First name:

ENGLISH LANGUAGE ABILITY FORM 2020 Last name:

Exchanges ID:
CIEE Representative code:

Your English ability may be validated in one of the following ways:

• By a qualified staff member at your international representative via the Work & Travel USA online
application.
• By submitting results of a TOEFL or Cambridge English Exam. You may upload your scores to your
Work & Travel USA online application.
• By submitting this form, completed by a qualified English teacher. You may upload this form to your
Work & Travel USA online application.
• By submitting a supplemental letter from a qualified English teacher that certifies your English ability
(if your teacher will not complete this actual form). You may upload this letter to your Work & Travel USA
online application.

Ineligible
c 1: Beginner No ability to express oneself verbally in English. Knows only a few words.
c 2: Elementary Very basic communication limited to simple words.
Difficult to understand, requiring repetition.
c 3: Lower-intermediate Basic communication. Limited understanding and vocabulary.
Frequent hesitation. Slow speaking speed.

Eligible
c 4: Intermediate Effective and independent use of language in familiar situations.
Can discuss general, everyday tasks and past experiences.
c 5: Upper-intermediate Speaks in full sentences with minimal pauses and some complex sentence
structure. Extensive vocabulary.
c 6: Advanced Always understandable. Speaks with ease, conversation is fluid and easy.
Rarely misunderstands vocabulary.
c 7: Fluent Native English Speaker. Language is used fluently, accurately, and
appropriately.
Additional comments about the student’s knowledge of English and his/her ability to function in an
English-speaking workplace:

Name (please print):

Name of Educational Institution (please print):
Signature: Date (MM/DD/YYYY):

ciee.org/in-the-usa/work/work-travel-usa 1-888-COUNCIL (268-6245) contact@ciee.org Updated: 07-25-19