Need Analysis Form for Students of English

Needs Analysis Form - English Students
What kind of devices do you have? (you can check more than one)
English Level *
If you have not taken a placement test, please estimate your level using the table on this page.
How many classes do you want per week?
What areas do you want to improve? (You can choose more than one)

How often and how do you use English in your everyday life?

How would you rate your ability in the following skills?