Client Education Assessment Questionnaire
Help us understand your educational background, learning preferences, and goals so we can tailor our support to your needs.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What is your highest completed level of education?
*
Please Select
High School or equivalent
Associate Degree
Bachelor's Degree
Master's Degree
Doctorate/PhD
Other
Please select the area(s) you wish to focus on or improve.
*
Reading comprehension
Writing skills
Mathematics
Critical thinking
Computer skills
Other
How would you describe your preferred learning style?
*
Visual (seeing and reading)
Auditory (listening and speaking)
Kinesthetic (hands-on, doing)
Reading/Writing
Not sure
Please rate your confidence in the following areas:
*
Rows
Not confident at all
Somewhat confident
Confident
Very confident
Reading comprehension
1
2
3
4
Writing skills
5
6
7
8
Mathematics
9
10
11
12
Critical thinking
13
14
15
16
Computer skills
17
18
19
20
What are your main goals for this educational program or support?
*
What challenges or obstacles do you face in achieving your educational goals?
How do you prefer to receive support?
One-on-one sessions
Group workshops
Online resources
Printed materials
Other
Is there anything else you would like us to know about your educational needs or preferences?
Submit Assessment
Should be Empty: