Home Language Survey (HLS)

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Student Name*
First Middle Last
Home Language Survey (HLS)
The Civil Rights Act of 1964, Title VI, Language Minority Compliance Procedures, requires school districts and charter schools to determine the language(s) spoken in each student's home in order to identify their students as outlined Plyer v. Doe, 457 U.S. 202 (1982).

The Purpose of this survey is to determine the primary or home language of the student. The HLS must be given to all students enrolled in the school district/ charter school. The HLS is administered one time, upon initial enrollment in South Carolina, and remains in the student's permanent record.

Please note that the answers to the survey below are student-specific. If a language other than English is recorded for ANY of the survey questions below, the W-APT will be administered to determine whether or not the student will qualify for additional English language development support.
Please answer the following questions regarding the language spoken by the student:
1. What is the language that the student first acquired?*
2. What is the primary language(s) most often spoken by the student?*
3. What is the language used in the home, regardless of language spoken by the student?*
4. In what language do you wish to have communication from the school?*
Student Name*
Grade*
Parent/ Guardian Name*
Parent/ Guardian Signature*
By signing here, you certify that responses to the three questions above are specific to your student. You understand that if a language other than English has been identified, your student will be tested to determine if they qualify for English language development services, to help them become fluent in English. If entered into the English language development program, your student will be entitled to services as an English learner and will be tested annually to determine their English proficiency.
Date*
Date Format: MM slash DD slash YYYY
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Home Language Survey (HLS)

Please answer the following questions regarding the language spoken by the student: