English Language Program: Interest Form

I wish to enroll in: *

Academic Writing

Academic Speaking

General English

Learning & Speaking about US Life and Culture

Last Name/ Family Name *

First Name/ Given Name *

Gender *

Date of Birth * +

Nationality *

Are you currently a student? *

Rochester Student ID Number

Degree Level *

Projected Graduation Date * +

Current Course of Study at UR *

Are you currently a UR affiliate (staff member, or family of a staff member or student)? *

UR School Affiliation *

Email Address *

Cell Phone Number *

ELP module interested in (select all that apply) *

Academic Speaking

Academic Writing

General English

Learning & Speaking about U.S. Life and Culture

What are your goals in studying English? *

How did you learn about this program? *

Skills Self-Assessment

For each of the four following questions, select the statement that best describes your situation.

1. When listening to English, *

I recognize familiar words and very basic phrases concerning myself, my family and immediate surroundings when people speak slowly and clearly.

I understand the main points of clear standard speech on familiar matters regularly encountered at work, and the main points of many radio or TV programs.

I understand extended speech and lectures and follow even complex lines of argument provided the topic is familiar.

I understand extended, unstructured speech even when relationships are only implied, as well as TV programs and films without too much effort.

3. When engaging in conversation in English, *

I interact in a simple way if the other person is prepared to repeat or rephrase things slowly and help me with what I'm trying to say.

I deal with most situations that come up at work, and take part in conversations on topics that are familiar to me.

I interact with native speakers with confidence and fluency, and can take part in discussions to explain my views.

I express myself fluently and spontaneously without much searching for the right words, and deliver ideas and opinions with precision.

4. When speaking in English, *

I use simple phrases and sentences to describe where I live and people I know.

I connect phrases in a simple way to describe experiences and events, my dreams, hopes and ambitions, and can give explanations for opinions.

I present clear, detailed descriptions on a wide range of topics related to my field of interest or a viewpoint on an issue, giving pro and cons of various options.

I present clear, detailed descriptions of complex subjects, integrating sub-themes, developing particular points including appropriate conclusions.

5. When writing in English, *

I can write a short, simple texts and ﬁll in forms with personal details (name, address).

I can write simple connected text on topics which are familiar or of personal interest.

I can write clear, detailed text on a wide range of subjects related to my interests, passing on information in support of or against a particular point (essay, report).

I can express myself in clear, well-structured, long texts including points of view.