DEED Home Language Survey Student InformationStudent Name(Required) First Last Alaska Student # Sex(Required) Female Male Birth Month(Required)Please enter a number from 1 to 12.Birth Day(Required)Please enter a number from 1 to 31.Birth Year(Required)Please enter a number from 2000 to 2030.School(Required)Naknek ElementaryBristol Bay Middle/High SchoolBristol Bay Correspondence SchoolGrade(Required)PreschoolKindergarten1st2nd3rd4th5th6th7th8th9th10th11th12thPlace of Birth(Required) City State / Province / Region Participating in a student exchange program?(Required) Yes No Has the student received formal education outside of the US?(Required) Yes No What is the language most often spoken by this student? Preschool Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th If yes, what was the Language of Instruction? Section A: Language BackgroundWhat is the primary language used in the home (regardless of the language spoken by the student)?(Required) English Other What is the primary language used in the home (regardless of the language spoken by the student)?(Required) English Other What is the first language this student learned to speak?(Required) English Other Section B: Communication PreferencesIn which language do you prefer to receive school communication?(Required) English Other Parent/Guardian SignatureName(Required) First Last Phone(Required)Date(Required) MM slash DD slash YYYY Parent/Guardian Signature(Required)
