Home_Language_Identification_Survey

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					              Warren County School System
            Home Language Identification Survey
        The native or home language of each student must be recorded in his/her permanent record.

A. Please ask each student the following four (4) questions about his/her language
background. Circle or write in your answer.

1. What was the first language your child learned to speak?
       English           Spanish           Other___________________________

2. What language does your child speak most often outside of school?
       English         Spanish          Other___________________________

3. What language do people usually speak in your child’s home?
       English         Spanish          Other___________________________

4. In what language do you want notices sent to you from the school?
        English         Spanish          Other___________________________

 If any of the above four questions have been answered with a language other than English,
                                   please fill out section B.

B. Student Information

Student Name:______________________________ Grade/Section:_______ Sex::______

Address:_________________________________________________________________
              Street                     City/State                Zip Code

Date of Birth:__________________ Place of Birth:_______________________________

Date this student entered U.S.:____________________ School(WCSS):_______________

Is this student an immigrant?   Yes    No           Is this student a refugee? Yes     No

Do parents/guardians speak and understand English? Yes No
If no, what language do they speak?___________________________________________

In your opinion, does this student need English as a Second Language Instruction? Yes No

                     Lau (Language Assessment Use) Category of Student

_____ Category A- speaks only the language other than English

_____ Category B- speaks mostly the language other than English

_____ Category C- speaks English and the other language equally well

_____ Category D- speaks mostly English

_____ Category E- speaks only English


____________________________                                 ____________________________
Signature of Parent/Guardian/Student                         Signature of Questioner

              Original goes to student’s permanent record; copy to central office
                            Home Language Survey Summary

       The following summary outlines how the home language survey is used in Warren

County and how the survey has been redesigned to meet the needs of the Warren County

Schools staff as well as adhering to the Tennessee State Board of Education Policy. The

home language survey is administered to every student enrolling in school for the first time.

The survey should be administered at the time of entrance in school by a staff member of

the ESL department. The survey must contain three basic questions; 1. What is the first

language your child learned to speak? 2. What language does your child speak most often

outside of school? 3. What language do people usually speak in your child’s home? These

questions are required questions that the English as a Second Language (ESL) Program

Policy dictates from the State Board of Education which was passed on first reading January

28, 2005. The other questions on the form are for ESL staff and will be used to aid school

staff in properly serving both students and families in receiving the best education they can

possibly obtain. I redesigned the survey to reflect the language in the state board policy to

be prepared for the policy to go into effect on passage of final reading April 15, 2005. If the

answer to any of the above questions is anything other than English the student will be

classified as NELB Non-English Language Background and will be tested for English

proficiency. In the second step of the process NELB students must provide documentation

from a previously attended school of meeting the definition of fluent English proficient. If

the student is not determined proficient in English by either English language proficiency

test or by documentation by another school then the student is determined to be limited

English proficient and is identified as an English language learner (ELL) and is required to

receive ESL services.

				
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