docSpring Independent School District
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Spring Independent School District
Spring Independent School District Texas Education Agency Home Language Survey Exhibit 1 Name of Student: _______________________________________________________ Nombre del Estudiante Campus: ______________________________Grade: ________________ ID Number: _________________ Escuela Grado Número de identificación Birth date: ______________ Country of Birth:_______________________ Fecha de nacimiento Lugar de nacimiento (País) 1) What language is spoken in your home most of the time? ¿Qué idioma se habla en su casa la mayoría del tiempo? English/ingles Spanish/español Vietnamese/ Việt Other (Specify)_________________ 2) What language does your child speak most of the time? ¿ Qué idioma habla su hijo la mayoría del tiempo? English/ingles Spanish/español Vietnamese/ Việt ________________________________________________________ Other (Specify)_________________ ___________ Signature of Parent or *Student (Firma del Padre o *Estudiante) Date (Fecha) *Student must be in grade 9-12 to sign (*El estudiante debe de estar del 9º al 12º grado para firmar) FOR OFFICE USE ONLY IMMIGRANT STATUS FOR PEIMS REPORT Student aged 3 through 21; were not born in any USA states and did not attend a school in USA for more than 3 full years. INDICATE IF THIS STUDENT IS AN IMMIGRANT: YES NO if YES, then refer to BIL/ESL Department for procedures. LANGUAGE Spanish, Vietnamese or other marked? YES NO if YES, then refer to BIL/ESL Department for testing. English/Spanish Spring Independent School District Texas Education Agency Home Language Survey Exhibit 1 Name of Student: _______________________________________________________ Tên của sinh Campus: ___________________________Grade: ______________ ID Number: _________________ Tẻn của Khu học Xà Lớp số id của học sinh Date of Birth: ______________ Ngày sinh Country of Birth:_______________________ Quốc gia sinh 1) What language is spoken in your home most of the time? Ngôn ngữ được nói ở nhà hầu hết thời gian? English/ingles Spanish/español Vietnamese/ Việt Other (Specify)_________________ 2) What language does your child speak most of the time? Ngôn ngữ khác hơn của bạn trẻ em? English/ingles Spanish/español Vietnamese/ Việt Other (Specify)_________________ ________________________________________________________ ___________ Signature of Parent or *Student (Chữ ký phụ huynh o * Sinh viên) *Student must be in grade 9-12 to sign *Học sinh phải có từ thế kỷ 9 đến lớp 12 để đăng nhập Date (Ngày) FOR OFFICE USE ONLY IMMIGRANT STATUS FOR PEIMS REPORT Student aged 3 through 21; were not born in any USA states and did not attend a school in USA for more than 3 full years. INDICATE IF THIS STUDENT IS AN IMMIGRANT: YES NO if YES, then refer to BIL/ESL Department for procedures. LANGUAGE Spanish, Vietnamese or other marked? YES NO if YES, then refer to BIL/ESL Department for testing. English/Vietnamese
