LEARNER PROFILE 
LEARNER PROFILE
 
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Text code : (do not fill in)
 
Essay :
Title :
Approximate length required :            -500 words 0            +500 words      
        0
Conditions :                           timed             0            untimed    
                  0
Examination :                                    yes                  0          
  no                    0
Reference tools :              yes                  0            no              
      0
 
What reference tools ?
            Bilingual dictionary :
            English monolingual dictionary :
            Grammar :
            Other(s) :
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Surname :                                        First names :
Age :                          Male               0                      Female  
          0
 
Nationality :
Native language :
Father's mother tongue :
Mother's mother tongue :
Language(s) spoken at home : (if more than one, please give the average % use of 
each)
 
Education :
 
Primary school - medium of instruction :
Secondary school - medium of instruction :
 
Current studies :
Current year of study :
Institution :
Medium of instruction :
            English only 0
            Other language(s) (specify) 0
            Both    0
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Years of English at school :
Years of English at university :
 
Stay in an English-speaking country :
Where ?
When ?                                                          How long ?
 
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Other foreign languages in decreasing order of proficiency :
 
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            I hereby give permission for my essay to be used for research 
purposes.
 
Date : ......................                          Signature : ...