ChicagoPublic
Schools
HOME
LANGUAGE
SURVEY
HLS 1 of 2SpanishPolish
ChineseArabicBosnianCroatianSerbian
Urdu
HLS 2 of 2Romanian
YorubaAssyrianGujaratiTagalogKorean
Office ofLanguage
andCultural
Education
RevisedMay 2016
____________________________________________________ ____________________________________________________Signature of School Official Date Signature of Parent/Guardian Date
Notes:• If the parent/guardian does not speak English and the school does not have staff who speaks the parent/guardian’s
language, identify the language spoken by the parent/guardian through any assistance available in the school.• If exact name of the language cannot be determined, enter “Other” as a temporary entry. If you entered “Other,” the
exact language must be determined within two weeks after enrollment.• If the language spoken by the parent is not reflected in this HLS, please visit the OLCE Forms page on the Knowledge
Center at bit.ly/OLCEforms and click on Home Language Survey in Additional Languages.
Complete this Home Language Survey at the student’s initial enrollment in a Chicago Public School.This form must be kept in the student’s folder.
School: ________________________________ Room: _____ School ID #: __________ Network: __________________
Student Name: ________________________________________ Student ID #: ___________________________________
bit.ly/OLCEforms
ChicagoPublic
Schools
HOME
LANGUAGE
SURVEY
HLS 1 of 2SpanishPolish
ChineseArabicBosnianCroatianSerbian
Urdu
HLS 2 of 2Romanian
YorubaAssyrianGujaratiTagalogKorean
Office ofLanguage
andCultural
Education
RevisedMay 2016
____________________________________________________ ____________________________________________________ Signature of School Official Date Signature of Parent/Guardian Date
Notes:• If the parent/guardian does not speak English and the school does not have staff who speaks the parent/guardian’s
language, identify the language spoken by the parent/guardian through any assistance available in the school.• If exact name of the language cannot be determined, enter “Other” as a temporary entry. If you entered “Other,” the
exact language must be determined within two weeks after enrollment.• If the language spoken by the parent is not reflected in this HLS, please visit the OLCE Forms page on the Knowledge
Center at bit.ly/OLCEforms and click on Home Language Survey in Additional Languages.
Complete this Home Language Survey at the student’s initial enrollment in a Chicago Public School.This form must be kept in the student’s folder.
School: ________________________________ Room: _____ School ID #: __________ Network: __________________
Student Name: ________________________________________ Student IS #: ___________________________________
bit.ly/OLCEforms
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