Clarke County Schools
Las escuelas del Condado de Clarke
155 Cobb Street
Grove Hill Alabama 36451
Casa de estudio de idioma
2010-2011
Este formulario debe completarse en la inscripción de cualquier estudiante. Un formulario debe completarse en cada niño en una familia.
Date___________________School_____________________Grade____________________
Nombre del niño _________________________________________________________________________
Media inicial de apellido de nombre
Padre o nombre del guardián ______________________________________________________________
Media inicial de apellido de nombre
Address______________________________________________________________________________
Estado de la ciudad de calle ZIP
Número de teléfono __________________ _________________________________
Casa de trabajo
Fecha de ___________ (hombre o mujer) de género de Age_____________ de Birth________________
Social Number________________________________ de Security/I.D.
¿Qué fecha el niño participaron los Estados Unidos? _________________
En qué país era estudiante nacido? ____________________________
¿Qué es el primer idioma que el estudiante aprendió a hablar? _____Other de ____Spanish de _____English
¿Qué idioma ¿habla el estudiante más a menudo? _____Other de _____Spanish de ______English
¿Qué idioma se habla más a menudo en casa del estudiante? _____Other de ___Spanish de ___English
¿En qué lengua es la lectura de estudiante? ________Other de _______Spanish de _________English
¿En qué idioma leen los padres del estudiante? ______Other de ____Spanish de ______English
Signature____________________________________Date_____________________________
SÓLO PARA USO DE OFICINA
|Estudiante ID # |Fecha distribuido |Fecha recibido |
| | | |
| | | |
| | | |
| | | |
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Clarke County Schools
155 Cobb Street
Grove Hill
, Alabama 36451
Home Language Survey
This form must be completed upon enrollment of any student.
A form must be completed on each child in a family.
Date___________________School_____________________Grade____________________
Child’s Name
_________________________________________________________________________
First Name Middle Initial Last Name
Parent or Guardian’s Name
______________________________________________________________
First Name Middle Initial Last Name
Address______________________________________________________________________________
Street City State Zip
Phone Number
__________________ _________________________________
Home Work
Date of Birth________________ Age_____________ Gender (male or female)___________
Social Security/I.D. Number________________________________
What date did the child enter the United States?_________________
In what country was student born?____________________________
What is the first language the student learned to speak?
_____English ____Spanish _____Other
What language does the student speak most often?
______English _____Spanish _____Other
What language is most often spoken in the student’s home?
___English ___Spanish _____Other
In what language does the student read?
_________English _______Spanish ________Other
In what language does the student’s parent(s) read?
______English ____Spanish ______Other
Signature____________________________________Date_____________________________
OFFICE USE ONLY
Student ID#
Date Distributed
Date Received
................
................
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