Example:
There are three parts in this questionnaire that you are required to answer. The first part would be your personal data, where as the second part is your parents’ background. Finally, the last part would be on questions related to your feelings about the English language and learning it.
Part A: Personal Details
Please tick ( / ) in the appropriate brackets.
1. Gender: ( ) Male ( ) Female
2. Age: ( ) 18 – 20 years old. ( ) 21 – 23 years old.
3. Faculty/Program you are enrolled in at U: ________________________
4. SPM English Grade: _____________
5. Language (s) spoken at home: 1. _________________
2. _________________
3. _________________
Part B: Parents’ Background:
1. Do your parents speak in English with each other? ( ) Yes ( ) No
2. Does your mother speak in English with you? ( ) Yes ( ) No
3. Does your father speak in English with you? ( ) Yes ( ) No
Please tick ( / ) in the appropriate brackets.
4. How often do your parents speak in English at home?
Never ( ) sometimes ( ) often ( ) very often ( )
5. How often does your mother speak in English with you?
Never ( ) sometimes ( ) often ( ) very often ( )
6. How often does your father speak English with you?
Never ( ) sometimes ( ) often ( ) very often ( )
7. Level of education:
Father: ______________
Mother: ______________
Part C: As for this part of questionnaire, you would have to rate each of the following items in terms of how you feel about it.
For each of the following statements, please indicate your response by circling
the number which you think is the most applicable.
Strongly Disagree Moderately Disagree Slightly Disagree Moderately Agree Strongly Agree
1 2 3 4 5
1. I love learning English. 1 2 3 4 5
2. I plan to learn as much English as possible. 1 2 3 4 5
3. I think that learning English is dull. 1 2 3 4 5
4. I really work hard to learn English 1 2 3 4 5
5. I wish I were fluent in English. 1 2 3 4 5
6. I pay much attention to the feedback 1 2 3 4 5
I receive in my English class.
7. I get nervous when I have to answer 1 2 3 4 5
a question in my English class.
8. I have a strong desire to know all aspects of 1 2 3 4 5
English.
9. Studying foreign languages is not enjoyable. 1 2 3 4 5
10. I try to understand anything that I see and hear 1 2 3 4 5
in English.
Strongly Disagree Moderately Disagree Slightly Disagree Moderately Agree Strongly Agree
1 2 3 4 5
11. I feel confident when asked to speak English 1 2 3 4 5
in class.
12. Knowing English is not really an important 1 2 3 4 5
goal in my life.
13. I hate English. 1 2 3 4 5
14. I don’t bother checking my assignments which I 1 2 3 4 5
get back from my English teacher.
15. I really enjoy learning English. 1 2 3 4 5
16. I keep up to date with English by working on it 1 2 3 4 5
almost every day.
17. I feel embarrassed to volunteer answers in my 1 2 3 4 5
English class.
18. I enjoy the activities of our English class much 1 2 3 4 5
more than those of my other classes.
19. I want to learn English so that it will become 1 2 3 4 5
natural to me.
20. To be honest, I really have little interest in my 1 2 3 4 5
English class.
21. It is not important for us to learn foreign 1 2 3 4 5
languages.
22. When I have a problem understanding something 1 2 3 4 5
in my English class, I always ask my teacher for
help.
23. It worries me that other students in my class 1 2 3 4 5
seem to speak English better than I do.
24. I like my English class so much, I look forward to 1 2 3 4 5
studying more English in future.
Strongly Disagree Moderately Disagree Slightly Disagree Moderately Agree Strongly Agree
1 2 3 4 5
25. I tend to give up and not pay attention when I 1 2 3 4 5
don’t understand my English teacher’s
explanation of something.
26. If I planned to stay in another country, I would try 1 2 3 4 5
to learn their language.
Perceptions towards learning English
27. Studying English is very important because I 1 2 3 4 5
will need it for my career.
28. Learning English is really great. 1 2 3 4 5
29. Learning English is important because it 1 2 3 4 5
will allow me to be more comfort with people
who speak English.
30. Studying English is important because I will be 1 2 3 4 5
able to interact more easily with speakers of
English.
31. English is one of my favorite courses. 1 2 3 4 5
32. Studying English is important because other 1 2 3 4 5
people will respect me more if I know English.
33. Studying English is important because it will 1 2 3 4 5
make me more educated.
34. Studying English is important because it will 1 2 3 4 5
allow me to meet and talk with more and varied
people.
35. Studying English is important because it will be 1 2 3 4 5
useful in getting a good job.
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