COMPTON
PHONOLOGICAL ASSESSMENT OF
FOREIGN ACCENT

Section I - Background Information
Please provide some background information by completing the following form:
Send Results To:
Date:
Name
Address
City
State
Zip
Country


Home Telephone
E-mail     
E-mail Confirmation:
     
Occupation
Job Title
Education Level or Background
Birthdate
Native Language/Dialect
Country of Origin
How did you find us?
How long have you lived in the U.S.A.?
How would you rate your pronunciation of English?

1
Poor
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 4
average
 5

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 7
good







How long have you been speaking English? 
In what country did you learn English?
Did your teachers speak with an accent?
Please describe how you learned English? (Check all that apply)
In  School
At Home
Self Taught
ESL program
Television
;
Other ( please specify below)
How would you describe your ability to use English to express yourself in your daily life:
Do other people have difficulty understanding you?

1
Usually
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 3

 4
sometimes
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 7
never







When do you feel most confident speaking English, i.e., at home, at work, social occasions, etc.?
When do you feel least confident speaking English?     
In what areas of spoken English (grammar, vocabulary, etc.) do you feel confident?
How would you rate your ability to write in English?

1
Poor
 2

 3

 4
average
 5

 6

 7
good







When do you speak English?    
How do you feel you would benefit from improving your spoken English?
What other language(s) do you speak?
Do you have a hearing problem or difficulty in hearing others talk?  If yes, please explain:

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Page last modified:Sunday, 11-Apr-2010 21:20:16 MDT