Woodsville Elementary School Home Language Survey

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Student Information

First & Last Name: *

Date of Birth *

YYYY

Gender: *

Female

Male

Prefer not to say

Other:

Country of Birth: *

Date first enrolled in a U.S. school: (month & year) *

Current grade *

not in school yet

Preschool

Kindergarten

First Grade

Second Grade

Third grade

Required

Family Information:

First & Last name of parent/legal guardian *

Phone number: *

Address: *

Would you like school notices translated? *

Yes

If yes, what language

Questions for Parents/Guardians:

Please list all languages spoken in your home: *

Which language did your child first hear or speak? *

If English is the only language list, please stop here. If another language is listed, please answer the rest of the questions.

Which language(s) do you speak to your child?

Which language(s) does your child spake at home with adults?

Which language(s) does your child speak at home with other children?

Date of completion of this form *

YYYY

For parents and guardians: If a language other that English is listed above, an ESOL teacher will test your child to find out if he or she can speak, understand, read, and write well in English. The results will be sent to you within 30 days. Based on the results of the test, your child may be eligible to enroll in an English language (ESOL) class at school. Parents/Guardians may accept or decline ESOL program services for their child.

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This form was created inside of School Administrative Unit # 23. Report Abuse

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