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__________________
Course & 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 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, seclusive, timid, languid, aggressive, inhibited, moody. Do you recall
embarassing speaking experiences of any kind in your life?
(Specify)____________________________________________________________________________
What is your professional 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 this course:

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

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SPEECH HISTORY

II. Course: What English subjects have you taken up?___________________________________________

VII. Adjustment to Speech Situations: Do you thoroughly dislike to speak to an

What is your professional aim?___________________________________________________________

List the expectations you have from this course:

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