Home Language Survey (English)

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This survey is the first of three steps to identify whether or not a student is eligible to be an English language learner (ELL).

Instructions:

Start with “Question 1” and continue until the HLS is complete. Select the answer for each question and follow the instructions. When you arrive at a decision (“Proceed to Records Review Process” or “Do not proceed to Records Review Process”), the Home-Language Survey is complete.

Student Information

Student First Name: *

Student Last Name: *

Student Birthdate *

YYYY

Student Grade *

Street Name: *

City: *

State: *

Zip code: *

Phone number: *

Survey Questions

Question 1: What was the first language used by the student? A language other than English, proceed to question 2a. If English, proceed to question 2b.

Question 2a: At home, does the student hear or use a language other than English more than half of the time? If Yes, proceed to question 7. If No, proceed to question 4.

Yes

Clear selection

Question 2b: At home, does the student hear or use a language other than English more than half of the time? If Yes, proceed to question 4. If No, proceed to question 3.

Yes

Clear selection

Question 3: Does the student understand a language other than English? If Yes, proceed to question 4. If No, proceed to 9.

Yes

Clear selection

Question 4: When interacting with his/her parents or guardians, does the student use a language other than English more than half of the time? If Yes, proceed to question 7, if No, proceed to question 5.

Yes

Clear selection

Question 5: When interacting with caregivers other than their parents or guardians, does the student use a language other than English more than half of the time? If Yes, proceed to question 8, If No, proceed to question 6.

Yes

Clear selection

Question 6: Has the student recently moved from another school district/charter school where he/she was identified as an English language learner? If Yes, proceed to question 8, If No, proceed to question 9.

Yes

Clear selection

Question 7: What are the home languages spoken? List below and proceed to 8.

8. Records Review Process (To be completed by NJ Certified Staff only – Reference ESSA ELL Entry and Exit Guidance, p. 4-https://www.state.nj.us/education/bilingual/policy/ESSAGuidance.pdf). Home Language Survey is complete.

9. Do not proceed to Step 2: Records Review Process. Home Language Survey is complete. Student is not an English-Language Learner (ELL).

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