Home Language Survey Form
The following questions are to be answered by the parent or guardian of each student. This information will be used to determine and provide appropriate educational services for students in accordance with the "Equal Education Act of 1974". This is a required form for each student to be completed upon enrollment.
Student's First Name *
Student's Last Name *
Are you Hispanic or Latino? (choose only one) *
What is your race? (choose one or more) *
Required
The language spoken MOST OFTEN in our home by members of our household is: *
Required
If Other is checked above, please specify which language.
The FIRST language my child learned to speak was: *
Required
If Other is checked above, please specify which language.
The language MOST OFTEN spoken by my child is: *
Required
If Other is checked above, please specify which language.
The language used by my child WHEN SPEAKING WITH ME is: *
Required
If Other is checked above, please specify which language.
Parent/Guardian's First and Last Name - By typing my first and last name in this box, I am providing my signature to verify I have answered these questions to the best of my knowledge. *
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