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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