Home Language Questionnaire
In order to best support our early learners and create a more inclusive approach to our program we request you complete this Home Language Survey. 
                                                        Thank you for your cooperation and partnership,
                                                                                                     Director Mara
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Email *
Child's Name (First, Middle, Last) *
Date of Birth *
MM
/
DD
/
YYYY
What site does your child attend? *
Child's Teacher *
Person who is completing this questionnaire *
What language did the child first speak when they learned to talk? (Please specify language if choosing Other) *
What language does the family speak in the home the majority of the time?  (Please specify language if choosing Other) *
What language does the person who primarily cares for the child speak most of the time?  (Please specify language if choosing Other) *
What language does the child speak with the primary caregiver most of the time?  (Please specify language if choosing Other) *
What language does the child speak with their siblings the majority of the time?  (Please specify language if choosing Other) *
What language does the child speak with their friends most of the time?  (Please specify language if choosing Other) *
Please list the preschool or daycare program your child has attended prior to this program *
In what language would you prefer to receive information from the school?   (Please specify language if choosing Other) *
What name do you call your child? (If different from the name listed above)
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