SSU 1 ANG

Data about the participant of the self-directed learning centre

Organisation:

Date of registration at the centre (enter the date of the first visit or talk with the participant)

1.Serial number of the participant

2.Name and surname

3.Street name and house number

4.Postcode

5.Post Country

Temporary residence

6.Telephone number

7.E-mail address □I do not have an e-mail address

M

/

F

8.Gender

9.Citizenship

10.Date of birth

11.Education

A / Unfinished primary education /

E

/ Vocational college
B / Complete primary education / F / University education
C / Lower secondary vocational, secondary vocational education / G / Specialisation, master’s degree, doctorate
Č / 4-year secondary vocational or technical education / H / Other, specify:
D / General secondary education, grammar school

12.Status

A / Employed /

Č

/ Farmer /

F

/ Child under 15
B / Unemployed / D / Housewife / G
/ Other, specify:
C / Retired / E / Student

13.How far is the self-directed learning centre from your place of residence?

A / Less than 1 kilometre /

Č

/ 6–10 kilometres
B / 1–2 kilometres / D / 11–20 kilometres
C / 3–5 kilometres / E / More than 20 kilometres

14.Where did you learn about the self-directed learning centre?

A / At the institution where you are registered in the centre /

D

/ On the radio, specify which:
B / From a publicity leaflet / E / On the television, specify the channel:
C / In a newspaper, specify which: / G / On the internet
Č / From friends or acquaintances / F / From other sources, specify:

1

obrazec SSU 1 ANG, podatki o udeležencu

projekt Razvoj organiziranega samostojnega učenja, januar 2004, januar 2016 – september 2018

SSU 1 ANG

15.Why did you decide on organised self-directed learning at the self-directed learning centre?

Select answers that best describe your reasons for choosing this form of learning.

A

/ I want to supplement the knowledge I receive at school, in a course, or elsewhere.

B

/ I wish to acquire knowledge in order to more easily find new employment, for promotion in the workplace, in the vocation, in the profession, etc.

C

/ I like learning and gaining new information.

Č

/ I can choose the time/rhythm/content of my learning and adjust them to my needs.

D

/ This type of learning/education is much cheaper or free.

E

/ There is no organised learning/education form (school, programme, course, etc.) for the knowledge I want to acquire.

F

/ The SDLC staff will help me select the study materials and in my study (as opposed to self-directed learning at home).

G

/ Other reasons (if none of the above answers suit you, write your reason here):

16.Are you participating in any other organised forms of education (programmes, course, seminar, school, etc.)?

A / Within the organisation where you are registered in the self-directed learning centre? / YES / NO
B / Outside of the organisation where you are registered in the self-directed learning centre? / YES / NO

17.How are your computer skills?

○ Excellent○ Good○ Average○ Poor○ I have no computer skills

18. Self-assessment of foreign language skills

Language and Level (Enter Language and Level A1 to C2) / The Legend of the Language Knowledge
A1: Survival levelA2: Intermediate level
B1: Communication thresholdB2: Higher level
C1: Efficiency levelC2: Mastery level

19. Please, write down, as shown in the example below, at least 3 (or 2) learning contents, in which you are interested, as a participant of organised independent learning in independent learning centres?

Example: Content Area 1: Excel, data processing in Excel with pivot tables

Content Area 2: Healthy diet in veganism

I am interested in the following learning content:

Content Area 1:
Content Area 2:
Content Area 3:
Content Area 4:
Content Area 5:

I agree that my personal data can be used as needed for the operation of the self-directed learning centre and for the needs of the project holder, Slovenian Institute for Adult Education, and confirm its authenticity with my signature.

Signature of the participant:

Data was reviewed by:

Signature:

Thank you for your data. We will handle it with care and confidentiality.

The data will be used solely for research and development purposes of the project.

1

obrazec SSU 1 ANG, podatki o udeležencu

projekt Razvoj organiziranega samostojnega učenja, januar 2004, januar 2016 – september 2018