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Elementary School Home Language Survey - English

Arizona Department of Education

Office of English Language Acquisition Services

Home Language Survey

The responses to this Home Language Survey (HLS) are used by the school to provide the most appropriate instructional programs and services for the student. The answers below will determine if a student will take the Arizona English Language Learner Assessment (AZELLA). Please respond to each of the three questions as accurately as possible. If you need to correct any of your responses, this must be done before the student takes the AZELLA Placement Test.

Please complete the form below. Required fields marked with an asterisk *

What language do people speak in the home most of the time?*

Answer Required

What language does the student speak most of the time? *

Answer Required

What language did the student first speak or understand?*

Answer Required

Student's Last Name*

Answer Required

Student's First Name*

Answer Required

Student's Date of Birth*

Answer Required

Parent/Guardian Signature*

Answer Required

Today's Date*

Answer Required

District or Charter - Kaleidoscope School

School - Kaleidoscope School

Please provide a copy of the Home Language Survey to the EL Coordinator/Main Contact on site. In AzEDS, please enter all three HLS responses.

These HLS questions are in compliance with Arizona Administrative Code (R7-2-306(B)(1),(2)(a-c). (Revised 01-2020)

Office of English Language Acquisition Services

1535 West Jefferson Street • Phoenix, Arizona 85007 • (602) 542-0753 • www.azed.gov/oelas

Confirmation Email

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