HOME LANGUAGE SURVEY
Parma School District #137
PLEASE LIST ALL CHILDREN IN YOUR HOME AND LANGUAGES SPOKEN:
(ONLY ONE FORM PER FAMILY IS NEEDED.)
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GRADE
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BIRTHDATE
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ENGLISH
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SPANISH
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OTHER
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Our school needs to know the language spoken and heard at the home of every child. This information is necessary to provide the best instruction for all students in the school. If any language other than English is spoken, please answer the following questions:
1. What language is spoken in your home?___________________________________
2. What was the first language learned by your child?___________________________
3. What language do you most often use to speak to your child?__________________
4. What language does your child use most often in the home?___________________
5. What language does your child use most often with friends outside the home?_____________________________________________________________
6. When did your child first enter school in the USA?______ In what state?_________
7. Is the student attending the school as a foreign exchange student?______________
8. Has the student ever been in a bilingual educational or English as a Second Language program in a school in the U.S.?_________________________________
If your student is Native American, please answer the following questions:
- Is your student’s language influenced by the Tribal language through a parent, grandparent, relative or guardian?
- Does the student have at least one grandparent that is part of a federally recognized tribe?
_______________________________________________/______________________
Parent/Guardian Signature Date
MIGRANT QUESTIONNAIRE:
1. Has your family moved within the past three years, even for a short time? YES NO
2. Was the move from one school district to another? YES NO
3. Was the move for a family member to find work in agriculture or fishing? YES NO