您的瀏覽器尚未啟用 JavaScript，因此無法開啟檔案。請於啟用後重新載入頁面。
Home Language Survey (English)
This survey is the first of three steps to identify whether or not a student is eligible to be an English language learner (ELL).
登入 Google
即可儲存進度。
瞭解詳情
* 表示必填問題
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:
*
您的回答
Student Last Name:
*
您的回答
Student Birthdate
*
MM
/
DD
/
YYYY
Student Grade
*
選擇
PreK
K
1
2
3
4
5
6
7
8
Street Name:
*
您的回答
City:
*
您的回答
State:
*
您的回答
Zip code:
*
您的回答
Phone number:
*
您的回答
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.
您的回答
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
No
清除選取的項目
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
No
清除選取的項目
Question 3: Does the student understand a language other than English? If Yes, proceed to question 4. If No, proceed to 9.
Yes
No
清除選取的項目
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
No
清除選取的項目
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
No
清除選取的項目
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
No
清除選取的項目
Question 7: What are the home languages spoken? List below and proceed to 8.
您的回答
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).
提交
清除表單
請勿利用 Google 表單送出密碼。
這份表單是在 South Hackensack Memorial School 中建立。
檢舉濫用情形
表單
