Home Language Survey
Student's First & Last Name
Date of Birth (XX/XX/XXXX)
Student Entering Grade
---3yr Pre-K4yr Pre-KKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade
Address (Street, City, State, Zip)
1. Was your child born in the United States? (If YES, which state. If NO, what other country)YesNo
State/Country of Birth
2. Has your child attended any school in the United States for any three years during there lifetime? YesNo ( If YES, please provide school name(s), state, & dates attended)
3. What language is spoken by you & your family most often at home?
4. If available, in what language would you prefer to receive communication form the school?
5. Is your child's first-learned or home language anything other than English?< br/>YesNo
If you answered YES to the previous question, please answer the next 3 questions.
5A. What language did your child learn when he/she first began to talk?
5B. What language does your child most frequently speak at home?
5C. What language do you most frequently speak to your child?
- Father's Language:
- Mother's Language:
6. Please describe the language understood by your child (check only one)
Understands only the home language & no EnglishUnderstands mostly the home language & some EnglishUnderstands the home language & English equallyUnderstands mostly English & some of the home languageUnderstands only English
Please write (using your mouse) your signature in the space below
Kindergarten & New Student Registration Form
Image & Internet Permission Form
Emergency Card Form
Transportation Registration Form
Enrollment Agreement Form
Student Race & Ethnicity Reporting Form
Request to Release Records & Information Form
Parish Verification Form