2018-19 Home Language Survey
Massachusetts Department of Elementary and Secondary Education regulations require that all schools determine the language(s) spoken in each student’s home in order to identify their specific language needs. This information is essential in order for schools to provide meaningful instruction for all students. If a language other than English is spoken in the home, the District is required to do further assessment of your child. Please help us meet this important requirement by
answering the following questions. Thank you for your assistance
Student's First Name *
Your answer
Student's Middle Name *
Your answer
Student's Last Name *
Your answer
Gender *
Country of birth *
Your answer
Date of Birth *
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Date first enrolled in ANY U.S. school *
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Start date in new school *
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Name of former school and town *
Your answer
Current Grade *
What is the native language(s) of parent or guardian 1? *
Your answer
What is the native language(s) of parent or guardian 2? *
Your answer
Which language(s) are spoken with your child? (please include relatives - grandparents, uncles, aunts, etc and caregivers) and how often are they used (seldom \ sometimes \ often \ always) *
Your answer
What language did your child first understand and speak? *
Your answer
Which language do use use most with your child? *
Your answer
Which other languages does your child know? and do they speak / read / write these languages? *
Your answer
Which language does your child use and how often (seldom/sometimes/often/always)? *
Your answer
Will you require written information from your school in your native language (other than English)? *
Will you require an interpreter/translator at Parent-Teacher meetings (other than English)? *
Name of parent or guardian completing this survey *
Your answer
today's date *
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