zb tr tr tr tr tr tr z ts z - Fluvanna County High School

F1
H
a
F1
/'
F1
{
t-
f-t
F1
t-
I
(n
z
Z
e
t-l
I
7
r-
7
F-l
E
-.
=
(t
o
Fl
F,l
o
o
F
-
o
a
E
CD
r,t
Fra
oa
;(.
-
3
o
n
CD
-
b
I
7
O
l'-r_
(D
.1
I
a?
I
L
I
a' I
-
o
-:
I
I
o-
(D
a
a
a
tD
O
t)
an
in
rr'l
-
a
tD
O
la
(D
FN
tr
?
o
o
CD
ts
F1
B
a
a
i'1.
(D
tsTr
F-
l<
-
E
o
.D
Fn
E
H
tt
I
I
I
l
l
tt
l
l
l
g
-
7
3
(D
H
l'-r'
z
t
-
to
fr
oCD
fr
I
(t
tr
t
o
CD
-
o
o
in
ts-l
E
O
fn
F
E
CD
a
-
=
( l
CD
i..
F
CD
I
o
CD
-
n
(t
o
o
q
-
o
'o
-
o
ts
L
o
F
o
7
.D
tr
? 3
Q - +
a - .
Y U
# a )
- 9
o
(D
o
o
z
a
a
a
li
o
-
zo
z
tr
z
ti
-
Fn
a
i'x
aD -a 7
(1
r5
a
-
s
t
o
F
6
a
o
L
-
a
t
q
>1
a
r
+ c J
! : i
^ ) 3
-cD
a
q
O
o
o
tr
-
(D
t
a
o
l
l
A ' P
a)
(D
FD n
(D
F1
CD
E
7
A
l
l
rD<
o q R
11
I
l
(n oi
c a E
(/)
CD
t
tt
l
l
a
CD
o
l
z(D
!
ni
t
t
lI
o
o
tr
7
I
l
I
l
t
5.
rn
l
I
l
I
t!
(n
CD
H
fr
4
T
I
I
tr tr
a
l=
o'
(D
o
a
p
-)
tr
--
9
l
. D l
t
o
a
rt
Fl
II
a
E
t-
?
- l
\ J I
t
tr
l.l
i
o
I
I
5
o
(D'
r-
o
Fl
'J
E
I
--
fr
6
.D
r-.t
5
z
H
o
@
x
FT
; + 7
l!e
o
tr
CD
5
-
IJ
a
=
a
- f r
I
-
p
:4,
-
x G.)
o
+
CD
I
I
a
a
a
o
CD
Fl
ts1
I
Ft
o
J
o-
0
o
7
U)
O
5
Ft
(D
0
E
Fn
F
'
n
o'
a
rn
p
z
Fl
-
(,
o
CD
H
+
m
6
rt
0
z
ts
U)
a
-
o
o
a
(D
O
a
z
tr
-
a
I
ta
ta
Fl
z
(D
n
o
+
+
ts
4
+
4
4
+
+
*
EvI H
t!
U E Lnol
nnnn
JLJLJLJ
E
a
F O
o R
.:.?.:.:
rli'swwH
r t
FE$|qSg5Eg$Hd
s E= Ei t q a
E
i=d
9 9 9 9 . : * e l F * i [ = F i$
ut .
F
w
-J.
a-.
A
o
U)
(t
i
, o q
oo
iiJ
3ae9
-
3 'o
n g i FB
r l + =
t=6j
s+:X
*.5-i i'
I
H
f;
s
$
E
+€
a
d E d E s r Q d
6 ' -ta
t s0c
H
5
6 E6o
E
o
$
J
:.:3.i
pxn6
;qFe
J
:dq =
s
Ns-'d
g
uig.=;
=
O
O
;ii
tr
*=::E i
-
E)
x o 4 5
iilEe
! * a ) l
= = r ;
@ - J o
@o\u-
..1
6:r-rI
a
o
rHYg
5
- d 9 t
lJtri
;3
5
i
^
Q J
x ' >
V
st i s tl * H
t-l
r}ggEqi
o
S- ,tc g F ? a 6 . F
a:i- cLE = ci6'ric
:Q
i -Q
o F
d
x E
= '==v s
9f l i ==
q' e
6= l *3 ii os =8 F
E
F
A-ll
X
9 +t
i.t e t,E
sr g
i Fi+l iealf
$:
=
>6
H 53F[?
z
(!
V
|
V
V
o 6 t r di€
o
:::
o
S
H
;
N
(D
oe
+
? 9 9 - 3
i '
Ch
8d.:F
8-
-
:y
)(/,i
9
o x 4 p
i o Y n
66-=.
!
*
(u
d(r-'=
^l
a U ? +
H a d ;
- '
_
*
;
A
r u
^ ;
=
9f,odi
x s g q
= X 6 =
E^?5
f
-
9
@
6
€
P
t
E
E
o-
X
-
B
+
sZ .
I
ee:
;gq
<
f
*
5
q
E
l
- o ,
6 o o
F n
:
t
iEd€ 'z
V^'
t-t
(D
dr 3
r alo
3 I I F E Eg
f ii B : S I
d5+ a'
;.aq 5
4
.a {
6E
+E
6
- 6 Yr
","iI
6"6 ia
o18 R' 8.23
Foo
0q
=p+ !D e q H T a F
i il$ =l,€
6tfi
56'
o
q
N
^
:
=
6
FPTg 5
*5:a
5 o69
T o
O "
A l - = u ' o
-'lC
a
5
A
- . ^
=
! 9 E
E +
J- 7
36
E
1 N <
\
t
F
H
- . v
!t Y
C
v !
C'
teJ ^f;'
(,
u5()
Fl
J
=
H= F
f , rE
=
i
E'e' a
S
'
T
d S . c j B u
6h'as 6
m E t I
- - + < !
5 n
.:hb'
ig gg Hg a
iFels;
C!
9 3q ; 5
;d*#
E 8-!7,
A \
^Y+r5
.. ? tr
nnlnni:'$ h 3
y f = i g _ . * E ? 6 -
EqEd e
F
-
Lrt al
( , H
)-'.
o +.
5'L-lB
.
R
^
O +
o
{
a
FTtrF5
od*,x
H
O
E i = d ^3 3 ;
€
R
V
g . 6 e 'Ii r r
A
H
' i 5 *i i =
= g F
s.
A
:
tra=
$ q E is
ssiilFgg
g
i + 7
f3 i il 6E' E +
fiq
- a"_d
ib
q ,
r + - ! ,
+
Lrl
n
Oa l---]n
i +
o
;'
-
I s e ' = ; da
R
6{eHi
:31;
^
F ? ? F 3E H
n
;fl6si 1
=
,r*Ea
F
TTtrrp
> s 3 t sd
9 d P 9
4
;.H 5.9d"F'g
€ d I i d;E
o P.€6--]x E
j'
+
o gE tFi 's* .' oa!a: +
.: 0
i*: E
ci6 =I
3 €* e I oc
J
_ r t
F g;'ta
i
HHHHE ; 9 I :
i T E EF
9
I er
R o o 5
*.8; A
= i
3 s n F 33
H
tri
aI.e^
v
=
-
c o
e
:ri :
I
€
)
H
F
;3
i
F
l
e
r
^
3=
F+''
fr
t"
I
I-
"H H
co
i+BE" =
: *
;F q
H i S b F
snli;
iaa; r
$*;i:
rzges' F
*o
:i=),
xiil.= H
5
' - = . FY
E E l i
s5
-
; Pj '
o
t
c
a
e
:
E
ir
?
I
A
V
:h<
E
=
F
rlr
5
AT
d
n
6'5
F 9'
gE
T
F
O =
e.' tE
o
A
v
(
g
2a
frl
is xE
F
)
=
: '
=
R
i.
o
0
a
z
o
FluvannaCountyPublicSchools
HomeLanguageRegistrationForm
Theinformationon this form mustbe collectedon all studentswho registerin FluvannaCountyPublicSchools.All informationmust
be collectedfrom parentsandguardiansin their nativelanguageif they areunableto reador speakin English. This form meets
irementsof the Equal Educational
ty Act20 USC 1703for identificationof nationalorigin minority children.
STUDENT:
First
Dateof Birth
Middle
Age _
Grade
School
Month/date/year
1. Is thereanyonein your homewho speaksa languageotherthanEnglish? YES
2. Wherewasthe studentborn?
UnitedStates
NO
kircle one)
OtherCountry:
A. last grade completed in native country
B , DatestudententeredU.S.
C. Circle all gradescompletedin U.S. schools:
None Pre-K K | 2 3 4 5 6 7 8 9 l0 ll
12
D. DatestudententeredVA schools
E. Studentis :
3. Hasthe studenteverreceivedESL or ESOLservices?
Ifyes, Dates
YES
immigrant _
NO
migrant _refugee
Not Sure
SchoolDistrict/State
English
Spanish French
Russian
Other:(specifl')
4. Whatwasthe first languagethe student
learnedto speak?
5. Whatlanguagedoesthe studentspeak
at home?
6. Whatlanguageis mostoftenspoken
at home?
7. What language(s)do adults speak
at home?
The lm,vrequires that all language minority children be screenedto determine English languageproficiency for acqdemicsuccessin
school. Screening takes approximately one hour or less, and you will be notified of the results.
8. Do you give permission for your child to be screened to determine English language proficiency?
Signatureof Parent/Guardian
Printed Name of Parent/Guardian
_YES
_
NO
Date
TelephoneNumber
SchoolRegistrar: A copy ofthe HLR form must be sent to your ELL coordinatorimmediately.
(Revised10/2008) Distribution: Orisinal-Cum.Folder/ESOL
Copy: SchoolLEP Coord./ESL District Office
(Espanolen ladotrasero)
Las Escuelas Ptiblicas del Gondado de Fluvanna
Documento de Solicitud Para ldioma Hablado en Gasa
sobreestaformase debeconseguir
La informaci6n
de todoslosestudiantes
matriculados
en escuelasp0blicasdelcondado
Todala informaci6n
se debeconseguir
de Fluvanna.
de padresy de guardas
en su lenguamaterna
si no puedenleero hablar
ingl6s.Estaformacumplerequisitos
del actoeducativo
de la oportunidad
igual20 USC'1703parala identificacion
de los
nifrosminoritarios
delorigennacional.
Nombredelestudiante:
Grado:_
Escuela:
Fechade nacimiento:
mes/fecha/afro
persona
1. lHaycualquier
en su hogarquehableunalenguaconexcepcion
de ingl6s? Si No (Elijauno)
naci6el estudiante?
2. s,D6nde
_Estados Unidos _El
otropais:
A. Grado reci6ncompletadoen pais nativo
B. Fechade la entradadelestudiante
en losEstados
Unidos
C . C e r q u e t o d looss g r a d o s c o m p l e t a d eo s ceune l a s dl oesE . E . U . U . : N i n g u n oPsr e - KK 1 2 3 4 5 6 7 I 9 1 0 1 1 1 2
D. Fechade entradaa las escuelasde Virginia
E. El estudiante
es:_inmigrante _migratorio _refugiado
servicios
delESLo de ESOL?Si No Incierto(Elijauno) Si si, Fechas
3. 4,Harecibido
el estudiante
escolar/estado
Ingl6s
Espafrol
Franc6s
Ruso
Distrito
Otro:
(especifioue)
4. a,Cu(tl
erael primer
idiomaqueel
aprendio
a
estudiante
hablar?
5 . a Q u ei d i o m ah a b l ae l
estudianteen casa
6 . ; Q u e i d i o m as e
hablalo m6s en casa?
7. aQue idiomashablan
los adultosen casa?
paraaveriguar
quetodoslosnifiosminatorios
cu5les su conocimiento
delidioma
de la lenguaseanevaluados
La leyrequiere
y
notificaran
hora
o
menos,
le
a
Ud.de
para
la
aproximadamente
una
en
escuela.
El
examen
toma
el
exito
acad6mico
ingles
losresultados.
quesu nifioseaevaluado
paraaveriguar
de ingl6s? Si
cu5les su conocimiento
8. iDa Ud.el permiso
Firmadelpadre/delguarda
Nombreimpresodel padre/delguarda
No(Elijauno)
Fecha,
Nimerode tel6fono
immediately.
A copyof theHLRformmustbe sentto yourELLcoordinator
SchoolRegistrar:
Folder/ESOL Copy:SchoolLEPCoord./ESL
District
on otherside)
Original-Cum.
Office (English
Distribution: