Peñasco Independent School District
P.O. Box 520
Peñasco, New Mexico 87553
(575) 587-2502
Darlene Ulibarri
Superintendent
Rosa Pacheco-Romero
Bilingual Coordinator
BILINGUAL PARTICIPATION
CONSENT FORM
Dear Parents/Guardians:
The Peñasco Bilingual Program is pleased to inform you that your child has the opportunity to
participate in the bilingual and bicultural education by receiving English, Spanish or Tiwa as part of
his/her school day.
The goal of the bilingual program is to promote and maintain our native languages. Teachers who
have a Bilingual or TESOL endorsement will provide effective teaching techniques in these
languages.
Students who are English Language Learners (ELL) will participate in a 2-hour program, which
includes English language strategies, Spanish or Tiwa languages through cultural activities. Students
not classified as ELL will take 2 hours of bilingual courses and the home language with emphasis in
cultural activities.
As a parent, you are given the decision whether you would allow your child to participate in the
bilingual program. Therefore we request that you indicate your preference.
Please return this form as soon as possible. If we do not hear from you we will then assume that
placement in the program is acceptable.
____ Yes, I want my child ___________________ to participate in the bilingual program.
_____ Spanish
______Tiwa
(Please check one)
____ No, I do not want my child _______________ to participate.
____ I would like to participate in the Bilingual/School Advisory Council.
_____________________________________________
__________________________
Parent's Signature/Firma de Padres
Date/Flecha
Please complete the
Home Language Survey/Cuestionario Sobre el Lenguage de la Casa
on the reverse side of this form/Por favor completen la forma atrás
Revised 7/9/2014
HOME LANGUAGE SURVEY
Name of Student:______________________________________
Grade:__________________
Please check the appropriate box:
What language(s) has your child learned to speak?
What language(s) does your child most often speak
at home?
What language(s) are commonly used in speaking
with your child?
ENGLISH
SPANISH
TIWA









Which best describes your child's speaking ability?
 English
 English, some Spanish
 Spanish
 Spanish, some English
 Tiwa
 Tiwa, some English
 Proficient in both English and Spanish
 Tiwa, some Spanish
 Proficient in both English and Tiwa
CUESTIONARIO SOBRE EL LENGUAGE DE LA CASA
Nombre del Estudiante:__________________________________
Grado:__________________
Por favor marca la repuesta apropiado:
INGLÉS
¿Que lenguaje(s) aprendió?
¿Cual(es) lenguaje(s) frecuentemente habla su
hijo(a) en la casa?
¿Que lenguaje(s) frecuentemente utilizé usted
cuando hablas con su hijo(a)?
ESPAÑOL
TIWA









.
Cual mejor describe su hijo's(a's) lenguaje competencia?
 Inglés
 Inglés poco Español
 Español
 Español poco Inglés
 Tiwa
 Tiwa poco Inglés
 Tiwa poco Español
 Proficiencia en Inglés y Español
 Proficiencia en Inglés y Tiwa
Revised 7/9/2014