Fillable Printable Language Proficiency Questionnaire

Language Proficiency Questionnaire

5. CONTROL LANGUAGE

1. NAME (Last, First, MI)

2. SSN 3. GRADE

6. SERVICE/AGENCY

12. REMARKS

d. UNIT/ORGANIZATION

4. SSI/PMOS

7. COMPONENT 8. ORGANIZATION AND STATION

a. TYPED NAME b. RANK/GRADE c. PHONE NUMBER

g. SIGNATURE

e. EMAIL

f. DATE (YYYYMMDD)

13. REPORTING OFFICIAL

LANGUAGE PROFICIENCY QUESTIONNAIRE

For use of this form see AR 11-6; the proponent agency is DCS, G-2

LISTENING

AUTHORITY:

PRINCIPLE:

PURPOSE:

DISCLOSURE:

DATA REQUIRED BY THE PRIVACY ACT OF 1974

9. LANGUAGE

READING

LANG.

CODE

HOW

ACQUIRED

YYYY MM DD

DA FORM 330, MAY 2008

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APD LC v1.02ES

PREVIOUS EDITIONS ARE OBSOLETE

RATINGMETHOD1st 3rd2nd

FOREIGN LANGUAGE

RATINGMETHOD

10. PROFICIENCY

RATING

SPEAKING

METHOD

b. c. d. e. f.

k.h. j.i. l. m. n.

This collection is authorized by Section 3012 of Title 10, United States Code, and Executive Order No. 9397 (SSN). The information

you furnish will be treated For Official Use Only and will be maintained and used in strict confidence in accordance with Federal

Privacy laws and regulations and will only be disclosed to authorized personnel within Army, DOD, and other government agencies

consistent with authorized disclosures under the Privacy Act.

Your SSN will be used to correctly identify you as an individual with a degree of language proficiency. During personal interviews,

you may also be asked to disclose personal information about your background, past experience, knowledge, etc.

This information will be used to evaluate and determine your eligibility for assignment to and performance of duty in positions

requiring foreign language proficiency.

Disclosure of this information is voluntary; however, failure to provide some or all of the requested information could result in

non-qualification for selection or assignment to duty requiring knowledge of the foreign language in question.

11. DATE OF

EVALUATION

INSTRUCTIONS

ITEM NO. TITLE AND EXPLANATION

proficiency was acquired by more than one method.

Civilian School A

Foreign Residence C

Home Environment D

Military School other than DLIFLC E

Self-study F

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APD LC v1.02ES

DA Form 330, MAY 2008

Determination of Entry for Listening, Reading, and Speaking Proficiency Ratings (Items 10g, 10i, and 10k) DA Form 330

Paper DLPT-1 Paper DLPT II, III, IV and Proficiency Data Code Rating

Raw Score DLRPT Converted Score Rating 10g/10i/10k

0-20 0-24 0 00

21-23 25-29 0+ 06

24-29 30-35 1 10

30-35 36-39 1+ 16

36-42 40-45 2 20

43-48 46-49 2+ 26

49-60 50+ 3 30

N/A N/A 3+ 36

N/A N/A 4 40

N/A N/A 4+ 46

N/A N/A 5 50

Language Evaluation Method (Items 10f, 10h, and 10j)

Method Code

DOD Standardized Test 1

Self-appraisal 2

Oral Proficiency Interview 3

1-4 SELF-EXPLANATORY

c-e - HOW ACQUIRED. Enter the code below for the foreign language evaluated. A maximum of 3 codes may be used if the

b - LANGUAGE CODE. Enter the language identification code for the foreign language evaluated.

a - FOREIGN LANGUAGE. Enter the foreign language evaluated.

8 ORGANIZATION AND STATION. Enter individual's organization and station.

7 COMPONENT. Enter the individual's Service component, e.g., Active, ARNG, Reserves.

6 SERVICE/AGENCY. Enter the individual's Service or Agency.

5 CONTROL LANGUAGE. Leave blank, U.S. Army Human Resource Command use only.

LANGUAGE. Enter the results of each language evaluated. Multiple skills for the same language evaluated on the same day can be

entered on one line. If the skills for the same language are evaluated on different days, enter them on separate lines.

Defense Language Institute Foreign Language Center (DLIFLC) B

13 a-g SELF-EXPLANATORY

12 REMARKS

n - Enter the day in the format DD for each foreign language tested.

l - Enter the year in the format YYYY for each foreign language tested.

m - Enter the month in the format MM for each foreign language tested.

11 DATE OF EVALUATION

g, i, k - RATING. Enter the data code based on the proficiency rating using the codes below.

f, h, j - METHOD. Enter the language evaluation method using the codes listed below.

10 PROFICIENCY (LISTENING , SPEAKING, AND READING)

Enter the type of DOD Standardized Test: DLPT-I, DLPT-II, DLRPT, DLPT-III, DLPT-IV, DLPT5, or OPI. For DLPT (I, II, III, IV, or 5) or

DLRPT enter whether it is lower or upper range. Also enter the form of test used if known. For individuals completing DLIFLC course

or equivalent, enter the class number and date completed.