HINGHAM PUBLIC SCHOOLS
HOME LANGUAGE SURVEY
220 Central Street
Hingham, MA 02043
In accordance with state and federal laws, school districts in Massachusetts are required to administer a
language survey to all new students and to assess the language proficiency of all students whose home
language is other than English.
In order to help your child succeed in school, we ask that you please answer the following questions for
each child in your family. Your answers will help us in creating the best possible educational program
for your child. The school will provide interpreting services if necessary.
Student Name:
DOB:
Address:
City and Country of Birth:
How Many Years in the USA?
School:
Grade Entering:
Has the student received ELE or bilingual services in the past?
If yes, for how long?
Yes
No
Where?
What language did the student first learn to speak?
English
Other
What language does the student use most often at home?
English
Other
What language do the parents use to speak to the student?
English
Other
What language do the adults at home most often speak?
English
Other
Can the student speak, read or write a language other than English?
Yes
No
What language does the student use most often to speak to friends?
English
Other
Name of Person Completing this Survey:
Relationship to Student:
Mother
Father
Guardian
Other (Please Specify)
Signature of Parent/Guardian
Date
For Office Use:
If the Home Language Survey indicates a first language other than English, a copy will be given to the Principal who will
then give a copy to the ELE teacher and the Director of Student Services. The ELE teacher will then assess the student for
English proficiency and notify the parents/guardians of the results. The Home Language Survey will be placed in the
student’s cumulative file.
Rev. 1/2013