I chose some basic questions to begin the survey, the student's name and the name they prefer to be called, to help introduce me to the student. Students with difficult-to-pronounce names might give alternatives, or perhaps a phonetic version of their name. I also asked what their first language is; from personal experience, I've learned that former or current ESL students often struggle in a regular English class, where many assumptions are made about their abilities or academic past. I hope that this question will help avoid language-based problems before they begin.
I thought it was important to see what their past experience with English is, and which units they most enjoyed and least enjoyed out of it. If most of the class as a whole enjoyed the novel unit, I could perhaps allocate more time towards that unit.
I also thought it was important to see what kinds of books students are reading in their spare time (fiction, non-fiction, biographies, mysteries, supernatural, etc.), to help guide the text selections for the upcoming year. At the same time, if half the students have recently read "The Hunger Games," then it might be prudent to choose something else for a required text. The frequency at which students read is also key, since it will give me an idea of how much reading the students are used to completing on a weekly basis.
Knowing what types of media the students engage with will likely be helpful for the media studies unit, and may help address any concerns about technicalities (eg: text speak) that may arise during the course. It will also give me an idea of the types of media they prefer to interact with, such as visual (graphic novels, television), audio (radio, podcasts), or any combination thereof.
Many students might claim that they do not engage in any writing in their spare time, so this question serves the double purpose of telling me what types of writing they do, as well as opening their eyes to what they are doing on a daily basis.
The transportation question might seem a bit odd, but knowing whether or not students are able to stay after school or arrive early is important when it comes to supplying extra support for students outside of class. Students who take the yellow bus, or another form of fixed transportation like a carpool, will be more likely to need support during lunch or a spare period.
While not all students may know what type of learner they are, having them identify which type they associate with will also be useful when planning lessons and assignments, to ensure that all students have a fair chance at doing well on them.
The last three questions are open questions to give students the chance to communicate their needs to me. The purpose of the 'What you wish to learn in English this year' question is similar to the previous question asking their favourite unit last year; it gives me the information to plan units of study that will be appealing to the students. Students might also give me creative ideas on how I can help them learn, perhaps by reading Shakespeare aloud to them, or having an 'open door' policy during lunch. The final question gives me the opportunity to learn a bit more about the students' personal needs, including any extra-curricular activities that they might be involved with, medical problems, or anything else that they deem relevant.
Overall, I hope that this survey gives me a broad overview of the needs of my students, as well as their likes and dislikes. With any luck, they will also see this survey as a chance to speak up, and the first of many communicative links between teacher and students.