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New Home Language Survey (English)

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Commissioner Mike Morath

1701 North Congress Avenue • Austin, Texas 78701-1494 • 512 463-9734 • 512 436-9838 FAX • tea.texas.gov

Student First Name*

Answer Required

Student Last Name*

Answer Required

Student ID #*

Answer Required

District Name: SAISD

Campus Name: St. Anthony Catholic High School

HOME LANGUAGE SURVEY

19 TAC Chapter 89, Subchapter BB, §89.1215

(Home Language Survey only administered during initial enrollment in Texas public schools)

To be completed by Parent or Guardian for students enrolling in Prekindergarten* through grade 8 (or by students in grades 9-12).

*Prekindergarten includes any student enrolling in a 3- or 4-year-old school program.

Part One:

The state of Texas requires that the following information be completed for each student who enrolls in a Texas public school for the first time. It is the responsibility of the parent or guardian, not the school, to provide the language information requested by the questions below.

Dear Parent or Guardian:

Please answer the questions below about the languages your child or family uses. If your responses indicate the use of a language other than English, the school will conduct a language proficiency assessment to determine how well your child communicates in English. This information will be used to determine any appropriate linguistic supports and inform instructional recommendations. If you have questions about the purpose and use of the Home Language Survey, or you would like assistance in completing the form, please contact your school/district personnel.

This survey shall be kept in each student’s permanent record folder. A copy of this survey shall follow the student while enrolled in any public or open enrolled charter school in Texas.

Part Two:

Please answer the questions to the best of your ability.

Which languages are used at home?*

Answer Required

Which languages are used by the child at home?*

Answer Required

If the child had a previous home setting, which languages were used? If there was no previous home setting, answer Not Applicable (N/A).*

Answer Required

By checking this box, I understand a request to correct an error to this HomeLanguage Survey can only happen if: (1) my child has not yet been assessed for English proficiency; and (2) corrections are made within two calendar weeks of my child’s enrollment date.*

Answer Required

I understand

Note: Please contact your school about the benefits of bilingual education services. The following resources may also provide information on program services that foster bilingualism.

Parent/ Guardian Rights

Bilingual Education Program

Program Information Videos

Please visit the Emergent Bilingual Support Portal (txel.org) for additional information.

I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By signing “I agree” using any device, means, or action, I consent to the legally binding terms and conditions of this document. I further agree that my signature on this document is as valid as if I signed the document in writing. I am also confirming that I am authorized to enter into this Agreement. If I am signing this document on behalf of a minor, I represent and warrant that I am the minor’s parent or legal guardian.

Parent/Guardian Signature*

Signature Required

Confirmation Email

Confirmation Email *

Email Required