Sample Home Language Survey (HLS):
HOME LANGUAGE SURVEY
Please answer the following questions for each student
Is a language other than English spoken in the home on a regular basis?
YES NO
□ □ If YES, what language(s)?_______________
Does the student use language other than English on a regular basis?
YES NO If YES, what language(s)?_______________
□ □
Is the student currently receiving “English Language Learner” services?
YES NO
□ □
School Note: If any question is marked “YES”, then the district has a legal obligation to evaluate for limited-English proficiency following the WI identification process. For more information see the following bulletin: http://www.dpi.wi.gov/esea/pdf/bul_0701.pdf.
