Participant Background Form Long

1. Name *

2. Age (years) *

3. Education (years) *

4. Which language do you consider to be your native language, or mother tongue *

5. Where have you lived and for what period of your life? *

Please provide city, country and for each from age __ to age __.

6. For each geographical locations where you have lived, which language(s) are predominantly spoken by members of that community? *

7. If you speak more than one language, please list the name(s) of the language(s)

8. If you speak more than more language, please specify the age at which you started to learn these languages in the following situations (write age and language next to any situation that applies)

a) At home

b) In school

c) After arriving in the second language speaking country

9. How did you learn the language up to this point (check all that apply)

a) Through formal classroom education

Mainly

Mostly

Occasionally

b) Through interacting with people

Mainly

Mostly

Occasionally

c) Or a mixture of both, but

More classroom

More interaction

Equally both

d) Other

10. Estimate, in terms of hours per day, how often you speak (or used to speak) your native and second languages with the following people. For each response indicate the language and the number of hours.

a) Father *

b) Mother *

c) Grandfather(s) *

d) Grandmother(s) *

e) Brother(s)/Sister(s) *

f) Other family members *

g) Spouse/Partner *

h) Friends *

i) Classmates *

j) Co-workers *

11. Write down the language(s) in which you received instruction in school, for each schooling level.

a) Primary/Elementary School *

b) High School *

c) College/University *

12. Among the languages you know, which language is the one you would prefer to use in these situations?

a) At home *

b) At work *

c) At a party *

d) In general *

13. List all of the languages you know in order of most proficient to least proficient. Rate your ability on the following aspects in each language. Please rate according to the following scale.

Language 1

	Poor	Fair	Functional	Good	Native-Like
Reading proficiency	Reading proficiency - Poor	Reading proficiency - Fair	Reading proficiency - Functional	Reading proficiency - Good	Reading proficiency - Native-Like
Writing proficiency	Writing proficiency - Poor	Writing proficiency - Fair	Writing proficiency - Functional	Writing proficiency - Good	Writing proficiency - Native-Like
Speaking fluency	Speaking fluency - Poor	Speaking fluency - Fair	Speaking fluency - Functional	Speaking fluency - Good	Speaking fluency - Native-Like
Listening ability	Listening ability - Poor	Listening ability - Fair	Listening ability - Functional	Listening ability - Good	Listening ability - Native-Like

Language 2

	Poor	Fair	Functional	Good	Native-Like
Reading proficiency	Reading proficiency - Poor	Reading proficiency - Fair	Reading proficiency - Functional	Reading proficiency - Good	Reading proficiency - Native-Like
Writing proficiency	Writing proficiency - Poor	Writing proficiency - Fair	Writing proficiency - Functional	Writing proficiency - Good	Writing proficiency - Native-Like
Speaking fluency	Speaking fluency - Poor	Speaking fluency - Fair	Speaking fluency - Functional	Speaking fluency - Good	Speaking fluency - Native-Like
Listening ability	Listening ability - Poor	Listening ability - Fair	Listening ability - Functional	Listening ability - Good	Listening ability - Native-Like

Language 3

	Poor	Fair	Functional	Good	Native-Like
Reading proficiency	Reading proficiency - Poor	Reading proficiency - Fair	Reading proficiency - Functional	Reading proficiency - Good	Reading proficiency - Native-Like
Writing proficiency	Writing proficiency - Poor	Writing proficiency - Fair	Writing proficiency - Functional	Writing proficiency - Good	Writing proficiency - Native-Like
Speaking fluency	Speaking fluency - Poor	Speaking fluency - Fair	Speaking fluency - Functional	Speaking fluency - Good	Speaking fluency - Native-Like
Listening ability	Listening ability - Poor	Listening ability - Fair	Listening ability - Functional	Listening ability - Good	Listening ability - Native-Like

14. Estimate, in terms of percentages, how often you use your native language and other languages per day (in all daily activities combined, circle one that applies)

Language use grid

	< 25%	25%	50%	75%	100%
Native language	Native language - < 25%	Native language - 25%	Native language - 50%	Native language - 75%	Native language - 100%
Second language	Second language - < 25%	Second language - 25%	Second language - 50%	Second language - 75%	Second language - 100%
Other language(s)	Other language(s) - < 25%	Other language(s) - 25%	Other language(s) - 50%	Other language(s) - 75%	Other language(s) - 100%

15. In which languages do you usually:

a) Count, add, multiply, and do simple arithmetic? *

b) Dream? *

c) Express anger of affection? *

Leave this field blank

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Participant Background Form Long

Department and University Information

School of Communication Sciences and Disorders (SCSD)