Student's Name  (a separate form is needed for ever student in your family)

Part A Ethnicity   Is student Hispanic/Latino?
No, not Hispanic/Latino
Yes, Hispanic/Latino (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.)

The above part of the question is about ethnicity, not race.
No matter what you selected, please continue to answer the following by marking what you consider your student's race to be.

Part B Race   What is the student's race?
American Indian or Alaskan Native – A person having origins in any of the original peoples of North or South America (including Central America), and who maintains tribal affiliation or community attachment.)
Asian – (A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.)
Black or African American – (A person having origins in any of the black racial groups of Africa.)
Native Hawaiian or Other Pacific Islander – (A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.)
White – (A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.)

Part C   Home Language
Please specify anything you mark as other in the blank line provided.
What language did your child first learn to speak/use? English   Spanish   Other
What language does your child most speak/use at home? English  Spanish   Other
What language do you most often speak/use with your child? English  Spanish  Other
What language do the adults at home most often speak/use? English  Spanish   Other

Part D   Parent/Guardian Information
In which language do you read/write? English  Spanish  Other