The following information is being gathered in compliance with Sec. 51.917, Texas Education Code, passed by the Texas Legislature in May, 1989. Sec. 51.917 requires all instructional staff to demonstrate proficiency in the English language. Instructional staff who report a primary language other than English are required to pass a test of spoken English.

Name: ___________________________________________________

Department: _______________________________________________

Mark as many of the following statements as apply:

English is the only language I speak: _____Yes _____No

Other than English, I speak the following languages: (add additional lines as necessary)

a.____________________ c.______________________

b.____________________ d.______________________

___________________________is my primary language, i.e., the language I feel most comfortable speaking.*

__________________________________ ______________
Signature Date

Return original to: Provost and Vice President for Academic Affairs Office
*Return one copy to: Assessment Office if English is not primary language

updated 3/2000