Arkansas Home Language Usage Survey

Arkansas Home Language Usage Survey
Student Name

First Name Last Name
Today's Date

Month Day Year
Date
Grade
School
Student State I.D. #
Gender
Date of Birth
Parent/Guardian Name
Signature

Clear
All parents have the right to information about their child’s education in a language they understand. In what language do you prefer to receive written communication from the school?
In what language would you prefer to communicate with school staff when speaking?
What language(s) is (are) spoken in your home?
What language did your child learn first?
What language does your child use most often at home?
What language does your family speak most often at home?
What language do adults speak most often with each other at home?
Where was your child born?
When did your child first attend a school in the United States (this includes all US territories)? (Kindergarten – 12th grade) Month/Day/Year
Should be Empty: