BIOGRAPHICAL QUESTIONERE, SUBJECT SELF RATING (SSR) FORM, AND
BILINGUAL BALANCE SCALE (BBS)
A. General Background
1. Subject Number
2. Name
3. Phone
4. Email
5. Age
6. Gender
7. Date of birth
8. Place of Birth
9. How old were you when you came to Indonesia?
10. How many years have you been living in Indonesia?
11. If you are not living in Indonesia anymore, how long did you stay in Indonesia?
12. Except Indonesia, have you ever been living outside of your home country? Y/N
13. If yes, what country was it?
14. How old were you?
15. How long did you live in that country for?
16. Did you speak their local language(s)? Y/N
B. Educational Bacground
1. Did you attend the whole of your education in your home country? Y/N
If no:
1.1 Where did you had it?
1.2 What level of education did you have it?
1.3 What is the name of the school?
1.4 How long did you attend that school for?
1.5 What language did you use in that school?
2. Did you use the same language in school and at home? Y/N
2.1 If not, what language did you use at home (outside of school)?
3. Did you learn any other language too? Y/N
3.1 If yes, please state. (English, German, French, Spanish, Russia, China, Japan, Other
(please specify))
3.2 Did you learn the language in a special language school?
3.3 If yes, how long did you study it for?
C. Language Proficiency
1. What is your native language?
2. How old were you when you began to study English?
3. In what country did you begin to learn English?
4. Where did you learn English? (please circle) Home – School – Work – Language school –
other (specify)
5. How old were you when you began to study Indonesian?
6. In what country did you begin to learn Indonesian?
7. Where did you learn Indonesian? (please circle) Home – School – Work – Language school
– Other (specify)
8. Do you speak English more than Indonesian? Y/N
9. Do you speak Indonesian more than English? Y/N
9.1 If yes, When did you start using Indonesian more than English?
10. Are you right | left handed? (please circle one)
10.1 If you are right handed, were you forced to use the right hand? Y/N
11. Have you ever take formal Indonesian language proficiency test? Y/N
11.1 If yes, what is your score?
12. Have you ever take any kind of Indonesian language proficiency test? Y/N
12.1 Where did you had it?
12.2 Who held it?
12.3 What is your score?
Self Rating
In the questions 1-10, please answer the question with number 1, 2, 3, or 4 that applies to you
according to the scale below (except for number 5 and 10).
1 – not at all
2 – fair
3 – well
4 – very well
1. How well do you understand spoken English? [1 – 2 – 3 – 4 ]
2. How well do you speak English? [ 1 – 2 – 3 – 4]
3. How well do you read in English? [ 1 – 2 – 3 – 4 ]
4. How well do you write in English? [ 1 – 2 – 3 – 4 ]
5. Do you think you speak English with accent? (please pick one)
[ strong - moderate - no accent at all ]
6. How well do you understand spoken Indonesian? [ 1 – 2 – 3 – 4 ]
7. How well do you speak Indonesian? [ 1 – 2 – 3 – 4 ]
8. How well do you read in Indonesian? [ 1 – 2 – 3 – 4 ]
9. How well do you write in Indonesian? [ 1 – 2 – 3 – 4 ]
10. Do you think you speak Indonesian with accent? (please pick one)
[ strong - moderate - no accent at all ]
Number 11-18, please answer these questions
11. What other language do you speak
12. Rate your language command from 0 (not at all) to 3 (very well) for each language in the
table below
Language(s)
Rate
English
Indonesian
13. How would you estimate your ability to learn foreign languages? (Please pick one)
[ can’t learn at all – difficult – fairly quickly – very easy ]
14. What languages do you speak at home?
15. What percent of each language do you use at home?
English ... %
Indonesian ......%
Other (specify) .... %
16. What languages do you speak with your friends?
17. What percent of each language do you use with your friends?
English ... %
Indonesian ......%
Other (specify) .... %
Bilingual Balance Scale
18. Check the box that reflects your degree of Indonesian – English bilingualism. Ignore any
language you may speak.
I speak only
Indonesian
I am fully bilingual
I speak only
English