Home Language Survey
English
School_________________________ Teacher_____________________________
Public law 100-297 requires schools to determine the language(s) spoken in the home by each student. This information is essential for the district to provide meaningful instruction for all students.
Your cooperation in helping us meet this important requirement is requested. Please answer the following questions and return this form to your child(s) teacher. Thank you for your help.
Student’s Name
____________________________ ________________________ ____________
Last First Middle
________________________ ____________
Grade Age
____1. Which language did your son/daughter learn when he/she began to talk?
____2. What language does your son/daughter use most frequently at home?
____3. What language do you use most frequently to speak to your son/daughter?
____4. Name the language most often spoken by the adults at home.
____________________________________
Signature of parent or guardian
____________________________________
Date
Office of Federal Programs