Sample Comprehensive Review Of Academic Records Page 4
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20Appendix B
Sample Language, Acculturation, and Developmental History
_________________________________________
________________________ __________________
__________
Person interviewed/relationship to student
Interviewer
Language Used
Date
Acculturation:
Country of family origin: ___________________
Number of Years in the U.S./Canada: ___
Number of Years in School/District: ___
Do you read to your child in their native language? ________
Language Development:
What language was your child first exposed to? ___________________
What language did your child first speak? ___________________
When did your child start talking? ___________________
Does your child having trouble understanding or expressing themselves in their native language? (i.e. slow to respond,
baby talk, poor pronunciation, etc…)
______________
Does your child understand questions?
Native language: Yes/No
English: Yes/No
Does your child understand directions?
Native language: Yes/No
English: Yes/No
Do other adults understand your child when they talk?
Almost never
Some of the time
Most of the time
Does your child get frustrated by their ability to communicate? ________
What language does the child speak with the following and how often:
-Mother
-Father
-Siblings
______
-Extended Family
-Peers
Organized by Beth Hoecker-Martinez (LBLESD), Leah Hinkle (GAPS), Claudia Nunez (LBLESD), 2014
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