Page 56 - 2016 Handbook FINAL 4.18.16

CULTURALLY AND LINGUISTICALLY DIVERSE ELD STAFF QUESTIONNAIRE

Student’s Name: __________Birth Date/Age: __________Date: ___________

Staff Member’s Name and Title: __

Does the student demonstrate language competencies in their native language? ____ Yes_____ No

Describe: ________________________________________________________________________

Does the student demonstrate narrative language competencies comparative of their peers?
_____Yes _____No Describe:

Dialect variation: _____________________Primary language spoken in the home? ______________

What are the parent’s perspectives about using English at home or school? _____________________

What are the student’s perspectives about using English at home or school? ____________________

What support services do you provide for the student?

What strategies have you found to be useful for developing academic success for this student?

Does the child follow directions? ___ Yes ___ No Describe:

Can the child pronounce words so that his or her speech is understood in their primary language?
___ Yes ___ No Describe:

Does the child initiate verbal interactions with peers? ___ Yes ___ No
Describe:

Does the child initiate or organize play activities with peers? ___ Yes ___ No
Describe:

Does the child demonstrate facial expressions, eye contact and gestures deemed appropriate by
peers? ___ Yes ___ No Describe:

Can the child tell stories that are representative of their peers in their primary language?
___ Yes ___ No Describe:

Does the child use code-switching (moving from on language to another inside a sentence or across
sentences) in the classroom? ___ Yes ___ No Describe:

Have you observed the child using code-switching in social situations (i.e., lunch room, playground)?
___ Yes ___ No Describe:

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