Home Language Form_2023-2024
Please complete this form for each child you will be registering. If you have any questions, please email mainoffice@ps140q.org
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Parent Full Name (First & Last Name) *
Child's Full Name (First & Last Name) *
Student Date of Birth
 *
MM
/
DD
/
YYYY
What language(s) do you speak at home? Check all that apply. *
Required
Does the child UNDERSTAND English?
Clear selection
What other language(s) does the child UNDERSTAND? *
Does the child SPEAK English? *
What other language(s) does the child SPEAK? *
Does the child READ yet? *
Does the child WRITE? *
Is English spoken in the child's home or residence MOST OF THE TIME? *
What other language(s) are spoken in the child's home most of the time? *
Does the child speak English with parents/guardians most of the time? *
What OTHER languages does the child speak with parents/guardians most of the time? *
Does the child speak ENGLISH with brothers, sisters, or friends most of the time? *
What OTHER language does the child speak with brothers, sisters, or friends most of the time? *
Does the child speak English with other relatives or caregivers (e.g. babysitter) most of the time? *
What OTHER languages does the child speak with other relatives or caregivers (e.g. babysitter) most of the time? *
Would you like your child to receive instruction using your home language (if available)? *
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