The purpose of this study was to develop and pilot a questionnaire that would (a) provide teachers and administrators of adult ESL programs with important information about their students and (b) enable large-scale data collection among these students for program-planning and research purposes. The questionnaire focuses on these students' goals, beliefs, and definitions of success related to learning English, as well as their patterns of actual English use. The instrument was developed based on interviews with 14 adult ESL students from diverse backgrounds enrolled in community and workplace ESL programs. It was then piloted with 37 learners. (Contains 9 tables and 2 figures.)