Arkansas Division of Elementary and Secondary Education (DESE) Home Language Usage Survey

Arkansas Division of Elementary and Secondary Education (DESE) Home Language Usage Survey
The Home Language Usage Survey is completed by all students initially enrolling in Arkansas schools.
Student Name
Grade
Date

MonthDayYear
Date
Name of School
Student State ID #
Gender
Date of Birth

MonthDayYear
Date
Parent/Guardian Name
Parent/Guardian Signature
Do you need to communicate in a language other than English?
1. a) In what language do you prefer to receive written communication from the school?
1. b) In what language would you prefer to communicate with school staff when speaking?
2. What language(s) is (are) spoken in your home?
3. What language did your child learn first?
4. What language does your child use most often at home?
5. What language does your family speak most often at home?
6. What language do adults speak most often with each other at home?
7. Where was your child born?
8. When did your child first attend a school in the United States (the 50 states, DC)? Please enter the Month in this box. You will enter the Day and Year in the designated boxes below.
Day
Year
9. Has your child attended a school in Puerto Rico?
Should be Empty: