MN Language Survey
Minnesota is home to speakers of more than 100 different languages. The ability to speak and understand multiple
languages is valued. The information you provide will be used by the school district to see if your student is
multilingual. In Minnesota, students who are multilingual may qualify for a Multilingual Seal upon further
assessment. Additionally, the information you provide will determine if your student should take an English
proficiency test. Based upon the results of the test, your student may be entitled to English language development
instruction. Access to instruction is required by federal and state law. As a parent or guardian, you have the right
to decline English Learner instruction at any time. Every enrolling student must be provided with the Minnesota
Language Survey during enrollment. Information requested on this form is important to us to be able to serve
your student. Your assistance in completing the Minnesota Language Survey is greatly appreciated.

Language use alone does not identify your student as an English learner. If a language other than English is indicated, your student will be screened for English language proficiency.
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Parent/Guardian email *
Student's full name (first, middle, last) *
Student's Birthdate *
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My student first learned
Select the phrase that best describes your student.
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This form was created inside of PiM Arts High School.