Wayland Public Schools

Wayland Public Schools

Home Language Survey
Massachusetts Department of Elementary and Secondary Education (DESE) regulations require that all schools determine the language(s) spoken in each student's home in order to identify their specific language needs. This information is essential in order to provide meaningful instruction for all students. If a language other than English is spoken with your child, the District is required to do further assessment of your child.

Thank you in advance for your assistance.
Student Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Student Gender*

MaleFemaleNon-Binary
Anticipated Start Date in Wayland Public Schools*

MonthDayYear
First Day Kindergarten: 9/5/2024, First Day Pre-K, 1-12: 9/3/2024
Current Grade*
Country of Birth*
Years in the United States*
Date first enrolled in ANY U.S. school*
MM/DD/YYYY
How many years has the student been in U.S. schools? (Not Including Preschool)*
For new 2024-2025 Kindergarteners, enter "0"
Name of former School*
Location of former School (City, State, Country)*
What is the primary language used in the home, regardless of the language spoken by the student?*
Which language do you use MOST with your child?*
Please enter just one language
Which other language is spoken with your child?
Language #2
How often are they used?

AlwaysOftenSometimesSeldom
Which other language is spoken with your child?
Language #3
How often are they used?

AlwaysOftenSometimesSeldom
Which language does your child use?*
How often are they used?

AlwaysOftenSometimesSeldom
Which language did your child first understand and speak?*
Will you require written translations from school in a language other than English?*

YesNo
If Yes, what language?
Will you require an interpreter/translator at Parent-Teacher meetings?*

YesNo
If Yes, what language?
Is there anything else that you would like to tell us about your child's language?
Name of person completing this form*

First NameLast Name
Signature*

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