Home Language Survey

Survey Date

Date on which the Survey details were provided

[S_AL_STU_HOMELANGSURVEY_X]SURVEYDATE

Date

1. Was your child born in the United States?

Survey Question 1. Respond with a Yes or No

[S_AL_STU_HOMELANGSURVEY_X]CHILDBORNINUSYN

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State

Indicates state in USA where the child was born. Required field if response to Survey Question 1 is Yes

[S_AL_STU_HOMELANGSURVEY_X]STATE

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Country

Indicates country other than USA where child was born. Required field if response to Survey Question 1 is No

[S_AL_STU_HOMELANGSURVEY_X]COUNTRY

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2. Has you child attended any school in the United States for any three years during their lifetime?

Survey Question 2. Respond with a Yes or No

[S_AL_STU_HOMELANGSURVEY_X]SCHOOLINGINUSANY3YEARSYN

1

School Name 1

Name of first school in USA attended by the child. To be filled if response to Survey Question 2 is Yes

[S_AL_STU_HOMELANGSURVEY_X]SCHOOL1

60

State 1

Name of state in USA of first school attended by the child. To be filled if response to Survey Question 2 is Yes

[S_AL_STU_HOMELANGSURVEY_X]STATE1

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Start Date 1

Date on which child started first school in USA. To be filled if response to Survey Question 2 is Yes

[S_AL_STU_HOMELANGSURVEY_X]STARTDATE1

Date

End Date 1

Date on which child exited first school in USA. To be filled if response to Survey Question 2 is Yes

[S_AL_STU_HOMELANGSURVEY_X]ENDDATE1

Date

School Name 2

Name of second school in USA attended by the child. To be filled if response to Survey Question 2 is Yes

[S_AL_STU_HOMELANGSURVEY_X]SCHOOL2

60

State 2

Name of state in USA of second school attended by the child. To be filled if response to Survey Question 2 is Yes

[S_AL_STU_HOMELANGSURVEY_X]STATE2

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Start Date 2

Date on which child started second school in USA. To be filled if response to Survey Question 2 is Yes

[S_AL_STU_HOMELANGSURVEY_X]STARTDATE2

Date

End Date 2

Date on which child exited second school in USA. To be filled if response to Survey Question 2 is Yes

[S_AL_STU_HOMELANGSURVEY_X]ENDDATE2

Date

School Name 3

Name of third school in USA attended by the child. To be filled if response to Survey Question 2 is Yes

[S_AL_STU_HOMELANGSURVEY_X]SCHOOL3

60

State 3

Name of state in USA of third school attended by the child. To be filled if response to Survey Question 2 is Yes

[S_AL_STU_HOMELANGSURVEY_X]STATE3

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Start Date 3

Date on which child started third school in USA. To be filled if response to Survey Question 2 is Yes

[S_AL_STU_HOMELANGSURVEY_X]STARTDATE3

Date

End Date 3

Date on which child exited third school in USA. To be filled if response to Survey Question 2 is Yes

[S_AL_STU_HOMELANGSURVEY_X]ENDDATE3

Date

3. What language is spoken by you and your family most of the time?

Survey Question 3. Select the Language from the dropdown list

[S_AL_STU_HOMELANGSURVEY_X]HOMELANGUAGE

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4. Do you require written translation or oral interpretation of district-level and school-level communications?

Survey Question 4. Respond with a Yes or No

[S_AL_STU_HOMELANGSURVEY_X]TRANSLATIONLANGUAGEYN

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Translation Language 1

Select the Language from the dropdown list. Required field if response to Survey Question 4 is Yes

[S_AL_STU_HOMELANGSURVEY_X]TRANSLATIONLANGUAGE1

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Translation Language 2

Select the Language from the dropdown list.

[S_AL_STU_HOMELANGSURVEY_X]TRANSLATIONLANGUAGE2

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5. Is your child's native language anything other than English?

Survey Question 5. Respond with a Yes or No.

[S_AL_STU_HOMELANGSURVEY_X]NATIVELANGUAGEYN

1

Native Language

Select the Language from the dropdown list. Required field if response to Survey Question 5 is Yes

[S_AL_STU_HOMELANGSURVEY_X]NATIVELANGUAGE

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6. What is the language the Student first acquired?

Survey Question 6. Select the Language from the dropdown list

[S_AL_STU_HOMELANGSURVEY_X]ACQUIREDLANGUAGE

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