ENGLISH LANGUAGE LEARNER



ENGLISH LANGUAGE LEARNER

HOME LANGUAGE SURVEY AND STUDENT PROFILE

Worcester County Public Schools

Student Name: ________________ _______________ _____________________

(First) (Middle) (Last)

Home Language Survey – The following questions must be asked of every new student upon enrollment:

1) Were you born in another (foreign) country? Yes _____ No _____

2) Is there currently, or has there been in the past, a language other than English spoken in your home? Yes _____ No _____

Student Profile – The following information should be obtained at the time of student registration:

Date of Birth: __________ Country at Birth: _______________ Grade Placement: _____

Home Language Spoken (other than English): ____________________

Native Language (if different than home language spoken): ____________________

Age at Enrollment in First Formal School: _____ Country: ____________________

Date of Enrollment in First School in United States: ____________________

Date of Enrollment in First School in Maryland: ____________________

Date of Enrollment in First School in Worcester County: ____________________

Number of Years Enrolled in ELL Services in Maryland: _____

Number of Years, if any, in Native Language School: _____

Was Schooling Interrupted at any time: Yes _____ No _____

Dates of Interruption: _______________ to _______________

Is Student an Immigrant? (see definition below) Yes _____ No _____

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IF THE ANSWER TO EITHER OF THE ABOVE QUESTIONS IS YES,

PLEASE COMPLETE THE FOLLOWING INFORMATION

AND FORWARD THIS FORM TO THE ELA STAFF

An Immigrant child is: 3 through 21 years of age; was not born in any of the United States, and; has not been attending any school(s) in the United States for more than 3 (three) academic years.

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