HOME LANGUAGE SURVEY · ANKETË MBI GJUHËN QË FLITET NË SHTËPI Emri i Nxënësit: _ Data e Lindjes: _Gjinia: Mashkull Femër

00NCLB-B1 (Rev. 04/13 - IA) © 2013 TransACT Communications, Inc.

OFFICE USE ONLY

Student ID # Date Distributed Date Received

HOME LANGUAGE SURVEY

Student Name: ____________________________________________ Birth Date: ___________________ Sex: Male Female

Parent/Guardian Name: ________________________________________________________________________________________

Address: ____________________________________________________________________________________________________

Home Telephone: __________________________________________ Work Telephone: ____________________________________

School: __________________________________________________ Grade: ______________________ Date: ________________

1. Was your child born in the United States? Yes No

If yes, in which state? ___________________________________

If no, in what other country? ___________________________________

2. Has your child attended any school in the United Statesfor any three years during their lifetime? Yes No

If yes, please provide school name(s), state, and dates attended:Name of School ____________________________________________ State ________ Dates Attended________________Name of School ____________________________________________ State ________ Dates Attended________________Name of School ____________________________________________ State ________ Dates Attended________________

3. What language is spoken by you and your family most of the time at home? ___________________________________

4. If available, in what language would you prefer to receivecommunication from the school? ___________________________________

. Is your child’s first-learned or home language anything other than English? Yes No

If you responded “Yes” to question number above, please answer the following questions:

. What language did your child learn when he/she first began to talk? ___________________________________

. What language does your child most frequently speak at home? ___________________________________

. What language do you most frequently speak to your child? (Father) ___________________________________

(Mother) ___________________________________

. Please describe the language understood by your child. (Check only one)A. Understands only the home language and no English.B. Understands mostly the home language and some English.C. Understands the home language and English equally.D. Understands mostly English and some of the home language.E. Understands only English.

______________________________________________ ___________________________________Parent or Guardian's Signature Date

SpanishHome Language Survey


OFFICE USE ONLY


ENCUESTA DE IDIOMA DOMESTICO

Nombre del alumno: ________________________________________ Fecha de nacimiento: ___________Sexo: Masculino Femenino

Nombre de los padres/apoderado: ________________________________________________________________________________

Dirección: ___________________________________________________________________________________________________

Teléfono de la casa: ________________________________________ Teléfono del trabajo:__________________________________

Escuela: _________________________________________________ Grado: ______________________ Fecha: _______________

1. ¿Nació su hijo/a en Estados Unidos? Sí No

De ser así, ¿en qué estado? _____________________________________

De no ser así, ¿en qué país? _____________________________________

2. ¿Ha asistido su hijo/a a alguna escuela de Estados Unidos durantetres años cualesquiera de su vida? Sí No

Si la respuesta es afirmativa, indique el nombre de la escuela (o escuelas),estado, y fechas de asistencia:

Nombre de la escuela ___________________________________________ Estado _______ Fechas de asistencia ____________



3. ¿Qué idioma habla usted y su familia con más frecuencia en el hogar? _____________________________________

4. Si hay a disposición, ¿en qué idioma le gustaríarecibir la comunicación de la escuela? _____________________________________

. ¿Es el idioma primario de su hijo(a) o el que sehabla en el hogar distinto al inglés? Sí No

Si su respuesta a la pregunta es “Sí”, responda las siguientes preguntas:

. ¿Qué idioma aprendió su hijo cuando recién comenzó a hablar? _____________________________________

. ¿Qué idioma habla en casa su hijo(a) con más frecuencia? _____________________________________

. ¿En qué idioma le habla con más frecuencia a su hijo(a)? (Padre) _____________________________________

(Madre) _____________________________________

. Describa el idioma que su hijo(a) entiende. (Marque sólo uno)A. Entiende solamente el idioma del hogar y no inglés.B. Entiende mayormente el idioma del hogar y algo de inglés.C. Entiende el idioma del hogar y el inglés por igual.D. Entiende inglés mayormente y algo del idioma del hogar.E. Entiende inglés solamente.

______________________________________________ ___________________________________Firma del padre o tutor Fecha

Por favor respondaen inglés

ANKETË MBI GJUHËN QË FLITET NË SHTËPI

Emri i Nxënësit: ______________________________________________ Data e Lindjes: _____________ Gjinia: Mashkull Femër

Emri i Prindit/Kujdestarit: _______________________________________________________________________________________

Adresa: ____________________________________________________________________________________________________

Numri i telefonit të shtëpisë: ____________________________________ Numri i telefonit të punës: __________________________

Shkolla: ____________________________________________________ Klasa: _____________________Data: _______________

1. A u lind fëmija juaj në Shtetet e Bashkuara? Po Jo

Nëse po, në cilin shtet? __________________________________

Nëse jo, në çfarë vendi tjetër u lind? __________________________________

2. A ka ndjekur fëmija juaj ndonjë shkollë në Shtet e Bashkuara për tre vjetgjatë jetës së tij/të saj? Po Jo

Nëse po, ju lutem jepni emrin e shkollës (ave), shtetin dhe datat e frekuentimit:

Emri i Shkollës ____________________________________________ Shteti _______ Datat e Frekuentimit ___________



3. Cila gjuhë flitet nga ju dhe familja juaj në pjesën më të madhe të kohës në shtëpi? __________________________________

4. Nëse është e mundur, në çfarë gjuhe do të preferonitqë të komunikohet me te në shkollë? __________________________________

. A është gjuha e parë e mësuar nga fëmija juaj osegjuha e folur në shtëpi e ndryshme nga Anglishtja? Po Jo

Nëse iu përgjigjët “Po” pyetjes numër më sipër, ju lutemi përgjigjuni pyetjeve të mëposhtme:

. Cilën gjuhë mësoi fëmija juaj kur ai/ajo filloi të flasë për herë të parë? __________________________________

. Cilën gjuhë flet më shpesh në shtëpi fëmija juaj? __________________________________

. Në çfarë gjuhe i flisni më shpesh fëmijës suaj? (Babai) __________________________________

(Nëna) ______________________________________

. Ju lutemi përshkruani gjuhën që kuptohet nga fëmija juaj. (Shënoni vetëm një)A. Kupton vetëm gjuhën që flitet në shtëpi e nuk kupton anglishten.B. Kupton kryesisht gjuhën që flitet në shtëpi dhe pak anglisht.C. I kupton të dyjat njësoj, si gjuhën që flitet në shtëpi ashtu edhe anglishten.D. Kupton kryesisht anglisht dhe pak gjuhën që flitet në shtëpi.E. Kupton vetëm anglisht.

__________________________________________________ ______________________________________Nënshkrimi i prindit ose kujdestarit Data

Ju lutemi përgjigjuninë gjuhën angleze

AlbanianHome Language Survey

© 20 TransACT Communications, Inc.

OFFICE USE ONLY


ما هي اللغة التي تستعمل عادة وإجماالما هي اللغة التي تستعمل عادة وإجماال

ما هي اللغة التي تستعمل عادة وإجماالما هي اللغة التي تستعمل عادة وإجماال

ما هي اللغة التي تستعمل عادة وإجماال

في المنزل في المنزل

في المنزل في المنزل

في المنزل

أنثى ذكر اجلنس: يخ امليالد:تارإسم الطالب / الطالبة:

لي األمر:إسم األم / األب / و

ان:العنو

هاتف العمل:هاتف املنزل:

يخ:التارالصف:سة:املدر

ال نـعــم يكية؟اليات المتحدة األمرلد طفلك في الوهل و1.

الية؟اب نعم، في أي وإذل كان الجو

لة؟اب كال، في أي دوإذا كان الجو

اليات المتحدة ألي مدة ثالثسة في الوهل التحق طفلك بأي مدر.2

ال نـعــم ات خالل حياته؟سنو

:يخ اإللتحاقتارالية والوس وجى ذكر أسماء المداراب نعم، يرإذا كان الجو

قاحتلإلا خيراتةيالولاةسردملا مسا



؟قت في املنزلتك معظم الوأسري لغة تتحدثها أنت و.3

سة؟اسالت من المدرل استالم المرإذا كان هناك إمكانية، في أية لغة تفض.4

هل كانت أول لغة تعلمها طفلك في البيت غير اللغة اإلنجليزية؟ نـعــم ال .

إذا أجبت بـ «نعم» على السؤال رقم إذا أجبت بـ «نعم» على السؤال رقم

إذا أجبت بـ «نعم» على السؤال رقم إذا أجبت بـ «نعم» على السؤال رقم

6إذا أجبت بـ «نعم» على السؤال رقم أعاله، يرجى اإلجابة على األسئلة التالية: أعاله، يرجى اإلجابة على األسئلة التالية:

أعاله، يرجى اإلجابة على األسئلة التالية: أعاله، يرجى اإلجابة على األسئلة التالية:

أعاله، يرجى اإلجابة على األسئلة التالية:

؟أي لغة تعلمها طفلك في البداية عندما بدأ يتكلم / تتكلم.7

ما هي اللغة التي يتكلمها طفلك أكثر في البيت؟.8

(األب)ما هي اللغة التي تستعملها أنت أكثر عندما تتحدث مع طفلك؟.9

(األم)

احدة فقط) (أشر على والتي يفهمها طفلك.جى وصف اللغة ير.10

A.ية.ال يفهم اللغة اإلنكليزيفهم فقط اللغة التي تستعمل في المنزل و

B.ية.بعض من اللغة اإلنكليزيفهم معظم اللغة التي تستعمل في المنزل و

C.اء.ية على السو اللغة اإلنكليزأيضايفهم اللغة التي تستعمل في المنزل و

D.بعض من اللغة التي تستعمل في المنزل.ية و اللغة اإلنكليزايفهم أكثر

E.ية.يفهم فقط اللغة اإلنكليز

_____________________________________ _____________________________________لي األمرقيع األهل أو وتو يخالتار


OFFICE USE ONLY


ArabicHome Language Survey

جاء اإلجابةالر

يةباللغة اإلنكليز

PODACI O JEZIKU KOJIM SE GOVORI KOD KU]E

Ime u~enika: ______________________________________________ Datum ro|enja: _______________ Pol: Muko @ensko

Ime roditelja/staratelja: ________________________________________________________________________________________

Adresa: ____________________________________________________________________________________________________

Kuni telefon: _____________________________________________ Telefon na poslu: ___________________________________

[kola: ___________________________________________________ Razred: _____________________ Datum: ______________

1. Da je li Vae dijete ro|eno u Sjedinjenim Ameri~kim Dràvama? Da Ne

Ukoliko jeste, u kojoj dràvi? __________________________________

Ukoliko nije, u kojoj drugoj zemlji je ro|eno? __________________________________

2. Da je li Vae dijete poha|alo ijednu koli u Sjedinjenim Ameri~kim Dràvama,

u ukupnom trajanju od tri (3) godine, u bilo koje doba svog ìvota? Da Ne

Ukoliko jeste, molimo da napiete ime kole(a), dràvu(e) i daatume kada je poha|alo:

Ime kole ________________________________________________ Dràva ______ Datumi poha|anja ____________



3. Koji jezik Vi i ~lanovi Vae porodice na~aee govorite kod kue? __________________________________

4. Ako je mogue, na kojem jeziku biste èljeli komunicirati sa koloskim osobljem? __________________________________

. Da li je jezik koji je Vae dijete prvo nau~ilo govoriti ili jezik kojim

se govori kod kue bilo koji jezik razli~it od engleskog jezika? Da Ne

Ukoliko ste odgovorili sa “Da” na pitanje broj gore, molimo Vas da odgovorite slijedea pitanja:

. Koji jezik je Vae dijete u~ilo kada je prvi put po~elo da pri~a? __________________________________

. Koji jezik Vae dijete naj~ee govori kod kue? __________________________________

. Kojim se jezikom Vi naj~ee obraate svojem djetetu? (Otac) __________________________________

(Majka) __________________________________

. Molimo da opiete jezik koji je razumljiv Vaem djetetu. (Ozna~ite samo jedno)

A. Razumije samo jezik kojim se sluì kod kue i nita Engleskog.

B. Razumije veinom jezik kojim se sluì kod kue i malo Engleskog.

C. Jednako razumije jezik kojim se sluì kod kue i Engleski.

D. Razumije veinom Engleski i malo jezika kojim se sluì kod kue.

E. Razumije samo Engleski.

__________________________________________________ ______________________________________Potpis roditelja ili staratelja Datum

BosnianHome Language Survey

Molimo odgovorite

na engleskom jeziku


OFFICE USE ONLY


CambodiankarsÊg'emIlPasaenAtampÊHkarsÊg'emIlPasaenAtampÊHkarsÊg'emIlPasaenAtampÊHkarsÊg'emIlPasaenAtampÊHkarsÊg'emIlPasaenAtampÊH

eQµaHsisß : ____________________________________________ Ex´z©qñaMkMeNIt :_________________ ePT : ®bus ®sI

®sI matabita¿/ñk/aNaB¥a◊l : _______________________________________________________________________________

/asydƒan : _________________________________________________________________________________________

elxTUrs‡BÊpÊH : ___________________________________________ elxTUrs‡BÊkEn¬geZ√Ikar : _______________________________

salaer\n : ____________________________________________ zñak : ______________________ kalbriecœT : ___________

1. etIkUnrbs'/ñkekItenAkñ¨gshrdƒ/aemrik… ? ◊T…ca± eT

®bsinebIEmn etIkñ¨grdƒNa ? _______________________________®bsinebIminEmn etIkñ¨g®beTsNa ? _______________________________

2. etIkUnrbs'/ñk◊ncUler\nkñ¨gsalaNamYykñ¨gshrdƒ/aemrik

◊nry:eBlbIqñaMkñ¨gGML¨gCIvitrbs'eK…eT ? ◊T…ca± eT

®bsinebIEmn sUmp ∂l'nUveQµaHsala rdƒ nig Ex ´z© qñaM Edl◊ncUler\n:

eQµaHsalaer\n rdƒ Ex ´z© qñaMcUl:



3. etIPasa/ √ IEdl/ñknig®KYsarrbs'/ñke®bIe®cInCageKenApÊH? _______________________________

4. ebI/aceZ √ IeTA◊n etIelak/ñkeBjcit†O¥salaer\ne®bIPasamYyNamkniyayCamYynigkUnelak/ñk? _______________________________

. etIkUnrbs'/ñker\nPasadMbUg …PasaniyaytampÊHNamYy e®kABIPasa/g'eK¬s? ◊T…ca± eT

®bsinebI/ñk◊neq¬Iyza®bsinebI/ñk◊neq¬Iyza®bsinebI/ñk◊neq¬Iyza®bsinebI/ñk◊neq¬Iyza®bsinebI/ñk◊neq¬Iyza “◊T◊T◊T◊T◊T/cas±cas±cas±cas±cas±” cMeBaHsMnYrelx cMeBaHsMnYrelx cMeBaHsMnYrelx cMeBaHsMnYrelx cMeBaHsMnYrelx 6 xagelI sUmeq¬IynwgsMnYrdUcxage®kamenH: xagelI sUmeq¬IynwgsMnYrdUcxage®kamenH: xagelI sUmeq¬IynwgsMnYrdUcxage®kamenH: xagelI sUmeq¬IynwgsMnYrdUcxage®kamenH: xagelI sUmeq¬IynwgsMnYrdUcxage®kamenH:

. etIPasa/ √ IEdkkUnrbs'/ñke®bIenAeBlEdleKcab'ep†ImniyaydMbUg? _______________________________

. etIPasa/ √ IEdlkUnrbs'/ñkniyayjwkjab'e®cInCageKenAtampÊH? _______________________________

. etIPasa/ √ IEdl/ñkniyayjwkjab'e®cInCageKCamYykUnrbs'/ñk? (øBuk) _______________________________

(m ∂ay) _______________________________. sUm/ZIb∫ayBIPasaEdlkUnrbs'/ñkyl's∂ab'◊n (KUsykEtmYyb"ueNâH)

A. yl'PasaniyayenApÊHEtb"ueNâH minecH/g'eK¬seT .

B. yl'PasaniyayenApÊHe®cIn yl'/g'eK¬sx¬H@ .

C. yl'PasaniyayenApÊHehIynigPasa/g'eK¬sesµIKña .

D. yl'Pasa/g'eK¬se®cIn yl'PasaniyayenApÊHx¬H@ .

E. yl'Pasa/g'eK¬sEtb"ueNâH .

_________________________________________ ___________________________________ht Ωelxarbs'matabita…/aNaB¥a◊l Ex´z©qñaM

Home Language SurveysUmeqI¬ytb

CaPasa/g'eK¬s

03NCLB-B1 (Rev. ) © 20 TransACT Communications, Inc.

OFFICE USE ONLY


ChineseHome Language Survey


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!<$` __________________________________________________ P __________ c!de() _________________

!<$` __________________________________________________ P __________ c!de() _________________

!<$` __________________________________________________ P __________ c!de() _________________

3. [email protected] ___________________________________

4. I!<rstuvwJ?xy!<z?|W~MopqH ___________________________________

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SONDAGE DE LANGUES PARLÉES À DOMICILE

Nom de l'élève: ______________________________________________ Date de naissance: __________ Sexe: Masculin Féminin

Nom du parent/tuteur: _________________________________________________________________________________________

Adresse: ___________________________________________________________________________________________________

Téléphone du domicile: ________________________________________ Téléphone professionnel: ___________________________

École: _____________________________________________________ Classe: ___________________ Date: ________________

1. Votre enfant est-il né aux États-Unis ? Oui Non

Si oui, dans quel État ? __________________________________

Si non, dans quel pays ? __________________________________

2. Votre enfant a-t-il fréquenté une école aux États-Unis pendanttrois ans de suite ? Oui Non

Si oui, donnez le nom de l’école, l’État où elle se situe et les dates de fréquentation :

Nom de l’école ____________________________________________ État ________ Dates de fréquentation _________



3. Quelle langue vous et votre famille parlez-vous chez vous la plupart du temps ? __________________________________

4. En quelle langue préféreriez-vous recevoir les communicationsde l’école si elles étaient disponibles en cette langue ? __________________________________

. La première langue de votre enfant ou la langue parlée

à la maison est-elle une autre langue que l’anglais ? Oui Non

Si vous avez répondu « Oui » à la question numéro ci-dessus, répondez aux questions suivantes :

. Quelle langue votre enfant a-t-il apprise lorsqu’il a commencé à parler ? __________________________________

. Quelle langue votre enfant parle-t-il le plus souvent à la maison ? __________________________________

. Quelle langue parlez-vous le plus souvent à votre enfant ? (Père) __________________________________

(Mère) __________________________________

. Veuillez décrire la langue comprise par votre enfant. (Cochez une seule réponse)A. Comprend seulement la langue parlée à domicile et pas d’anglais.B. Comprend surtout la langue parlée à domicile et un peu d’anglais.C. Comprend aussi bien l’anglais que la langue parlée à domicile.D. Comprend plus l’anglais et un peu la langue parlée à domicile.E. Comprend seulement l’anglais.

_____________________________________________ __________________________________Signature du parent ou du gardien Date

FrenchHome Language Survey

Veuillez rempliren anglais


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OFFICE USE ONLY



િવ ાથીરન નામ: __________________________________________ જ મ તારીખ: _________________ જાિત: પરષ ી

માતાિપતા/વાલીન નામ: ______________________________________________________________________________________ સરનામ : ___________________________________________________________________________________________________ ઘરનો ટલીફોન : ___________________________________________ કામના થળનો ટલીફોન :________________________________ િનશાળ:_________________________________________________ ગરડ:__________________________ તારીખ:______________

1. તમારા બાળકનો જ મ અમિરકામા થયો? હા ના જો હા, તો કયા રા યમા? __________________________________

જો ના, તો બીજા કયા દશમા ? __________________________________

2. તમારા બાળક એના જીવનમા કોઈપણ તરણ વષર અમિરકામા કોઈ િનશાળમા અ યાસ કય છ? હા ના જો હા, તો િનશાળન નામ(નામો), રા ય, અ યાસની તારીખો જણાવો:િનશાળન નામ______________________________________________ રા ય _______ અ યાસની તારીખો ______________િનશાળન નામ______________________________________________ રા ય _______ અ યાસની તારીખો ______________િનશાળન નામ______________________________________________ રા ય _______ અ યાસની તારીખો ______________

3. તમ અન તમા કટબ ઘરમા ઘણોખરો વખત કઈ ભાષા બોલો છો? __________________________________

4. મળી શક તો, તમ િનશાળના પતરો કઈ ભાષામા મળવવાન પસદ કરશો? __________________________________

5. તમારા બાળકની પરથમ શીખલી અથવા ઘરની ભાષા અગરજી િસવાય કોઈ બીજી છ? હા ના

ઉપર પર 5નો જવાબ “હા” હોય તો, નીચના પર ોના જવાબ આપશો: 6. તમા બાળક (ત/તણી) બોલવા લાગય યાર કઈ ભાષા શીખય ? __________________________________

7. તમા બાળક ઘરમા મોટા ભાગ કઈ ભાષા બોલ છ? __________________________________

8. તમ તમારા બાળક સાથ મોટા ભાગ કઈ ભાષામા વાત કરો છો? (િપતા) __________________________________

(માતા) __________________________________

9. તમા બાળક સમજત હોય તવી ભાષા દશારવો. (માતર એક િનશાની કરો)A. માતર ઘરની ભાષા સમ છ, અગરજી નિહ. B. મોટા ભાગ ઘરની અન થોડીઘણી અગરજી સમ છ. C. ઘરની ભાષા અન અગરજી એકસરખી રીત સમ છ. D. મોટા ભાગ અગરજી અન થોડીઘણી ઘરની ભાષા સમ છ. E. માતર અગરજી સમ છ.

______________________________________________ ___________________________________માતાિપતા અથવા વાલીની સહી તારીખ

ઘરની ભાષાની મોજણી Gujarati

Home Language Survey

જવાબો અગરજીમા લખવા િવનતી છ

SONDAJ LANG LAKAY

Non Elev: _________________________________________________ Dat: ________________________ Seks: Gasòn Fi

Paron/Gadyen Non:___________________________________________________________________________________________

Adres: _____________________________________________________________________________________________________

Telefòn Lakay: _____________________________________________ Telefòn Travay: _____________________________________

Lekòl:____________________________________________________ Klas: ________________________ Dat: ________________

1. Eska ti moun w fèt Etazini? Wi No

Si ou reponde wi, nan ki eta? __________________________________

Si non, nan ki lòt pe? __________________________________

2. Eska ti moun w alle nenpot lekol Etazini pou twaz ane pandan lavi li? Wi No

Si wi, tanpri ekri nom pou lekol, eta, ak dat yo li alle:

Nom lekol la ______________________________________________ Eta _________ Dat yo li alle _________________



3. Kisa lang ou pale a lakay w? __________________________________

4. Si li disponib, nan ki lang ou ta prefereresevwa kominikasyon ki soti nan lekòl la? __________________________________

. Èske premye lang pitit ou a, oswa lang manman l se yon lòt lang pase angle? Wi No

Si w reponn « Wi » pou kesyon nimewo pi wo la a, tanpri reponn kesyon ki pi ba la yo:

. Kisa lang ti moun te apran ki le li apran premye li komanse pale? __________________________________

. Ki lang pitit ou a pale pi plis lakay li? __________________________________

. Ki lang ou pale pi plis ak pitit ou a? (Papa) __________________________________

(Manman) __________________________________

. Tanpri, di ki lang pitit ou a konprann. (Make youn sèlman.)A. Konprann sèlman lang ki pale nan kay la, pa anglè.B. Konprann plis lang ki pale nan kay la ak yon ti anglè.C. Konpran lang ki pale nan kay la menm jan ak anglè.D. Konprann plis anglè e yon ti kras lang ki pale nan kay la.E. Konprann anglè sèlman.

___________________________________________________ ___________________________________Siyati Paran oubyen Moun ki reskonsab Dat

Haitian CreoleHome Language Survey

Tanpri reponnnan angle


OFFICE USE ONLY



OFFICE USE ONLY


HmongHome Language Survey

Thov Pab teb ualus Askiv SOJ NTSUAM TXOG COV LUS HAIS HAUV TSEV

Menyuam Npe: ____________________________________________ Hnub Yug: ___________________ Yog: Txiv neej Poj niam

Niam txiv/Tus saib xyuas Npe: __________________________________________________________________________________

Chaw nyob: _________________________________________________________________________________________________

Xov tooj hauv Tsev: _________________________________________ Xov tooj tim Haujlwm: ________________________________

Tsev kawm ntawv: __________________________________________ Qib: ________________________ Hnub: _______________

1. Koj tus menyuam puas yog yug tim Teb Chaws Mis Kas no? Yog Tsis Yog

Yog tias yog, yug rau lub xeev twg? _____________________________________

Yog tias tsis yog, yug rau lub teb chaws twg? _____________________________________

2. Koj tus menyuam puas tau mus kawm lwm lub tsev kawm ntawvhauv Teb Chaws Mis Kas no tau li peb xyoo hauv nws lub neej? Yog Tsis Yog

Yog tau, thov sau lub (cov) tsev kawm ntawv npe, xeev, thiab lub sij hawm uas mus kawm:

Tsev Kawm Ntawv Npe _________________________________________ Xeev _________ Lub Sij Hawm Kawm _____________



3. Yam lus twg yog yam koj thiab koj tsev neeg hais ntau tshaj tom tsev? _____________________________________

4. Yog muaj, koj xav kom tsev kawmntawv sau ntawv uayam lus twg tuaj rau koj? _____________________________________

. Koj tus menyuam puas tau xub kawm lossis hais tom tsev ib yamlus uas tsis yog lus Askiv? Yog Tsis Yog

Yog tias koj teb “Yog” rau sob lus nug sauv, thov teb cov lus nug hauv qab no:

. Yam lus twg yog yam uas koj tus menyuam kawm thaum uas nws pib txawj hais lus? _____________________________________

. Thaum nyob tsev, koj tus menyuam hais yam lus dabtsi? _____________________________________

. Koj pheej hais yam lus dabtsi rau koj tus menyuam? (Txiv) _____________________________________

(Niam) _____________________________________

. Thov piav yam lus uas koj tus menyuam totaub. (Kos ib qhov xwb)A. Totaub lus Hmoob xwb, tsis totaub lus Askiv li.B. Totaub lus Hmoob thiab me ntsis lus Askiv.C. Totaub lus Hmoob thiab lus Askiv sib npaug.D. Totaub lus Askiv thiab me ntsis lus Hmoob.E. Totaub lus Askiv xwb.

________________________________________________ _____________________________________Niamtxiv/Tus Saibxyuas Kos Npe Hnub

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@A% ❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵

@'%❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵ )B% ❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵

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SQQRTUVWFXH$Z[\]^_`QP

__________________________________

SQQRTUVWXDaUGHbU]H)

__________________________________

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@A$

__________________________________________________

Y ❵❵❵❵❵❵❵❵❵❵❵ l@tuxvw) ❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵

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Y ❵❵❵❵❵❵❵❵❵❵❵ l@tuxvw) ❵❵❵❵❵❵❵❵❵❵❵❵❵❵❵__________________________________________________

oyNXCrsoyNUznz|J~FJqOP3. ______________________________________

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CDEnj@_XMNF[z|JlifQFXUJqO

. FQ QQR

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______________________________________

JapaneseHome Language Survey

J¡Rf^_`Q

OFFICE USE ONLY

Student ID # Date Distributed


Date Received

KoreanHome Language Survey


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!"# $% : _____________________________________________ "&'( : ___________________ )* : + ,

!-. //01 $% : __________________________________________________________________________________________

23 : ______________________________________________________________________________________________________

14 5670 : ____________________________________________ 89 5670 : _____________________________________

!: : ___________________________________________________ !& : _______________________ ;< :________________

1. 1= ?@AB C"DEFGH ? I JGK

‘I ’( LM NO 2 (! )AB PNQFGH ? ___________________________________

'JGR '( LM 1= PNS @T UVDWXK . ___________________________________

2. 1= ?@AB !:T YZ U$ .\ ]^ 3&$ _GH ? I JGK ‘I '( LM !:` , 2 a YZ ;<T JbA UVDWXK .

!:` ____________________________________________________ 2 (! ) _____ c:d ;< ___________________!:` ____________________________________________________ 2 (! ) _____ c:d ;< ___________________!:` ____________________________________________________ 2 (! ) _____ c:d ;< ___________________

3. eAB !-.fg h$ 2i jkDl mNT UVDWXK ? ___________________________________

4. !: nopq Nr mNi sUT t uDWGH (vw LM )? ___________________________________

5. 1= xyi Fzd mN l e |AB jkD ~l mNN JZ Y mNGH ? I JGK

!" 6# $%& “' ” () *+,-. /0 $%& *123" 456/ :

6. 1= DU XDEq jkd mNT UVDWXK ? ___________________________________

7. 1= DU XDEq Nr mNT FzDEFGH 3? ___________________________________

8. 1= eAB 2i Nr mNT jk]GH ? (J ) ___________________________________

(NG ) ___________________________________9. 1= $^Dl mNT UDWXK . (D X )

A.

AB jkDl mN $^D Nl $^D .B.

AB jkDl mNT - $^D NT $^ .

C.

AB jkDl mN NT $ $^ .D.

NT 2i $^D AB jkDl mNT $^ .E.

N $^ .

______________________________________________ __________________________________

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=njoadiPoG _____________________________________________ ;aogfnvoxugdufG ________________________ grfG =kp py'

=njr|c,j/z6hxqd8v'G________________________________________________________________________________________________

muj26jG ________________________________________________________________________________________________________

g[u4mItla[[hkoG ________________________________________________ g[u4mItla[[jvogIaf;PdG _______________________________

4I’IPoG _____________________________________________________ =AoIPoG_____________________ ;aomuG _________________

1. lUkKwgtÆanekIdyU ÆSAHAlzdEmÆnbB? c,jo bBEmÆn

T™aEmÆn, lavekIdyU ÆlzdVd? __________________________________T™abBEmÆn, lavekIdyU ÆpAetdVd? __________________________________

2. lUkKwgtÆanRd™eKXaohghWnVdVnyUÆSAHAlzdepznevla Sam pIVnsIvidKwgeKqaecXa HlJ bB? c,jo bBEmÆn

T™aeKXa, cGgewqasJ ÆKwgohghWn, lzd ElA vzntItI ÆeKXaohghWn:

sJ ÆohghWn ___________________________________________________ †>ó¢ºî _________ vzntItIÆeKXaohghWn __________________sJ ÆohghWn ___________________________________________________ †>ó¢ºî _________ vzntItIÆeKXaohghWn __________________sJ ÆohghWn ___________________________________________________ †>ó¢ºî _________ vzntItIÆeKXaohghWn __________________

3. lj;os]kpg;]k27j[hko mjko c]t 8v[8q;-v'mjkog;Qkrklkspa'L __________________________________

4. ´æÄ–©æ†æí–ïø–‘í„, ï‡æó–––°æÄ–‘í„–∑ ºô–Å‡æ¶–©æó–ÖæÄ–“∑Ñ–∑Ùó ï¡·–ÅÙó–Œöºó–ùæ©æ–”í–ô„æÑ? __________________________________

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. ;]k]7dg0Qkg]uj,safxkd ]7dg0QkIPorklkspa'L __________________________________

. ]6d0v’mjkoIPo.-hrklk.fs]kpmjul5f.og;]k1j6gInvoL __________________________________

. mjko,ad.-hrklkspa’s]kpmjul5f.og;]kg;Qkda[]6d0v’mjkoIPoL (ô¿íæ) __________________________________

(†æóíæ) __________________________________. 9qj’vtmy[kprklksju]6d0v’mjkog0Qk.9fu X.sh\kp.ljc8jrklkfP;gmqjkoAo?

A. ŒÅ‰÷–”Ö–©ªŒùæª–œì‡–ùæ©æ–ï¡·–”á„–Äºó–ùæã–”ó–Ç≠ô–ÇÃ œ§ª–ûºÑ–ùæ©æ–≠ ºÑÄ¿í–ôŸ·–ŒÅ‰÷–”Ö–Œ§¡ã.

B. ŒÅ‰÷–”Ö–ùæ©æ–ï¡·–”á„–Äºó–ùæã–”ó–Ç≠ô–ÇÃ‘í„–´§æã–ï¡·–©»í œ§ª–ûºÑ–ùæ©æ–≠ ºÑÄ¿í–ŒÅ‰÷–”Ö–ô„æÑ.

C. ûºÑ–ùæ©æ–ï¡·–”á„–Äºó–ùæã–”ó–Ç≠ô–ÇÃ–œ§ªùæ©æ–≠ ºÑÄ¿í–ŒÅ‰÷–”Ö–í¡–Œï·÷ & Äºó–ïºÑ–©≠Ñ–ùæ©æ.

D. ŒÅ‰÷–”Ö–ùæ©æ–≠ ºÑÄ¿í‘í„–´§æã–ï¡·–©»í œ§ª–ûºÑ–ùæ©æ–ï¡·–”á„–Äºó–ùæã–”ó–Ç≠ô–ÇÃ–ŒÅ‰÷–”Ö–ô„æÑ.

E. ûºÑ–ùæ©æ–≠ ºÑÄ¿í–ŒÅ‰÷–”Ö–ùÙÑ–ùæ©æ–íÙ¶–Œï·÷–óº‰ó.

_________________________________________ ___________________________________§æã–Œáºó–Å≠Ñ–ùŸ·, œ†‡ ´¢ ≈ –õ„…–ö>Ä–Ç≠Ñ– ¶ºó–ï¡



OFFICE USE ONLY


Äª¢»óæ–ÅÙó–Çø–ì≠ô

–Œöºóùæ©æ≠ ºÑÄ¿í

PESQUISA SOBRE O IDIOMA FAMILIAR

Nome do estudante: ______________________________________________ Data de nascimento: _________ Sexo: Masculino Feminino

Nome do pai/mãe/responsável: ________________________________________________________________________________________

Endereço: ________________________________________________________________________________________________________

Telefone residencial: ______________________________________________ Telefone comercial: __________________________________

Escola: ________________________________________________________ Série: ______________________ Data: _________________

1. O seu filho nasceu nos Estados Unidos? Sim NãoSe sim, em que estado? __________________________________Se não, em que país nasceu? __________________________________

2. O seu filho já freqüentou alguma escola nos Estados Unidospor um total de três anos da vida dele? Sim NãoSe sim, forneça o nome das escolas, o estado e as datas em que freqüentou:Nome da escola ___________________________________________ Estado ______ Datas em que freqüentou_______Nome da escola ___________________________________________ Estado ______ Datas em que freqüentou_______Nome da escola ___________________________________________ Estado ______ Datas em que freqüentou_______

3. Qual é o idioma falado por você e sua família a maior parte do tempo em casa? __________________________________

4. Se houve disponibilidade, em que idioma você preferereceber as comunicações da escola? __________________________________

. O primeiro idioma que seu filho(a) aprendeu ou o idiomausado em casa é outro além do inglês? Sim Não

Se respondeu “Sim” à questão número acima, responda às seguintes questões:

. Qual foi o idioma que o seu filho(a) aprendeu quando começou a falar? __________________________________

. Qual é o idioma que seu filho(a) usa mais freqüentemente em casa? __________________________________

. Qual é o idioma com o qual se comunica maisfreqüentemente com o seu filho(a)? (Pai) __________________________________

(Mãe) __________________________________

. Indique qual é o idioma que o seu filho(a) compreende. (Marque somente um)A. Compreende somente o idioma familiar e não o inglês.B. Compreende bem o idioma familiar e um pouco de inglês.C. Compreende igualmente o idioma familiar e o inglês.D. Compreende bem o inglês e um pouco do idioma familiar.E. Compreende somente o inglês.

__________________________________________________ ______________________________________Assinatura do pai responsável ou do tutor Data

Responda eminglês

PortugueseHome Language Survey


OFFICE USE ONLY


PunjabiGr dI BwSw dI pVqwlGr dI BwSw dI pVqwlGr dI BwSw dI pVqwlGr dI BwSw dI pVqwlGr dI BwSw dI pVqwl

«Ú«Á¡≈Ê∆ Á≈ Èª¡ : _________________________________________ ‹ÈÓ Â≈∆ı : ___________________ «¶◊ : ÍπÙ «¬√Â∆

Ó≈Â≈-«ÍÂ≈/√Íº√Â Á≈ Èª¡ : _____________________________________________________________________________________

ÍÂ≈ : ______________________________________________________________________________________________________

ÿ Á≈ ‡ÀÒ∆¯ØÈ : _____________________________________________ ’øÓ Á∆ Êª Á≈ ‡ÀÒ∆¯ØÈ : _________________________________

√’±Ò : ____________________________________________________ ◊∂‚ : _______________________ Â≈∆ı : _______________

1. ’∆ Â ∞‘≈‚ ∂ Ïº⁄ ∂ Á≈ ‹ÈÓ ¡Ó∆’≈ «Ú⁄ ‘Ø«¬¡≈ √∆? hW nhIN‹ ∂ ‘ª, Âª «’√ √‡ ∂‡ «Ú⁄? __________________________________‹ ∂ È‘ƒ, Âª ‘Ø «’√ Á ∂Ù «Ú⁄? __________________________________

2. ’∆ Â ∞‘≈‚≈ Ïº⁄≈ ¡≈Í‰ ∂ ‹∆ÚÈ’≈Ò «Ú⁄ ’Ø¬∆ Ú∆ «ÂøÈ √≈Ò ¡Ó∆’≈ Á ∂ «’√∂ √’±Ò

«Ú⁄ Í«Û ∑¡≈ ‘À? hW nhIN‹ ∂ ‘ª, Âª «’Í≈ ’’ ∂ √’±Ò Á≈ Èª¡ (√’±Òª Á ∂ Èª¡) √‡ ∂‡ ¡Â ∂ √’±Ò «Ú⁄ ÍÛ ∑È Á∆¡ª Â≈∆ıª Á√ Ø:

√’±Ò Á≈ Èª¡ √‡ ∂‡ ÍÛ ∑È Á∆¡ª Â≈∆ıª √’±Ò Á≈ Èª¡ √‡ ∂‡ ÍÛ ∑È Á∆¡ª Â≈∆ıª √’±Ò Á≈ Èª¡ √‡ ∂‡ ÍÛ ∑È Á∆¡ª Â≈∆ıª

3. ÿ «Úº⁄ Ï‘ πÂ≈ √Óª Â ∞√ƒ ¡Â ∂ Â ∞‘≈‚≈ Í«Ú≈ «’‘Û∆ Ì≈Ù≈ ÏØÒÁ ∂ ‘Ø? __________________________________

4. jy iml skdI hovy qW qusIN skUl qoN ikhVI BwSw ivc sUcnw pRwpq krnI cwhogy? __________________________________

. ‹∂’ Â∞‘≈‚∂ Ïº⁄∂ È∂ «¬≥◊«ÒÙ ÂØ∫ ¡Ò≈Ú≈ Í«‘Ò∂ ’Ø¬∆ ÿ¨ Ì≈Ù≈ ‹≈ ’∞¤ ‘Ø «√º«÷¡≈? hW nhIN

‹∂ ¿µÍ «ÁºÂ∂ ◊¬∂ √Ú≈Ò ÈßÏ F Ò¬∆ Âπ‘≈‚≈ ‹fl≈Ê T‘ªU «fl⁄ ‘À, Âª «’Í≈ ’’∂ ‘∂· «Ò÷∂ √Ú≈Òª Á∂ ‹Ú≈Ï «Á¿π :‹∂ ¿µÍ «ÁºÂ∂ ◊¬∂ √Ú≈Ò ÈßÏ F Ò¬∆ Âπ‘≈‚≈ ‹fl≈Ê T‘ªU «fl⁄ ‘À, Âª «’Í≈ ’’∂ ‘∂· «Ò÷∂ √Ú≈Òª Á∂ ‹Ú≈Ï «Á¿π :‹∂ ¿µÍ «ÁºÂ∂ ◊¬∂ √Ú≈Ò ÈßÏ F Ò¬∆ Âπ‘≈‚≈ ‹fl≈Ê T‘ªU «fl⁄ ‘À, Âª «’Í≈ ’’∂ ‘∂· «Ò÷∂ √Ú≈Òª Á∂ ‹Ú≈Ï «Á¿π :‹∂ ¿µÍ «ÁºÂ∂ ◊¬∂ √Ú≈Ò ÈßÏ F Ò¬∆ Âπ‘≈‚≈ ‹fl≈Ê T‘ªU «fl⁄ ‘À, Âª «’Í≈ ’’∂ ‘∂· «Ò÷∂ √Ú≈Òª Á∂ ‹Ú≈Ï «Á¿π :‹∂ ¿µÍ «ÁºÂ∂ ◊¬∂ √Ú≈Ò ÈßÏ F Ò¬∆ Âπ‘≈‚≈ ‹fl≈Ê T‘ªU «fl⁄ ‘À, Âª «’Í≈ ’’∂ ‘∂· «Ò÷∂ √Ú≈Òª Á∂ ‹Ú≈Ï «Á¿π :

. ‹ÁØ∫ Â ∞‘≈‚ ∂ Ïº⁄ ∂ È ∂ Í«‘Ò∆ Ú≈ ◊ ºÒÏ≈Â ’È∆ Ù π » ’∆Â∆ Âª ¿ ∞√È ∂ «’‘Û∆ Ì≈Ù≈ «√ º÷∆ √∆? __________________________________

. Â ∞‘≈‚≈ Ïº⁄≈ ÿ «Ú⁄ «’‘Û∆ Ì≈Ù≈ Ë≈≈-ÍÃÚ≈‘ ÏØÒÁ≈ ‘À? __________________________________

. Â∞√ƒ ¡Í‰∂ Ïº⁄∂ È≈Ò «’‘Û∆ Ì≈Ù≈ «Ú⁄ ¡≈ÓÂΩ Â∂ ◊ºÒÏ≈Â ’Á∂ ‘Ø? (ipqw) __________________________________

(mwqw) __________________________________

. «‹‘Û∆ Ì≈Ù≈ Â∞‘≈‚≈ Ïº⁄≈ √ÓfiÁ≈ ‘À, «’Í≈ ’’∂ ¿∞‘ Ì≈Ù≈ ‘∆ «Ò÷ØÕ («√Î «¬’ ‘∆ «Ò÷Ø)

A. kyvl pMjwbI smJdw hY, AMgryjI nhIN[B. ijAwdw qr pMjwbI smJdw hY Aqy QoVI QoVI AMgryjI[C. pMjwbI Aqy AMgryjI ie`ko ijhI smJdw hY[D. ijAwdw qr AMgryjI smJdw hY Aqy QoVI ijhI pMjwbI[E. kyvl AMgryjI smJdw hY[

__________________________________________________ ______________________________________mwqw-ipqw jW r`Kvwly dy dsq^q qrIk


ikRpw krky AMgRyjIivc jvwb idau


OFFICE USE ONLY


RussianHome Language Survey


OFFICE USE ONLY


éèêéë «üáõä éÅôÖçàü Ç ëÖåúÖ»

àÏfl Û˜‡˘Â„ÓÒfl: ___________________________________________ Ñ‡Ú‡ ÓÊ‰ÂÌËfl:_______________ èÓÎ: ÏÛÊÒÍÓÈ ÊÂÌÒÍËÈ

àÏfl Ó‰ËÚÂÎfl/ÓÔÂÍÛÌ‡: _______________________________________________________________________________________

Ä‰ÂÒ: _____________________________________________________________________________________________________

ÑÓÏ‡¯ÌËÈ ÚÂÎÂÙÓÌ:________________________________________ ê‡·Ó˜ËÈ ÚÂÎÂÙÓÌ: __________________________________

òÍÓÎ‡: ___________________________________________________ äÎ‡ÒÒ: ______________________ Ñ‡Ú‡: ________________

1. Ç‡¯ Â·ÂÌÓÍ Ó‰ËÎÒfl ‚ ëòÄ? Ñ‡ çÂÚ

ÖÒÎË ‰‡, ÚÓ ‚ Í‡ÍÓÏ ¯Ú‡ÚÂ? ________________________________________

ÖÒÎË ÌÂÚ, ÚÓ ‚ Í‡ÍÓÈ ÒÚ‡ÌÂ? ________________________________________

2. á‡ ‚ÒÂ „Ó‰˚ Ò‚ÓÂÈ ÊËÁÌË ÔÓÒÂ˘‡Î ÎË ‚‡¯ Â·ÂÌÓÍ Í‡ÍÛ˛-ÌË·Û‰¸¯ÍÓÎÛ ‚ ëòÄ Ì‡ ÔÓÚflÊÂÌËË 3-ı ÎÂÚ ? Ñ‡ çÂÚ

ÖÒÎË ‰‡, ÔÓÊ‡ÎÛÈÒÚ‡, ÛÍ‡ÊËÚÂ Ì‡Á‚‡ÌËÂ ¯ÍÓÎ˚ (¯ÍÓÎ), ¯Ú‡Ú Ë ‚ÂÏfl ÔÓÒÂ˘ÂÌËfl ¯ÍÓÎ (˚):

ç‡Á‚‡ÌËÂ ¯ÍÓÎ˚________________________________________________ òÚ‡Ú _________ Ñ‡Ú˚ ÔÓÒÂ˘ÂÌËfl ________________



3. ç‡ Í‡ÍÓÏ flÁ˚ÍÂ ˜‡˘Â ‚ÒÂ„Ó ‚˚ Ë ‚‡¯‡ ÒÂÏ¸fl ‡Á„Ó‚‡Ë‚‡ÂÚÂ ‰ÓÏ‡? ________________________________________

4. ç‡ Í‡ÍÓÏ flÁ˚ÍÂ ‚˚ ıÓÚÂÎË ·˚ ÔÓÎÛ˜‡Ú¸ ÍÓÂÒÔÓÌ‰ÂÌˆË˛ËÁ ¯ÍÓÎ˚ (ÂÒÎË ¯ÍÓÎ‡ ÒÛÏÂÂÚ Û‰Ó‚ÎÂÚ‚ÓËÚ¸ ˝ÚÓ ÔÓÒ¸·Û)? ________________________________________

. üÁ˚Í, Ì‡ ÍÓÚÓÓÏ ‚‡¯ Â·ÂÌÓÍ ‚ÔÂ‚˚Â Á‡„Ó‚ÓËÎ ËÎË‚ÔÂ‚˚Â ÛÒÎ˚¯‡Î ‰ÓÏ‡, ·˚Î ÌÂ ‡Ì„ÎËÈÒÍËÈ flÁ˚Í, ˝ÚÓ Ú‡Í? Ñ‡ çÂÚ

ÖÒÎË ‚˚ ÓÚ‚ÂÚËÎË “‰‡” Ì‡ ‚ÓÔÓÒ ÌÓÏÂ ‚˚¯Â, ÔÓÊ‡ÎÛÈÒÚ‡, ÓÚ‚ÂÚ¸ÚÂ Ì‡ ÒÎÂ‰Û˛˘ËÂ ‚ÓÔÓÒ˚:

. ç‡ Í‡ÍÓÏ flÁ˚ÍÂ ‚‡¯ Â·ÂÌÓÍ Ì‡˜‡Î „Ó‚ÓËÚ¸? ________________________________________

. ç‡ Í‡ÍÓÏ flÁ˚ÍÂ ˜‡˘Â ‚ÒÂ„Ó ‚‡¯ Â·ÂÌÓÍ ‡Á „Ó‚‡Ë‚‡ÂÚ ‰ÓÏ‡? ________________________________________

. ç‡ Í‡ÍÓÏ flÁ˚ÍÂ ‚˚ ˜‡˘Â ‚ÒÂ„Ó ‡Á„Ó‚‡Ë‚‡ÂÚÂ ÒÓ Ò‚ÓËÏ Â·ÂÌÍÓÏ? (ÓÚÂˆ) ________________________________________

(Ï‡Ú¸) ________________________________________

. èÓÊ‡ÎÛÈÒÚ‡, Ì‡ÁÓ‚ËÚÂ flÁ˚Í, ÍÓÚÓ˚È ÔÓÌËÏ‡ÂÚ ‚‡¯ Â·ÂÌÓÍ. (ÓÚÏÂÚ ÚÂ ÚÓÎ¸ÍÓ Ó‰ËÌ)A. èÓÌËÏ‡ÂÚ ÚÓÎ¸ÍÓ flÁ˚Í, Ì‡ ÍÓÚÓÓÏ „Ó‚ÓflÚ ‰ÓÏ‡, ÌÂ ÔÓÌËÏ‡ÂÚ ÔÓ-‡Ì„ÎËÈÒÍË.B. Ç ÓÒÌÓ‚ÌÓÏ ÔÓÌËÏ‡ÂÚ flÁ˚Í, Ì‡ ÍÓÚÓÓÏ „Ó‚ÓflÚ ‰ÓÏ‡, ÌÂÏÌÓ„Ó ÔÓÌËÏ‡ÂÚ ÔÓ-‡Ì„ÎËÈÒÍË.C. é‰ËÌ‡ÍÓ‚Ó ÔÓÌËÏ‡ÂÚ flÁ˚Í, Ì‡ ÍÓÚÓÓÏ „Ó‚ÓflÚ ‰ÓÏ‡, Ë ‡Ì„ÎËÈÒÍËÈ flÁ˚Í.D. Ç ÓÒÌÓ‚ÌÓÏ ÔÓÌËÏ‡ÂÚ ‡Ì„ÎËÈÒÍËÈ flÁ˚Í, ÌÂÏÌÓ„Ó ÔÓÌËÏ‡ÂÚ flÁ˚Í, Ì‡ ÍÓÚÓÓÏ „Ó‚ÓflÚ ‰ÓÏ‡.E. èÓÌËÏ‡ÂÚ ÚÓÎ¸ÍÓ ‡Ì„ÎËÈÒÍËÈ flÁ˚Í.

___________________________________________________ _______________________________________èÓ‰ÔËÒ¸ Ó‰ËÚÂÎfl ËÎË ÓÔÂÍÛÌ‡ Ñ‡Ú‡

èÓÊ‡ÎÛÈÒÚ‡, ÓÚ‚ÂÚ¸ÚÂ Ì‡ ‡Ì„ÎËÈÒÍÓÏ flÁ˚ÍÂ

TIROKOOBKA LUQADA GURIGA

Magaca Ardayga: ____________________________________ Taariikhda Dhalashada: __________ Qof ahaanta: Lab Dheddig

Magaca Waalidka/Wakiilka: _____________________________________________________________________________________

Cinwaanka: _________________________________________________________________________________________________

Taleefanka Guriga: ___________________________________________ Taleefanka Shaqada: ______________________________

Dugsiga: ___________________________________________________ Fasalka: ___________________ Taariikhda: ___________

1. Canugaagu Mareykanka miyuu kudhashay? Haa MayaHaddii jawaabtu haa tahay, gobolkee ayuu kudhashay? __________________________________Haddii jawaabtu maya tahay, waddankee kale ayuu kudhashay? __________________________________

2. Canugaagu marna madhigtay wax iskuul ah oo kuyaalla Mareykankasaddex sanadood muddo gaareysa intay noolaayeen noloshooda? Haa MayaHaddii jawaabtu haa tahay, fadlan sheeg magacyada iskuulka, gobolka, iyo taariikhaha uu dhigtay:Magaca Iskuulka __________________________________________ Gobolka ______ Taariikhaha uu Dhigtay _________Magaca Iskuulka __________________________________________ Gobolka ______ Taariikhaha uu Dhigtay _________Magaca Iskuulka __________________________________________ Gobolka ______ Taariikhaha uu Dhigtay _________

3. Luqaddee ayaad ku hadashaan adiga iyo qoyskaagu waqtiga intiisa badanguriga markii la joogo? __________________________________

4. Haday suuragal tahay, afkeed jeclaan lahayd in lagugula soo xidhiidho? __________________________________

. Luqaddii ugu horreysay ee canuggaagu barto amaluqadda guri ma wax kaduwan Ingiriisi baa? Haa Maya

Haddii jawaabtaada su’aasha aad ee kor ku xusan ay tahay “haa”, fadlan ka jawaab su’aalaha soo socda:

. Luqaddee ayaa canuggaagu bartay markii isaga/iaydu bilowday inuu hadlo? __________________________________

. Waa maxay luqadda uu canuggaagu inta badan kuhadlo guriga? __________________________________

. Waa maxay luqadda aad inta badan kula hadashaa canuggaaga? (Aabaha) __________________________________

(Hooyada) __________________________________

. Fadlan qeex luqadda uu fahmo canuggaagu. (Hubi hal kaliya uun)A. Afka hooyo mooyee ma yaqaan af ingiriisi.B. Afka hooyo aad ayuu u yaqaanaa ingiriisigana wax yar.C. Afka hooyo iyo ingiriisidaba si isleeg buu u yaqaana.D. Af ingiriisiga ayuu aad uga yaqaan afka hooyo.E. Af ingiriisi ayuunbuu yaqaana.

_____________________________________________ __________________________________Waalidka ama Saxeexa Masuulka Taariikhda

SomaliHome Language Survey

Ku soo JawaabAf-Inginiisi

OFFICE USE ONLY



PAGSUSURI NG WIKA SA BAHAY

Pangalan ng Petsa ng

Estudyante: _______________________________________________ Kapanganakan: ______________ Kasarian: Lalaki Babae

Pangalan ng Magulang/Tagapangalaga: ___________________________________________________________________________

Address: ___________________________________________________________________________________________________

Telepono sa Bahay: _________________________________________ Telepono sa Trabaho: ________________________________

Paaralan: _________________________________________________ Grado: _____________________ Petsa: ________________

1. Ang iyo bang anak ay ipinanganak sa Estados Unidos? Oo Hindi

Kung oo, sa aling estado? _____________________________________

Kung hindi, saang bansa siya ipinanganak? _____________________________________

2. Ang iyo bang anak ay pumasok o nag-aral sa alinmang paaralan sa

Estados Unidos nang hanggang tatlong taon ng kanyang buhay? Oo Hindi

Kung oo, paki-bigay ang (mga) pangalan ng paaralan, ang estado at ang mga petsa na nag-aral siya:

Pangalan ng Paaralan __________________________________________ Estado _______ Mga Petsa na Nag-aral ___________



3. Anong wika ang sinasalita mo at ng iyong pamilya sa karamihan ng mga oras

sa bahay? _____________________________________

4. Kung maaari, sa anong wika ninyo nais tumanggap

ng mga pakikipag-ugnayan mula sa iskuwela? _____________________________________

. Ang unang wikang natutunan o wika sa bahay ng

inyong anak ba ay iba sa wikang Ingles? Oo Hindi

Kung sumagot ka ng “Oo” sa katanungan bilang sa itaas, mangyaring sagutin ang mga sumusunod na katanungan:

. Anong wika ang natutuhan ng iyong anak nang una siyang magsimulang magsalita? _____________________________________

. Anong wika ang pinakamadalas na sinasalita ng iyong anak? _____________________________________

. Anong wika ang pinakamadalas mong sinasalita kapag

kinakausap mo ang anak mo? (Ama) _____________________________________

(Ina) _____________________________________

. Pakilarawan kung anong wika ang naintindihan ng inyong anak. (Markahan ang isa lang)

A. Nakakaintindi lamang ng wika sa bahay at hindi wikang Ingles.

B. Nakakaintindi kadalasan ng wika sa bahay at ilang wikang Ingles.

C. Nakakaintindi ng parehong wika sa bahay at wikang Ingles.

D. Nakakaintindi kadalasan ng wikang Ingles at ilang wika sa bahay.

E. Nakakaintindi ng wikang Ingles lamang.

________________________________________________ _____________________________________

Lagda ng MagulangTagapang-Alaga Petsa

TagalogHome Language Survey

Mangyaring sumagotsa Ingles


OFFICE USE ONLY


ThaiÄæ¢–©ø¢¶Ö–Äæ¢–”á„–üæ®æ–üæ°–”ó–Ç¢≠ô–Ç¢º¶Äæ¢–©ø¢¶Ö–Äæ¢–”á„–üæ®æ–üæ°–”ó–Ç¢≠ô–Ç¢º¶Äæ¢–©ø¢¶Ö–Äæ¢–”á„–üæ®æ–üæ°–”ó–Ç¢≠ô–Ç¢º¶Äæ¢–©ø¢¶Ö–Äæ¢–”á„–üæ®æ–üæ°–”ó–Ç¢≠ô–Ç¢º¶Äæ¢–©ø¢¶Ö–Äæ¢–”á„–üæ®æ–üæ°–”ó–Ç¢≠ô–Ç¢º¶

™◊ËÕπ —°‡√ ’¬π: _______________________________________________________________ ‡¥ ◊Õπ «—π ªï‡°‘¥: _______________________ ‡æ»: ™“¬ À≠‘ß

™ ◊ËÕ ∫‘¥“¡“√¥“/ºŸâª°§√Õß: ___________________________________________________________________________________________

∑’ËÕ¬Ÿà: _______________________________________________________________________________________________________

‚∑√»—æ∑å∑’Ë∫â“π: _____________________________________________________________ ‚∑√»—æ∑å∑ ’Ë∑”ß“π: __________________________________________________

‚√ß‡√’¬π: ___________________________________________________ ™—Èπ: _________________________________ «—π∑’Ë: ______________________

1. ∫ÿµ√¢Õß∑ à“π‡°‘¥∑ ’Ë À√—∞Õ‡¡√ ‘°“ „™àÀ√◊Õ‰¡à? „™Ë ‘†‡Œö πó

∂ â“ „™à ∫ ÿµ√‡°‘¥∑’Ë√ —∞Õ–‰√? __________________________________∂â“ ‰¡à„™à ∫ ÿµ√‡°‘¥∑ ’Ëª√–‡∑»Õ–‰√? __________________________________

2. ∫ÿµ√¢Õß∑ à“π‡§¬‡¢â“‚√ß‡√ ’¬π„π À√ —∞œ ‡ªìπ‡«≈“ 3 ªï „™àÀ√◊Õ‰¡à? „™Ë ‘†‡Œö πó

∂ â“ „™à ‚ª√¥·®âß ™ ◊ËÕ‚√ß‡√ ’¬π, √ —∞ ·≈– «—π∑’Ë ‡¢â“-ÕÕ° ‚√ß‡√ ’¬π™ ◊ ËÕ‚√ß‡√ ’¬π _______________________________________________________________________ √—∞ ______________ «—π∑ ’ Ë ‡¢â“-ÕÕ° ‚√ß‡√ ’¬π ____________________™ ◊ ËÕ‚√ß‡√ ’¬π _______________________________________________________________________ √—∞ ______________ «—π∑ ’ Ë ‡¢â“-ÕÕ° ‚√ß‡√ ’¬π ____________________™ ◊ ËÕ‚√ß‡√ ’¬π _______________________________________________________________________ √—∞ ______________ «—π∑ ’ Ë ‡¢â“-ÕÕ° ‚√ß‡√ ’¬π ____________________

3. ‡«≈“ à«π„À≠ à∑ ’Ë∫â“π ∑ à“π·≈–§√Õ∫§√ —«¢Õß∑ à“πæŸ¥¿“…“Õ–‰√°—π? __________________________________

4. ´æÄ–©æ†æ¢î–ïø–‘í„ ï‡æó–––ì„≠Ñ–Äæ¢–‘í„–¢ºô–Å‡æ¶–©æ¢–ÖæÄ–“¢Ñ–Œ¢¡°ó ï¡·–ŒÅ¡°ó–Œö πóüæ®æ–≠ª‘¢–ô„æÑ? __________________________________

. ≈Ÿ°¢Õß§ÿ≥æŸ¥¿“…“Õ◊Ëπ‡ªÁπ¿“…“·√°À√◊Õ‡ªÁπ ¿“…“∑’Ë∫È“ππÕ°‡Àπ◊Õ®“°¿“…“Õ—ß°ƒ…À√◊Õ‰¡Ë? „™Ë ‘†‡Œö πó

∂â“∑à“πµÕ∫ “„™à” „π§”∂“¡¢âÕ∑ ’Ë ¢â“ßµâππ’È ‚ª√¥µÕ∫§”∂“¡µàÕ‰ªπ ’È:. „π¢≥–∑’Ë‡√ ‘Ë¡æŸ¥π —Èπ ∫ÿµ√¢Õß∑à“πÀ—¥æŸ¥¿“…“Õ–‰√? __________________________________

. ¿“…“„¥∑’Ë≈Ÿ°¢Õß§ÿ≥æŸ¥∫ ËÕ¬∑’Ë ÿ¥‡¡◊ËÕÕ¬ŸË∫ È“π? __________________________________

. ¿“…“„¥∑’Ë§ÿ≥„™ÈæŸ¥°—∫≈Ÿ°∫ËÕ¬∑’Ë ÿ¥? (ô¿íæ) __________________________________

(†æ¢íæ) __________________________________. ‚ª√¥√–∫ ÿ¿“…“∑ ’Ë≈Ÿ°¢Õß§ÿ≥ø—ß‡¢È“„® (‡≈◊Õ°‡æ’¬ß¢ÈÕ‡¥’¬«)

A. ŒÅ„æ–”ÖŒÜŒùæª–œì‡–üæ®æ–ï¡·–”á„–Äºó–üæ°–”ó–Ç¢≠ô–Ç¢º¶ œ§ª–ûºÑ–üæ®æ–≠ ºÑÄ£®–‘†‡–ŒÅ„æ–”Ö–Œ§°

B. ŒÅ„æ–”Öüæ®æ–ï¡·–”á„–Äºó–üæ°–”ó–Ç¢≠ô–Ç¢º¶‘í„–†æÄ–ï¡·–©»í œ§ª–ûºÑ–üæ®æ–≠ ºÑÄ£®ŒÅ„æ–”Ö–ô„æÑ

C. ûºÑ–üæ®æ–ï¡·–”á„–Äºó–üæ°–”ó–Ç¢≠ô–Ç¢º¶–œ§ªüæ®æ–≠ ºÑ£®–ŒÅ„æ–”Ö–í¡–Œï‡æ & Äºó–ï‰ºÑ–©≠Ñ–üæ®æ

D. ŒÅ„æ–”Ö–üæ®æ–≠ ºÑÄ£®‘í„–†æÄ–ï¡·–©»í œ§ª–ûºÑ–üæ®æ–ï¡·–”á„–Äºó–üæ°–”ó–Ç¢≠ô–Ç¢º¶–ŒÅ„æ–”Ö–ô„æÑ

E. ûºÑ–üæ®æ–≠ ºÑÄ£®–ŒÅ„æ–”ÖŒù¿°Ñ–üæ®æ–Œí¡°¶–Œï‡æ–óº‰ó

_____________________________________________ ____________________________§æ°–† ≈≠ –á ≈ ·≠ – –Å≠Ñ–ù‡≠ œ†‡ ´¢ ≈≠ –õ„…–öÄ–Ç¢≠Ñ– ¶ºó–ï¡·



OFFICE USE ONLY


Ä¢»ëæ–ŒÅ¡°ó–Çø–ì≠ô

–Œö πóüæ®æ≠ ºÑÄ£®

ywi!*y»uz

±Å ! ±» ! ½: _______________________________ @*gõaZö: _______________________________________________________________ ¤!D»**x:

______________________________________________________________________________________________________________________________ zZ−+&u6,„"»**x:

_________________________________________________________________________________________________________________________________________ Ø:

___________________________________________________________ Ší»Üy: _______________________________________________________________ y»Üy:

_______________________ @*gõ: ___________________________________ ¤/i+: ___________________________________________________________________ Zjw:

7 ! ;V ! HW\»gc*/ñ!~aZƒZå? .1

Z¤/;VÔÂ¾gc*„"~?

Z¤/7ÔÂ¾Šzuo~?

HW\ÆaäZKi0+Ï~ËÌ&‚wÆŠzgZyg;/ñ .2

7 ! ;V ! !ÆËZjw~½0*ðì?

Z¤/;VÔÂ',Z™xZjw»**xgc*„!ZzgZjwYäÅ@*g:VÅ,Š,:

q¢~Å@*gõ gc*„! _______________________________________________ Zjw»**x

q¢~Å@*gõ gc*„! _______________________________________________ ZZjw»**x

q¢~Å@*gõ gc*„! _______________________________________________ Zjw»**x

y6,ic*ŠF,Zz‡]~M\ZzgM\»0+ZyÃyÏi!*y1mì? .3

¾i!*y~zßw™**e!Ð? Z¤/Šø7[ƒÂW\ZjwÐÈYäzZàZ:¬] .4

„!7 ! V;! HZôm,~Æ´zM\ÆaÅƒ!Ð«-ƒðc*Ãðywi!*yì? .

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HOME LANGUAGE SURVEY · ANKETË MBI GJUHËN QË FLITET NË SHTËPI Emri i Nxënësit: _____ Data e Lindjes: _____Gjinia: Mashkull Femër

HOME LANGUAGE SURVEY · ANKETË MBI GJUHËN QË FLITET NË SHTËPI Emri i Nxënësit: _ Data e Lindjes: _Gjinia: Mashkull Femër