• (The original is to be given to the CORE ESOL teacher in your building OR sent to USD383's ESOL Coordinator)

  • The US Department of Education requires that USD383 determine the number of children attending school who live in homes where a language other than English is spoken. Federal law also requires that USD383 test the English proficiency of all children who live in homes where a language other than English is spoken within 30 days of their enrollment The information on this survey also provides the basis for Federal Title III funding for the school district that provide testing, English language education for PK-12 students, curriculum materials and ESOL professional development for USD383 teachers and staff. The information on this form will not be released without your written approval.

  • Date of Birth*
     / /
  • Gender*
  • #1. Does anyone in the home speak a language other than English?*

  • STOP HERE, if the answer to question #1 is NO.

    Please provide signature and date at the bottom of the page

  • What date did your child enter the U.S. (if not born in the U.S.)
     / /
  • What date did your child first enroll in a U.S. school?
     / /
  • What date did your child first enroll in a Kansas School?
     / /
  • What date did your child first enroll in Manhattan Ogden USD 383?
     / /
  • Has your child ever qualified for an English Language Development (ESOL, ESL, ELL, ELD) program?

  • Does your child's mother understand and/or speak English?

  • Does your child's mother understand English?
  • Does your child's mother read English?
  • Does your child's father understand English?
  • Does your child's father read English?
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Would you be willing to serve as an interpreter to assist other families?*
  • Date*
     / /
  • Should be Empty: