• This Home Language Survey (HLS) is to be completed by the parent or legal guardian of the student enrolling in this school.
• The information on this form helps us identify students who may needsupport inincreasing their Englishlanguage skillsnecessary for success in school.
• Completion of the survey is optional, thoughindicating that English wasnotthechild’sfirstlanguagemay lead toadditional resources or supports to assist in your child’sdevelopment in the English language for academicachievement.

1. If your child isidentified as a possible English Language Learner through this Home Language Survey the studentwill go through a process to make a final determination.
2. Your childwill be screenedto determine the child’s English languagestatus. If the student scores a26 or loweron the Kindergarten W-APT or below a 4.5 on the 1st-12thWIDA Screener the child will be identified as an EnglishLanguageLearner.
3. Youwill receive a Parental Notification Letter of your child’s score and the eligibility.a.If your child is identified as English Language Learner you will be notified of educational services he/shewill receive and will be tested annually to determine if he/she becomes proficient in the Englishlanguage.b.The letter will offer you the option to decline some or all services to your child.Your child’s scorewill beentered intothe Native American Student Information System (NASIS).
4. If you haveany questions, please contact the school Administrator.

Student Languages - Please check Yes or No

If you answered YES to Question 2 and/or 3: What language is used by the student or used more than half of the time at home?