Online Student Interest Survey
You are completing a student interest survey for a TUITION-FREE English VIRTUAL class. We will have daily virtual ZOOM meetings (Monday - Friday). We will not be meeting in person.
Sign in to Google to save your progress. Learn more
What is your name? (Last name, First name) Example: Jobs, Steve *
Please use two names only. Give your LAST (family) name first, and then write your FIRST name. Please write the name that you want people to call you in the class. Write ONE last name and then write ONE first name separated by a comma.
What is an email address that you check frequently? *
What is your date of birth? (mm/dd/yr) Use slashes / / to separate mm/dd/yr *
Please write the month, then day, and then year (So please write 02/15/81 for February 15, 1981). We need to know that you are 21 years or older. Please use slashes //. Please do NOT use dots like this: 2.15.81. Also please do NOT use dashes like this: 2-15-81. Please REMEMBER you were NOT born in 2018!
What is your mobile phone number here in the USA? *
Enter numbers in this format: 212-555-5555 (with dashes after area code and first 3 numbers)
I certify that I am completing this application by myself in English without any friends or family translating it for me. *
If you cannot understand this application alone, then our advanced classes are too hard for you. We do not offer beginners classes.
You must have a NYC address (Any of the 5 boros such as Manhattan, Queens, Brooklyn, etc) to apply for my classes. Do you have a NYC address? *
We cannot accept people with New Jersey addresses. You must have a NYC address when you come in to be evaluated for my classes.
What is your first language? *
It is helpful to your progress to have a variety of first language speakers in the class. That is, you will learn faster if there is greater diversity in the class.
What other languages do you speak fluently? Please list. *
It is helpful to balance the speakers of different languages in the class to promote diversity.
On scale of 1 to 10 how much do you want to improve your listening skills? *
On scale of 1 to 10 how much do you want to improve your speaking in English? *
On scale of 1 to 10 how much do you want to improve your grammar?
Clear selection
Are you interesting in taking VIRTUAL English (ESL) classes? We will NOT be meeting in person. *
Are you available for daily (Monday - Friday) meetings in Zoom? The classes will be 1.5 hours every day and you are expected to be participating online for the 1.5 hours each day. *
Which time works better for you? Do you prefer morning or afternoon classes? VVirtual meetings will last 1.5 hours every day (Monday-Friday). You can only choose ONE class. It is NOT possible to sometimes join the AM class and sometimes the PM class. *
I understand I must attend at least 80 percent of the classes in a month. *
Although the classes are free, you are expected to take them seriously. Please find another class if you will not come regularly. We have several vacations; please see the school calendar later to arrange your schedule around our days off.
Do you have access to INTERNET? *
Check all the devices you have access to for online learning: *
On scale of 1 to 10 how comfortable are you with computers?
Clear selection
What is your expected date to leave the class? Minimum stay should be 3 months in the class. *
How did you find out about the classes? *
Did a friend tell you about the classes? If so, what is his or her name? *
Please tell me something about yourself. Write a minimum of 50 and a maximum of 100 words. (Hobbies? Job? Dreams? Plans?...) *
Who are you? What do you do? What did you study before in school or college? What are your hobbies/interests? Why do you want to improve your English? (Please write this yourself without any help). Answering this question helps me to understand how you might fit in my classes and whether this class can help you.
Will you be attending another school during the period that you be in our classes, such as another ESL program, college, etc? *
I want to know if you will have any schedule conflicts or if you will be too busy to attend my class. I am strict about attendance. It is NOT all right to be absent when you get busy in another school/college.
If you are currently enrolled in another English class, please list the school's and teacher's name.
Are you working now? If so, please write your work schedule. *
I want to know if your work schedule will interfere with the class schedule.
Do you have any questions/comments?
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.