Home Primary Language Survey by 0CYvwr


									                                          Our Future, Our Commitment, Our Students

Dr. Eddie Ingram,                                     HOME (PRIMARY) LANGUAGE SURVEY
                                To the ADMINISTRATOR: This survey is to be administered once to every student enrolled
                                in your local unit beginning September, 1994. The answer to each question should come from
Thomas E. Piper, Ed.S.          the list of languages which follows. If the answer to any one of the questions asked is a
Assistant Superintendent        language other than English, the student will need to be reported on the Home Language
for Auxiliary Services          Survey Summary and will need to be assessed further for appropriate placement and English
                                language assistance. It is recommended that a copy of the Home Language Survey be placed
                                with the student’s permanent record. Language surveys in Vietnamese and Loatian are
Lynn M.N. Henderson, M.S. Ed.   contained in “Here They are…What do we do?” which was previously distributed to each
Assistant Superintendent        superintendent and is currently available from NCDPI Communication Services. If a student
for Human Resources
                                and teacher cannot complete a form, additional assistance may be needed from a translator.

Douglas H. Moore, C.P.A.                                                                     DATE:
Assistant Superintendent        _______________________
for Business and Finance
                                STUDENT: _____________________________________________________________
                                          (Family name)                  (First name)          (Middle
Wendy R. Vavrousek, M.S.        initial)
Executive Director
for Student Support Services    GRADE: _____________________________                GENDER: ____________________

                                HOMEROOM TEACHER: ________________________________________________

                                        1.       What is the first language you learned to speak? _____________________

                                        2.       What language do you speak most often? __________________________

                                        3.       What language is most often spoken in your home? __________________

                                        4.       Besides languages studied in school, do you speak any language other than
                                                 English? NO __________ YES ____________
                                                 If YES, list language(s)
                                                 ____________ ____________ ____________ ____________

53 West River Road
Louisburg, NC 27549
Phone 919.496.2457
Fax 919.496.1322

To top