AXIS Home Language Survey

Home Language Survey

AXIS International Academy Preschool to 5th Grade
The Home Language Survey is required for NEW students enrolling for the first time at AXIS International Academy in grades Preschool - 5th.

This form does not factor into partner language placement; it is solely for the purpose of determining eligibility for English Language Learner (ELL) academic supports.

For questions regarding this form, please contact AXIS International Academy at info@axiscolorado.org or call 970-658-4199.
Name of Parent/Guardian Completing Survey*

First NameLast Name
Confirmation Email*
example@example.com
Student Language Information
Please answer the questions below accurately and completely. This information is necessary to provide the most appropriate placement and instruction for your child and will not be used for any other purposes. (If you have multiple students enrolling at the same time, please fill out a separate Home Language Survey form for each student.)
Name of Student*

First NameLast Name
What is the primary language used in the home, regardless of the language spoken by the student?*
What is the language most often spoken by student?*
What is the language that the student first acquired?*
Signature
I certify that I am a parent or legal guardian of the student listed on this form, and that all the information I have provided is true and correct to the best of my knowledge.

Clear
Should be Empty:

Home Language Survey