Home Language Survey
Fields marked * are required.
What is your name? *
Your answer
Student's first name *
Your answer
Student's last name *
Your answer
Student's birthdate *
Your answer
Sex *
Parent/Guardian Name *
Your answer
Address *
Your answer
Telephone number *
Your answer
Grade *
Your answer
Was your child born in the United States? *
If yes, in which state? *
Your answer
If no, in what other country? *
Your answer
Has your child attended any school in the United States for any three years during their lifetime? *
If yes, please provide school name(s), state, and dates attended: *
Your answer
What language is spoken by you and your family most of the time at home? *
Your answer
If available, in what language would you prefer to receive communication from the school? *
Your answer
Is your child’s first-learned or home language anything other than English? *
What language did your child learn when he/she first began to talk? *
Your answer
What language does your child most frequently speak at home? *
Your answer
What language do you most frequently speak to your child? *
Your answer
Please describe the language understood by your child (Check only one) *
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