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Birmingham City Schools
HOME LANGUAGE SURVEY
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* Indicates required question
Email
*
Your email
Student Name:
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Your answer
Birth Date:
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Your answer
Sex
*
Choose
Male
Female
Address
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Your answer
Home Telephone
*
Your answer
Work Telephone
*
Your answer
School
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Your answer
Grade
*
Option 1
Today's Date
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Your answer
Was your child born in the United States?
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Yes
No
If yes, which state?
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Your answer
Has your child attended any school in the United States for any three years during their lifetime?
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Yes
No
If yes, please provide school name(s), state, and dates attended:
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Your answer
What language is spoken by you and your family most of the time at home?
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Your answer
If available, in what language would you prefer to receive communication from the school?
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Your answer
Please check if your child is:
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Native American Indian
Alaska Native
Native Pacific Islander
Native U.S. Virgin Islander
Required
Is your child's first-learned or home language anything other than English?
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Yes
No
If you resonded yes to the question above, please answer the following questions.
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Your answer
What language did your child learn when he/she first began to talk?
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Your answer
What language does your child most frequently speak at home?
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Your answer
What language do you most frequently speak to your child?
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Your answer
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