South Hills Catholic Academy Home Language Survey

South Hills Catholic Academy Home Language Survey*

South Hills Catholic Academy Registration Requires Completion of this Form (One per Family)
The Civil Rights Law of 1964, Title VI, requires that school districts/charter schools identify Limited English Proficient (LEP) students. Pennsylvania has selected the Home Language Survey as the method for the identification.
School District? *
Please Enter Mt. Lebanon
School? *
Please Enter South Hills Catholic Academy
Please Complete

Student(s) Names *

Do any students speak a language other than English? *

Yes No
If "Yes," Specify Student and Language (Do not include languages learned in school)
What Language(s) is/are Spoken in your Home? *
Parent / Guardian Name *

First Name Last Name
Parent / Guardian Email *
example@example.com
Relationship to Child *
*The school district/charter school has the responsibility under the federal law to serve students who are limited English proficient and need English instructional services. Given this responsibility, the school district/charter school has the right to ask for the information it needs to identify English Language Learners (ELLs). As part of the responsibility to locate and identify ELLs, the school district/charter school may conduct screenings or ask for related infom1ation about students who are already enrolled in the district as well as from students who enroll in the school district/charter school in the future.
Please Enter Date
Date *

Month Day Year
Please Sign

IMPORTANT: You must click "SUBMIT" after signing. If "SUBMIT" isn't clicked, we will not receive your document.
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South Hills Catholic Academy Home Language Survey*