Home Language Survey

Dear Parents/Guardians:

Massachusetts Department of Elementary and Secondary Education regulations require that all schools determine the language(s) spoken in each student's home in order to identify their specific language needs. This information allows the Hull Public Schools to create the best possible educational program for your chhild to ensure their success in school.

Please answer the following questios for each child in your family. If a language other than English is spoken in the home, the Hull Public School District is required to do further assessment of your child. Please sign and return this form to the school office as soon as possible. Thank you for your prompt attention and assistance.

Student Information

First Name*

Answer required for "First Name"

Middle Name*

Answer required for "Middle Name"

Last Name*

Answer required for "Last Name"

Gender*

Answer required for "Gender"

Male

Female

Non-binary

Country of Birth*

Answer required for "Country of Birth"

Date of Birth*

Answer required for "Date of Birth"

Date first enrolled in ANY U.S. school

Answer required for "Date first enrolled in ANY U.S. school"

School Information

Start Date in New School

Answer required for "Start Date in New School"

Name and location of former school

Answer required for "Name and location of former school"

Current Grade

Answer required for "Current Grade"

Questions for Parents/Guardians

What is the native language(s) of each parent/guardian? (write language(s) for each)

Mother

Answer required for "Mother"

Father

Answer required for "Father"

Guardian

Answer required for "Guardian"

Which language(s) is/are spoken with your child? Choose 1 language here (include relatives -grandparents, uncles, aunts, etc. and caregivers)

Answer required for "Which language(s) is/are spoken with your child? Choose 1 language here (include relatives -grandparents, uncles, aunts, etc. and caregivers)"

How often is the above language spoken to your child?

Answer required for "How often is the above language spoken to your child?"

Seldom

Sometimes

Often

Always

Which language(s) is/are spoken with your child? Choose 1 language here (include relatives -grandparents, uncles, aunts, etc. and caregivers)

Answer required for "Which language(s) is/are spoken with your child? Choose 1 language here (include relatives -grandparents, uncles, aunts, etc. and caregivers)"

How often is the above language spoken to your child?

Answer required for "How often is the above language spoken to your child?"

Seldom

Sometimes

Often

Always

What language did your child first understand and speak?

Answer required for "What language did your child first understand and speak?"

Which language do you use most with your child?

Answer required for "Which language do you use most with your child?"

Which other languages does your child know? Choose 1 language here.

Answer required for "Which other languages does your child know? Choose 1 language here."

Check all that apply to above language

Answer required for "Check all that apply to above language"

Speak

Read

Write

Which other languages does your child know? Choose 1 language here.

Answer required for "Which other languages does your child know? Choose 1 language here."

Check all that apply to above language

Answer required for "Check all that apply to above language"

Speak

Read

Write

Which language does your child use to READ? Chose 1 language

Answer required for "Which language does your child use to READ? Chose 1 language"

How often does your child use the above language to READ?

Answer required for "How often does your child use the above language to READ?"

Seldom

Sometimes

Often

Always

Which other language does your child use to READ? Chose 1 language

Answer required for "Which other language does your child use to READ? Chose 1 language"

How often does your child use the above language to READ?

Answer required for "How often does your child use the above language to READ?"

Seldom

Sometimes

Often

Always

Which language does your child use to SPEAK? Chose 1 language

Answer required for "Which language does your child use to SPEAK? Chose 1 language"

How often does your child use the above language to SPEAK?

Answer required for "How often does your child use the above language to SPEAK?"

Seldom

Sometimes

Often

Always

Which language does your child use to SPEAK? Chose 1 language

Answer required for "Which language does your child use to SPEAK? Chose 1 language"

How often does your child use the above language to SPEAK?

Answer required for "How often does your child use the above language to SPEAK?"

Seldom

Sometimes

Often

Always

Which language does your child use to WRITE? Chose 1 language

Answer required for "Which language does your child use to WRITE? Chose 1 language"

How often does your child use the above language to WRITE?

Answer required for "How often does your child use the above language to WRITE?"

Seldom

Sometimes

Often

Always

Which language does your child use to WRITE? Chose 1 language

Answer required for "Which language does your child use to WRITE? Chose 1 language"

How often does your child use the above language to WRITE?

Answer required for "How often does your child use the above language to WRITE?"

Seldom

Sometimes

Often

Always

Will you require written information from school in your native language?*

Answer required for "Will you require written information from school in your native language?"

Yes

Will you require an interpreter/translator at Parent/Teacher meetings?*

Answer required for "Will you require an interpreter/translator at Parent/Teacher meetings?"

Yes

Parent/Guardian Signature*

Signature Required

Please fix the highlighted areas below before submitting.

Home Language Survey