Home Language Questionnaire

This KnowledgeBase archive includes content and external links that were accurate and relevant as of September 30, 2019.

School: _______________________________   Teacher: ____________________________________

Our school needs to know the language(s) spoken and heard at home by each child. This information is needed in order for us to provide the best instruction possible for all students. Please answer the following questions and have your child return this form to his/her teacher.  Thank you for your help.

Name of child: ________________________________________      _________     __________                           Last                      First                      Middle                   grade                  age

1.  Which language did your child first learn to speak? _______________________

2. What language does your child use most often at home? _________________________

3. What language do you most often use to speak to your child? __________________________

4. In what country was your child born? __________________________________

5.  If your child was not born in the U.S., what date did they enter the U.S.? _____________

______________________________________   __________ Signature of Parent or Guardian                            Date     

Preguntas del Lenguaje Hablado en Casa

Escuela: __________________________________  Profesor/a: _______________________________

Nuestra escuela necesita saber el lenguaje y o­do en casa por cada nio/a. Esta informacion es necesaria para proveer la mejor instruccion posible para todos los alumnos. Por favor de contestar las siguientes preguntas y regrese esta forma con su hijo/a al profesor. Gracias por su ayuda.

Nombre del alumno: ___________________________________________   __________   _________                                     apellido           Primer nombre                 segundo                grado            edad

1. ¿Que idioma comenzo su hijo/a hablar primero?  __________________________________

2. ¿Que idioma usa mas su hijo/a en la casa?  _____________________________________

3. ¿Que idioma usa usted con mas frecuencia para hablar con su hijo/a? ________________________

4. ¿En que pais nacio su hijo? _____________________________

5. ¿Si no nacio en los EEUU en que fecha entro su hijo/a los EEUU? ____________________________

____________________________________    ____________ Firma del Padre o Guardian                                   fecha       

The contents of this website were developed under a grant from the U.S. Department of Education and are intended for general reference purposes only. However, those contents do not necessarily represent the policy of the U.S. Department of Education or the Center, and you should not assume endorsement by the Federal Government. Some resources on this site require Adobe Acrobat Reader. This website archive includes content and external links that were accurate and relevant as of September 30, 2019.