Name:

Department(s):


Your Undergraduate Major(s):

Your Minor(s):


Please provide the following information about your formal study of foreign languages:


Language(s) Studied:

No. of Years:

High School:

Undergraduate College/Univ:

Other (Specify):

Foreign language proficiency exams completed for graduate degree:


Please provide the following information about your residence in a foreign country (please list travel in item #5):

Foreign Country in Which You Resided.....Length of Stay.....Purpose (brief explanation)






Please provide the following information about your significant personal/professional travel in non-English speaking countries:

Use of Foreign Language While Traveling in Country

Country.....Length of Visit..........Extensive..........Some.....Little/None






1) Please circle those languages below in which you have some reading, speaking and/or writing skill.

2) For each language circled, please complete the grid below. Place the language abbreviation on the line that best describes the level of your reading ability (A), speaking ability (B), and listening ability (C) in that language.

Ch = Chinese.....G = German.....J = Japanese.....N = Norwegian.....S = Spanish

F = French.....Gk = Greek.....L = Latin.....R = Russian.....__ = (specify other)

A. Reading
__I cannot read in the language at all.

__I can recognize isolated words and I can use isolated words and phrases.

__I can read and comprehend whole sentences as long as they pertain to basic survival needs (food, lodging, transportation, etc.)

__I can read and comprehend paragraph length discourse that pertains to concrete topics (school, work, current events).

__I can read and comprehend articles in professional journals.

B. Speaking
__I cannot speak the language at all.

__I can use isolated words and phrases. I can name days of the week, month, seasons, family members, etc.

__I can survive in the foreign culture, speak in sentences, carry on a simple conversation, ask and answer simple questions, get a hotel room, obtain directions, order a meal, buy a train ticket.

__I can speak in extended dialogue with a native speaker when we discuss concrete topics--school, work, current events.

__I can use the language in a professional context--for giving a paper, discussion research with foreign colleagues.

C. Listening
__I cannot understand a word of the spoken language.

__I can recognize isolated words and phrases.

__I can understand the language well enough to survive in the culture. I can understand sentences and basic questions related to common needs (food, lodging, transporation)

__I can understand the bulk of what a native speaker says so long as the topic is concrete, not abstract, and so long as I am familiar with the topic.

__I can understand virtually everything that is said by native speakers, whether the topic be concrete or abstract. I can function professionally in the language.

7. To what extent are you interested, ifi at all, in developing your foreign language skills through some type of formal instruction (auditing,
special evening or summer courses, etc.)?

Foreign Language..........Very Interested..........Somewhat Interested



8. Please indicate the approximate number of times each of theh following occurred last year:

During the year, how often did you:
a. Read an article written in a foreign language?
b. Correspond with a professional colleague in a foreign language?
c. Attend a meeting where some of the papers were presented in a language other than English?
d. Include a source written in a foreign language as optional reading for the students?
e. Include a source written in a foreign language as required reading?
f. Have a request from a student to use a foreign text?
g. Receive a student paper that used a foreign language text as a source?

9. In the area(s) in which you teach, how important is it for students to be able to read texts written in languages other than English?
1. Very Important
2. Important
3. Somewhat Important
4. Not Important

10. What is the potential for incorporating texts written in a foreign language into the courses you teach?
1. A great deal of potential
2. Some potential
3. A little
4. Essentially none at all.


What courses are you teaching or might you teach that could offer students an applied foreign language component?

Course...............Have Taught...............Could Teach






Feel free to attach a sheet with comments and/or questions about the "program of applied language work across the curriculum."