22-23 MDE Demographic & Language Survey

MN DEPARTMENT OF EDUCATION
Dear Parent or Guardian:

Recent changes to Minnesota law require districts and charter schools to collect more detailed student information on the race and ethnicity categories set by the U.S. Department of Education.

The purpose of collecting the information is to assist schools in providing targeted programs and services to help all students succeed.

As a result of the new law, and starting with the 2019-20 school year, all Minnesota schools will collect information using the attached forms. Information is considered private student data.

Ethnic and Racial Demographic Form: Federal questions are in bold. Families are not required to answer the federal questions for their children. However, if you choose not to answer the federal questions, federal law requires schools to choose for you. This is a last resort-we prefer that parents or guardians complete the form.

State questions are below the federal questions and labeled "Optional." Schools will not fill in this information for you. Refusal to respond will not impact enrollment in the school.

Under the Optional questions, choose "decline to indicate" if you prefer not to use any of the more detailed selections. Choose "Other" if you do not see your specific group represented.

Minnesota Language Survey: Minnesota is home to speakers of more than 100 different languages. The ability to speak and understand multiple languages is valued. In Minnesota, students who are multilingual may qualify for a Multilingual Seal upon further assessment.

Results of the assessment will be used to determine if your student is entitled to English language development instruction. Access to instruction is required by state and federal law. As a parent or guardian, you have the right to decline English Learner instruction at any time.

Please complete the enclosed forms and return them to your school by September 16, 2022.

For more information about the forms, please contact the Minnesota Department of Education or check the MDE website: https://education.mn.gov/MDE/fam/count/MDE074811
Ethnic and Racial Demographic Designation Form
Name

Student's First Name Middle Name/Initial Last Name
Date of Birth

MonthDay Year
Date
Student ID
District
School
Schools are required to report ethnicity and race to the state and to the U.S. Department of Education. Because of recent changes to Minnesota state law, Minnesota disaggregates each category into detailed groups to further represent our student populations. Parents or guardians are not required to answer the federal questions (in bold) for their children. If you choose not to answer the federal questions (in bold), federal law requires schools to choose for you. This is a last resort-we prefer if parents or guardians complete the form. State questions are labeled as "Optional" and schools will not fill in this information for you. This information helps improve teaching and learning for everyone and helps us accurately identify and advocate for students currently underserved. The information this form collects is considered private information. You can review the privacy notice to learn more about the purpose of collecting this information, how it will be used and not used, and how the detailed groups were identified. The privacy notice can be found in our Frequently Asked Questions: Ethnic and Racial Designation Form.
Is the student Hispanic/Latino as defined by the federal government? The federal definition includes persons of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.¹

Yes [If yes, go to Question A.]No [If no, go to Question 1.]
Optional Question A: If yes was chosen above, select all that apply from the list below (this question will not be answered by school staff):
Spanish-American

Decline to indicateGuatemalanSalvadoranOther Hispanic/LatinoColombianMexicanSpaniard/Spanish/Spanish AmericanUnknownEcuidorianPuerto Rican
[Select "yes" to at least one of the Questions (1-6) below.]
Question 1: Does the student identify as American Indian or Alaska Native as defined by the state of Minnesota? The state of Minnesota definition includes persons having origins in any of the original peoples of North America who maintain cultural identification through tribal affiliation or community recognition. [This question is needed to calculate student aid/funding]

Yes [If yes, go to Question 1a.]No [If no, go to Question 2.]
Optional Question 1a: If yes was chosen above, select all that apply from the list below (this question will not be answered by school staff)

Decline to indicateCherokeeOther North American Indian Tribal AffiliationAnishinaabe/OjibweDakota/LakotaUnknown
Question 2. Is the student American Indian from South or Central America?

Yes [go to question 3]No [go to question 3]
Question 3. Is the student Asian as defined by the federal government? The federal definition includes persons having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Yes [If yes, go to question 3a]No [if no, go to question 4]
Optional Question 3a. If yes was chosen above, select all that apply from the list below (this question will not be answered by school staff

Decline to indicateChineseKarenOther AsianAsian IndianFilipinoKoreanUnknownBurmeseHmongVietnamese
Question 4. Is the student black or African American as defined by the federal government? The federal definition includes persons having origins in any of the black racial groups of Africa.

Yes [If yes, go to Question 4a.]No [If no, go to question 5.]
Optional Question 4a. If yes was chosen above, select all that apply from the list below (this question will not be answered by school staff):

Decline to indicateEthiopian-OtherSomaliAfrican-AmericanLiberianOther blackEthiopian-OromoNigerianUnknown
Question 5. Is the student Native Hawaiian or Other Pacific Islander as defined by the federal government? The federal definition includes persons having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.¹

Yes [go to question 6]No [go to question 6]
Question 6. Is the student white as defined by the federal government? The federal definition includes persons having origins in any of the original peoples of Europe, the Middle East, or North Africa.

YesNo
Minnesota Language Survey

Minnesota is home to speakers of more than 100 different languages. The ability to speak and understand multiple languages is valued. The information you provide will be used by the school district to see if your student is multilingual. In Minnesota, students who are multilingual may qualify for a Multilingual Seal upon further assessment. Additionally, the information you provide will determine if your student should take an English proficiency test. Based upon the results of the test, your student may be entitled to English language development instruction. Access to instruction is required by federal and state law. As a parent or guardian, you have the right to decline English Learner instruction at any time. Every enrolling student must be provided with the Minnesota Language Survey during enrollment. Information requested on this form is important to us to be able to serve your student. Your assistance in completing the Minnesota Language Survey is greatly appreciated.
1. My student first learned

Language(s) other than English.English and language(s) other than EnglishOnly English
Please indicate the language(s) other than English
2. My student speaks

Language(s) other than English.English and language(s) other than English.Only English
Please indicate the language(s) other than English
3. My student understands

Language(s) other than English.English and language(s) other than English.Only English
Please indicate the language(s) other than English
My student has consistent interaction in

Language(s) other than EnglishEnglish and language(s) other than English.Only English
Please indicate the language(s) other than English
Language use alone does not identify your student as an English learner. If a language other than English is indicated, your student will be screened for English language proficiency.
Parent(s)/Guardian
Full name
Parent/Guardian Email
example@example.com
Parent/Guardian Signature

Clear
Date

MonthDay Year
Date
* All data on this form is private. It will only be shared with district staff who need the information to best serve your student and for legally required reporting
about home language and service eligibility to the Minnesota Department of Education. At the district and at the Minnesota Department of Education, this
information will not be shared with other individuals or entities, except if they are authorized by state or federal law to access the information. Compliance with
this request for information is voluntary.
Should be Empty:

MN DEPARTMENT OF EDUCATION

[Select "yes" to at least one of the Questions (1-6) below.]