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Language Proficiency Assessment Committee (LPAC)
Table of Contents Home Language Surveys
English ............................................................................................................................................................... 141
Spanish .............................................................................................................................................................. 142
Vietnamese ........................................................................................................................................................ 143
English/Albanian................................................................................................................................................. 144
English/Amharic.................................................................................................................................................. 145
English/Arabic..................................................................................................................................................... 146
English/Bosnian.................................................................................................................................................. 147
English/Cambodian............................................................................................................................................ 148
English/Chinese.................................................................................................................................................. 149
English/Farsi....................................................................................................................................................... 150
English/French.................................................................................................................................................... 151
English/German........................................................................................................................................... 152-153
English/Gujurati.................................................................................................................................................. 154
English/Haitian Creole........................................................................................................................................ 155
English/Hindi....................................................................................................................................................... 156
English/Hmong................................................................................................................................................... 157
English/Japanese............................................................................................................................................... 158
English/Korean................................................................................................................................................... 159
English/Laotian................................................................................................................................................... 160
English/Portuguese............................................................................................................................................ 161
English/Punjabi................................................................................................................................................... 162
English/Russian.................................................................................................................................................. 163
English/Somali.................................................................................................................................................... 164
English/Tagalog.................................................................................................................................................. 165
English/Thai........................................................................................................................................................ 166
English/Tigrigna.................................................................................................................................................. 167
English/Ukrainian................................................................................................................................................ 168
English/Urdu....................................................................................................................................................... 169
Texas Education Agency Special Populations Division 2017-2018│ 140
Language Proficiency Assessment Committee (LPAC)
____________________INDEPENDENT SCHOOL DISTRICT/CHARTER SCHOOL
HOME LANGUAGE SURVEY-19 TAC Chapter 89, Subchapter BB, §89.1215 (Home Language Survey applicable ONLY if administered for students enrolling in pre-kindergarten through grade 12)
TO BE COMPLETED BY PARENT OR GUARDIAN FOR STUDENTS ENROLLING IN PREKINDERGARTEN THROUGH GRADE 8 (OR BY STUDENT IN GRADES 9-12): The state of Texas requires that the following information be completed for each student who enrolls in a Texas public school for the first time. It is the responsibility of the parent or guardian, not the school, to provide the language information requested by the questions below.
NAME OF STUDENT: ______________________________ STUDENT ID#: _______________________________
ADDRESS: _______________________________________ TELEPHONE #: _______________________________
CAMPUS: ________________________________________
NOTE: PLEASE INDICATE ONLY ONE LANGUAGE PER RESPONSE.
1. What language is spoken in the child’s home most of the time? ________________________
2. What language does the child speak most of the time? ________________________
_______________________________________ ________________________________Signature of Parent/Guardian Date
_______________________________________ ________________________________Signature of Student if Grades 9-12 Date
NOTE: If you believe you made an error when completing this Home Language Survey, you may request a correction, in writing, only if: 1) your child has not yet been assessed for English proficiency; and 2) your written correction request is made within two calendar weeks of your child’s enrollment date.
____________________INDEPENDENT SCHOOL DISTRICT/CHARTER SCHOOL Texas Education Agency Special Populations Division 2017-2018│ 141
Dear Parent or Guardian:
To determine if your child would benefit from Bilingual and/or English as a Second Language program services, please answer the two questions below.
If either of your responses indicates the use of a language other than English, then the school district must conduct an assessment to determine how well your child communicates in English. This assessment information will be used to determine if Bilingual and/or English as a Second Language program services are appropriate and to inform instructional and program placement recommendations. If you have questions about the purpose and use of the Home Language Survey, or you would like assistance in completing the form, please contact your school/district personnel.
For more information on the process that must be followed, please visit the following website: https://projects.esc20.net/upload/page/0081/docs/JuneUpdates/EnglishLearnerIdentification-ReclassificationFlowchart.pdf
This survey shall be kept in each student’s permanent record folder.
Language Proficiency Assessment Committee (LPAC)
Cuestionario sobre el idioma que se habla en el hogar 19 TAC Chapter 89, Subchapter BB §89.1215
DEBE DE COMPLETARSE POR EL PADRE O TUTOR PARA ESTUDIANTES QUE CURSEN DESDE PREKINDER HASTA EL OCTAVO GRADO: (O POR EL ESTUDIANTE SI CURSA GRADOS DEL 9-12): El estado de Texas requiere que la siguiente información sea completada para cada estudiante que se matrícula por primera vez en una escuela pública de Texas. Es la responsabilidad del padre o tutor, no de la escuela, proporcionar la información del idioma requerida por las siguientes preguntas.
NOMBRE DEL ESTUDIANTE: ______________________________ ID#: _____________________________________
DIRECCIÓN: ____________________________________________ TELÉFONO: _______________________________
ESCUELA: ______________________________________________Nota: Indique sólo un idioma por respuesta.
1. ¿Qué idioma se habla en la casa de su hijo(a) la mayoría del tiempo? _____________________________
2. ¿Qué idioma habla su hijo(a) la mayoría del tiempo? _____________________________
______________________________________________________ ____________________________Firma del padre o tutor Fecha______________________________________________________ __________________________Firma del estudiante si esta en los grados 9-12 Fecha
NOTA: Si cree que cometió un error al completar este cuestionario sobre el idioma que se habla en el hogar, puede solicitar una corrección, por escrito, solo si: 1) su hijo/(a) aún no ha sido evaluado para el dominio del inglés; y 2) su solicitud de corrección por escrito se realiza dentro de las dos semanas calendario posteriores a la fecha de inscripción de su hijo(a).
Texas Education Agency Special Populations Division 2017-2018│ 142
Querido padre o tutor:
Para determinar si su hijo(a) se beneficiara de los servicios de los programas bilingües y/o de inglés como segundo idioma, por favor responda las dos preguntas siguientes.
Si cualquiera de sus respuestas indica el uso de un idioma que no sea inglés, entonces el distrito escolar debe realizar una evaluación para determinar que tanto se comunica su hijo(a) en inglés. Esta información resultante de la evaluación se usará para determinar si los servicios de programas bilingües y/o de inglés como segundo idioma son apropiados e informará las recomendaciones en cuanto a la instrucción y la asignación del programa. Una vez completada la evaluación de su hijo(a), no se permitirán cambios a las respuestas en el cuestionario. Si tiene preguntas sobre el propósito y el uso del cuestionario sobre el idioma que se habla en el hogar, o si necesita ayuda para completar el cuestionario, por favor comuníquese con el personal del distrito escolar.
Para más información sobre el proceso que debe seguirse, por favor visite el siguiente sitio web: https://projects.esc20.net/upload/page/0081/docs/JuneUpdates/Spanish_English_Learner_Identification_Reclassification_Flowchart.pdf
Este cuestionario se deberá archivar en el expediente permanente del estudiante.
Language Proficiency Assessment Committee (LPAC)
____________________TR NG BÁN CÔNG/KHU H C CHÁNH Đ C L P ƯỜ Ọ Ộ ẬKH O SÁT V NGÔN NG NHÀ-19 TAC Ch ng 89, Ch ng ph BB, §89.1215Ả Ề ỮỞ ươ ươ ụ
(Kh o sát v ngôn ng nhà CH áp d ng n u qu n lý cho h c sinh đăng ký vào m m non đ n l p 12)ả ề ữ ở Ỉ ụ ế ả ọ ầ ế ớ
C N Đ C HOÀN THÀNH B I PH HUYNH HO C NG I GIÁM H C A H C SINH ĐĂNG KÝ VÀO M M NON Đ N L P 8 (HO C B I H C SINH L P 9-12)Ầ ƯỢ Ở Ụ Ặ ƯỜ Ộ Ủ Ọ Ầ Ế Ớ Ặ Ở Ọ Ớ : Bang Texas yêu c u cung c p thông tin sau đây v i m i h c sinh l n đ u tiên đăng ký vào m t tr ng công Texas. Ph huynh ho c ng i giám h , ch không ph i nhà tr ng, có trách ầ ấ ớ ỗ ọ ầ ầ ộ ườ ụ ặ ườ ộ ứ ả ườnhi m cung c p thông tin v ngôn ng đ c yêu c u trong các câu h i d i đây. ệ ấ ề ữ ượ ầ ỏ ướ
TÊN H C SINH: ________________________________Ọ ID H C SINH: _________________________________Ọ
Đ A CH : _______________________________________Ị Ỉ S ĐI N THO I: _______________________________Ố Ệ Ạ
C S TR NG: ________________________________________Ơ Ở ƯỜL U Ý: VUI LÒNG CH NÊU M T NGÔN NG TRONG M I CÂU TR L I.Ư Ỉ Ộ Ữ Ỗ Ả Ờ
1. Trong ph n l n th i gianầ ớ ờ nhà, tr nói ngôn ng gì? ________________________ở ẻ ữ
2. Trong ph n l n th i gianầ ớ ờ , tr nói ngôn ng gì? ________________________ẻ ữ______________________________________ _______________________________Ch ký c a Ph huynh/Ng i giám hữ ủ ụ ườ ộ Ngày
______________________________________ _______________________________Ch ký c a h c sinh, n u là h c sinh l p 9-12ữ ủ ọ ế ọ ớ Ngày
LƯU Ý: Nếu quý vị cho rằng mình đã nhầm lẫn khi làm Khảo sát Ngôn ngữ tại nhà, quý vị có thể gửi yêu cầu sửa đổi bằng văn bản, chỉ khi: 1) con của quý vị chưa được đánh giá về trình độ tiếng Anh; và 2) quý vị gửi yêu cầu chỉnh sửa bằng văn bản trong vòng hai tuần kể từ ngày đăng ký của con quý vị.
Texas Education Agency Special Populations Division 2017-2018│ 143
Kính g i Ph huynh ho c Ng i giám h !ử ụ ặ ườ ộĐ xác đ nể ị h xem con quý v có đ c h ng l i t các d ch v c a ch ng trình Song ng và/ho c ti ng Anh nh Ngôn ng Th hai hay không, vui lòng tr l i hai câu h i d i ị ượ ưở ợ ừ ị ụ ủ ươ ữ ặ ế ư ữ ứ ả ờ ỏ ướđây.
N u có m t trong hai câu tr l i c a quý v cho th y vi c s d ng m t ngôn ng khác ngoài ti ng Anh, thì khu h c chánh ph i ti n hành đánh giá đ xác đ nh kh năng giao ti p ế ộ ả ờ ủ ị ấ ệ ử ụ ộ ữ ế ọ ả ế ể ị ả ếti ng Anh c a con quý v . Thông tin đánh giá này s đ c s d ng đ xác đ nh xem các d ch v c a ch ng trình Song ng và/ho c ti ng Anh nh Ngôn ng Th hai có thích ế ủ ị ẽ ượ ử ụ ể ị ị ụ ủ ươ ữ ặ ế ư ữ ứh p hay không, đ ng th i đ cung c p thông tin cho vi c đ xu t s p x p ch ng trình và gi ng d y. Khi con quý v đ c đánh giá, quý v s không th thay đ i các câu tr l i ợ ồ ờ ể ấ ệ ề ấ ắ ế ươ ả ạ ị ượ ị ẽ ể ổ ả ờcho Kh o sát v Ngôn ng nhà. N u quý v có th c m c v m c đích và cách s d ng Kh o sát v Ngôn ng nhà ho c quý v c n đ c giúp đ hoàn thành bi u m u, ả ề ữỞ ế ị ắ ắ ề ụ ử ụ ả ề ữỞ ặ ị ầ ượ ỡ ể ẫvui lòng liên h v i nhân viên khu h c chánh c a mình.ệ ớ ọ ủhttps://projects.esc20.net/upload/page/0081/docs/JuneUpdates/Vietnamese_EnglishLearnerIdentification-ReclassificationFlowchart.pdf
B n kh o sát này s đ c l u gi trong h s lâu dài c a m i h c sinh.ả ả ẽ ượ ư ữ ồ ơ ủ ỗ ọ
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