First Name:

Last Name:

Vocation:

Company:

Age:

Email:

Phone:

On a scale of 0 to 10, 10 being an educated native Spanish speaker, what do you believe is your present level of Spanish?
…select one012345678910

On a scale of 0 to 10, 10 being an educated native Spanish speaker, what is your desired level of Spanish?
…select one012345678910

On a scale of 0 to 10, 10 being off the charts, super motivated, what is your level of motivation to learn Spanish?
…select one012345678910

Personality 1
…select onevery shyshyoutgoingextreme extrovert

Personality 2
…select onevery patientsomewhat patientsomewhat demandingvery demanding

Personality 3
…select onenon perfectionistsomewhat perfectionistvery perfectionist

Personality 4
…select onelow self-esteemaverage self-esteemhigh self-esteem

Personality 5
…select onenever discouragedsometimes discouragedeasily discouraged

Personality 6
…select onevery tolerantsomewhat tolerantsomewhat controllingvery controlling

Personality 7
…select onevery carefreesomewhat carefreesomewhat seriousvery serious

Personality 8
…select onefrequently get upsetsometimes get upsetnever get upset

Personality 9
…select onelife of the partytalk with selected peoplestay to myself

Your normal response when someone cuts in front of you in traffic?
…select onestay relatively calmget a bit upsetget very upset

Check the FIVE words that best describe you. Please limit to FIVE.
nervous
calm
controlling
intense
stable
smart
fun-loving
goal-oriented
hyper
great

History 1
…select oneslow learneraverage learnerabove-average learneroutstanding learner

History 2
…select onedifficult to achieve good gradesnot too difficult to achieve good gradeseasy to achieve good grades

History 3
…select oneNo High School DiplomaHigh School Diploma or GEDBachelor’s DegreeMaster’s DegreeDoctoral Degree

Tell us about your grades in HIGH SCHOOL.
…select oneMy grades were C averageMy grades were B averageMy grades were A averageMy grades were below C average

Choose your TWO best subjects.

Math
Science
History
Social Studies
English
Spanish
Gym Class
Music Art
Debate

Choose your TWO worst subjects.

Math
Science
History
Social Studies
English
Spanish
Gym Class
Music Art
Debate

Communications 1
…select onezero acting backgroundminimal acting background fairly extensive acting backgroundvery extensive acting background

Communications 2
…select onezero radio backgroundminimal radio background fairly extensive radio backgroundvery extensive radio background

Communications 3
…select onezero music backgroundminimal music background fairly extensive music backgroundvery extensive music background

Communications 4
…select onezero art backgroundminimal art background fairly extensive art backgroundvery extensive art background

Communications 5
…select onezero public speaking backgroundminimal public speaking backgroundfairly extensive public speaking backgroundvery extensive public speaking background

Communications 6
…select onezero professional writing backgroundminimal professional writing backgroundfairly extensive professional writing backgroundvery extensive professional writing background

Communications 7
…select onenot very creativesomewhat creativehighly creative

Non-verbals 1
…select onepoor eye contactaverage eye contactabove average eye contact excellent eye contact

Non-verbals 2
…select onepoor postureaverage postureabove average postureexcellent posture

Non-verbals 3
…select onepoor volume of voiceaverage volume of voiceabove average volume of voiceexcellent volume of voice

Non-verbals 4
…select onepoor energy levelaverage energy levelabove average energy levelexcellent energy level

Non-verbals 5
…select onepoor use of gesturesaverage use of gesturesabove average use of gesturesexcellent use of gestures

Memory 1
…select onepoor memoryaverage memoryabove average memoryexcellent memory

Memory 2
…select onevery analyticalsomewhat analyticalsomewhat creativevery creative

Memory 3
…select onelow stress in lifeaverage stress in lifesomewhat high stress in lifevery high stress in life

Memory 4
…select oneexercise 4x or more weeklyexercise 3x weeklyexercise 2x weeklyexercise 1x weeklydo not exercise

Memory 5
…select onein poor physical shapein average physical shapein above average physical shapein outstanding physical shape

Memory 6
…select onepoor family relationsaverage family relationsabove average family relationsexcellent family relations

Memory 7
…select onetake medicine that negatively affects my memorydo not take medicine that negatively affects my memorytake medicine but not sure if it negatively affects my memory

Memory 8
…select oneremember all of what I readremember most of what I readremember half of what I readremember very little of what I read

Memory 9
…select oneneed a lot of repetition to remember thingsneed average repetition to remember thingsneed minimal repetition to remember thingshave a photographic memory

Choose the one that is most true for you:
…select oneread a book once a year or lessread a book every six monthsread a book every three monthsread a book monthlyread a book weekly

Choose the one that is most true for you:
…select onesleep four hours or lesssleep 5 hourssleep 6 hourssleep 7 hourssleep 8 hours or more

Choose the one that is most true for you:
…select onesleep oksleep poorlysleep great

Choose the one that is true for you:
…select onepractice yoga or meditationdo not practice yoga or meditation

Choose the one that is true for you:
…select onedo deep breathing exercises 4x or more weeklydo deep breathing exercises 3x weeklydo deep breathing exercises 2x weeklydo deep breathing exercises 1x weeklydo not do deep breathing exercise

How much time can you realistically commit to learning Spanish on a WEEKLY basis?
…select one2 hours3 hours4 hours5 hours6 hours8 hours10 hoursmore than 10 hours

How frequently do you travel?
…select onealmost never2x a yearonce a quarteronce a monthWeekly

How long are you normally gone when you travel?
…select onea few daysa week or somore than a week at a time

Would you prefer course materials to use on the computer or hard-copy to physically have with you?
…select onecomputer or onlinehard-copy in possessiona combinationdoesn’t matter to me

In the event you enroll in a tutoring program, what time of day is best to take tutoring?
…select onemorningslunch timeafternoonEvenings

Pick the TWO qualities that are most important to you in an instructor.

caring
direct
patient
punctual
knowledgeable
native-speaker

In which time zone do you normally reside?
…select oneAtlanticEasternCentralMountainPacificAlaskaHawaiiOther / Outside U.S.

Please confirm your email address.

Please confirm your phone number.

As specifically as possible, please tell us why you want to learn Spanish and how you envision using it in the future.

Please tell us of any additional comments, concerns or special needs we should understand to meet your specific learning and logistical needs.