How are the scores interpreted?
• If you have taken Test 1A and 2A, add together the scores to give a total out of 80.
➤ A score of 0–40 points indicates your level of English is Elementary.
➤ A score of 41–80 points indicates your level of English is Pre-intermediate.
➤ No one other than you (student/participant) should answer the questions.
➤ You will see your test results/score at the end of completing all of part 3 forms and copy of results will be emailed to you. Do not close this link until you finish the test and see your results, otherwise it will be considered uncompleted.
I confirm I have completed test 1A & 2A on my own without any form of assistance.Signature* Date*
SECTION YES OR NO 1. Have you had any problems learning in middle school or junior high?Yes No* 2. Do you have difficulty working from a test booklet to an answer sheet?Yes No* 3. Do you have difficulty or experience problems working with numbers in a column?Yes No* 4. Do you have trouble judging distances?Yes No* 5. Do any family members have learning problems? Yes No* 6. Have you had any problems learning in elementary school? Yes No* 7. Do you have difficulty or experience problems mixing mathematical signs (+/x)? Yes No* 8. Do you have difficulty or experience problems filling out forms? Yes No* 9. Do you experience problems or difficulty memorizing numbers? Yes No* 10. Do you have difficulty remembering how to spell simple words you know? Yes No* 11. Do you have difficulty or experience problems taking notes? Yes No* 12. Do you have trouble adding or subtracting small numbers in your head? Yes No* 13. Were you ever in a special program or given extra help in school? Yes No*
EDUCATION 14. Were you ever in special education classes in school? Yes No* 15. Have you ever been diagnosed or told you have Learning Disabilities? Yes No* If YES, by Whom When? Type(s) of Learning Disability (if known): 16. Have you ever been diagnosed or told you have Learning Disabilities with or without hyperactivity? Yes No*
GLASSES 17. Do you need or wear glasses or contact lenses? Yes No* 18. Was your last vision test within the last two years? Yes No*
HEARING 19. Do you need or wear a hearing aid? Yes No* 20. Have you had your hearing tested in the last 12 months? Yes No*
SPEECH 21. Have you ever seen a speech or language therapist? Yes No*
MEDICAL/PHYSICAL 21. Have you ever had any of the following: • a lot of ear infections? Yes No* • a lot of sinus problems? Yes No* • high fevers that lasted a long time? Yes No* • diabetes (high blood sugar)? Yes No* • severe allergies? Yes No* • a lot of headaches or migraines? Yes No* • a head injury? Yes No* • convulsions or seizures? Yes No* • serious health problems? Yes No* 23. Are you taking any medication that affect the way you think, act, or feel? Yes No* If YES, What?
Signature: Signature* Date: Date* Please check below:Signed by Participant Signed by Parent/Guardian of Participant (If Participant Is under 18 years of age)*