Speech History

SPEECH HISTORY Instructions: This form contains an analysis of needs in communication so that you can begin an effective speech communication program this semester. Complete the form by answering all the questions honestly. Student’s Name ______________________________________ Date ____________________________ Year _____________ Section __________________________ I. Family: What is your father’s first language?__________________________________________ Your mother’s? ____________________In what province were you reared? _______________________ _______________ What languages or dialects have you been exposed to? _________________________ II. Course: What English subjects have you taken up? _____________________________________ Write only those which you passed. ________________________________________________________ _____________________________________________________________________________________ Have you had private lessons in speech? ____________________________________________________ III. Extemporaneous Speech: Have you made reports in other classes before you enrolled in this class? _______________________________________________________________________________ How many times have you spoken before an audience? ________________________________________ Have you participated in speech contests? ___________________________________________________ In debating? _______________ Have you ever been a salesman, a leader, an officer in an organization, or a person engaged in meeting and influencing people? (Specify) __________________________________ _______________________________ In what situations do you speak best?_______________________ _____________________________________________________________________________________ In which most poorly? __________________________________________________________________ Do you wish to participate in the school’s extracurricular speech activities? ________________________ IV. Interpretative Speech: Have you participated in oral reading contests? (Specify) ______________ _____________________________________________________________________________________ Have you participated in other activities as a reader? __________________________________________ Do you wish to participate in oral reading recitals? ____________________________________________ Have you taken part in stage presentations? (Specify) _________________________________________ _____________________________________________________________________________________ Do you wish to participate in dramatics? ____________________________________________________ V. Voice: Do you stutter? _____________ Do you lisp? ______________ Have you ever had a deformity of mouth, nose, or throat that interfered with your speech? (Specify) _____________________ _____________________________________________________________________________________ Do you often have to repeat to get people to understand you? __________ Underline any of the following sounds with which you have difficulty: p, b, m, wh, w, f, v, th (soft), th (hard), t, d, n, s, z, sh, zh, ch, j, l , r, k, g, ng, y. Has any teacher helped you with these sounds?_______ Does your voice carry well?______ Do you think you have a weak voice? ________ Do you think the pitch of your voice is too high, too low, or just right? (Specify) ________ Are you able to control or change your voice at will? _______________

VI. Music: Do you sing? __________ Play an instrument? __________________________________ Can you tell when someone else is out of tune? ______________________________________________ VII. Adjustment to Speech Situations: Do you thoroughly dislike to speak to an audience? __________ Describe your feelings when you speak: ____________________________________________________ a) I face the audience with confidence, enthusiasm, uncertainty, fear of being laughed at, fear of forgetting. b) I feel at ease, tense, unstable. c) I am nervous, frightened, hesitant, unable to say what I want to say. d) I frequently forget, cannot follow my notes. e) My knees, hands, shake; my breathing, voice, is unnatural; my heart pounds, my mouth feels dry. f) These feelings continue throughout my speech; they leave after I have talked for a time. g) I feel satisfied, relieved, when I have completed my talk. Do you worry a great deal in advance of the time you have to speak? Were you ever severely frightened while speaking to an audience? __________________ Have you ever been made fun of or laughed at because of your manner of speaking? ______________ Would it upset you to use gestures in a speech or reading? _______________ With whom do you feel most comfortable? ___________________________ Are you troubled by criticism? ___________________ Do you make friends easily? _________________ Are you at ease when you converse with your friends? ___________ With new acquaintances? ________ VIII. General: Describe yourself by underlining the appropriate words in the following list: bold, dependent, conservative, friendly, cautious, quick-tempered, lethargic, shy, self-conscious, sensitive, stolid, suspicious, self-reliant, reclusive, timid, languid, aggressive, inhibited, moody Do you recall embarrassing speaking experiences of any kind in your life? (Specify) _________________ What is your personal aim? ______________________________________________________________ What is your chief hobby? _______________________________________________________________ In what field is your chief reading interest? __________________________________________________ What outside activities are you engaged or interested in? ______________________________________ List the expectations you have from the course: ______________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________