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    Home Language Survey

    English

     

    School : Mannsdale Elementary                    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 Initial

     

    _________________________    __________________________

    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

     

    Note: The district’sHome Language Surveyis available in over twenty different languages.

     

    Madison County School District

    Office of Federal Programs