intake form

date

Name

Age

Place of birth

language(s) you speak fluently

How long have you been living in Holland?

Have you had Dutch classes yet?

If so, for how long?

• No

• yes, at_____________________ for about __________ hours/months/years

If so: what method have you used?

• Dutch for dummies

• Dutch for self-study

• Stap 1

• stap 2

• Alexander

• Code deel 1

• Code deel 2

• de Finale

• 1,2,3

• ABC

• 7/43 nivea 1 / 2 / 3

• Aap

• allemaal taal

• Audiocursus _________________________

• Contact 1 / 2 / 3

• de Basis

• Delftse methode

• de Kop erop

• de Sprong

• Duidelijk Nederlands

• Goed Zo 1 / 2

• Help 1 / 2 / 3

• het hele verhaal

• hogerop

• klare taal

• lezen, las gelezen 1 / 2

• naar nederland ___________

• Nederlands in gang

• Nederlands nu!

• Nederlands voor buitenlanders

• Nieuwe Buren

• Nieuwe Start!

• Nota Bene!

• Pakket Staatsexamen I / II

• Schrijven op B1 / B2

• Stap 1 / 2 / 3

• start.nl 1 / 2

• Taal Vitaal

• Taaltalent 1 / 2 / 3

• Totaal 1 / 2

• Tweede ronde

• Vanzelfsprekend ____________

•  

• other _________________

What is you highest education?

• Elementary school

• professional training

• university

What level of Dutch do you have?

(Choose whatever level you are familiar with)

• I'm not sure

• Total beginner

• Beginner

• medium level

• advanced level

• professional

• near native

• Staatexamen I

• Staatsexamen II

• NT2-1

• NT2-2

• NT2-3

• NT2-4

• NT2-5

• CEF A1 for speaking / listning / writing / reading

• CEF A2 for speaking / listning / writing / reading

  CEF B1 for speaking / listning / writing / reading

  CEF B2 for speaking / listning / writing / reading

  CEF C1 for speaking / listning / writing / reading

What would you like to achieve with classes of Dutch? Choose as many as you like

• Talk to my Dutch family

• Talk to my Dutch friends and neighbours

• Help my children with their Dutch school

• prosper in my job

• find a job

• achieve 'Inburgering'

• _______________________

What are the most difficult things about Dutch in your experience?

• Grammar

• pronunciation

• people talking English to me all the time

• use of expressions

• writing Dutch

•