Home Language Survey

The fields below should be completed for any student that a qualified LEA staff person has identified is an English Learner (EL) and/or an “Eligible Immigrant.” Please do not complete this online form for any student who is determined to be neither an EL nor an “Eligible Immigrant.”
Only qualified LEA staff designated by the LEA to submit Home Language Surveys (HLSs) of identified ELs and “Eligible Immigrants” should access the HLS collection site. Designated staff should ensure that all information submitted is accurate and that all fields are complete. Parents/guardians and students should never access the HLS collection site.
All fields indicated as required must be completed in order to submit a record.
Multiple languages may be entered from the dropdown menus in the Family Information section.
If the parent(s) has indicated on their “paper” HLS survey a language that does not appear in the dropdown menus, please select that specific language from the dropdown menu in the final Family Information question. Then, please reach out to Stephanie Vogel for guidance regarding which broader language group that specific language belongs to, in order to respond to the other questions in the Family Information section.
LEA staff should contact Stephanie Vogel (Stephanie.Vogel@vermont.gov) with questions or concerns about the process described above.

Student Information

First name:

Last Name:

Date of Birth:

Gender:

Male

Female

Country of Birth:

Select...

Date of Entry in U.S.

Date Student first began in any U.S. school:

Family Information

What language(s) are spoken in your home?

Select...

What language do you most often speak to your child?

Select...

What language does your child currently use most often at home?

Select...

What are the native languages of the parent/guardians?

Select...

Which language did your child learn first?

Select...

For Federal reporting reasons, certain languages have been omitted, or consolidated into smaller groupings. While not ideal in terms of accuracy of reporting, please try to match the language listed above to the best of your ability.

School Information

What school will the student attend?

Select...

Beginning date in this school

What grade will the student enter?

Select...

Was this student screened for English Language Proficiency and identified as an English Learner (EL)?

Yes

Name of Test Administrator

Date Student Screened

If not identified as an English Learner, does the student meet the ESSA Definition of "Immigrant Children and Youth"?

Yes