CAE
CPE
other:

F. How long would you like to study? (weeks)

G. What special classes would you like to take in addition to your English classes? (Examples: golf, scuba, surfing, snowboarding, dance...
Please specify:

V. Accommodations

A. What type of accommodation would you prefer?

American family
Student apartment
Private apartment
Hotel

B. What is the maximum distance you would want your
accommodation to be from the school?

Walking distance
15 minutes by car or public transportation
30 minutes by car or public transportation
30-45 minutes by car or public transportation

VI. What else would you like ESL Agent to know so we can find the right English program for you?



VII. How did you hear about us?