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First Day of School- Student Information Level 3 ESOL
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* Indicates required question
What is your full name? First and Last name
*
Your answer
What name do you want us to call you in class?
*
Your answer
What is your e-mail address?
*
Your answer
What is your cell phone number?
*
Your answer
What is the best way to contact you?
*
My PCC email address
My personal email address
Text my phone
Call my phone
Other:
What devices can you use for our online class this term? Check everything that is true for you.
*
I have a laptop or computer that I can use all the time.
I have a tablet or iPad.
I have a phone.
My family or friend has a computer that I can use.
Other:
Required
How can you connect to our online class this term? Check everything that is true for you.
*
I have data on my phone.
I have wifi/internet.
Other:
Required
Did you pay for this class already?
*
No
Yes
I don't know.
If you did not pay for this class, do you have Oregon Health Plan or Food Stamps (SNAP)?
No
Yes
I don't know.
Clear selection
Do you have the Level 3 English in Action books?
Yes, I have the textbook and workbook.
I only have the textbook.
I only have the workbook
No, I do not have the books
Other:
Clear selection
If you have a job, what is your job and how many hours do you work?
Your answer
What country are you from?
Your answer
What is your first language?
*
Your answer
What other languages can you speak?
Your answer
How many years of school do you have in your country?
Middle school 7-9 years
Elementary school 1-6 years
Some university or job training after high school
High school 9-12 years
Finished university
Other:
Clear selection
Did you have a job in your country? What was it?
Your answer
Do you have children?
Yes, I have young kids living with me.
Yes, I have older kids living with me.
Yes, I have adult kids living with me.
Yes, but my kids don't live with me.
No, I don't have kids.
Clear selection
Do you have any questions for me?
Your answer
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