USD320 Wamego

USD 320 HOME LANGUAGE SURVEY

TO BE COMPLETED BY PARENT OR GUARDIAN. The state of Kansas requires that the following information be completed for each student that enrolls in Kansas public schools. If any language other than English is indicated, your child will be assessed to identify if English for Speakers of Other Languages (ESOL) services are needed. This survey shall be kept in each student’s permanent record folder. The information on this form will not be released without your written approval.

Note: This survey does NOT need to be completed if the child has attended USD 320 schools in the previous year(s). Only complete this survey if this is the first year the child will attend a USD 320 school.

Name of Student:

Age:

Gender:

Current School:

Grade:

Date of Birth:

Directions: Circle the correct response for each question and indicate other language as appropriate.

1. What language did your child learn when she/he first began to talk?	English	Spanish	Other
2. What language does the family speak at home most of the time?	English	Spanish	Other
3. What language does the parent(s) speak to his/her child most of the time?	English	Spanish	Other
4. What language does the child speak to his/her parent(s) most of the time?	English	Spanish	Other
5. What language does the child hear and understand in the home?	English	Spanish	Other
6. What language does the child speak to his/her brothers/sisters most of the time?	English	Spanish	Other
7. What language does the child speak to his/her friends most of the time?	English	Spanish	Other

If “Other” was chosen, please list that language:

For questions #8-#12 please choose either “Yes” or “No”.

8. Can an adult family member or extended family member speak English?	Yes	No
9. Can they read English?	Yes	No
10. Do the parents/guardians request oral and/or written communication from the school to be in English?	Yes	No
11. Has your family moved in the last 36 months to seek or obtain agriculture or fishing related work?	Yes	No
12. If yes to question #11, was the move from one school district to another?	Yes	No

If you need a translator, please contact USD 320 District ESOL Coordinator, Jessica Meitler at meitlerj@usd320.com or by phone at 785-456-7382

Migrant Education Program Information

The Migrant Education Program (MEP) is authorized by Title I Part C of the Elementary and Secondary Education Act of 1965 (ESEA). The MEP provides formula grants to local education agencies to establish or improve education programs for children who may qualify for the Migrant Program. Please help us determine your child’s eligibility for the Migrant Program by responding to the following questions.

Have you or a member of your family moved in the last 36 months to do, or apply for, agriculture or fishing related work, including dairies, nurseries, meat or vegetable processing, feed yards, or field work?

Yes _____No _____

Have your children moved with or to join the worker above in the past 36 months?

Yes _____ No _____