Templates › Forms › SEO page

Run: English Learner Identification and Service Plan Documentation

Use this English Learner Identification and Service Plan Documentation template to record the home-language survey, EL screening, placement decision, and ann...

Fill this out, get a PDF emailed to you. No account required. Want to run it with your team and track results? Sign up free →

Submission Notice and Privacy Disclosure

I understand this form is used to document EL identification and service planning. (required)

Yes No N/A

I acknowledge that student information will be used only for educational placement, service planning, and compliance purposes. (required)

Yes No N/A

Consent to collect and use language background information for educational placement (required)

Yes No N/A

Who is completing this form? (required)

Student and Case Identification

Student ID (required)

Student Name (required)

Date of Birth

Collect only if needed to match the student record.

School Name (required)

Grade Level (required)

Home-Language Survey

What language is most often spoken at home? (required)

What was the first language the student learned?

Other languages used by the student or family

Has the language used at home changed since the last school year? (required)

Describe the change in language background (required)

Briefly describe the change and when it occurred.

EL Identification and Placement

Was a language screening completed? (required)

Screening Date (required)

Screening Result (required)

English Learner Identification Status (required)

Placement Decision (required)

Placement Notes

Include only placement details needed for service delivery.

Annual EL Service Plan

Service Year (required)

Service Model (required)

Service Frequency (required)

Minutes of EL Support per Week (required)

Language Support Goals (required)

Summarize the annual language development goals and supports.

Review Date (required)

Team Members and Sign-Off

Case Manager Name (required)

Guardian acknowledgement received (required)

Team Members

Final Comments

Get your results

Enter your email — we'll send you a PDF of your filled-out template, plus the occasional MangoScoop newsletter (templates, workflow tips, product updates). Unsubscribe anytime — link is in every email.

Email (required)

Your name (optional)

Generated with MangoApps Templates — browse 250+ free