Chicago Complete this Home Language Survey at the ... - Aspen

Chicago Public Schools

Complete this Home Language Survey at the student's initial enrollment in a Chicago Public School. This form must be kept in the student's folder.

The state requires the district to collect a Home Language Survey for every new student. This information is used to count the students whose families speak a language other than English at home. It also helps to identify the students who need to be assessed for English language proficiency and may be eligible for English Learner services.

School:______________________________ Room:____________ School ID #: _________________ Network:___________

Student Name:_______________________________________________________ Student ID #:_______________________

English

1. Is a language other than English spoken in your home?

ASPEN REGISTRATION PROCESS

H O

No

Yes ________________________ (language)

(For Office Use only) ? All five fields have to be entered on Aspen: date, answer to question 1,

Home language, answer to question 2, and Native language. ? If the Home language is English, but the Native language is a language

M E

2. Does the student speak a language other than English?

No

Yes ________________________ (language)

other than English, that Non-English language has to be listed as both Home and Native language ? If there are two languages other than English listed, enter the language identified in question 2 as both Home and Native language.

If the answer to either question is yes, the law requires the school ? English can be entered as the Home language ONLY if both questions are

L

to assess your child's English language proficiency.

answered No and English is listed for both questions.

A

Spanish/Espa?ol 1. ?Se habla alg?n otro idioma que no sea ingl?s en su

Polish/Polski 1. Czy m?wi si w domu jzykiem innym ni angielski?

N hogar?

G

No

S? ________________________ (Idioma)

U 2. ?Habla el estudiante alg?n otro idioma que no sea

A G

ingl?s?

No

S? ________________________ (Idioma)

Nie

Tak ________________________ (jzyk)

2. Czy ucze m?wi innym jzykiem ni angielski?

Nie

Tak ________________________ (jzyk)

Jeli udzielili Pastwo twierdzcej odpowiedzi na kt?rekolwiek z

E

Si la respuesta a cualquiera de las preguntas es "S?", la ley requiere que la escuela eval?e la competencia de su ni?o en

powyszych pyta, przepisy wymagaj aby szkola sprawdzila poziom znajomoci jzyka angielskiego waszego dziecka.

ingl?s.

S Chinese/

Arabic/

U

R

V

E

Y

HLS 1 of 2 Spanish

Polish Chinese Arabic Bosnian Croatian Serbian

Urdu

HLS 2 of 2 Romanian

Yoruba Assyrian Guajarati Tagalog Korean

Bosnian/Serbian(Latin) Bosanski/Srpski 1. Da li se u kui govori na stranom jeziku (razlicitom od engleskog)?

NE

DA ________________________ (jezik)

2. Da li ucenik govori neki drugim jezikom (razlicit od engleskog)?

NE

DA ________________________ (jezik)

Ukoliko ste na bilo koje od ovih pitanja odgovorili sa ,,Da", skola e biti zakonski duzna da procijeni nivo znanja engleskog jezika kod vaseg djeteta.

Urdu/

Page 1 of 2

Form Updated

07/20

___________________________________________________________

__________________________________________________________

Signature of School Official

Date

Signature of Parent/Guardian

Date

? If the parent/guardian does not speak English and the school does not have staff who speaks the parent/guardian's language, identify the language spoken by the parent/guardian through any assistance available in the school, i.e. using interpretation services from a vendor.

? If the language is not included on the list of languages available on Aspen, enter "Other." ? If the language spoken by the parent/guardian is not included on either page of this form, please visit the OLCE KC Page, Forms, and click on "Home Language Survey in

Additional Languages" which will take you to ISBE's HLS page.

Chicago Public Schools

Complete this Home Language Survey at the student's initial enrollment in a Chicago Public School. This form must be kept in the student's folder.

The state requires the district to collect a Home Language Survey for every new student. This information is used to count the students whose families speak a language other than English at home. It also helps to identify the students who need to be assessed for English language proficiency and may be eligible for English Learner services.

School:______________________________ Room:____________ School ID #: _________________ Network:___________

Student Name:_______________________________________________________ Student ID #:_______________________

H

English 1. Is a language other than English spoken in your home?

O M

No

Yes ________________________ (language)

ASPEN REGISTRATION PROCESS (For Office Use only)

? All five fields have to be entered on Aspen: date, answer to question 1, Home language, answer to question 2, and Native language.

? If the Home language is English, but the Native language is a

E

2. Does the student speak a language other than English?

No

Yes ________________________ (language)

language other than English, that Non-English language has to be listed as both Home and Native language ? If there are two languages other than English listed, enter the language identified in question 2 as both Home and Native language.

L

If the answer to either question is yes, the law requires the school to

A

assess your child's English language proficiency.

? English can be entered as the Home language ONLY if both questions are answered No and English is listed for both questions.

N

Romanian/Rom?n 1. In familia dvs. se vorbete i alt limb dec?t engleza?

Yoruba/Yor?b?

G U

Nu

Da ________________________ (limba)

2. Studentul vorbete i alt limb dec?t engleza?

A G

Nu

Da ________________________ (limba)

E

Dac ai rspuns afirmativ la oricare dintre ?ntrebri, prin lege,

instituia de ?nvm?nt trebuie s evalueze cunotinele de limb

S

englez ale copilului dvs. Assyrian

Gujarati/

U

R

V

E

Y

HLS 1 of 2 Spanish

Polish Chinese Arabic Bosnian Croatian Serbian

Urdu

HLS 2 of 2 Romanian

Yoruba Assyrian Guajarati Tagalog Korean

Tagalog 1. May iba pa bang lengguwahe bukod sa Ingles na ginagamit sa iyong tahanan?

Hindi

Oo ________________________ (Lengguwahe)

2. May ginagamit ba na ibang lenggguwahe ang mag-aaral bukod sa Ingles?

Hindi

Oo ________________________ (Lengguwahe)

Ayon sa batas, kung "Oo" ang sagot sa parehong tanong, kailangan suriin ng paaralan ang kakayahan at kaalaman na magaaral sa wikang Ingles.

Korean/ 1. ?

_______________________ ()

2. ?

_______________________ ()

Page 2 of 2

Form Updated

07/20

___________________________________________________________ __________________________________________________________

Signature of School Official

Date

Signature of Parent/Guardian

Date

? If the parent/guardian does not speak English and the school does not have staff who speaks the parent/guardian's language, identify the language spoken by the parent/guardian through any assistance available in the school, i.e. using interpretation services from a vendor.

? If the language is not included on the list of languages available on Aspen, enter "Other." ? If the language spoken by the parent/guardian is not included on either page of this form, please visit the OLCE KC Page, Forms, and click on "Home Language Survey in

Additional Languages" which will take you to ISBE's HLS page.

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