2011 - 2012 Heritage and Language Survey
Name: 


A red asterisk (*) indicates required questions.

  1. Child's Name:*


  1. Child's Last Name*


  1. Grade:*
    Prek 3
    Prek 4
    K
    1
    2
    3
    4
    5
    6


  1. 1. Which country represents your family heritage?
    Afghanistan
    Algeria
    Anguilla
    Antigua and Barbuda
    Argentina
    Armenia
    Aruba
    Australia
    Austria
    Bahamas
    Bahrain
    Barbados
    Belarus
    Belgium
    Belize
    Bermuda
    Bolivia
    Bosnia and Herzegovina
    Botswana
    Brazil
    Bulgaria
    Cambodia
    Canada
    Cayman Islands
    Central African Republic
    Chad
    Chile
    China
    Colombia
    Democratic Republic of the Congo
    Conge, Republic of
    Costa Rica
    Croatia
    Cuba
    Czech Republic
    Denmark
    Dominican Republic
    Ecuador
    Egypt
    El Salvador
    Ethiopia
    Finland
    France
    French Guiana
    Gabon
    Germany
    Ghana
    Great Britain
    Greece
    Greenland
    Grenada
    Guadeloupe
    Guam
    Guatemala
    Guernsey
    Guinea
    Guyana
    Haiti
    Honduras
    Hong Kong
    Hungary
    Iceland
    India
    Indonesia
    Iran
    Iraq
    Ireland
    Israel
    Italy
    Jamaica
    Japan
    Jordan
    Kazakhstan
    Kenya
    Korea, Democratic People's Republic
    Korea, Republic of
    Kuwait
    Latvia
    Lebanon
    Liberia
    Libya
    Liechtenstein
    Lithuania
    Luxembourg
    Macedonia, Republic of
    Madagascar
    Malawi
    Malaysia
    Mali
    Malta
    Martinique
    Mexico
    Monaco
    Mongolia
    Montserrat
    Morocco
    Mozambique
    Namibia
    Nepal
    Netherlands
    Netherlands Antilles
    New Zealand
    Nicaragua
    Niger
    Nigeria
    Norway
    Pakistan
    Palestinian National Authority
    Panama
    Paraguay
    Peru
    Philippines
    Pitcarin Island
    Poland
    Portugal
    Puerto Rico
    Qatar
    Romania
    Russian Federation
    Rwanda
    St. Kitts and Nevis
    Saint Lucia
    Saint Vincent and the Grenadines
    Samoa
    Saudi Arabia
    Scotland
    Sierra Leone
    Singapore
    Slovankia
    Slovenia
    Solomon Islands
    Solmalia
    South Africa
    Spain
    Sri Lanka
    Sudan
    Swaziland
    Sweden
    Switzerland
    Syria, Syrian Arab Republic
    Taiwan
    Tanzania
    Thailand
    Tibet
    Trinidad and Tobago
    Tunisia
    Turkey
    Turks and Caicos Islands
    Uganda
    Ukraine
    United Arab Emirates
    United Kingdom
    United States
    Venezuela
    Yemsn
    Zimbabwe


  1. If your country is not listed, kindly place your countries name here.


  1. 2. Using the list below, check the primary languages used in your home.
    Chinese, Mandarin
    Spanish
    English
    Bengali
    Hindi
    Portuguese
    Russian
    Japanese
    German, Standard
    Chinese, Wu
    Javanese
    Korean
    French
    Vietnamese
    Telugu
    Chinese, Yue
    Marathi
    Tamil
    Turkish
    Urdu
    Chinese, Min Nan
    Chinese, Jinyu
    Gujarati
    Polish
    Arabic, Egyptian Spoken
    Ukranian
    Italian
    Chinese, Xiang
    Malayalam
    Chinese, Hakka
    Kannada
    Oriya
    Panjabi, Western
    Sunda
    Panjabi, Eastern
    Romanian
    Bhojpuri
    Azerbaijani, South
    Farsi, Western
    Maithili
    Hausa
    Arabic, Algerian Spoken
    Burmese
    Serbo-Croatian
    Chinese, Gan
    Awadhi
    Thai
    Dutch
    Yoruba
    Sindhi
    Arabic, Moroccan Spoken
    Arabic, Saidi Spoken
    Uzbek, Northern
    Malay
    Amharic
    Indonesian
    Igbo
    Tagalog
    Nepali
    Arabic, Sudanese Spoken
    Saraiki
    Cebuano
    Arabic, North Levantine Spoken
    Thai, Northeastern
    Assamese
    Hungarian
    Chittagonian
    Arabic, Mesopotamian Spoken
    Madura
    Sinhala
    Haryanvi
    Marwari
    Czeck
    Greek
    Magahi
    Chhattisgarhi
    Deccan
    Chinese, Min Bei
    Belarusan
    Zhuang, Northern
    Arabic, Najdi Spoken
    Pashto, Northern
    Somali
    Malagasy
    Arabic, Tunisian Spoken
    Rwanda
    Zulu
    Bulgarian
    Swedish
    Lombard
    Oromo, West-Central
    Pashto, Southern
    Kazakh
    Ilocano
    Tatar
    Fulfulde, Nigerian
    Arabic, Sanaani Spoken
    Uyghur
    Haitian Creole French
    Azerbaijani, North
    Napoletano-Calabrese
    Khmer, Central
    Farsi, Eastern
    Akan
    Hiligaynon
    Kurmanji
    Shona


  1. If your countries language is not listed, kindly place your countries language here.





Mrs. Holifield
FL