Preschool Home Language Survey

Preschool Home Language Survey Parent/Guardian Questionnaire

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* Please Enter the child's first name

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* Please enter the child's last name

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* Please enter the child's middle name

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* Please enter the child's date of birth

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* Person completing the survey

Mother

Father

Grandparent

Guardian

Other

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* What language did the child learn when he/she first began to talk?

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* What language does the family speak at home most of the time?

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* What language (s) does the primary caregiver (s) speak to the child most of the time?

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* What language (s) does the child speak to his/her primary caregiver (s) most of the time?

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* What language (s) does the child speak to his/her brothers and sisters most of the time?

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* What language does the child speak to his/her friends most of the time?

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* Please list any preschool program(s) your child attended before coming to our program or indicate none if not prior programs have been attended by the child:

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* In which language do you wish to receive information from the school?

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* What name do you use for your child (if different from above)?

Please enter this confirmation code in your OnCourse Registration form: lh12q