Required Home Language Survey
Georgia Department of Education ESOL & Title III Unit
Dear Parent or Guardian: In order to provide your child with the best possible education, we need to determine how well he or she speaks and understands English. This survey assists school personnel in deciding whether your child may be a candidate for additional English language support. Final qualification for language support is based on results of an English language assessment. Thank you
Basic Information
Student Name
*
First Name
Middle Name
Last Name
Language Background
1. Which language does your child best understand and speak?
*
2. Which language does your child most frequently speak at home?
*
3. Which language do adults in your home most frequently use when speaking with your child?
*
Language for School Communication
Signature
*
Date
*
-
Month
-
Day
Year
4. In which language would you prefer to receive school information?
*
Submit
Should be Empty: