EMPIRE JUSTICE CENTER LANGUAGE ACCESS SURVEY

Your Name:
____________________________________________________
Position: (Circle one): Advocate, Administrative, Support, Management, Volunteer / Intern
Office Location: (Albany, White Plains, Rochester) __________________________________

► LANGUAGE CAPACITY
1. Do you know any lLanguage(s) oOther tThan English?  No 
Yes,_______________
2. Indicate your ability to speak, read, and write in each language:
Speak_______________________ the language:
 Limited Proficiency 
Conversation  Fluency
Read / Wwrite_______________________ in that language:
Can write
 Can read

____________ 

► LEP ESTIMATES

( LEP= Limited English Proficient (LEP), refers to individuals who do not speak
English as their primaryimary language and have a limited ability to read, speak, write, or understand English)

3. Please estimate the number of LEP individuals who attempt to contact you each
month.______________________________________________________________
4. Please estimate the number of LEP individuals who use or receive services from you
each month._________________________________________________________
5. Please estimate the total number of LEP individuals who use or receive services from
you each
monthyear._______________________________________________________

► LANGUAGE IDENTIFICATION
6. Please indicate the language(s) spoken by LEP clients or prospective clients that have
come to you for assistance. (Select all languages that apply)
 African Languages
 Cayuga
 Arabic
 Mohawk
 Armenian
 Navajo
 Bengali
 Oneida
 Bosnian
 Onondaga
 Cambodian
 Seneca
 Cantonese
 Tuscarora
 Mandarin
 Other Native American
 Taiwanese
 Pashto
 Other Chinese
 Polish
 Czech
 Portuguese
 Dutch
 Punjabi
 Farsi (Persian)
 Romanian
 French
 Russian
 French Cajun
 Servo-Croatian
 French Creole
 Spanish
 German
 Tagalog
1

 Greek
 Thai
 Hebrew
 Ukrainian
 Hindi
 Urdu
 Hungarian
 Vietnamese
 Italian
 Yiddish
 Japanese
 Sign Language/ Braille
 Korean
 Other: (specify)
 Laotian
7. Below, please specify the top six languages (other than English) you encountered and
how oftenn they occur. (Please iIddentify frequency by writing:filling in: once a year, 23 times a year, 4-10 times a year, once a month, twice a month, once a week, twice a
week, or almost every day)
Language
Frequency
Most Often __________________________ _____________________
2nd Most Often________________________
____________________________________
3rd Most Often ________________________
____________________________________
4th Most Often ________________________
____________________________________
5th Most Often ________________________
____________________________________
6th Most Often ________________________
____________________________________

► WRITTEN MATERIALS
8. To the best or your knowledge, select the languages in which office documents
(retainer agreements, intake forms, disclosure forms, etc.) are available. List the
specific document(s) next to each language chosen.















African Languages______________________
Arabic_______________________________
Armenian_____________________________
Bengali_______________________________
Bosnian______________________________
Cambodian___________________________
Cantonese____________________________
Mandarin_____________________________
Taiwanese____________________________
Other Chinese_________________________
Czech_______________________________
Dutch________________________________
Farsi (Persian)________________________
French______________________________
French Cajun_________________________
French Creole________________________

2
















Cayuga______________________________
Mohawk______________________________
Navajo_______________________________
Oneida_______________________________
Onondaga____________________________
Seneca______________________________
Tuscarora____________________________
Other Native American__________________
Pashto_______________________________
Polish________________________________
Portuguese___________________________
Punjabi_______________________________
Romanian____________________________
Russian______________________________
Servo-Croatian________________________
Spanish______________________________









German_____________________________
Greek_______________________________
Hebrew______________________________
Hindi________________________________
Hungarian____________________________
Italian_______________________________
Japanese____________________________
Korean______________________________
Laotian______________________________

Tagalog______________________________
Thai_________________________________
Ukrainian_____________________________
Urdu_________________________________
Vietnamese___________________________
Yiddish_______________________________
Braille_______________________________
Other (specify) ________________________
________________________________________








9. Do written materials need to be completed to access your services?
 No
 Yes
Please list the written materials and indicate whether they are available in languages
other than English. Please specify. ________________________________________
_____________________________________________________________________
_____________________________________________________________________

► BILINGUAL SERVICES
10. Specify all the languages for which you can assist with with LEP clients intake:
 African Languages
 Cayuga
 Arabic
 Mohawk
 Armenian
 Navajo
 Bengali
 Oneida
 Bosnian
 Onondaga
 Cambodian
 Seneca
 Cantonese
 Tuscarora
 Mandarin
 Other Native American
 Taiwanese
 Pashto
 Other Chinese
 Polish
 Czech
 Portuguese
 Dutch
 Punjabi
 Farsi (Persian)
 Romanian
 French
 Russian
 French Cajun
 Servo-Croatian
 French Creole
 Spanish
 German
 Tagalog
 Greek
 Thai
 Hebrew
 Ukrainian
 Hindi
 Urdu
 Hungarian
 Vietnamese
 Italian
 Yiddish
 Japanese
 Sign Language/ Braille
 Korean
 Other (specify)
_________________________
 Laotian

3

11. Do you feel the office would benefit from employing (additional) bilingual staff?
 No
 Yes
If yes, for which languages? ____________________________________________
12. Do you work with any community-based organizations that are familiar with the
language needs of LEP individuals that come to your office?
 No
 Yes
13. If yes, please list the names of community-based organizations, the type of language
assistance they provided (translation, interpreting, etc.), and in which languages they
provided assistance. ____________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

► ADDITIONAL LANGUAGE SERVICES
14. If we were to expand language services in the office, which of the following language
groups do you feel would benefit the most ? most?
 African Languages
 Cayuga
 Arabic
 Mohawk
 Armenian
 Navajo
 Bengali
 Oneida
 Bosnian
 Onondaga
 Cambodian
 Seneca
 Cantonese
 Tuscarora
 Mandarin
 Other Native American
 Taiwanese
 Pashto
 Other Chinese
 Polish
 Czech
 Portuguese
 Dutch
 Punjabi
 Farsi (Persian)
 Romanian
 French
 Russian
 French Cajun
 Servo-Croatian
 French Creole
 Spanish
 German
 Tagalog
 Greek
 Thai
 Hebrew
 Ukrainian
 Hindi
 Urdu
 Hungarian
 Vietnamese
 Italian
 Yiddish
4



Japanese
Korean
Laotian

Sign Language/ Braille
Other (specify)
_________________________


15. For each language identified, explain how you think these clients or potential clients
could be provided more effective language services?_________________________
___________________________________________________________________
___________________________________________________________________
Please list additional resources you or other organizations have used to successfully serve
LEP populations in your community. _____________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Please list any additional information you would like to share:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
PLEASE SEND

THE

COMPLETED FORM

5

TO

MICHAEL MULÉ