HOME LANGUAGE SURVEY. What language did your son/daughter learn when s/he first began to talk? What language does your son/daughter most frequently use at home? What language do you use most frequently when speaking to your son/daughter? What language is most frequently spoken by the adults at home?
HOME LANGUAGE SURVEY. Q- #1 What was the first language used by the student?
HOME LANGUAGE SURVEY. What language did your son/daughter learn when s/he first began to talk? 8) EMERGENCY INFORMATION: Name of Contact Phone # _Relationship Name of Contact Phone # _Relationship Name of Physician Phone # City: Insurance Company Policy and/or Medi-Cal # _ Conditions which might lead to health problems (allergies, seizures, asthma etc): In Case of sudden illness or injury to your son/daughter, every effort will be made by school officials to contact you, your family physician or the person named by you above to be called in an emergency. If it is impossible to reach you, your signature above will assure emergency treatment by authorized medical and/or hospital personnel. I (We) the undersigned parent(s)/legal guardian of the above named minor, do hereby authorize the Orange County Department of Education and its employees as agents for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any physician and surgeon licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital no matter where such service is rendered. The agent for the undersigned and its employees are released of any civil of financial liabilities for the aforementioned diagnosis, treatment, hospital care, or any other acts performed that reasonable and necessary for the welfare of the minor. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. This authorization shall remain effective unless revoked in writing and delivered to said agent. The signatures below indicate understanding and acceptance of information listed above. Parent Signature: _ Date: _ Student Signature: _ Date: _ Legal Name: Last First MiddleA Prior ACCESS student: -No -Yes, If yes, has your name changed from a prior enrollment: -No -Yes If yes, indicate name used in the prior enrollment: Sex: -Male Female Birth Date: Grade: If 9th grade or greater, initial 9th grade entry year: Parent Ed Level (Refer to back of form): Name of Mother: -Parent -Guardian -Caregiver Name of Father: -Parent -Guardian -Caregiver Home Phone: Father’s Work Phone: Ext: Mother’s Work Phone: Ext: Mailing Address Apt City Zip Code Residence Address (If different than above) Apt City Zip Code Father’s Cell Phone: Mot her’s Cell Phone: Student’s Cell Phone: Father’s Email Address: Mother’s Email Addr...
HOME LANGUAGE SURVEY. A Delaware education policy requires schools to determine the language(s) spoken at home by each student. Your cooperation in helping us meet this important requirement is requested. Thank you for your help.
HOME LANGUAGE SURVEY. Q- #1 What was the first language used by the student? Q- #2 At home, does the student hear or use a language other than English more than half of the time? Yes No Q- #3 Does the student understand a language other than English? Yes No When interacting with his/her parents or guardians, does this student use a language other than English more than half of the time? When interacting with caregivers other than his/her parents or guardians, does the student use a language other than English more than half of the time? Has the student recently moved from another school district where he/she was identified as an English language learner? List home language(s) spoken: Proudly Charting a Course for Success Student's Name: Xxxxxx Xxxxx Middle School requires all middle school students to take four core classes: LA, Math, Social Studies and Science. What math level class did you take in your last district (regular level or accelerated)? Please check off ONE World Language option that your prefer. This is based on class availability. • Spanish • Italian If you did not take Spanish or Italian in your last district, what foreign language class did you take? Descriptions:
