Neb. Admin. Code EDUCATION, DEPARTMENT OF, tit. 92, ch. 15, app A

Current through September 17, 2024

Appendix A - Sample Home Language Survey

Student Name: ___________________________ Birth Date: _____________ Gender: __Male __ Female

Parent/Guardian Name: _________________________________________________________________

Address: _____________________________________________________________________________

Home Telephone: _______________________ Work Telephone: _______________________________

School: _________________________________ Grade: _______ Date: _________________________

What language did your child first learn to speak? ___________________________________________

What language is spoken most often by your child? __________________________________________

What language is primarily used in the student's home regardless of the language spoken by the student?

Neb. Admin. Code EDUCATION, DEPARTMENT OF, tit. 92, ch. 15, app A

Amended effective 5/8/2018