Title VI Template



Appendix 7Limited English Proficient (LEP) Tools “I Speak” Language Identification Card“I Speak” Language Identification CardMark this Box if you speak…Language Identification ChartLanguageI speak EnglishEnglishYo hablo espa?olSpanishKug has lug MoobHmong我說中文ChineseSimplifiedE nói ti?ng Vi?tVietnamese??????KoreanMarunong akong mag-TagalogTagalogIch spreche Deutsch GermanЯ говорю по-русскиRussiano magsalita ng TagalogTagalog??? ????? ????? ???Hindi??? ?? ???? ????? ???UrduNote: For additional languages visit the US Census Bureau website of LEP EncountersDateTimeLanguage Spoken By Individual(if available)Name and Phone Numberof Individual(if available)Service RequestedFollow Up RequiredStaff MemberProviding AssistanceNotesLanguage Translation Request LogDateLanguage Spoken By Individual(if available)Name and Phone Numberof Individual(if available)Service RequestedFollow Up Actions (Was Translation Services Provided?Staff MemberProviding AssistanceNotes ................
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