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This form will help us to understand how well you can communicate in English, so that we can decide on the best support for you. Please answer as many questions as you can.

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Your name *

Your email address

Your role or organisation

About you

What is your name? *

What is your address? Please make sure you include your full address, including house number or name.

Building and street line 1 of 2

Building and street line 2 of 2

Town or city

County

Postcode

Your English

Can you say your name and address in English?

Yes

Can you read this form without using a translation app?

Yes

Can you read these questions without a friend's help?

Yes

Do you write emails?

Yes

Who do you write emails to?

What food do you buy at the supermarket?

What did you do yesterday? (please write 1-100 words)

Can you read English on a computer?

Yes

Can you write English on a computer?

Yes

Going to the library

Can you go to the library at

Bexhill

Crowborough

Eastbourne

Hastings

Hailsham

Seaford

I can't go to a library

Please tick all the reasons why you can't go to a library

I can't walk very far

I don’t have money for transport

I have a baby

I care for my family

I don't like going outside

Is someone helping you to answer these questions? *

Yes

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Phone

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