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English questionnaire (EEG emotion study)

1. Name *

2. Sex *

Male

Female

3. Age (years) *

4. Years of formal education *

5. Since birth, what is/are your native language(s)? *

6. Where were you born? *

7. Please list the places (city, country) you lived after birth until present *

For each place, please specify the period of time (from age __ to age __ ) and the language(s) that are predominately spoken by members of that community. E.g., Toronto, Canada, from birth to 18 years-old, English.

8. Please list your parents' and grandparents' native languages, countries of birth, and countries of descent (where family ancestors came from). E.g., Mother: English, Canada, UK.

Father *

Mother *

Paternal grandfather *

Paternal grandmother *

Maternal grandfather *

Maternal grandmother *

9. Which languages do you routinely speak with family members? If you speak more than one language with any of the following family members, please estimate the percentage of speaking each language (e.g. Father: English, 80%; French, 20%). If any of the following items is not applicable for you, please write N/A.

Father *

Mother *

Grandparents *

Sibling(s) *

Spouse *

Child *

10. What was your language of instruction while attending school, and for each from age __ to age __? E.g., Primary/Elementary School: English, 6-12 years old. If any of the following items is not applicable for you, please write N/A

Primary/Elementary School *

Secondary/Middle School *

High School *

Undergraduate *

Master *

PhD *

11. What language(s) do you currently use at school/work? Please specify for each of the following partners. If you speak more than one language with any of them, please estimate the percentage of speaking each language, eg. Classmates: French, 20%; English, 80%. If any of the following items is not applicable for you, please write N/A.

Teachers *

Classmates *

Colleagues *

Friends *

12. What other languages have you acquired some knowledge of? If not applicable, please write N/A *

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English questionnaire (EEG emotion study)

Department and University Information

School of Communication Sciences and Disorders (SCSD)