Appendix E
ESOL Home Language Survey
Federal, state, and local regulations require schools districts to determine the language(s) used by
students in their homes. Please answer each question below. Languages other than or in addition
to English will result in the administration of the state mandated English language proficiency
assessment. The results of this assessment will determine your child’s eligibility for enrollment
in the English for Speakers of Other Languages (ESOL) program. Thank you for your
cooperation.
Student’s Name:
Elementary School:
1. What language(s) do you or others speak to your child?
2. What language(s) does your child speak to you or others?
Parent/Guardian Signature