ELL Family Information Form
Student
Name__________________________________________
Birth Date_______________
Mother's Name_________________________________________ Speaks English?___________
Father's Name__________________________________________ Speaks English?___________
Address_______________________________________________ Phone __________________
Brothers and Sisters Names:
_______________________________________Age____________ Speaks English?__________
_______________________________________Age____________ Speaks English?__________
_______________________________________Age____________ Speaks English?__________
_______________________________________Age____________ Speaks English?__________
_______________________________________Age____________ Speaks English?__________
Others Living in the Home:
________________________________Relationship_______________ Speaks English?_________
________________________________Relationship_______________ Speaks English?_________
When is the best time to call you?______________________________________________________
What phone number would you like me to use when I call you?_______________________________
If you have email, what is your email address?_________________________________________________________
What is the language used most often in the home?________________________________________
What country is your family originally from? _____________________________________________
How long have you lived in the United States?____________________________________________approximate date_______________________________
What holidays and special occasions does your family celebrate?
_________________________________________________________________________________
_________________________________________________________________________________
Does your child have any food restrictions?
__________________________________________________________________________________
__________________________________________________________________________________
What are your child's interests?
__________________________________________________________________________________
__________________________________________________________________________________
Is there anything else you would like me to know about your child?
__________________________________________________________________________________
__________________________________________________________________________________
Is there anything else you would like me to know about your culture or family?
__________________________________________________________________________________
__________________________________________________________________________________
Mother's Name_________________________________________ Speaks English?___________
Father's Name__________________________________________ Speaks English?___________
Address_______________________________________________ Phone __________________
Brothers and Sisters Names:
_______________________________________Age____________ Speaks English?__________
_______________________________________Age____________ Speaks English?__________
_______________________________________Age____________ Speaks English?__________
_______________________________________Age____________ Speaks English?__________
_______________________________________Age____________ Speaks English?__________
Others Living in the Home:
________________________________Relationship_______________ Speaks English?_________
________________________________Relationship_______________ Speaks English?_________
When is the best time to call you?______________________________________________________
What phone number would you like me to use when I call you?_______________________________
If you have email, what is your email address?_________________________________________________________
What is the language used most often in the home?________________________________________
What country is your family originally from? _____________________________________________
How long have you lived in the United States?____________________________________________approximate date_______________________________
What holidays and special occasions does your family celebrate?
_________________________________________________________________________________
_________________________________________________________________________________
Does your child have any food restrictions?
__________________________________________________________________________________
__________________________________________________________________________________
What are your child's interests?
__________________________________________________________________________________
__________________________________________________________________________________
Is there anything else you would like me to know about your child?
__________________________________________________________________________________
__________________________________________________________________________________
Is there anything else you would like me to know about your culture or family?
__________________________________________________________________________________
__________________________________________________________________________________