| General Information |
| Your Name: (optional) |
| Today’s Date: Age: Gender: |
| Are you a currently working with a VEP tutor? ¨Yes ¨No/Date Ended: |
| Are you participating in any other ESL programs? ¨Yes/Where:________________________________ ¨No |
| How many people are in your household? ____Adults ___Children |
| Please check R your personal income range: Weekly:__________________
¨$0-$18,000 ¨$19,000-$24,000 ¨$25,000-$31,500 ¨$32,000-$36,500 ¨$37,000-$43,00 ¨ $44,000-$49,000 ¨$50,000-$55,000 ¨$56,000 or above |
| Satisfaction Circle the number that best describes your answer No Somewhat Yes Yes, very much I am(was) satisfied with my tutor match 1 2 3 4 I like(d) where my tutor and I meet 1 2 3 4 I am(was) satisfied with the provided VEP workbooks 1 2 3 4 I am(was) satisfied with what I am learning 1 2 3 4 |
| Areas in my life that have improved because of VEP: Check R all that apply. Use the back of the page if needed.
Education ¨Yes ¨No ¨In Progress | Explain: Employment ¨Yes ¨No ¨In Progress | Explain: Home and Family ¨Yes ¨No ¨In Progress | Explain: Financial Security ¨Yes ¨No ¨In Progress | Explain: Personal Safety ¨Yes ¨No ¨In Progress | Explain: Participation in my neighborhood ¨Yes ¨No ¨In Progress | Explain: Citizenship ¨Yes ¨No ¨In Progress |Explain: Confidence in speaking English ¨Yes ¨No ¨In Progress | Explain: Other: |
| What goal(s) are you working on now? |
| Please tell us more about a special accomplishment in your VEP experience (new job, new home, family member, citizenship, etc.)
What else do you want to accomplish by learning English?
How may we improve the Volunteer English Program?
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