Language SurveyStudent's Full Name* First Middle Last Birthdate* Month Day YearMy student first learned* language(s) other than English English and language(s) other than English only EnglishIndicate the language(s) other than English* My student speaks* language(s) other than English English and language(s) other than English only EnglishIndicate the language(s) other than English* My student understands* language(s) other than English English and language(s) other than English only EnglishIndicate the language(s) other than English* My student has consistent interaction in* language(s) other than English English and language(s) other than English only EnglishIndicate the language(s) other than English* Language use alone does not identify your student as and English learner. If a language other than English is indicated, your student will be screened for English language proficiency.Parent/Guardian Name (printed)*Parent/Guardian Signature*Date* Month Day YearCAPTCHAΔ
