Home Language Survey

The Civil Rights Act of 1964, Title VI - Language Minority Compliance Procedures, requires that school districts/charter schools identify limited English proficient (LEP) students. PDE selected the Home Language Survey as the method of identification.

• School District

  The school district/charter school has the responsibility under the federal law to serve students who are limited English proficient and need English instructional services. Given this responsibility, the school district/charter school has the right to ask for the information it needs to identify English Language Learners (ELLs). As part of the responsibility to locate and identify ELLs, the school district/charter school may conduct screenings or ask for related information about students who are already enrolled in the district as well as from students who enroll in the school district/charter school in the future.
• School of Attendance
  High School Middle School Allard Elementary Bon Meade Elementary Brooks Elementary Hyde Elementary McCormick Elementary

  Select the school that your child attends.
• Student's Last Name *
• Student's First Name *
• Full Mailing Address *

  Be sure to include your street address, city, state, and zip code.
• Student's Gender *
  male

  female
• Which grade level is your child currently attending?
  Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
• Home/Primary Telephone Number *
• What was the student's first language? *
• Does the student speak a language other than English? (If yes, name the language) *

  Do not include languages learned in school.
• What languages are spoken in your home? *

  Please list any and all languages that are spoken within your home.
• Name of person completing this form. *
• Accuracy Statement *
  I attest that this information is true.
• Relation to child. *
  Parent

  Guardian

  Authorized Third Party
• Date Form Completed *