Self-Evaluation Form Name __________________________

1. Pre-Course & Post-Course Self-Evaluation Form for Language Skills

The checklist is a review of students’ overall proficiency in English and as a reference for monitoring students learning progress and
course learning tasks. Instructions: Use the checklist to record what you think you can do.
For Pre-Course Self-Evaluation, use √ to mark in the columns: 1. I cannot do this. 2. I can do this with great effort. 3. I can
do this under normal circumstance.
For Post-Course Self-Evaluation, use O to mark in the columns: 1. I cannot do this. 2. I can do this with great effort. 3. I can
do this under normal circumstance.

Listening 1 2 3

I can understand when people speak to me clearly and articulate carefully.

I can understand directions: how to get from X to Y or any operation
instructions.
I can follow the main points of extended discussion around me.
I can follow lectures, talks and reports in my field of professional or
academic interest.
I can understand any kind of spoken language, where live or broadcast.
Speaking
I have a good command of a broad vocabulary.
I can consistently maintain a high degree of grammatical accuracy.
I can express my ideas and opinions spontaneously, clearly and
effortlessly.
I can give a clearly developed presentation on a subject in my fields of
personal or professional interest.
I can express my ideas and opinions fluently, clearly, and almost
effortlessly on personal, professional or academic topics.
Reading
I can understand instructions even they are not in my field of interest.
I can understand information in news summaries or news articles.
I can understand reports, analyses and commentaries where opinions,
viewpoints and connections are discussed.
I can understand literary texts of different genres (poetry, prose, drama).
Writing
I can describe an event and report what happened, when, and where.
I can express myself in writing on a wide range of general or professional
topics in a clear and user-friendly manner.
In a report I can give a complete account of a topic based on research I
have carried out.
I can make a summary of the opinions of others, and give and evaluate
detailed information and facts.
I can write summaries of factual texts and literary works.
2. Pre-Course & Post-Course Self-Evaluation Form for Cultural Competence
Instructions: Use the checklist to record what you think you can do.
For Pre-Course Self-Evaluation, use √ to mark in the columns.
For Post-Course Self-Evaluation, use O to mark in the columns.

1=Never 2=Sometimes 3=Always

Awareness 1 2 3
Value Diversity I view human difference as positive and a cause for celebration.
Know myself I have a clear sense of my own ethnic, cultural and racial identity.
Share my culture I am aware that in order to learn more about others I need to
understand and be prepared to share my own culture.
Be aware of areas of I am aware of my discomfort when I encounter differences in race,
discomfort color, religion, sexual orientation, language, and ethnicity
Challenge my I am aware of my discomfort when I encounter differences in race,
stereotypes color, religion, sexual orientation, language, and ethnicity.
Be curious I take any opportunity to put myself in places where I can learn about
difference and create relationships.
Aware of social justice I am aware of the impact of then social context on the lives of
issues culturally diverse population, and how power, privilege, and social
oppression influence their lives.
Assess the limits of my I recognize that my knowledge of certain cultural groups is limited
knowledge and commit to learn more.
Acknowledge the I know that differences in color, culture, ethnicity etc. are important
importance of difference parts of an individual’s identity which they value and so do I.
Understand the influence I recognize that cultures change over time and can vary from person
culture can have to person, as does attachment to culture.
Know my limitations I continue to develop my capacity for assessing areas where there are
gaps in my knowledge.
Awareness of multiple I recognize that people have intersecting multiple identities, drawn
social identities from race, sex, religion, ethnicity, etc. and the importance of each of
these identities varies from person to person.