2010-11 Academic Year

Dear Parent(s)/Guardian(s):

Under the terms of a federal project administered by the Maine Department of Education, data must be collected on home language usage for all kindergarten and incoming new students.  Also, schools are required under federal civil rights laws to identify all students whose home language is not English.  Parents and guardians are most qualified to provide the school with this information. Please take a few moments to complete the questionnaire on the reverse side of this page about the language(s) spoken in your home.  After answering the questions, please have your child return the questionnaire to his/her homeroom teacher promptly.

You may be assured that the information that you provide in the questionnaire will be used only to assist the Department in planning programs to provide appropriate educational opportunities to all students in your school.  The federal government will receive group data only.  Access to the information provided in the short survey cannot be released without permission from you.  Only those persons with legitimate educational interests, including in this case the Maine Department of Education, will have access to this information.

Please stress to your son or daughter the importance of returning the completed questionnaire promptly.  Do not hesitate to call your school principal if you have questions about the survey.  Thank you for your assistance in helping us meet this requirement.

Sincerely,

Nancy Mullins, Director

No Child Left Behind, Title III  (Instruction for English Language Learners)

STUDENT'S NAME________________________________SCHOOL_____________________

GRADE__________ TOWN______________________________DATE__________________

Directions:       

Y   For Question 1, circle the name of the language.

Y   For Questions 2-5, write the name(s) of the language(s) that apply in the space provided. 

Please do not leave any question unanswered.

 

1.     What language do you MOST OFTEN use when speaking to your child?

English                   French             Passamaquoddy

Vietnamese             Arabic              Khmer      

Spanish                  American Sign    Somali

Other: (specify) ___________________________________

2.   What language did your child FIRST learn to speak?  ___________________________________       

3.     What language does your child MOST OFTEN use when speaking to brothers, sisters,

      and other children at home?    ___________________________________

4.     What language does your child MOST OFTEN use when speaking to you and other adults in the home?  (grandparents, aunts, uncles, guests)  ___________________________________

5.    What language does your child MOST OFTEN use when speaking with friends or neighbors,

      OUTSIDE the home?   ___________________________________

 

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

 TO THE TEACHER:  

(1)  If you have observed this student use a language other than English, please indicate other language here:___________________________________________

(2)  Was the child's first language development interrupted at some point in time due to adoption, relocation of family or similar event that might suggest second language usage? ____Yes     ___No