HOME LANGUAGE 2022-2023 QUESTIONNAIRE

HOME LANGUAGE 2022-2023 QUESTIONNAIRE - NS KR

Swink School District
I have already done this form...
Today's Date

Month Day Year
Date
Student *

First Name Middle Name Last Name
Students Date of Birth *

Month Day Year
Date
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student Grade *
Has your child attended school in another country? *
If yes, how many years?
If yes, what country

Street Address

Street Address Line 2

Country
Language used for instruction *
All students enrolled in our school district need to have their parent(s) or guardian(s) complete and sign this form. We value a student's ability to speak a language other than English and we encourage the student to maintain those language skills. However, if a student is having difficulty speaking, reading or writing the English language, we want to help him/her improve English language skills.
Is any language other than English spoken in your home? *
If yes, what is the other language?
Did you child learn to speak a language other than English before learning English? *
Please describe the language spoken by your child by checking one response below. *

Speaks no English, only the other language Speaks some English, mostly the other language Speaks English and the other language Speaks mostly English and some of the other language Speaks only English
Please describe the language understood by your child by checking one response below. *

Understands no English, only the other language Understands some English, mostly the other language Understands English and the other language Understands mostly English and some of the other language Understands only English
Which of the following best describes the language spoken in the home by parents and other family members? *

Only the other language and not English is spoken Mostly the other language and some English is spoken The other language and some English is spoken Mostly English and some of the other language is spoken Only English is spoken in the home
Parent Legal Guardian *

First Name Last Name
Signature *

Clear
Should be Empty:

HOME LANGUAGE 2022-2023 QUESTIONNAIRE - NS KR