ORRJHS Home Language Survey
Dear Parents/Guardians:
In order to help your child succeed in school, please answer the following questions for each child in your family that attends ORRJHS. Fill out separate forms for each child. Your answers will help us create the best possible educational program for your child. Please complete this form in it's entirety.
Student Number *
The "Student Number" is a 5 digit number. It is also called the "LASID". It is the first five digits of your child's lunch pin number, and Google password. If you don't know it please use 12345
Your answer
Child's Last Name *
Your answer
Child's First Name *
Your answer
Grade *
Date of Birth *
MM
/
DD
/
YYYY
Place of Birth *
Your answer
What language did your child first understand or speak?
Your answer
What language do you use most often when speaking with your child at home?
Your answer
What language does your child use most often when speaking with you at home?
Your answer
What language does your child use most often when speaking with other family members?
Your answer
What language does your child use most often when speaking with friends?
Your answer
What language(s) does your child read?
Your answer
What language(s) does your child write?
Your answer
At what age did your child start attending school?
Your answer
Has your child attended school every year since that age?
If no, please explain:
Your answer
Is this your child's first year in U.S. schools?
What language would you prefer oral or written communication from the school? *
Required
Name of person filling out this form. *
Your answer
Email Address
Your answer
Signature Block *
Checking the block will serve as your signature for this form. After an initial assessment, the District will determine if further testing is needed. If further assessment is not necessary, parents who wish for additional testing may indicate this below.
Required
I request additional testing.
Please call the main office at the school 508-758-4928 id you would like this document translated into a language other than English.
Submit
Never submit passwords through Google Forms.
This form was created inside of Old Rochester Regional School District. Report Abuse - Terms of Service