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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