Education Class Placement - Rian Immigrant Center

Personal Information

Name*

First Last

Birthdate (Example- October 1, 1989)*

Gender*

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How many people live in your home?*

How would you us to contact you?*

Email
Phone

Country of origin (where are you from?)*

What is your native language?*

Race/Ethnicity*

How long have you lived in the United States (how many months or years)?*

What is your employment status?*

Working full-time (40 hours)
Working part-time
Not working

How much is your paycheck for 1 month?*

What education did you finish before?*

None
High School
Associate or Bachelor's Degree
Master or Doctorate Degree

Have you taken any English classes before?*

Yes
No

Why do you want to take an English class?*

Who told you about ESOL classes at Rian Immigrant Center?*

JVS
PAIR
Project Citizenship
BIJAN
Family
A friend
A coworker
Other

Technology Information

Due to the COVID-19 stay at home order we are currently offering classes online. Please help us understand your access to technology.

Do you have access to technology at home?*

Check all that apply

Computer
Tablet
Smartphone

Is there someone in your home who can help you with technology if you need help?*

Yes
Maybe
No

Do you use email?*

Yes, I check it daily
Yes, I check it weekly
Yes, I don't check it often
No

Do you have a printer at home?*

Yes
No

Do you have access to wi-fi at home?*

Yes
No

Do you use WhatsApp?*

Yes
No
I know what WhatsApp is but I have not used it
I don't know what WhatsApp is

Do you use Zoom?*

Yes
No
I know what Zoom is but I have not used it
I don't know what Zoom is

Please answer these questions by yourself, without help from someone else

Choose the answer you believe is correct.

I ___________ from Haiti.*

is
are
am
be

This is my friend. ________ name is John.*

Her
Our
Your
His

My brother is ______________ artist.*

an
a

_______ 20 desks in the classroom*

This is
There is
There are
They are

Sarah _______ going to the movies.*

likes not
don't like
doesn't like
isn't likes

Sorry, I can't talk. ______________ right now*

I driving
I'm driving
drives
Drive

She __________ at school last week*

didn't be
weren't
wasn't
isn't

_________ had ice cream?*

Did you ever
Are you ever
Have you ever
Do you ever

We've been friends _________ many years.*

since
from
during
for

You _________ pay for the tickets. They're free.*

have to
don't have
don't need to
doesn't have to

Jeff was sick last week and he ___________ go out.*

needn't
can't
mustn't
couldn't

These are photos __________ I took on vacation.*

which
who
what
where

We'll stay at home if it ____________ this afternoon.*

raining
rains
will rain
rain

He doesn't exercise now, but he ___________ a lot when he was young.*

has exercised
exercises
used to exercise
was exercised

Mark plays football _______________ anyone else I know.*

more good than
better than
best than

I promise I _______ you as soon as I finish cleaning.*

will help
am helping
going to help
have helped

This town ____________ by lots of tourists during the summer.*

visits
visited
is visiting
is visited

He said that his friends __________ to speak to him after they lost the football match.*

not want
weren't
didn't want
aren't wanting

Excuse me, can you _____________ me the way to the station, please?*

give
take
tell
say

Its cold so you should ___________ on a warm jacket.*

put
wear
dress
take

She ________ a lot of her free time reading.*

does
spends
has
makes

Hello, this is Simon. Could I ___________ to Jane, please?*

say
tell
call
speak

They're coming to our house __________ Saturday.*

in
at
on
with

What specifically do you need to focus on as you study and practice English (i.e. communication with doctors, teachers, lawyers; get a job; citizenship; etc.)?*

When are you interested in starting classes?

The next semester (Summer)
I am not sure

Are you interested in citizenship classes?*

Yes, I only want citizenship class, NOT English class.
Yes. I want citizenship class AND English class.
No, I only want English class, NOT citizenship class.

English Language Placement Test

Personal Information

Technology Information

Please answer these questions by yourself, without help from someone else