Primary Home Language Survey PRIMARY HOME LANGUAGE SURVEY Student Name * Student Name First Name First Name Last Name Last Name Date of Birth * Grade Entering * FACE CBFACE HBKINDERGARTEN1ST2ND3RD4TH5TH6TH7TH8TH9TH10TH11TH12TH 1. What was the first language your child learned? * 2. What language is primarily spoken by family members, at home? * Does your child understand any languages other than English? * YES NO If Yes, what Language? If the answers to the above indicate your child is an English Language Learner, do you want your child to be tested for ELL placement? * YES NO By signing below, I indicate that I have read and understand the above and the implications for my child's education. Parent/Guardian Name * Relationship to Student * Parent/Guardian Signature * signature keyboard Clear Date * Submit If you are human, leave this field blank.
