| Visitor
Survey Please
note that all fields followed by an asterisk must be filled in.
 | 
| First
Name* First
Name* |  | 
| E-mail
Address* E-mail
Address* |  | 
| Country* Country* |  | 
| How
old are you?* How
old are you?* |  | 
| Are
you a...* Are
you a...* | 
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| If
you answered "Other" for the question above, please specify: | 
|  | 
| What
is your level of English?* What
is your level of English?* | 
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| Would
you like to improve your level of English? If so, why?*
 Would
you like to improve your level of English? If so, why?*
 | 
|  | 
| What
is the English level of your students (if you are a teacher)*
 What
is the English level of your students (if you are a teacher)*
 | 
|  | 
| What
subjects are you (or your students) having the most difficulties with?*
 What
subjects are you (or your students) having the most difficulties with?*
 | 
| What
is the subject you are having the MOST difficulties with? Please give
details.* What
is the subject you are having the MOST difficulties with? Please give
details.* | 
|  | 
| What
additional materials would you like to see on the Really Learn English
website?* What
additional materials would you like to see on the Really Learn English
website?* | 
|  | 
| Are
you currently studying English? If so, where and how?*
 Are
you currently studying English? If so, where and how?*
 | 
|  | 
| Which
of the following services would you might be interested in?* Which
of the following services would you might be interested in?* | 
| Please enter the word that you see
below.
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