Case File
efta-01709600DOJ Data Set 10OtherEFTA01709600
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Unknown
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DOJ Data Set 10
Reference
efta-01709600
Pages
100
Persons
0
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EFTA01709600
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EFTA01709601
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EFTA01709602
STATE OF FLORIDA
DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES
CUMULATIVE SCHOOL HEALTH RECORD
(This form is not intended for physician's use)
Name
Address
Date of Birth
Place of Birth J
Immunization Certification:
Special Immunization Programs
Yes ra
No El
Race 11/
Sex
School
ther's Name
Mother's Name
Birth Recorded:
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Special Health
Problems - See
Narrative
A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES
Screening and
Assessment
Grades
K-3
K
1
2
3
Screening
Date
To
S
cc
0
Outcome
Screening
Date
Referral
Outcome
Screening
Date
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cc
0
Outcome
Screening
Date
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Nutrition
Dental Health
Mental Health
Communicable Disease
Records Review
Physical Assessment
Other
Other
Screening and
Assessment
Grades
4-8
4
5
6
7
8
Screening
Date
Referral
Outcome
Screening
Date
To
03
13
cc
Outcome
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Date
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Outcome
Screening
Date
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HRS-H Form 3O41. MAY 8O (Replaces previous editions and MCH 3O4)
EFTA01709603
PICTURR
CARD
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Year
Grade.------
Last .
School
Year
Grade
Fast
Middle
School
Year
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EFTA01709604
FCAT
Heikki Compreheastre A‘settiatal lest
Spring 2003
Florida Comprehensive Assessment Test (FCAT)
SUNSHINE STATE STANDARDS
Grade 09 Student Report
District Number and Name
50-PALM BEACH
The Florida Department of Education believes that every student has the ability to learn and succeed. The purpose of the FCAT is to ensure that
Florida's publit schools are providing the best education possible, and preparing students to succeed in the competitive 21st Century Job market.
Working with teachers, the State has developeda measurement system that allows you to track a students academic achievement from year to
year and determine if a year's worth of learning has occurred In a year's time. This system also allows you to compare a student's score to a
score that represents 'grade lever achievement. If a students score is above the 'grade lever score, then they are performing at a level above
their current grade. If it is below, they are in need of improvement. Using the 'Content Scores; you are able to identity any Specific academic
skills needing improvement.
Below you will find your 2003 FCAT Reading and Mathematicsscores., as well as your scores from previous years. The chart on the right side of
the page snows your score compared to the score that represents grade level achievement.
Your Reading score is on grade level. You have answered many of the
questions on FCAT correctly.
2003 Reading Content Scores
Content Areas
Points
PossiNt
Pants
Earned
Words/Phrases
7
7
Main Idea/Purpose
18
15
Comparisons
10
7
Reference/Research
10
9
Year
2001
2002
2003
Grade Tested
7
8
9
Achievement Level
4
3
3
FCAT Score •
1970
1957
2085
FCAT Score
Reading
2soo-
MOO-
Grade 1 Gni* 4
Grade
Grade a
Grade
Grade
Grad*
Grad 10' 11•
■ Your Score
CI On Grade Level
Your Mathematics score is above grade level. You have answered most
o1 the questions on FCAT correctly.
2003 Mathematics Content Scores
Content Areas
Points
Possible
Points
Earned
Number Sense
8
6
Measurement
7
4
Geometry
11
10
Algebraic Thinking
10
6
Data Analysts
8
5
Year
2001
2002
2003
Grade Tested
7
8
9
Achievement Level
3
4
4
FCAT Score •
1902
2012
2070
FCAT Score
Mathematics
250:t-
203o-
1500-
1000-
Grad* 3
Grade 4
Grade
• 6
Grad*
Grade
Grade
• Your Score
O On Grade Level
Grad 10
11+
• These scores show your achievement on the day you were tested. If you had taken this test numerous times, it is likely that all of your scores would
have been within a certain range. Your 2003 FCAT Reading scores probably would have been between 1993 and 2177.
Your 2003 FCAT Mathematics scores probably would have been between 2036 and 2104.
NT -Not Tested
NR-Not Reported
NA -Data Not Available
Data Run Date: 05/09/2003
0162122
EFTA01709605
FCAT Reports
Separate reports are produced for the Sunshine State
Standards tests in FCAT Reading and Mathematics,
Science, and Writing. A separate report is also printed
for the norm-referenced tests in Reading and
Mathematics.
FCAT Norm-Referenced Test (NRT) Report The FCAT
NRT report shows reading and mathematics scores on
a Florida version of the SAT9 (published by Harcourt
Educational Measurement).
Student scores are
compared to a national "norm" group, where a percentile
rank score of 50 is average.
Sunshlne State Standards (SSS) Reports The FCAT
SSS Reading, Mathematics, and Science reports show
test scores trom Florida's tests of academic standards.
These reports contain subject scores and content
scores.
Subject scores describe
the overall
achievement, and content scores give the number of
points earned in specific skill areas. Success on the
Reading and Mathematics tests can be best understood
by using the achievement levels where a 3 or higher is
on or above grade level.
Achievement Levels Five categories of achievement
describe the success students have with the content
tested on the FCAT Reading and Mathematics. Level 5
is the highest and Level 1 is the lowest. Since science
achievement levels have not been determined, science
scores are ranked as to whether they fall in the lowest,
middle, or highest third of statewide student
performance.
5 This student has success with the most challenging content
of the Sunshine State Standards. A student scoring in Level
5 answers most of the test questions correctly, including the
most challenging questions.
4 This student has success with the challenging content of the
Sunshine State Standards. A student scoring in Level 4
answers most of the test questions correctly, but may have
only some success with questions that reflect the most
challenging content.
3 This student has partial success with the challenging
content of the Sunshine State Standards. but performance
is inconsistent. A student scoring in Level 3 answers many
of the test questions correctly. but is generally lens
successful with questions that are the most challenging.
2 This student has limited success with the challenging
content of the Sunshine State Standards.
1 This student has little success with the challenging content
of the Sunshine State Standards.
FCAT Certificates
Students who earn Level 5 scores or
whose science scale scores are greater than 400 receive
Certificates of Achievement. For writing, certificates are given
to all students with scores of 5.5 or 6 and to fourth graders with
scores of 5, 5.5, and 6. Certificates are not awarded basad on
the FCAT Norm-Referenced Test scores.
Informes FCAT (SpanIsh)
Se preparan informes separados para los exámenes del FCAT
de lectura y matemáticas, ciencias y redacción según las
normas estatales Sunshine State Standards.
También se
imprime otro informe por separado para los exámenes de lectura
y matemáticas de acuerdo a las normas de aplicación nacional.
Informe sobre el FCAT ceñido a normas de aplicación
nacional (NRT)
El informe del FCAT NRT presenta los
resultados de lectura y matemáticas en una versión del estado
de Florida del SAT9 (publicada por Harcourt Educational
Measurement). Los resultados obtenidos por los estudiantes se
comparan con el grupo modelo o 'norma", en el que la
clasificación es de un 50% del promedio.
Informes según las normas estatales Sunshlne State
Standards (SSS)
Los informes según las normas estatales
SSS del FCAT presentan las calificaciones de los exámenes de
lectura, matemáticas y ciencias de las normas académicas de
Florida. Estos informes contienen calificaciones por materias y
calificaciones por contenido.
Las calificaciones por materia
proporcionan un resumen general del rendimiento y las
calificaciones por contenido que proveen el número de puntos
obtenidos en áreas de habilidades específicas. El éxito de los
exámenes de lectura y matemáticas puede entenderse mejor
utilizando los niveles de rendimiento en los que una calificación
de 3 o superior está al nivel del grado o por encima.
Niveles de rendimiento El éxito que un estudiante ha logrado
en el contenido examinado en el FCAT de lectura y matemáticas
se describe por medio de cinco categorías. El nivel 5 es el más
alto y el nivel 1 es el más bajo. Como los niveles de rendimiento
en ciencias no se han determinado, las calificaciones de
ciencias se clasifican con respecto a si entran dentro del tercio
inferior, medio o superior del rendimiento estudiantil a nivel
estatal.
5 Este estudiante tiene éxito con el contenido más difícil de las
normas Sunshine State Standards. Un estudiante del Nivel 5
responde a la mayoría de las preguntas del examen
correctamente, incluyendo las preguntas más difíciles.
4 Este estudiante tiene éxito con el contenido difícil de las
normas Sunshine State Standards. Un estudiante del Nivel 4
responde a la mayoría de las preguntas correctamente, pero
es posible que sólo tenga cierto éxito con las preguntan que
reflejan el contenido más dificil.
3 Este estudiante tiene un éxito parcial con el contenido difícil
de las normas Sunshine State Standards, pero su rendimiento
es inconsistente. Un estudiante del Nivel 3 responde muchas
de las preguntas del examen correctamente, pero por lo
general tiene menos éxito con las preguntas que son más
difíciles.
2 Este estudiante tiene éxito limitado con el contenido dificil de
las normas Sunshine State Standards.
1 Este estudiante tiene poco éxito con el contenido difícil de las
normas Sunshine State Standards.
Certificados del FCAT Los estudiantes que se clasifiquen en
el Nivel 5 o cuyos resultados de ciencias sean superiores a 400,
reciben Certificados de rendimiento.
En redacción, los
certificados se otorgan a todos los estudiantes que han obtenido
calificaciones de 5.5 y 6. y a los estudiantes de cuarto grado que
han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados
en los resultados del FCAT ceñido a normas de aplicación
nacional.
Rape, FCAT (Haltlan Creole)
Yo prepare rapó apa pou egzamen lekti ak matematik, syans
ak redaksyon FCAT bay swivan prensip Sunshine State
Standards yo. Yo ekri yon rapb apa tou pou lekti ak matematik
pou "modèl egzamen ofisyèl FCAT itilize pou fè evalyasyon"
an.
Rapó egzamen ofisyèl FCAT itilize pou fè evalyasyon
(NRT) Rapb FCAT NRT a montre nbt lekti ak matematik nan
vèsyon Florida genyen pou SAT9 la (Se Harcourt Educational
Measurement ki pibiliye li.) Yo konpare nbt elèv la ak yon
gwoup nbt yo konsidere kbm "modèl pou egzamen ofisyèl" la,
kote swivan klasman pa pousantaj la, nbt mwayèn nan se 50.
Rapó Sunshine State Standards (SSS) Rapb FCAT SSS
pou lekti, matematik ak syans lan montre nbt elèv yo fè nan
egzamen Florida bay sou prensip akademik yo. Rapb sa yo
gen nbt pou matyè ak nbt pou kontni ladan yo. Nbt pou matyè
yo dekri tout sa elèv la reyalize anjeneral epi nbt pou kontni yo
bay kantite pwen elèv la fè nan yon matyè byen detèmine. Ou
ka konprann kisa elèv la reyalize nan egzamen lekti ak
matematik la pi byen si w itilize yon nivo siksè kote 3 oswa plis
se yon nbt ki nan nivo klas la oswa yon nbt ki pi wo pase nivo
klas la.
Nlvo siksè elèv yo Gen senk kategori siksè ki dekri nivo
siksè elèv yo pote nan kontni yo teste nan egzamen lekti ak
matematik FCAT la. Pi gwo nivo a se nivo 5 epi pi piti nivo a
se nivo 1. Piske yo poko detèminen nivo siksè nan egzamenn
syans tan, yo klase nbt pou syans lan swivan si li tonbe pi ba.
nan mitan oswa pi wo yon tyé pèfbmans elèv toupatou nan eta
a.
5 Elèv sa a gen siksè nan matyè ki te gen pi plis difikilte ladan
yo nan egzamen Sunshine State Standards la. Yon elèv ki
nan 5yèm Nivo reponn pift) kesyon egzamen yo
kbrèkteman, elèv la menm reponn kesyon ki gen pi plis
difikilte ladan yo.
4 Elèv sa a gen siksè nan matyè ki te gen difikilte ladan yo
nan egzamen Sunshine State Standards la. Yon elèv ki nan
4yèm Nivo reponn pifb kesyon egzamen yo kbrèkteman,
men li ka gen kak siksè sèlman nan kesyon ki sanble yo gen
pi plis difikilte laden yo.
3 Elèv sa a gen enpe siksè nan matyè ki gen difikilte ladan yo
nan egzamen Sunshine State Standards la, men pèfbmans
lan pa rete estab. "'ion elèv ki nan 3yèm Nivo reponn anpil
nan kesyon egzamen yo kbrèkteman, men anjeneral li gen
mwens siksè ak kesyon ki sanble yo gen pi plis difikilte ladan
yo.
2 Elèv sa a gen siksè limite nan matyè ki gen difikilte ladan yo
nan egzamen Sunshine State Standards la.
1 Elèv sa a gen yon ti siksè tou piti nan matyè ki gen difikilte
ladan yo nan egzamen Sunshine State Standards la.
Sètifika FCAT Elèv ki fè nbt 5yèrn Nivo oswa elèv ki fè gwo
nbt ki pi plis pase 400 nan syans ap resevwa Sètifika pou
Siksè. Yo bay tout elèv ki fè nbt 5.5 oswa 6 ak elèv klas
katriyèm ki fè nbt 5, 5.5. ak 6 yon sètifika pou redaksyon. Yo
pa bay sètifika swivan nbt elèv fè nan egzamen ki baze sou
"modèl egzamen ofisyèl FCAT itilize pou fè evalyasyon" (NRT)
an.
EFTA01709606
FCAT
Florida Comprehensive Assessment Test
Spring 2004
Florida Comprehensive Assessment Test (FCAT)
SSS Science Student and Parent Report
Grade 10
The Florida Department of Education believes that
every student has the ability to learn and succeed
The purpose of the FCAT is to ensure that Ronda's
public schools are providing the best education
possble and prepannp students to succeed for the
future
A high level of science knowledge has been dentifed
as crthdal 101SLX:ten en the compete.* 21st century
job market Working with Florida educators. the state
has developed a lost to measure a student's
achievement of the important science skills in the
Sunshne State Standards. This report provides your
students 2004 Spence Score which allows you to
compare
your
students pedormance
to
the
performance of other students vi the state
in
addition. the content scores help you to dented
academic skies that may need improvement
El Florida Department ol Education (Departamento
de Education del estado de Florida) tree que todos
los estudiantes Denen ta capacidad de aprender y
tenor Ono El proposal° del FCAT es asegurar clue
las escuctlas pita= de Florida propormonen la
metor educaabn posble y PreParen a los eStudantes
pare toner Onto en el Mum)
Se ha demostrado que. pare el exio en el
CPI:WOW° mercaclo Laboral del siglo X)0. es crucial
poster can alto novel de conoomentos de ciencias.
Trabajando con educadores de Florida. el estado ha
desanollado un examen pan medr be ogres de on
°students en malaria de cienoas de acuerdo a las
norms Sunshine State Standards. Este marine
proporciona a su estudianto la calsficacen de
cenoas de 2004. b que b permite comparar el
condiment° de su estudiame con La de caps
eskidantes en el estado
Achoonalmente. Las
cakticamones de contend° le ayudan a dentacar las
habadades academicas en las que puede see
necesaro meprar
NAME:
ID:
SCHOOL
DISTRICT: 50-PALM BEACH
°coalman Eclicasyon nan Florida hwe chap hrtanun
pen kapasae pou aprann ep gen skse Obpktif
FCAT La se pou yo ka mien *kbl pkilk nan Florida
3P bay p bon edicasyon ki post la ep yap prepare
elev yo pou yo ka gen Wise nan lavni.
To damilye yon rwo konesans kt elve nan syans se
yon bagay ki esansyill pou yen noon ka pen slcse
nan konpetayon Iti ponyen nan mache travay ta nan
21yom syta La Eta Florida a travay ansanm ak
pwoleso yo pou yo devlOPe Yon °gunmen ki Pen*
yo mewe rannman yon elev nan egzamen syans ki
enpotan nan Sunshne State Standards La Rapti sa
a bay Nt4 elev fe nan Syans pou Ane 2004 La opt sa
pen* ou konpare ON:mans elbv ou yo ak polOmans
lei elev nan Eta a Anglo, not yo kt nan rape a ode
ou idanutye nan kt matye akademh elev la bezwen fs
amelycwasyon
Your 2004 Science Content Scores
Content Areas
Points
Earned
Points
Possible Percent
Compared to Other Students
Low
wage
High
Physical and Chemical
7
14
50 %
./
Earth and Space
8
11
73 %
I
Life and Environmental
10
15
67 %
i
Scientific Thinking
9
11
82 %
I
Your 2004 FCAT Science Score
Score '
Compared to Other Students
Low
Middle
High
341
i
500
400
300
200
100
Stdent's Scots
State Average
This score shows your achievement on the day
you were tested. If you were to take this test
again, it is likely that your 2004 FCAT Science
score would be between 326 and 356.
Science Content
Contenido de clenclas
Kisa ki gen nan egzamen syans Ian
• Physical and CheniCal Science explains
matter, motion, force. and energy including
their properties and interactions; also identifies
Il Clenches f isicas y quintals explican la
materia, el movirmento, la I uerza y la energla,
incluyendo sus propiedades e interacciones;
• Syans fizik ak chimik- esplike matye,
mouvman, Ids, ak eneji, sa lie di pviopriyete
yo ak Jason youn reyati ak itil; epi tou idar*llye
atoms. elements. compounds, and mixtures.
tamben identitican los atomos, elementos,
compuestos y mezclas.
atom, eleman, konpoze chimik ak melanj.
a Earth and Space Science- explains Earth's
• Syans late ak espas- esplike chanjman Id eel
changes over time including geologic patterns,
the rock cycle, minerals and weather systems;
• Clenclas de he Tierra y el espacio explican
los cambios de la Tierra a craves del tempo.
sou Late ane apre ane, sa vie di aktivIle
fewolojik, faz with. sistern mineral ak sistern
also describes the solar system and universe.
incluyendo los patrones geoiogicos, el tido de
las rocas. minerales y sistemas
larneteyo a. epi li debt sislem sole a ak inive a.
• Life and Environmental Science identifies
rneteorolOgicos; tambien describen el sistema
Syans biyolojik sk anviwonmen idantlye
and explains plants, animals, and the
solar y el universo.
• epi esplike plant, bet. ak anviwonman an, sa
environment, including lite processes.
vie di yrrosesis biygobjik, konsevasyon resous
conservation of resources, and the
• Clenches de he vide y el medio ambiente
yo, ak entedepandans Oganis ak skstem yo.
interdependence of organisms and systems.
Identilican y explican las piantas, animates y
el medio ambiente, incluyendo bs procesos
Rezonman syantifik- itilize pwosede syantilik
• Scientific Thinking- applies scientific
shales. la conservation de recursos y la
• pou rezoud pwoblem, rekonet regilarite aft
processes to problem solving, recognizes
interdependenica de organismos y sistemas.
sister?), epi konprann enpak teknolo8 sou
patterns and systems. and understands the
lasosyete.
Impact of technology on society.
• Pensarniento cient•Ico- apica procesos
cientlficos a la resolucien de problemas,
reconoce patrones y sistemas, y comprende
el impacio de la tecnoiogia en la sociedad.
Data Run Oafs: OR2S2004
005763
EFTA01709607
FCAT
Fhwil:le Compitheniive Assessmenl hit
Spring 2004
Florida Comprehensive Assessment Test (FCAT)
SUNSHINE STATE STANDARDS
Science Performance Task Student Report
Grade 10
This report provides your results on the FCAT 2004 Science
performance tasks. each pedOrmance task on FCAT requires you to
respond with either a short response or a longer, more detailed
response. Short-response tasks are scored on a 2-point rubric and
extended-response tasks are soared on a 4-point rubric.
One of the short-response tasks is shown below with a copy of your
answer. The number of points you earned for your answer is shown
in the box to the right.
nil= al N6 Is cwwwwliintS (um rises dry nowt and smart with each abet
l&efeelieloole Pas el the World
Detialtit • setkick net •rd • ralock lormition eat car. ant rites Oaks cot&
FCAT 2004
SCIENCE PERFORMANCE TASKS
Student Name
Student Number
School Name
School Number
District Name
District Number
PALM BEACH
50
This Performance
Tags Response
AN Science
Performance Task
Responses
Points Possible
2
10
Points Earned
1
5
Data Run Date: 04712004
0054284
685000618
EFTA01709608
FCAT
Florida Comprehensive Assessment Test
Spring 2004
Florida Comprehensive Assessment Test (FCAT)
Writing
Grade 10 Student Report
Writing to Convince
NAME: =WI
ID:
SCHOOL:
DISTRICT: 50-PALM BEACH
SCORE:
5.0
How Papers Are Scored
The student responses are scored by trained readers using the holistic method to evaluate
a piece of writing for its overall quality. The readers consider four elements: focus,
organization, support, and conventions. In this type of scoring, readers make a judgment
about the entire response and do not focus on any one aspect of the writing.
Focus refers to how clearly the paper presents and maintains a clear main idea,
theme, or unifying point. Papers representing the higher end of the point scale
demonstrate a consistent awareness of the topic and do not contain extraneous
information.
Organization refers to the structure or plan of development (beginning, middle,
and end) and whether the points are logically related to one another. Organization
also refers to (I) the use of transitional devices to relate the supporting ideas to the
main idea, theme, or unifying point and (2) the evidence of a connection between
sentences. Papers representing the higher end of the point scale use transitions to
signal the plan or text structure and end with summary or concluding statements.
Support refers to the quality of the details used to explain, clarify, or define. The
quality of the support depends on word choice, specificity, depth, and
thoroughness. Papers representing the higher end of the point scale provide
examples and illustrations in which the relationship between the supporting ideas
and the topic is clear.
Conventions refers to punctuation, capitalization, spelling, and variation in
sentence structure used in the paper. The conventions are basic writing skills
included in Florida's Sunshine State Standards. Papers representing the higher end
of the point scale follow, with few exceptions, the conventions of punctuation,
capitalization, and spelling and use a variety of sentence structures to present
ideas.
Dear Student:
The paper you wrote in February as part of the FCAT has been read
independently by two people trained to score this test. Each reader
judged the paper against standards set by Florida educators and gave it
an overall score. Your score is the average of the two readers' scores.
This writing score will help you, your parents or guardians, and your
teachers understand how well you performed on this statewide writing
test. A description of how papers are scored is printed on the left side
of this report. A description of each possible score is printed on the
back of this report.
Remember, you were given 45 minutes to read the assigned topic. plan
what to write, and then write your response.
The conditions under
which you write papers in class or at home may not be the same as
those for this test: therefore, the writing may not be the same. You and
your teachers should consider the score on this test along with all of
your other writing when planning activities to continue developing
your writing skills.
DESCRIPTION OF THE TOPIC:
You were asked to persuade community leaders whether
to set a weekend curfew.
Data Run Date: 04/07/04
50-2331
EFTA01709609
Description of Grade 4 Writing Scores
6.0: The writing focuses on the topic. is logically organized. and
includes ample development of supporting ideas or examples.
It demonstrates a mature command of language. including
precision in word choice. Sentences vary in structure.
Punctuation, capitalization, and spelling arc generally correct.
53: The writing was given a 5 by one reader and a 6 by the other
reader.
5.0: The writing focuses on the topic with adequate development of
supporting ideas or examples. It has an organizational pattern.
though lapses may occur. Word choice is adequate. Sentences
vary in structure. Punctuation. capitalization, and spelling are
generally correct.
4.5: The writing was given a 4 by one reader and a 5 by the other
reader.
4.0: The writing generally focuses on the topic. though it may
contain extraneous information. An organizational pattern is
evident, but lapses may occur. Some supporting ideas contain
specifics and details, but others are not developed. Word
choice is adequate. Sentences vary somewhat in structure.
though many are simple. Punctuation, capitalization, and
spelling are usually correct.
33: The writing was given a 3 by one reader and a 4 by the other
reader.
3.0: The writing generally focuses on the topic. though it may
contain extraneous information. An organizational pattern has
been attempted. but lapses may occur. Some of the supporting
ideas or examples may not be developed. Word choice is
adequate. Sentences vary somewhat in structure, though many
are simple. Punctuation and capitalization are sometimes
incorrect, but most commonly used words are spelled correctly.
2.5: The writing was given a 2 by one reader and a 3 by the other
reader.
2.0: The writing may be slightly related to the topic or offer little
relevant information and few supporting ideas or examples.
There is little evidence of an organizational pattern. Word choice
may be limited or immature. Sentences may be limited to simple
constructions. Frequent errors may occur in punctuation,
capitalization, and spelling.
1.5: The writing was given a I by one reader and a 2 by the other
reader.
1.0: The writing may only minimally address the topic because there is
little or no development of supporting ideas or examples. No
organizational pattern is evident. Ideas are often provided through
lists, and word choice is limited or immature. Unrelated
information may be included. Frequent errors in punctuation,
capitalization, and spelling may impede communication.
U: The writing is unrelated to the assigned topic or cannot be read.
Description of Grade 8 Writing Scores
6.0: The writing focuses on the topic, is logically organized, and
includes substantial development of supporting ideas or
examples. It demonstrates a mature command of language,
including precision in word choice. Sentences vary in
structure. There are few, if any, usage, punctuation, or spelling
errors.
5.5: The writing was given a 5 by one reader and a 6 by the other
reader.
5.0: The writing focuses on the topic with ample development of
supporting ideas or examples. It has an organizational pattern.
though lapses may occur. It demonstrates a mature command
of language. Sentences vary in structure. Punctuation,
capitalization, and spelling are generally correct.
4.5: The writing was given a 4 by one reader and a 5 by the other
reader.
4.0: The writing generally focuses on the topic, though it may
contain extraneous information. An organizational pattern is
evident, but lapses may occur. Some supporting ideas contain
specifics and details, but others are not developed. Word
choice is adequate. Sentences vary somewhat in structure.
though many are simple. Punctuation, capitalization, and
spelling are usually correct.
33: The writing was given a 3 by one reader and a 4 by the other
reader.
3.0: The writing generally focuses on the topic, though it may
contain extraneous information. An organizational pattern has
been attempted. but lapses may occur. Some of the supporting
ideas or examples may not be developed. Word choice is
adequate. Sentences vary somewhat in structure, though many
are simple. Punctuation and capitalization arc sometimes
incorrect, but most commonly used words arc spelled correctly.
2.5: The writing was given a 2 by one reader and a 3 by the other
reader.
2.0: The writing may be slightly related to the topic or offer little
relevant information and few supporting ideas or examples.
There is little evidence of an organizational pattern. Word
choice may be limited or immature. Sentences may be limited
to simple constructions. Frequent errors may occur in
punctuation, capitalization, and spelling.
1.5: The writing was given a I by one reader and a 2 by the other
reader.
1.0: The writing may only minimally address the topic because there is
little or no development of supporting ideas or examples. No
organizational pattern is evident. Ideas are often provided through
lists, and word choice is limited or immature. Unrelated
information may be included. Frequent errors in punctuation,
capitalization, and spelling may impede communication.
Description of Grade 10 Writing Scores
6.0: The writing focuses on the topic, is logically organized, and
includes substantial development of supporting ideas or
examples. It demonstrates a mature command of language with
freshness of expression. Sentences vary in structure. There are
few. if any, usage• punctuation, or spelling errors.
53: The writing was given a 5 by one reader and a 6 by the other
reader.
5.0: The writing focuses on the topic, is logically organized, and
includes ample development of supporting ideas or examples.
It demonstrates a mature command of language. Sentences
vary in structure. Usage, punctuation, and spelling are
generally correct.
4.5: The writing was given a 4 by one reader and a 5 by the other
reader.
4.0: The writing focuses on the topic, though it may contain loosely
related information. An organizational pattern is apparent.
Some of the supporting ideas contain specifics and details, but
others do not. Word choice is adequate. Sentences vary in
structure. Usage, punctuation. and spelling are generally
correct.
3.5: The writing was given a 3 by one reader and a 4 by the other
reader.
3.0: The writing generally focuses on the topic, though it may
contain loosely related information. An organizational pattern
is demonstrated. Development of the supporting ideas may be
uneven. Word choice is adequate. There is some variation in
sentence structure. Usage, punctuation. and spelling are
generally COMO.
2-5: The writing was given a 2 by one reader and a 3 by the other
reader.
2.0: The writing addresses the topic. though it may lose focus by
including extraneous information. An organizational pattern is
demonstrated. Development of the supporting ideas may be
nonspecific. Word choice may be limited. Frequent errors may
occur in sentence construction, usage, punctuation, and spelling.
IS: The writing was given a I by one reader and a 2 by the other
reader.
1.0: The writing addresses the topic, though it may lose focus by
including extraneous and loosely related ideas. The organizational
pattern is weak. Ideas arc often presented through lists and limited
or inappropriate word choice. Frequent errors may occur in
sentence construction, usage, punctuation, and spelling.
U: The writing is unrelated to the assigned topic or cannot be read.
U: The writing is unrelated to the assigned topic or cannot be read.
ISO1409
EFTA01709610
THE SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC)
New and Returning Student Registration
NEW STUDENTS: Complete all non-shaded areas on both sides of the form.
RETURNING STUDENTS: Review both sides. If the pre-printed information is incorrect, correct the information by carefully and lightty
ctossing out the incorrect information and wilting the correct information above it
(1) STUDENT NUMBER
DIST:2451 TOP
061 STDT
CRS:2100010
SEC:01
BL06:01 RM:172
08/16/01
(3) mucous LEGAL NAME put Aril mdde)
(4) ALSO KNOWN AS
(5) LOCAL ADDRESS (Aaneno. s steer risme)
WI no)
(cry)
(stay)
( ,i, code)
LOXAHATCHEE FL 33470
(6) MAKING ADDRESS (house no a flee nuns)
OS Po I
WO
Is!**)
(zip coda)
(7) SOCIAL SECURITY NO 0050060 (8) HOME TELEPHONE NO (9) SEX
F
(10) RACES-WPC ORIGIN
M
0 I-American Indian/Alaskan Native 0 8-Black. Non-Hispanic
0 H-Hispanic
0 A-Asian/Pacific Islander
0 W-White, Non-Hispanic
0 M-Multiracial
(11) GATE OF BIRTH
(540.500NYYY)
(12) PLACE OF BIRTH (oty, state. county)
IL
US
ILLINOIS
(13) RESOENT STATUS
3
0 0. Foreign Exchange Student
0 1. Out-of-county Resident
0 2. Out-of-state Resident
0 3. In-county Resident
(14) USA ENTRY DATE
(MIA00/Yrry)
(15) FEDERAL IMPACT SURVEY
YES NO
0
0
A. The student resides on federal ptoperly.
•
C
8. The student resides in low rent housing.
0
0
C. The parent is employed on federal property located in P.8. County.
0
0
D. The parent is employed on low rent housing located in P. B. County.
00
E The parent is in the uniformed services of the United States.
0
0
If E. is YES. is the parent on active duty? Check service below:
0 Air Force 0 Army 0 Coast Guard • Marines O National Guard 0 Navy
(16) PRESCHOOL ENROLLMENT iNFORmAT)ON
m
Place an X by each program attended. Aisll. indicate with
an asterisk (') the program your child was in the longest.
0 N Non-subsidized Child Care 0 M. Migrant Pre-K
0 O. Pre-K Disabilities
0 H. Headstart
0 I. Pre-K Early Intervention
0 C. Chapter I
0 S. Subsidized Child Care
• 0. Other
(17) LS THE STUDENT A
PARENT?
SIN
NO
0 YES 0 NO
05) CURRENT GRADE LEVEL
08
TRANSFER INFORMATION
(19) NAME OF SCHOOL TRANSFERRING FROM
520) CITY OR LOCAT)ON
(21) LAST ATTENDANCE DATE
(1S) LAST GRADE LEVEL
(23) LAST PUBLIC SCHOOL ATTENDED IN PALM BEACH COUNTY
(24) DATE ATTENDED IN PBC
HEALTH SCREENING INFORMATION
FREE OR REDUCED
PRICE LUNCH
(25) Students will receive non-invasive health screenings pursuant to Florida Statute 381.0056(7)(d) Non-invasive
screenings may include vision, hearing, sodas*. height. and weight. These tests may be given individually or
in groups. Parents or guardians, however, have the right to request an exemption in writing Ifau100 NOT
want your child to receive the screenings, write the words' o not screen" here'
NOT SCREEN
iv) Have you filled cut an
application for free and
reduced lunch?
•
YES 0 NO
(Application is provided
with this form)
(This exemption wit cover al types of screenings)
(26) I give permission for my child to participate in the sodium fluoride program to prevent tooth decay. E YES C NO
(permission is valid through 6th grade)
NO
NEW STUDENTS TO PALM BEACH COUNTY
(28) HOME LANGUAGE SURVEY
YES NO
•
•
1. Is a language other than English used in the home?
If YES, what language?
0
0
2. Does the student have a first language other than English?
If YES, what language?
0
0
3. Does the student most frequently speak a language other than English?
If YES, what language?
R9) 4. What language is spoken in the home by the parent or guardian?
(30) 5. What language is the students first language?
(31) What is the date of entry Into an ESOL program?
0
032) silken LNES WITH (check one)
Mother 0 Father
0 Both Parents
0 Other
(33) DISCLOSURES FOR ENTRY INTO PBC SCHOOL DISTRICT
YES NO
0
0 I. Has the student ever been e,pelled from school?
0
0
2. Has the student ever had an arrest resulting in a charge?
0
0
3. Has the student ever had any Juvenile Justice actions?
(31) CUSTODY STATUS OF STUDENT (check one)
•
Mother 0 Father El Shared Custody
0 Other
MN Is there a court order barring either parent from removing or contacting the student during the school day?
.0 YES
0 NO
If YES, provide the school with a copy of the court order.
PESO 0636 (REV. 5/29/2001)
page 1 of 2
EFTA01709611
THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION
(36) FATHER OR LEGAL GUARDAN first rmcWe Hap SAD
IIIIIII
IIIII
PU: Y
giimOR4211 OR LEGAL GUARDIAN (last mAMM nee! WV
PU: Y
ADDRESS (steel numbs. Ova nano, imwbnent number)
ADDRESS (OW number. fl eet name aptalment numb*')
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
OCCUPATION
OCCUPATION
PLACE Of EMPLOYMENT
PLACE OF EMPLOYMENT
NOME TEL
BUSINESS TELEPHONE
6
...4(bAGER NUMBER
HOME TELEPNCNE
BUSINESS TELEPHONE
CELUPETCR NUMBEfr
EMAIL ADDRESS (44P4440
EMAIL ADDRESS foptcrer)
EMERGENCY HEALTH AND SAFETY INFORMATION
Person(s) other than parent authorized to pick up student
isisi PASSWORD (krnt 10 characters)
(39) NAME (leg middle ,Thtet 430
OR
(41) NAME (Int middle neat MO
ADORESS (OW numbs; awe nem, •Pein*Ilf numbs')
ADDRESS 011.0 number. SFR name. 'prima,' twritkvi
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
TELEPHONE
RELATIONSHIP
(40) AUTHORIZED FOR
EMERGENCY PCKUP
•
YES 0 NO T
TELEPHONE
RELATIONSHP
OTHER
(42) AUTHORIZED FOR
EMERGENCY PICKUP
•
YES 0 NO T
(43) If school personnel are unacce to contact you in case of illness or accident.
(44) MECCA& INFORMAT
MI satienws irre:34I. bresov.x, hoc",
ION
spot
bintsbora)
may we have your permission to call your doctor or
emergency services (91 ) for transport to the hospdal?
il YES 0
NO
issuin.
mectocabons. or tts physar
(45) FAMILY PHYSICiAN
(46) PHYSCIAN PHONE
(48) Does your child currently have
health Insurance? 0 YES 0 NO
If YES. Indicate
(47) HOSPITAL PREFERENCE
p Medicaid
0
Private
•
Healthy Kids, l60 Care
ID interested In receiving information
PARENTS/GUARDIAN'S OTHER CHILDREN IN PALM BEACH COUNTY SCHOOLS
(49) NAME OF CHILD twat m404. 440
SCHOOL ATTENDING
STUDENT NO pcNINNTO
GRADE
DATE OF BIRTH
(50) NAME OF CHILD (Ent middle. MO
SCHOOL ATTENDING
STUDENT NO (optKAN)
DRAM
DATE OF BIRTH
(51) NAME OF CHILD (hat middle MAD
SCHOOL ATTEKONG
STUDENT NO POP HO
(-inn;
DATE OF BIRTH
(52) NAME OF CHILD (Ent middle. HAD
SCHOOL ATTENDING
STUDENT NO (c9bons0
GRADE
DATE OF BIRTH
PARENT/GUARDIAN SIGNATURE
I verify that the information given
is true and accurate to the best of
my knowledge.
FOR OFFICE USE ONLY
(53) SOT NO
2451
(54) STUDENT NO
(5$) OCR
51) ENTRY CO
US
I
E01
(57) ENTRY OAT
08/14/01
MI GP IN
08
(59)CIL
01
( CO) TEACHER NO
(51) REASSIGN CODE
KZ TRAKSPORTADDI
0
PBC Bus a
D Pakn Tran
03)894114 VERF
1 2 3 4 51
(64) HAS
A
0
Parent/Student Trans
•
Walk
•
Base
6 7 8 9T
B 2
(65) Din arNTATION CITECKLIST (PHI aNS Ple alum tserNE
0
Immunizations (date)
0
Birth Records Verif. (date)
a Soc. Sec. No. (date)
0
Physical Exams (date)
okjOATA ENTRY OnakElID BY
DATE
u
DATE
PBSD 0636 (REV. 4/920015/29/2001)
EFTA01709612
a-e./C 01- fig' , I)
02-/ 6-4
0 -1 411
64) icia)
712V
n C V
6*,
Pe-Gas-via-
4O ./ I be 6 Litt
W-
4-6 chb . Thy_ iek it9 tibia-
;
to
Car
a./,re ht nioriced
m
Cal phone Mt
t9-7t-k
etc.
EFTA01709613
THE SCHOOL DISTRICT OF PALM BEACH COUNTY
1998-1999 END-OF-YEAR RE OR for GRADES 1-5
tudent
Grade
Principal
This school year, your child:
cv did not have an Academic Improvement Plan (AIP)
had an individual Academic Improvement Plan (AIP) for:
0
reading
0
writing
K mathematics
This AIP identified remediation strategies used to assist your child this year. Your child
may need another AIP next school year.
Ass
of your child's performance this school year, your child is being recommended for:
Promotion to the next grade level
O Retention in the same grade level
K
Administrative Placement to the next grade level
K
Summer School (for Limited English Proficient students)
O Extended School Year (for Exceptional Student Education students)
O
2.5 Summer Reading Program (for retained second grade students)
O
5.5 Transition Program (for fifth grade students with Administrative Placement to grade 6)
K
Other (Specify):
In a continuing effort to keep you informed, this report is being provided to notify you of your
child's progress toward meeting the school district's levels of performance in reading, writing, and
mathematics. Your child's end-of-year performance level in reading, writing, and mathematics
is identified below:
READING
O
Above grade level
EV- At grade level
K
Below grade level'
K
Substantially below
grade level**
WRITING (COMPOSITION)
El Above grade level
[ThAt grade level
O
Below grade level*
K
Substantially below
grade level—
MATHEMATICS
Above grade level
At grade level
Below grade level'
Substantially below
grade level—
If below grade level has been indicated for reading, writing, and/or mathematics, you may
be asked to participate in the development of a plan to improve your child's academic
performance. This plan will be developed at the beginning of the 1999-2000 school year.
" If substantially below grade level has been indicated for reading, writing, and/or
mathematics, you will be asked to participate in the development of a plan to improve your
child's academic performance. This plan will be developed at the beginning of the 1999-2000
sc ool year.
eacher Signature
Date
PBSD
4 FY00 Printing
White/Cumulative Folder
Yellow/school Use
Pink/Report Card
EFTA01709614
THE SCHOOL DISTRICT OF PALM BEACH COUNTY
Grade
ELEMENTARY REPORT CARD
E - Excellent
V - Very Satisfactory
A
B
C
D
F
Year 19 98 -19 99
Student
Teacher
MARKING CODES - ACADEMIC SUBJECTS
GRADES 1 and 2
S - Satisfactory
N - Needs Improvement
GRADES 3-5
- Outstanding (94% - 100%)
- Above Average (85% - 93%)
- Average (77% - 84%)
- Below Average (70% - 76%)
- Failing (0% - 69%)
- Incomplete
ACADEMIC SUBJECTS
Marking Period
ist
2nd
3rd
4th
I Mathematics .frec.,arr eve. with ache:.
,_.
On or above grade level
Below grade level
A
&e. ti
V
.4
✓__
.43
I,.
_✓
_
.60
V
Reading .rndcarc .eve A '' a tree
i
On or above grade level
I
Below grade level
8
V''' .8
fre... Ei
1,'....' -0
V
Composition
3
3,6 3.5'
-(1
Language
.,
Spelling
)
1 Handwriting/Penmanship
Social Studies
c...
i Science/Health
.F5 13 C
• Grades not given this nine weeks
MARKING CODES - FINE ARTS
3 - Outstanding effort and participation
2
Satisfactory effort and participation
1 - Inadequate effort and participation: parent conference
requested
FINE ARTS REPORT
Marking Period
1st
2nd
3rd
4th
3
3
Art
Music
_3 33
Physical Education
3
3 ,3
School
_
Principal
SOCIAL DEVELOPMENT/CLASSROOM STUDY HABITS
Please work on the area(s) that have a check (I).
Marking Period
1st
2nd
3rd
4th
Overall effort
Works cooperatively
Works independently
Completes classwork on time
1.,"
Completes homework on time
V
1-7
Follows classroom rules and
routines
Uses time wisely
Follows directions
Accepts responsibility for own
actions
Comes to class prepared with
materials
ALTERNATE ASSESSMENTS
Indicate thoSe used with a check (I)
Marking Period
1st
2nd
3n1
4th
Skills Checklist(s)
Portfolio
V
V
V
i.---•
Audio Cassette Recording
Video Recording
Computer Program
7
V
V
I,
Standardized Test(s)
V
V
V
,,/
ObservationsMiritten Comments
V
V
V
tr."
Other
ATTENDANCE
Regular attendance and punctuality
are essential for quality education.
Days Present
Days Absent
Days Tardy
Information Included
Marking Period
PLACEMENT •
PARENT/GUARDIAN/TEACHER
CONFERENCE
Grade
Special Session
Marking Period
1st
2nd
and
4th
• If Special Session program is indicated, grade placement will
be determined by the Nome school.
Conference conducted (Indicate datets))
PBSD 0768 (Rev. 6/98)
Goldenrod/1st Period
Pink/2nd Period
Canary/3rd Period
Green/4th Period
White/Office Copy
EFTA01709615
THE SCHOOL DISTRICT OF PALM BEACH COUNTY
Grade Sh
ELEMENTARY REPORT CARD
Year 19 9 7 -19 9 8
Student
Teacher
MARKING CODES - ACADEMIC SUBJECTS
GRADES 1 and 2
E - Excellent
S - Satisfactory
V - Very Satisfactory
N - Needs Improvement
A
B
C
D
F
GRADES 3.5
- Outstanding (94% - 100%)
- Above Average (85% - 93%)
- Average (75% - 84%)
- Below Average (65% - 74%)
- Failing (0% - 64%)
- Incomplete
ACADEMIC SUBJECTS
Marking Period
1st
2nd
3rd
4th
(3
Mathematics (Imitate level vet, a check)
On or above grade level
Below grade level
B
V
[2)
kr ce
- V - 1
-
Reading finthcate kvel wen a check)
On or above grade level
Below grade level
Pi _bB.
V
l/
V/
.
PC_
Composition
Lt
Language
i t
Spelling
I
Handwriting/Penmanship
Social Studies
g i
Science/Health
A
Grades not given this nine weeks
MARKING CODES • FINE ARTS
3 - Outstanding effort and participation
2 - Satisfactory effort and participation
1 - Inadequate effort and participation; parent conference
requested
FINE ARTS REPORT
Marking Period
to
2nd
3rd
4th
Art
Music
3
.3
Physical Education
3 3
School
Principal J
SOCIAL DEVELOPMENT/CLASSROOM STUDY HABITS
Please work on the area(s) that have a check (I).
Marking Period
1st
2nd
3rd
4th
Overall effort
Works cooperatively
V
/
Works independently
Completes classwork on time
/
l.,
/
Completes homework on time
t./ /
/
Follows classroom rules and
routines
Uses time wisely
ti
7
Follows directions
Accepts responsibility for own
actions
Comes to class prepared with
materials
ALTERNATE ASSESSMENTS
Indicate those used with a check (!)
Marking Period
in
2nd
3rd
4m
Skills Cheddist(s)
Portfolio
Audio Cassette Recording
Video Recording
Computer Program
Standardized Test(s)
ObservationsNVritten Comments
Other
ATTENDANCE
Regular attendance and punctuality
are essential for quality education.
Marking Period
to
2nd
3rd
4th
Days Present
71}
i
t
1
- 2
I
Days Absent
Days Tardy
Information Included
V
V
PLACEMENT •
PARENT/GUARDIAN/TEACHER
Marking Period
CONFERENCE
Grade V
Special Session
in
3rd
4th
• if Special Session program is indicated, grade placement win
be determined by the home school.
I Conference conducted [Indicate date(s)]
PBSD 0768 (Pilot FY 95)
Goldenroditst Period
Plnk/2nd Period
Canary/3rd Period
Green/4th Period
White/Office Copy
EFTA01709616
Student
Teacher
THE SCHOOL DISTRICT OF PALM BEACH COUNTY
Grade 3
ELEMENTARY REPORT CARD
MARKING CODES - ACADEMIC SUBJECTS
GRADES 1 and 2
E - Excellent
S - Satisfactory
V - Very Satisfactory
N - Needs Improvement
GRADES 3-5
A
Outstanding (94% - 100%)
B - Above Average (85% - 93%)
C
Average (75% - 84%)
D
Below Average (65% - 74%)
F
Failing (0% - 64%)
I
Incomplete
ACADEMIC SUBJECTS
Marking Period
ist
Ind
3rd
41/‘
Mathematics (wan MW at a McNQ
On or above.
Below grade le - ', .-
Reading (nchcare level wrth a check/
On or above grade level
Below grade level .•
Composition
Language
Spelling
Handwriting/Penmanship
Social Studies
Science/Health
A
• Grades not given this nine weeks
MARKING CODES - FINE ARTS
3 - Outstanding effort and participation
2 - Satisfactory effort and participation
1 - Inadequate effort and participation; parent conference
requested
FINE ARTS REPORT
Marking Period
in
2nd
3rd
ati,
Art
3a
5_
:
Music
1
Physical Education
3
3 s
PARENT/GUARDIAN/TEACHER
CONFERENCE
Marking Period
lit
2nd
3rd
4th
Conference conducted [Indicate clarets))
School
Principal
Year 1996
-19 97
Ma=
n
SOCIAL DEVELOPMENT/CLASSROOM STUDY HABITS
Please work on the area(s) that have a check (I).
Marking Period
let
2nd
1rd
4th
—Overall effort
Works cooperatively
Works independently
Completes classwork on time
/
Completes homework on time
Follows classroom rules and
routines
Uses time wisely
Follows directions
Accepts responsibility for own
actions
Comes to class prepared with
materials
ALTERNATE ASSESSMENTS
Indicate those used with a check (i).
Marking Period
lit
2nd
3rd
4th
Skills Checklist(s)
Portfolio
/
/1
/
Audio Cassette Recording
Video Recording
Computer Program
Standardized Test(s)
Observations/Written Comments
i
V
1111 V
Other
V
V
ATTENDANCE
Regular attendance and punctuality
are essential for quality education.
Meriting Period
In
raid
3rd
lth
Days Present
Days Absent
fl
tl
iii
Days Tardy
Information Included
PLACEMENT •
Grade
Special Session
• If Special Session program is indicated. grade placement will
be determined by the home school.
PBSD 0768 (Rev. 7194)
Goldenrod/1st Period
Plnk/2nd Period
Canaryr3rd Period
Gnmord4th Period
WhIte/OffIce Copy
EFTA01709617
SCHOOL BOARD OF PALM BEACH COUNTY
Notice of Student with Special Characteristics
PLEASE PLACE THIS NOTICE IN THE STUDENT'S CUMULATIVE RECORD
IL NAME OF STUDENT
Please check 2 in pencil each of the information items below which are accurate for
this student. When changes occur please update by adding or erasing check marks as
appropriate. Please sign and date each time the information on this page is changed.
ErIcychological evaluation has been completed.
Student is being processed for placement in an exceptional student program.
Student has been staffed for an exceptional student program but has not been officially placed.
Student has been placed in a full-time exceptional student program.
List:
Student has been placed in a part-time exceptional student program.
List:
K
Student has been referred for attendance problems.
O Dispensing of medication during the school day has been authorized.
K
Evidence regarding high risk medical condition is in folder.
ID Student has been referred to the Community Mental Health Center.
El Student has been referred to community agencies for service.
El Migrant Student
El Other
This page has been updated
OV
4a97
a5-
BY:
PBSD 0269 (REV. 1/88)
EFTA01709618
FLORIDA CERTIFICATION OF IMMUNIZATION
Legal Authority: FLORIDA STATUTES 232.032, s. 10D-3.088, F.A.C. and s. 10M-12, F.A.C.
LAST NAME
PARENT OR GUARDIAN
FIRST
MI
DOB
MCYDAAR
Child's SS# (optional)
STATE IMMUNIZATION Mal
Directions:
•
Enter all appropriate doses and dates below.
•
Sign and date appropriate certificate (A-1, A-2, B, or C) on reverse side of form.
•
If the child is presenting for the 7th grade requirement only and has previously filed a Certificate of Immunization (680A
or 680A-1) with their current Florida school, fill in boxed areas below and complete Part A-2 on the reverse side of this
form.
•
For additional information: Sec Immunization Guidelines for School and Child Care Facilities for information and
instructions on form completion and immunization requirements. Guidelines are updated annually and arc available
from the local county health department.
VACCINE
DTaP/DTP2
DT'
Td4
PoHos
HIB6
MMR (Combined)9
(Separate)*
DOE
Dose S
Dose 2
Dose 3
Dosc 4
Dose 5
Hepatitis B9
F PON
rr
•
The state immunization ID# is an identifier supplisby the state immunization registry (optional).
2
DTP 5 doses required. If the fourth primary dose is administered on or after the fourth birthday a fifth dose
is not required. DTaP is an acceptable alternative for one or more doses of DTP.
3
DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis
contraindication.)
4
Td (Adult) Vaccine is recommended for children 7 years of age or older.
5
Polio 4 doses required. If the third dose is administered on or after the fourth birthday, a fourth dose is not
required. IPV is an acceptable alternative for one or more doses of OPV. Polio vaccine is not required for children 18
years of age or older.
6
Hib is required for child cart and preschool entry and attendance only.
7
1st dose valid if given on or after 1st birthday. Second dose (measles) valid if given at least 1 month after 1st dose.
A second dose of measles (preferably MMR) is required for students in grades K-4 in the 1997-98 school year, and
7th grade entry and attendance effective with the 1997/98 school year. In each subsequent year thereafter, the next
highest grades arc included.
Includes single measles vaccine (G), single mumps vaccine (H) or single rubella vaccine (I).
9
Hepatitis B vaccine series is required for seventh grade entry and attendance effective with the 1997-98 school year and
kindergarten entry and attendance effective with the 1998-99 school year. In each subsequent year thereafter, the next
highest grades arc included.
EFTA01709619
LAST NAME
BAST
MI
DOB (NtO/DANR)
Certificate of Immunization for K-12 Excluding 7th Grade Requirements
PART A-1 (Immunizations are complete for school entry and attendance grades kindergarten through 12 with the exception of
the 7th grade requirement.) DOE Code 1
I have reviewed the records available, and to the best of my buiwledge, the above named child has been adequately immunized against
diphtheria, tetanus, pertussis polio, measles, mumps, rubella and hepatitis B (for kindergarten effective with the 1998/99 school year) for
school attendance as documented on the reverse side of this form.
Physician or Clinic Name:
(Print or stamp)
Address:
couwAtowes. FL 994.70
Physician or
Authorized Signature:
Certificate of Immunization Supplement for 7th Grade Requirement
PART A-2 (Immunizations are complete for students who enter or attend the 7th grade after the beginning of the 1997/98
school year. Each subsequent year thereafter, tll next highest grade will be included in the requirement.) DOE Code 8
I have reviewed the records available, and to the best of my low
the above named child
ceived the following immunizations
required for entry and attendance in 7th grade effective with the 1997.98 schoo
iphtherig booster, hepatitis B vaccine series,
and second dose of measles vaccine as documented on the reverse side of this fo
a.red area
'
Physician or Clinic Name:
(Print or stamp)
?Po
Address:
Physician or
Authorized Signature:
Temporary Medical Exemption
PART B (For preschool children, children in day care and school children who are incomplete for immunizations in Pan A-1
or A-2.) Invalid without expiratio date. DOE Code 2
I cent ifir that the above named child has recce
the immunizations docum
e reverse side of this form and has commenced a schedule to
complete the required immunizations. Additiona
munizations
.t medically indicated at this time.
e
Physician or Clinic Name:
(Print or stamp)
Address:
Expiration Date:
(15 days after ant inuntuthafteei appointment)
hvsician or
ignature:
Permanent Medical Exemption
PART C For medically contraindicated immun
exemption: DOE Code 3
tions, list each vaccine and state valid clinical reasoning or evidence for
I certify that the physical condition of this child is such that immun.
((s) as
icated in Part C above is medically contraindicated.
Physician or Clinic Name:
(Print or stamp)
Address:
Physician Sign
re:
C41 680, II/96. obsolete* eel
echunra (Sack Nernter 5740-000-0660.6)
EFTA01709620
FLORIDA CERTIFICATION OF IMMUNIZATION
Legal Authority: sections 232.032, 402.305, 402.313, Florida Statutes;
rules 64D-3.011, 65C-22.006, 65C-20.011, Florida Administrative Code
LAST NAME
PARENT OR GUARDIAN
FIRST NAME
MI
DOB
MO/DA/YR
CHILD'S SS# (optional)
STATE IMMUNIZATION ID#'
Directions:
•
Enter all appropriate doses and dates below.
•
Sign and date appropriate certificate (A-I, A-2, B, or C) on reverse side of fem.
•
If the child is presenting for the 7th grade requirement only and has previously filed a Certificate of Immunization (DH 680, Part A-I)
with their current Florida school, fill in boxed areas below and complete Part A-2 on the reverse side of this form.
•
For additional information: See Immunization Guidelines for Sch0ol andChild Care Facilities for information and instructions on form
completion and immunization requirements. Guidelines are available from the local county health department.
VACCINE
DTaP/DTP'
DT'
Td'
Polio`
Hib'
MMR (Combined)'
(Separate)"
Hepatitis B'
Varicella"
Varicella Disease
I
The state immunization ID# is an identifier supplied by the state immunization registry (optional).
2
DTP/DTaP 5 doses required. If the 4' primary dose is administered on or after the 4th birthday a 51" dose is not required.
3
DT (pediatric) is acceptable if pertussis vaccine is medically contraindicated. (Complete Part C for pertussis contraindication.)
4
Td (Adult) vaccine is recommended for children 7 years of age or older.
S
Polio 4 doses required. If the 3'd dose in an all OPV or all IPV series is administered on or after the 4th birthday, a 4th dose is not
required. Polio vaccine is not required for children 18 years of age or older.
6
I lib is required for child care, family day care and preschool entry and attendance only.
7
First dose valid if given on or after I" birthday. Second dose (measles) valid if given at least I month after I" dose. A 2nd dose of
measles (preferably MMR) is required for students in grades K-6 and 7th grade entry and attendance effective with the 1997/1998
school year. In each subsequent year thereafter, the next highest grades are included.
8
Includes single measles vaccine (G), single mumps vaccine (H) or single rubella vaccine (1).
9
Hepatitis B vaccine series is required for 7th grade entry and attendance effective with the 1997/1998 school year and kindergar-
ten entry and attendance effective with the 1998/1999 school year. In each subsequent year thereafter, the next highest grades are
included. Hepatitis B vaccine series is required for preschool entry and attendance effective with the 2001/2002 school year
10
Varicella vaccine is required for entry and attendance in preschool and kindergarten effective with the 2001/2002 school year. In
each subsequent year thereafter, the next highest grades are included. Susceptible children 13 years of age or older should
receive 2 doses, given at least 4 weeks apart. Varicella vaccine is not required if child has documentation of history of varicella
disease.
EFTA01709621
LAST NAME
J
FIRSi
MI
DOB (MO/DA/YR)
Certificate of Immunization for K-12 Excluding 7th Grade Requirements
PART A-1 (Immunizations arc complete for school entry and attendance grades kindergarten through 12 with the exception of
the 7th grade requirement.) DOE Code 1
I have reviewed the records available. and to the best of my knowledge. the above named child has been adequately immunized against
diphtheria, tetanus, pertussis. polio. measles, mumps. rube a and hepatitis B (for kindergarten effective with the 1998/
school year) and
varicella. varicella vaccines not indicated if history of dis ase either physician documented or parental recall (for kind
arten effective with
the 2001/2002 school year) for school attendance as do mented on the reverse side of this form.
Physician or Clinic Name:
(Print or stamp)
Address:
Physician or
Authorized Signature:
Certificate of Immunization Sup ement for 7th Grade Requirement
Part A-2 (Immunizations arc complete or students who enter or attend the 7th grade after the beginning of the 1997/98 school year.
Each subsequent year thereafter, the next highest grade will be included in the requirement.) DOE Code 8
I have reviewed the records available, and to the best of my knowledge, the above named child has received the following immunizations required for
entry• and attendance in 7th grade effective with the 1997/98 school year: tetanus-diphtheria booster. hepatitis B vaccine series, and second dose of measles
vaccine as documented on the reverse side of this form (boxed areas).
Physician or Clinic Nam
(Print or stamp)
Addres
Physician or
Authorized Signature:
LOXAHAXCHHZ. FL 33470
X
3 4O1
Temporary Medical Exemption
PART B (For children in child care, family day care, preschool and grades kindergarten through 12 who are incomplete for
immunizations in Part A-I or A-2.) Invalid without expiration date. DOE Code 2
1 certify that the above named chi has received th immunizations documented on the reverse side of this form and has commentyd a schedule to
complete the required immunizatio
Additional i munizations are not medically indicated at this time.
Expiration Date:
Physician or Clinic Name:
(I5 days after next immunization
(Print or Stamp)
appointment)
Physician or
Address:
Authorized Signature:
soning or evidence for exemption:
Permanent Medical Exempti n
PART C For medically contraindi ated immuni ations, list each vaccine and state valid clinical re
DOE Code 3
/ certify that the physical condition
Physician or Clinic Name:
(Print or stamp)
Address:
D11600. &2000, obtain., enIkr edition, (SI
is such that immunization(s) as indicated in Part C above is medic
indicated.
Numbyr: 5140400-0680-6)
Physician Signature:
EFTA01709622
FLORIDA CERTIFICATION OF IMMUNIZATION
Legal Authority: FLORIDA STATUTES 2.32.032, s. 10D-3.088, F.A.C. and s. 10M-12, F.A.C.
LAST NAME
PARENT OR GUARDIAN
FIAIST
MI
DOB
MO/DA/YR
Child's SS# (optional)
STATE IMMUNIZATION ION
Directions:
•
Enter all appropriate doses and dates below.
•
Sign and date appropriate certificate (A-1, A-2, B, or C) on reverse side of form.
•
If the child is presenting for the 7th grade requirement only and has previously filed a Certificate of Immunization (680A
or 680A-1) with their current Florida school, fill in boxed areas below and complete Part A-2 on the reverse side of this
form.
•
For additional information: See Immunization Guidelines for School and Child Care Facilities for information and
instructions on form completion and immunization requirements. Guidelines are updated annually and are available
from the local county health department.
VACCINE
DTaP/DTP2
DT3
Td'
Polio'
HIB6
MMR (Combine
(Separate
Hepatitis B9
The state im
2
DTP 5 doses required. If the fourth primary dose is administered on or after the fourth birthday a fifth dose
is not required. DTaP is an acceptable alternative for one or more doses of DTP.
DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis
contraindication.)
4
Td (Adult) Vaccine is recommended for children 7 years of age or older.
5
Polio 4 doses required. If the third dose is administered on or after the fourth birthday, a fourth dose is not
required. IPV is an acceptable alternative for one or more doses of OPV. Polio vaccine is not required for children 18
years of age or older.
6
Hib is required for child care and preschool entry and attendance only.
7
1st dose valid if given on or after ist birthday. Second dose (measles) valid if given at least I month after 1st dose.
A second dose of measles (preferably MMR) is required for students in grades K-4 in the 1997-98 school year, and
7th grade entry and attendance effective with the 1997/98 school year. In each subsequent year thereafter, the next
highest grades arc included.
Includes single measles vaccine (G), single mumps vaccine (H) or single rubella vaccine (I).
9
Hepatitis B vaccine series is required for seventh grade entry and attendance effective with the 1997-98 school year and
kindergarten entry and attendance effective with the 1998-99 school year. In each subsequent year thereafter, the next
highest grades arc included.
EFTA01709623
LAST iCIAME
FIRST
MI
DOB (MO/DA/YR)
Certificate of Immunization for K-12 Excluding 7th Grade Requirements
PART A-I (Immunizations are complete for school entry and attendance grades kindergarten through 12 with the exception of
the 7th grade requirement.) DOE Code I
I have reviewed the records available, and to the best of my knowledge, the above named child has been adequately immunized against
diphtheria, tetanus, pertussis, polio, measles, mumps, rubella and hepatitis B (for kindergarten e ective with the 1998199 school year) for
school attendance as documented on the reverse side of this form.
Physician or Clinic Name:
(Print or stamp)
Authorized Signature:
Address:
Physician or
Date: 7kAk
Certificate of Immunization Supplement for 7th Grade Requirement
PART A-2 (Immunizations arc complete for students who enter or attend the 7th grade alter the beginning of the 1997/98
school year. Each subsequent year thereafter, the next highest grade will be included in the requireme
• •E Code 8
I have reviewed the records mailable, and • the best of my knowledge, the above name
has received the following immunizations
required for entry and attendance in 7th grade 1 ective with the 1997/98 school yea
etanus-diphtheria booster, hepatitis B vaccine series,
and second dose of measles vaccine as documented
the reverse side of this
(boxed areas).
Physician or Clinic Name:
(Pant or stamp)
Address:
Physician or
ture
Temporary Medical Exemption
PART B (For preschool children, children in day care and school children who arc incomplete for immunizations in Part A-1
or A-2.) Invalid without expiration date. DOE Code 2
I certify that the above named child has recen
complete the required immunizations. Additiona
Physician or Clinic Name:
(Print or stamp)
Address:
the immunizations documented on the reverse
is form and has commenced a schedule to
munizations are not medically i
at this time.
Expiration Date:
(15 days after wert InimonLtatbn app6Intrnent)
Physician or
Signature:
Permanent Medical Exemption
PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for
exemption: DOE Code 3
I certify that the physical condition of this child is such
Physician or Clinic Name:
(Print or stamp)
hysiclan Signature:
e is medically contraindicated.
Address:
DH 611{1 I I /96. obsolete. whet editions (Stock Mtge 57411.041)6e0 6)
EFTA01709624
S
'01_ BOARD OF PALM BEACH COUNTY, F!
DA
SCHOOL ATHLETIC HEALTH EXAMINATION FORM
STUDENTS NAME
SCHOOL
IN THE EVENT OF AN EMERGENCY WHEN A PARENT OR GUARDIAN CANNOT BE REACHED, CONTACT THE PERSON BELOW:
NAME
ADDRESS
STUDENTS PERSONAL PHYSICIAN
HOSPITALIZATION OR MEDICAL INSURANCE COMPANY AND POUCY NUMBER:
PHYSICAL EXAMINATION:
Pulse Rate CCU
Wood Pressure
I 10
r (CO
(00 -
CITY
PHONE
Height
Weight
NOTE: Minimum weight at which this student may wrestle i
I.
NORMAL
2.
ABNORMAL
L C ..
NOT
EXAMINED
COMMENTS
EXAMINER
1. Eyes
lY
2. Ears. Nose, Throat
t..."
3. Neck (soft tissue)
—7
4. Mouth and Teeth
,_../
5. Cardiovascular
i_.../
6. Chest and Lungs
...-7
7. Abdomen
._V
-
8. Genitalia-Hernia
_....,
9. Skin and Lymphatics
_..."
10. Neck
_ea-
11. Spine
--
12. Shoulders
_....
13. Arms and Hands
„.../
14. Hips
c.../
15. Thighs
_......1
16. Knees
,.../
-
17. Ankles
_./
18. Feet
...."
19. Neurological
..../
20. TubercuilnymNlype
Dave
Rskia.
. 2
(Required tor grades 6, 9, and any student new fo the
Florida School System)
Urinalysis (Opsbck)
(optional) Lo4Jt
22. HematocnwHemoglobin GM
(optional)
,*
---
,...._
VISION:
Right Eye
Leh Eye
PHONE
Normal
I iOntriout glasses
2 9
with glasses
Abnormal
3 9
without glasses
4
with glasses
pounds. Skin calipers must be used to determine minimum weight.
Based ol ihnludol ard
IsQl elanatchr Ire ictbrang 2,10Itaftes nere bald and
RE
IDATIONS: (Attach additional information if necessary)
need vealmat.
17
.T4tere were no history or physical findings on this examination which
would prohibit this student from panimpating in competitive athletics.
2
ri This student stould have the to:lowing health problems evaluated or
treated pnot to participation in competitive athletics:
This student has health problems which need to be accommodated
to enable the child to participate in competitive athletics:
O This student has health problems which would prohibit him or her from
participating in competitive athletics.
S
P It
PHYSICIAK S
ADDRESS
DATE 74%
TELEPHONE NO.
PBSO 1482 (NEW 8193)
GC6684a
EFTA01709625
SL
.d0L BOARD OF PALM BEACH COUNTY, FL
ADA
SCHOOL ATHLETIC HEALTH EXAMINATION FORM-(PRE-PARTICIPATION)
THIS FORM MUST BE FILLED OUT COMPLETELY BEFORE STUDENT IS ALLOWED TO PRACTICE AND OR COMPETE
STUDENTS NAM
SCHOOL
A
PARENT'SGUARDIANS
NAME
HOME ADDRESS
SCHOOL ATTENDED
LAST YEAR
DATE OF BIRTH
GRADE
HOME PHONE
BUS. PHONE: 'rum.,
BUS. PHONE: Newer)
CSTWSTATE
HEALTH HISTORY
PRE-PARTICIPATION EVALUATION AND HISTORY: (To be completed by student and/or parents)
HAVE YOU EVER HAD (Check yes or no in appropriate box for each of the following questions
YES
NO
1.
My throne or recurrent ienesses?
2.
My Mess lasing more than a week?
3.
My ridsptalizations?
4.
My surgery other than mn%eclomy?
5.
My inymes Nearing treatment oy a physician?
6.
My problem with blood pressure or heart?
7.
My dizziness, Wong. convulsions or frequent headaches?
8.
MY Ion cgs??
9.
My knee surgery?
10.
MY arta WY?
II.
My neck inysy?
12
My other pint sprain or dislocations (shoulder. wrist)?
13.
My broken bones (rrangeS)?
It
My heat eirausuan or heal stroke?
Ate you presently taking any medication/
16
Have you ever been knocked out or had a concussion?
17.
Do you wear eyeglasses or contact lenses?
Do you wear any dental appliances such as Paces. bodge or plates?
1a
Are you alerts to ANY medications (aspen. penoWn. etc.)?
al
Do you have to stop while running around V. mile tiara Nye?
a
Have any mernoers of your larnty had heart problems or heart attack under the age of 50?
a
Has anyone in your close family ever had ciabetes thigh sugar in blood)'
ZS
Has anyone n your tansy under age 50 died suddenly?
24
Do you have any organ missing other man wises (appenon. eye. kidney)?
ATE OF LAST KNOWN TETAN
tie main past tin years
use this space if
explain
provide any additional information:
This application to compete In
interscholastic athletics for the above
school is entirely voluntary on my part
and is made with the understanding that
I have not violated any of the eligibility
rules and regulations of the Florida High
School Activities Association.
DATE
SIGNATURE OF STUDENT
PARENT'S OR GUARDIAN'S PERMISSION:
Parent or Guardian to Read and Sign — Ice* the above information is true and I consider hinvher physically capable of parmapaung in athletics.
I hereby give my consent lor the above named student (I) to represent hisrher school in athletic actrwbes. except those exceptions cited by the
examining physician provide that such athletic activities are approved by the State Association: (2) to accompany school team of which he/she is
a member on any of its local or out of town tnps. I authorize the school to obtain, through a physician of its own choice, any emergency medical
care that may become reasonably necessary for the student in the course of such athletic acLvities or such travel. I also agree not to hold the
school or anyone acting in its behalf or the Florida High School Activities Association responsible for any injury occurring to the above named student
in the course of such travel. I also grant permission to the Palm Beach County School System to release any and all athletic injury information
relating 10 the above named student to a Sports Medicine Program Injury Registry.
SIGNATURE OF PARENTGUARDIAN
DATE
POND 1068 (REV. 8/93)
GC66841)
EFTA01709626
Student
Full Na
STATE OF FLORIDA
DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES
STUDENT HEALTH EXAMINATIONS
Dale CO. I I • CO
Phone
Address
Birthdal,
Name of Parent or Guardian
A.
HEALTH EXAMINATION
Race ei
Sex
levant
106
1 Pre'sure
Iccb
(I) Normal-N: Abnormal=A
N
A
COMMENT: Abnormal Findings. by number
1 Appearance
C.-0/7
0
.99133
CL), ..DJ.906
651-4 n
2. Skin/Nose
t.---17
.../
3. Head/Scalp
4 Eyes
..7
5. Visual Acuity IIR & LI
.....-
6. Ears
7. Auditory Acuity IR & LI
8 Nose / Throat
.7
9. Mouth. Teeth and Gums
10. Chest / Lungs
..--"*"
11. Heart
..„..--
12. Abdomen
,...---
13. Genitals and Anus
,...----'
14. Musculo-Skeletal
....,-
15. Neurological
V
16 Alertness
.../
17. Emotional / Mental/
Behavior Rob I
18. Handicap. physical/
other (Specify)
19. Activity Restrictions
(Specify)
20. Abuse. substance/
physical / emotional
21. Nutrition
L.,-
22 Other
-----"----
B.
HEALTH HISTORY serious Illnesses Injuries: explain)
(attach narrative if additional space needed)
C.
LABORATORY (
indicated)
Hemoglobin/Hematocrit
Lead
Stool (0 & PI
Sickle Cell
Tuberculin test
type
date
resuk
Na
A
(Pt
ti—OXAHATCHEE.
L.
33470
Au
a
ignature
MRS-M Form 3040, Mar 91 (Obsotetes previous editions)
(Stock Muter: 5744.000-3040-2)
dL
ate
EFTA01709627
Student's
Full Name.,
Address
STATE OF FLORIDA
DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES
STUDENT HEALTH EXAMINATIONS
Date
Age
Race
Sex
Birth-JP.,
Name of Parent or Guardian
School
11 0/66
A. HEALTH EXAMINATION
Heght
f
Weight
`
Blood Pressure
(v) Normal-N: Abnormal-A
N
A
COMMENT: Abnormal Findings, by number
1 Appearance
2. Skin/Nose
3 Head/Scalp
4. Eyes
5. Visual Acuity (R & LI
6. Ears
7. Auditory Acuity (R & LI
8. Nose / Throat
9. Mouth. Teeth and Gums
10. Chest / Lungs
11. Heart
12. Abdomen
13. Genitals and Anus
14. Musculo-Skeletal
15. Neurological
16. Alertness
17. Emotional / Mental/
Behavior Prob.
18 Handicap. Physical/
other (Specify)
19. Activity Restrictions
(Specify)
20. Abuse. substance/
physical / emotional
21. Nutntion
22 Other
B.
HEALTH HISTORY Serious Illnesses Infuriesi explain)
(attach narrative if additional space needed)
C.
LABORATORY
pvicl ted)
Heriluglobing LoiertuLrit
t:-/ •
Stool (O 8 13)
Tuberculin test
Lead
NAME:
TITLE:
ADDRESS:
(Please Print)
o:
r oil
WEST PALM BEACH, )-1.
type 7 .15/7 1-1C
date.
f:r1 /
results
Authorized Signature
Date
IIRS-11 Form 3040, Mar 91 (0bsotetes previous editions)
(Stock Number:
5744-000-3040.2)
EFTA01709628
Pint a MANS
otraanson a st
FLORIDA CERTIFICATE OF IMMUNIZATION (HRS 680 - PART A)
(Florida Statutes 232.032)
FOR CHILDREN WHO HAVE COMPLETED ALL REQUIRED IMMUNIZATIONS FOR SCHOOL ATTENDANCE
DATE OF BIRTH
1 CHILD'S NAME
MO
DA ' YR
DOCTOR: PART A OF THIS FORM IS USED ONLY IF THE CHILD HAS RECEIVED ALL REQUIRED IMMUNIZATIONS LISTED BELOW. IF NOT. SEE REVERSE SIDE.
DTP — 5 DOSES REQUIRED
PARENT OR GUARDIAN
IF THE FOURTH PRIMARY DOSE OF DTP IS ADMINISTERED ON OR AFTER THE FOURTH BIRTHDAY, A FIFTH DOSE IS NOT REQUIRED.
OT (PEDIATRIC) VACCINE IS ACCEPTABLE IF PERTUSSIS VACCINE IS MEDICALLY CONTRAINDICATED (COMPLETE PART C FOR PERTUSSIS CONTRAINDICATION.)
Td (ADULT) VACCINE (A SERIES OF 3 DOSES) IS ACCEPTABLE AND RECOMMENDED FOR CHILDREN 7 YEARS OF AGE Oft OLDER.
POLIO (TOPV) - 4 DOSES REQUIRED
IF THE THIRD PRIMARY DOSE OF TOPV IS ADMINISTERED ON OR AFTER THE FOURTH BIRTHDAY. A FOURTH DOSE IS NOT REQUIRED.
POLIO VACCINE IS OMITTED FROM THE REQUIRED IMMUNIZATIONS OF CHILDREN 18 YEARS OF AGE OR OLDER.
MEASLES. MUMPS. AND RUBELLA - I DOSE REQUIRED
!AMR COMBINED - 1 DOSE AT 12 MONTHS OF AGE OR OLDER AND IN 1968 OR LATER (RECOMMENDED AT 15 MONTHS)
-OR-
MEASLES SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER AND IN 1968 OR LATER (RECOMMENDED AT 15 MONTHS)
MUMPS SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER
RUBELLA SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER
MO
DA
ALL APPROPRIATE DOSES AND DATES INCLUDING BIRTHDATE MUST BE ENTERED. AND THE CERTIFICATE SIGNED BELOW BY A PHYSICIAN OR AUTHORIZED
PERSON AND DATED IN ORDER FOR THE CHILD TO ATTEND SCHOOL.
I HAVE REVIEWED THE RECOR
DIPHTHERIA, TETANUS. PERTU
WEST PALM BEACH, FL 33407
F MY KNOWLEDGE THE ABOVE NAMED CHILD HAS BEEN ADEQUATELY IMMUNIZED AGAINST
D RUBELLA AS REQUIRED BY FLORIDA LAW FOR SCHOOL ATTENDANCE.
PHYSICIAN OR CLINIC NAME (PLEASE PRINT)
PHYSICIAN OR AUTHORIZED SIGNATURE
EFTA01709629
DATE OF BIRTH
I
I
I
CHILD'S NAME
MO
DA
YR
PARENT OR GUARDIAN
DOCTOR: IF THE CHILD HAS NOT RECEIVED THE REOUIRED DOSES LISTED IN PART A, PLEASE COMPLETE PART B OR PART C. AS APPROPRIATE. AND SIGN AND DATE.
I CERTIFY
IMMUNIZATIONS.
TEMPORARY MEDICAL EXEMPTION (HRS 680 - PART B)
FOR PRESCHOOL CHILDREN AND FOR SCHOOL CHILDREN WITHOUT ALL IMMUNIZATIONS REQUIRED IN PART A
THAT THE ABOVE NAMED CHILD HAS RECEIVED THE IMMUNIZATIONS LISTED BELOW AND HAS COMMENCED A SCHEDULE TO COMPLETE THE
ADDITIONAL IMMUNIZATIONS ARE NOT MEDICALLY INDICATED AT THIS TIME.
REQUIRED
TYPE VACCINE
DATE (MO/DA/YR)
DATE (MO/DA/YR)
DATE (MO/DA/YR)
DATE (10/0A/YR)
DATE (MO/DA/YR)
DTP
DT
Td
POLIO
Nth
MMR
EXPIRATION BATE (MO/DA;YR)
RUBEOLA (MEASLES)
MUMPS
(SHOULD BE 15 DAYS AFTER NEXT APPOINTMENT
RUBELLA
PHYSICIAN OR AUTHORIZED SIGNATURE
DATE
PERMANENT MEDICAL
I CERTIFY THAT THE PHYSICAL CONDITION OF THIS CHILD IS SUCH THAT
CLINICAL REASONING OR EVIDENCE FOR EXEMPTION FOR EACH VACCINE.
EXEMPTION (HRS 680 - PART C)
IMMUNIZATION(S) IS MEDICALLY CONTRAINDICATED. LIST VACCINE(S) AND STATE VALID
HRS Farm 680. Mar 91 (DowMes Previous edtheris)
Bunk Number 5740.000.0680-6)
PHYSICIAN'S SIGNATURE
DATE
EFTA01709630
CCM
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I, DENNIS R. BING, duly elected, qualified and acting County Clerk of Champaign County, Illinois, •
and keeper of the records thereof, do hereby certify that the foregoing is a true and correct copy of the
original record of BIRTH OF
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this
17th
day of November
A.D. 1987
nty Cle
Deputy County Clerk
EFTA01709631
Customer Copy
Fold On Perforation Before Tearing
FPL
Please notify FPL of any changes in the
customer name or rate classlype of usage
(Example: Residential VS. Non-Residentiall.
Date Of This
New Owns
Total Amount
Statement
Past Dos After
Now Due
C
JUL 30 9 AUG 20 9
260'67
Customer Name
Class Of Service
RS-1
RESIDENTIAL
Service Address
Account Nunn
I Meter No.
Smice Used
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Mem hadiap
From
Oen Previews
Coital
JUN 301.TJUL 30130 762410592
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\
LATE PAYMENT CHARGE OF 1.5% WILL
APPLY IF NOT PAID BY AUG 20
HELP HOLD DOWN SUMMER COOLING
COSTS. CALL 1-800-DIAL-FPL AND
ASK FOR A FREE. SUMMER ENERGY
DIET KIT.
Kilowatt
Noun Used
Amount
2968
230 97**
GROSS RCPTS TAX INCR
237
FRANCHISE CHARGE
881
UTILITY TAX
1852
Total Amount Now Due )
26067
Energy Usage Information
KWH Used This Month
This
Year
lanai KWH Per Day
2968131
99
test
Year
0 to I I
•• Electric Service Amount Includes The Following Charges:
Cestome
Charge 565
Dollars
Per Month
1510
0205420490
4503
FPS Office Location
yoe have arryguestion or regain assistance, call or visit ley FPL business office.
. 411kt other FPl customer service location. See reverse side for additional information
MOW Energy Chagas
4582
1ST 750
5582 OVER 750
Coos Per KWH
4.
hal Camp
2262
Cab PINION
PALM BCH GARDENS
Dowd Charge
Dollars Per KW
697-8000
FPL non No.
Call
letth Waited
1117TDD11.00-C-6564.
EFTA01709632
REPORT fl
TEACHER:
CTBS/4 STUDENT REPORT
FOR:
SCHOOL:
TEST:
CTBS/4 LEVEL 15 FORM B
GRADE:
05
DATE OF TESTING:
STUDENT NUHBER:
4/13/99
TESTS
PERCENTILE
RANKS
WIEST
SCORE
AVERAGE
LOW
RANGES
low(
HIGHEST
READING COMPREHENSION
83
===m===
MATH CONCEPTS & APPLICATIONS
87
===w==
TOTAL LANGUAGE
LANGUAGE MECHANICS
LANGUAGE EXPRESSION
RANGES OF
PERCENTILE
RANKS
1-M
PERCENTILE
mi*
PERCENTILE
51-75
PERCENTILE
76-99
PERCENTILE
Dear Parent/Guardian:
This spring, 'I'll, was given the Comprehensive
Edition (CTRS 4 . This report explain
When compared with students across the nation,
range on all tests taken.
Additional information about these tests can be
page. If you would like more information about
contact our school.
Sincerely,
Principal
Tests of Basic Skills/Fourth
test results.
scored in the highest
found on the back of this
test scores, please
SCHOOL COPY
EFTA01709633
FCAT
1999
Individual Profile
Report
ID Number
Grade 5
CAT
Comprehensive
Assessment
Test
Achievement Level
Total Score Ranges
Mathematics
Level 5:
395-500
Level 4:
355-394
Level 3:
326-354
Level 2:
288-325
Level 1:
100-287
School Number. 2141
ACREAGE PINES ELEMENTARY
District Number 50
PALM BEACH
Run Dal, !,1:119!)
Achievement Levels
The Florida Comprehensive Assessment Test (I:CAT) measures student performance on selected benchmarks in reading and
mathematics as defined by the Sunshine Stare Standards. The Standards articulate challenging content that Florida students
are expected to know and be able to do.
A student achieves ono of five possible levels based on the student's Total Score. The Total Score that a student could achieve
on each subject area ranges from 100 to 500.
LEVEL 5: Performance at this level indicates that the student has success with the most challenging content of the Sunshine
State Standards. A Level 5 student answers most of the test questions correctly, including the most challenging
questions.
LEVEL 4: Performance at this level indicates that the student has success with the challenging content of the Suns/luxe State
Standards. A Level 4 student answers most of the questions correctly but may have only somo success with questions
that reflect the most challenging content.
LEVEL 3: Performance at this level indicates that the student has partial success with the challenging content of the Sunshine
State Standards, but performance is inconsistent. A Level 3 student answers many of the questions correctly but is
generally less successful with questions that are most challenging.
LEVEL 2: Performance at this level indicates that the student has limited success with the challenging content of the Sunshine
State Standards.
LEVEL 1: Performance at this level indicates that the student has little success with the challenging content of the Sunshine
State Standards.
The Total Mathematics Score of 336 indicates that
who took FCAT Mathematics in 1999.
Achievement
Level
Total
Score
Mathematics
3
336
scored in the highest third of grade 5 students
SubscoreS
Each Subscore represents the percentage of content in that area that the student responded to successfully.
0
25
50
75
100
Mathematics
Number Sense
64%
Measurement
69%
Geometry
62%
Algebraic Thinking
73%
Data Analysis
65%
If you
you were to take FCAT again, your total score and subscores might be slightly lower or higher than reported above.
However, your scores should fall within an expected range of scores. For FCAT Mathematics, you would be expected to score not
lower than 326 and not higher than 346. For the subscores, you would be expected to perform in the range represented by the
lines extending from the diamonds.
CTB
McGraw-HIII
EFTA01709634
Mathematics Content Tested
FCAT Mathematics is an assessment of the Sunshine State Standards
in mathomatics. FCAT Mathematics assesses content from the
following areas:
Number Sense, Concepts, and Operations
• identifying operations (+,
x, -l-) and effocts of operations
• determining estimates
• knowing how numbers are representod and used
Measurement
• recognizing moasurements and units of measurement
• comparing. conlrasting, and converting measurements
Geometry and Spatial Sense
• describing, drawing, identifying, and analyzing two- and
three-dimensional shapes
• visualizing and illustrating changos in shapes
• using coordinate geometry
Algebralc ThinkIng
• describing, analyzing, and generalizing patterns, relations,
and functions
▪ writing and using expressions, equations, inequalities,
graphs, and formulas
Data Analysis and ProbabIllty
• analyzing, organizing, and interpreting data
• identifying patterns and making predictions, inferences, and
valid conclusions
• using probability and statistics
Área de contenido del examen de Matemáticas
El examen de Matemáticas FCAT es el examen que evalúa las normas educativas
de Matemáticas del estado de la Florida (Stuuhine State Standards). Este examen
evalúa las habilidades siguientes:
Comprensión numérica, conceptos y operaciones
• identificación de operaciones (+,
x, -1 y efectos de operaciones
• estimación de resultados
• uso y representación de números
Medidas
• reconocimiento de medidas y de unidades de medidas
• comparación y conversión de medidas
Geometria y noción espacial
• descripción, dibujo, identificación y análisis de figuras de dos y tres dimensiones
• visualización e ilustración de cambios en figuras
• uso de geometría coordinada
Razonamiento algebraico
• descripción, análisis y generalización de patrones, relaciones y funciones
• escritura y uso de expresiones, ecuaciones, desigualdades, gráficas y fórmulas
Análisis de datos y probabilidad
•
análisis, organización e interpretación de datos
•
identificación de patrones y elaboración de predicciones, inferencias y
conclusiones válidas
•
uso de probabilidad y estadística
La Prueba de Evaluación Comprensiva del Estado de la Florida (FCAT) mide el rendimiento del estudiante según criterios específicos en áreas de lectura y
matemáticas, los cuales están especificados en las Normas Educativas del Estado de la Florida (Sunshine State Standards). Dichas normas establecen el nivel
de conocimientos que los estudiantes del estado de la Florida deben tener y saber aplicar.
El estudiante puede alcanzar uno de los cinco niveles de rendimiento posibles, en base a la calificación total. El estudiante puede alcanzar una calificación entre
100 y 500 en cada área de estudio.
Nivel 5: Este nivel de rendimiento indica que el estudiante ha alcanzado con facilidad el nivel de conocimientos establecido en las Normas Educativas del Estado
de la Florida. Un estudiante del Nivel 5 responde a la mayoria do las preguntas correctamente, incluyendo las más complicadas.
Nivel 4: Este nivel de rendimiento indica que el estudiante ha alcanzado satisfactoriamente el nivel de conocimientos establecido en las Normas Educativas del
Estado de la Florida. Un estudiante del Nivel 4 responde a la mayoría de las preguntas correctamente, pero responde acertadamente solamente a
algunas de las preguntas más complicadas.
Nivel 3: Este nivel de rendimiento indica que el estudiante ha alcanzado de una manera parcialmente satisfactoria el nivel de conocimientos establecido
en las Normas Educativas del Estado de la Florida y presenta un rendimiento variable. Un estudiante del Nivel 3 responde a muchas de las preguntas
correctamente, pero en general, tiene bastante dificultad con las preguntas más complicadas.
Nivel 2: Este nivel de rendimiento indica que el estudiante, de una manera limitada, ha podido alcanzar el nivel de conocimientos establecidos en las Normas
Educativas del Estado de la Florida.
Nivel 1: Este nivel de rendimiento indica que el estudiante ha tenido poco éxito en alcanzar el nivel de conocimientos establecido en las Normas Educativas del
Estado de la Florida.
;ya CTB
McGravv-Hill
EFTA01709635
REPORT 81
TEACHER:
SCHOOL:
CTBS/4 STUDENT REPORT
TEST:
CTBS/4 LEVEL 14 FORM A
FOR:
GRADE:
04
DATE OF TESTING:
4/20/98
STUDENT NUMBER:
TESTS
PERCENTILE
RANKS
LOWEST
SCORE
AVERAGE
LOH
RANGES
HIGH
HIGHEST
TOTAL READING
READING COMPREHENSION
99
=a
READING VOCABULARY
TOTAL MATHEMATICS
MATH CONCEPTS & APPLICATION
97
..m=
MATH COMPUTATION
SCIENCE
SOCIAL STUDIES
RANGES OF
PERCENTILE
RANKS
1-25
PERCENTILE
26-50
PERCENTILE
51-75
PERCENTILE
76-99
PERCENTILE
Dear Parent/Guardian:
This spring,
was given the Comprehensive Tests of Basic Skills/Fourth
test results.
Edition (CTBS 4 . This report explains
When compared with students across the nation,
scored in the highest
range on all tests taken.
Additional information about these tests can be found on the back of this
page. If you would like more information about
test scores, please
contact our school.
Sincerely,
Principal
SCHOOL COPY
EFTA01709636
FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2000
NORM-REFERENCED TEST
Student Report
Grade 06
This report shows your results from the FCAT National Norm-Referenced Test.
Student Name
District Name and Number
50 • PALM BEACH
The FCAT Norm-Referenced Test measures your achievement on a test that was given to a national sample of students. Your norm-referenced scores in
Reading Comprehension and in Mathematics Problem Solving describe your performance in relation to the performance of students throughout the nation.
Your scores are shown below.
SUBJECT SCORES
Scale
Score
National
Percentile
Rank
Stanine
Reading
Comprehension
726
95
8
Mathematics
Problem Solving
697
87
7
The Scale Score expresses your performance and allows comparisons from year to year.
Reading Comprehension Scale Scores range from 491 to 810. Mathematics Problem Solving
Scale Scores range from 497 to 814.
The National Percentile Rank and Stanine indicate your relative standing in comparison to the
national reference group. National Percentile Ranks range from 1 to 99. Stanines range from 1 to
9.
It you took the test again, your National Percentile Rank might be slightly higher or lower than
stated here. However, your National Percentile Rank would probably fall within a certain range.
For Reading Comprehension, your National Percentile Rank should be between 90 and 98. For
Mathematics Problem Solving, your National Percentile Rank should be between 81 and 93.
CONTENT SCORES
Number
of Points
Possible
Number
of Points
Earned
Number
of Questions
Attempted
Reading Comprehension
54
49
54
Initial Understanding
12
12
12
Interpretation
24
22
24
Critical Analysis
9
9
9
Strategies
9
6
9
Mathematics Problem Solving
48
38
48
Measurement
6
6
6
Estimation
4
2
4
Problem Solving
5
3
5
Number Relationships
6
5
6
Number Systems
5
4
5
Patterns & Functions
3
3
3
Algebra
3
3
3
Statistics
6
4
6
Probability
3
3
3
Geometry
7
5
7
The content tested is described on the back of this report. Each question was worth 1 point.
Run Date: 06/21/2000
0265714
EFTA01709637
Grades 5, 6, 7, and 8
The FCAT NRT Reading Comprehension Test assesses
the following objectives:
•
Initial Understanding - Demonstrate the ability to comprehend explicitly
stated relationships in a variety of reading selections.
•
Interpretation - Demonstrate the ability to form an interpretation of a variety
of reading selections based on explicit and implicit information in the
selections.
•
Critical Analysis - Demonstrate the ability to synthesize and evaluate
explicit and implicit information in a variety of reading selections.
•
Strategies - Demonstrate the ability to recognize and apply text factors and
reading strategies in a variety of reading selections.
The above objectives are measured within the following contexts:
•
Recreational- material typically read for enjoyment.
•
Textual - material typically found in grade-appropriate textbooks and other
sources of information.
•
Functional - material typically encountered in everyday life situations.
The FCAT NRT Mathematics Problem Solving Test
assesses the following objectives:
•
Measurement - Demonstrate an understanding of the principles of
measurement.
•
Estimation - Determine the reasonableness of results and apply estimation
in problem solving.
•
Problem Solving Strategies - Demonstrate an understanding of the process
of solving conventional and non-routine problems.
•
Number and Number Relationships - Represent and use numbers in
equivalent forms in real-world and mathematical problems, and demonstrate
number sense for whole numbers, fractions, decimals, and integers.
•
Number Systems and Number Theory - Demonstrate an understanding of
relationships among arithmetic operations and apply concepts of number
theory such as primes, factors, and multiples in real-world and mathematical
problems.
•
Patterns and Functions - Identify numerical and geometric patterns and
functions and use them to solve problems.
•
Algebra - Demonstrate the ability to evaluate expressions and solve linear
equations.
•
Statistics - Demonstrate an understanding of the relationships in data sets.
•
Probability - Demonstrate an understanding of the laws governing chance.
•
Geometry - Demonstrate an understanding of geometric principles.
Grados 5, 6, 7, y 8
La Prueba de Comprensiem de Lectura FCAT NRT evaltia
los siguientes objetivos:
•
Entendimiento - Demostrar su habilidad para comprender
expllcitamente el contenido y la relacien entre si dentro de una variedad de
solecciones de lecture.
•
Interpretation - Demostrar su capacidad interpretative dentro de una
variedad de solecciones de lecture, basandose en informaci6n expllcita o
impllcita en dichas selecciones.
•
Analisis crttico - Demostrar la habilidad para sintotizar y evaluar
information expllcita e impficita en una variedad de selecciones de lecture.
•
Estrategies
Demostrar habilidad para reconocer y aplicar el contenido del
texto y ostratogias utilizadas en una variedad de solecciones do lecture.
Los objetivos anteriores se evalOan en los contextos siguientes:
•
Recreativo - material utilizado para entretenimiento.
•
Textual - material utilizado en libros de texto del grade apropiado yen
otras medios informativo.
•
Funcional - material utilizado on la vide diaria.
La Prueba para Resolver Problemas de Matematicas
FCAT NRT evaltia los siguientes objetivos:
•
Medidas - Demostrar sus conocimientos de los principios de modir.
•
Estimacion - Deteminar cuen razonables son los resultados y aplicar la
estimation en la solution de problemas.
•
Estrategias pare resolver problemas - Demostrar comprension del
proceso de resolver problemas convencionales y fuera do lo comOn.
•
NOmeras y relaciones entre nOmeros
Represontar y usar nUmeros on
formes equivalentes en problemas de matematica y de la vide diaria, y
demostrar sentido para las fracciones, los decimates y los nUmeros enteros,
positivos y negativos.
•
Sistemas y toads de los nOmeras
Demostrar conocimiento numeric° de
las relaciones entre las operations de aritmetica y splicer conceptos de la
teorla de los nUmeros tales como nUmeros primes, factores y mUltiplos en
problemas de matematica y de la vide diaria.
•
Pautas y funciones - Identificar funciones y pautas numericas y usarlas
para resolver problemas.
•
Algebra - Demostrar la capacidad para evaluar expresionos algebraicas y
resolver ecuaciones lineales.
•
EstedIstica - Demostrar conocimiento en procesamiento do data.
•
Probabilided - Demostrar conocimiento de las leyes qua gobiernan el azar.
•
Geometria - Demostrar conocimiento do los principios de geometria.
nip Slanktd Atlyinernent Tat Sas, Moth Edison. Compsnclun of instrucbonai On•rrtr•s
4. Pined voth perms's+ by Hittest Edc•tlon•t ilsosursnunl, /foal I SOO
EFTA01709638
FCAT
1998
Individual Profile
Report
ID Number
Grade 4
CAT
Comprehensive
Assessment
Test
School Number 2141
ACREAGE PINES ELEMENTARY
District Number: 50
PALM BEACH
Run Date 0/30/98
CTB
KIW McGraw-Hill
Total Score
Total
Score
Reading
317
The Total Score indicates the student's level of achievement on FCAT Reading.
The Total Score that a student could achieve ranges from 100 to 500.
The Total Reading Score of 317 indicates that
scored In the
middle third of grade 4 students who took FC
ea ing in 1998.
Subscores
The Subscores indicate the student's level of achievement on separate content areas
of I:CAT Reading. Each Subscore represents the percentage of content in that area
that the student responded to successfully.
0
?5
50
75
Reading
Information
Literature
58%
88%
100
The Information content area contains reading passages such as magazine and newspaper articles about science,
history or other topics.
The Literature content area contains reading passages such as fictional stories, poems and folk tales.
Message to Parents:
The Florida Comprehensive Assessment Test (I:CAT) is a new achievement test for Florida students. FCAT
measures the Sunshine State Standards for reading and mathematics. Adopted in 1996, the Sunshine State Standards
are challenging expectations for Florida students. They apply to all students whether they plan to enter the world of
work or go on to further education after high school. The Standards signify what students should know and be able
to do as they progress through school. The Sunshine State Standards are the foundation for a strong accountability
system for Florida's schools.
1,CAT was administered for the first time in Florida schools in January 1998. The 1998 test scores will set the
baseline for future achievement of the Sunshine State Standards in reading and mathematics. 1:CAT scores are an
overall indicator of achievement of these challenging new standards. FCAT results will not be used in making
decisions concerning the promotion of students in 1998 but will be one consideration in promoting students in future
years.
EFTA01709639
Reading Content Tested / Grade 4
PCAT Reading is an assessment of the Sunshine Stale Standards
In reading. 1:CAT Reading assesses content from the following
areas:
• determining the meaning of words, phrases, and sentences in
the context of a passage
• determining stated or Implied main ideas or essential messages
• identifying the author's purpose
• recognizing the difference between facts and opinions
• recognizing the use of comparison and contrast
• recognizing cause and effect relationships
• understanding plot development and conflict resolution
• knowing similarities and differences among characters, settings,
and events
• reading and organizing information from different sources for a
variety of purposes
• selecting and using a variety of reference materials, including
maps, charts, and photographs, to gather information for
research projects
CAT
prebensive
Assessment
Test
Area de contenido del examen de Lectura / Grado 4
El examen de Lecture 1:CAT es el examen que evalUa las normas
educativas de Lectura del estado de la Florida (Sunshine Slate
Standards). Este examen evalUa las habilidades siguientes:
• determinar el significado de palabras, frases y oraclones dentro de
un contexto
• determinar las ideas prIncipales, Indicadas o impllcitas, o el mensaje
mas Importante de un texto
• identificar el propesito del autor
• reconocer la diferencia entre hechos y opinlones
• reconocer el use de la comparaclon y el contraste
• reconocer la relacien entre causa y efecto
• entender el desarrollo de una trama y su desenlace
• comprender las semejanzas y diferenclas entre personates, el lugar
donde ocurre una action y los acontecimlentos
• organizer los datos de diferentes fuentes de informacien para
diferentes usos
• seleccionar y usar diferentes fuentes de referencia, como mapas,
tablas y fotografias, para obtener informacien que se usare en
proyectos de investigaciones
Menu*, a los padres de familla:
La Prueba de Evaluacien Comprensiva de la Florida: Florida Comprehensive Assessment Test (1:CAT) es un examen
nuevo diseflado para los estudiantes del estado de la Florida. El examen 1:CAT mide las normas educativas (Sunshine
State Standards) de matematicas y de lectura. Dichas normas, que fueron adoptadas en 1996, tlenen expectativas altas
de los estudiantes del estado y se aplIcan a todos los estudiantes ya sea que vayan a trabajar o que sigan con
estudios universitarios despues de la escuela secundaria. Las normas educativas representan lo que los estudiantes
deben saber y pueden hater en su avance academico. Las normas educativas establecen la base para un sistema
que define una mayor responsabIlldad para las escuelas de la Florida.
El examen MCAT fue administrado por primera vez en enero de 1998 en las escuelas del estado de la Florida. Los
resultados del examen de 1998 determinaran la base para el futuro logro de las normas educativas del estado de la
Florida en las areas de lectura y matematicas. Los resultados del 1:CAT son un reflejo general de estas nuevas normas
educativas y sus altas expectativas. Los resultados del 1:CAT no se usaran en 1998 para decidir en que grado se
colocara el estudiante pero sl sera uno de los factores que se consideraran en el futuro.
CTB
:Jill
Mc
EFTA01709640
1998 Florida Writing Assessment
Student Name:
Student I.D. No.:
STUDENT REPORT
School:
Florida
/
.
Writing
/
Assessment
Program
Grade 4
TYPE OF WRITING TESTED: WRITING TO EXPLAIN
District:
PALM BEACH COUNTY
SCORE: 3.0
Description of Writing Scores
6.0: The writing focuses on the topic, is logically organized, and includes ample development of
supporting ideas or examples. It demonstrates a mature command of language, including
precision in word choice. Sentences vary in structure. Punctuation, capitalization, and spelling
are generally correct.
5.5:
The writing was given a 5 by one reader and a 6 by the other reader.
5.0:
The writing focuses on the topic with adequate development of supporting ideas or examples. It
has an organizational pattern, though lapses may occur. Word choice is adequate. Sentences
vary in structure. Punctuation, capitalization, and spelling are generally correct.
4.5: The writing was given a 4 by one reader and a 5 by the other reader.
4.0: The writing focuses on the topic, though it may contain extraneous information. An
organizational pattern is evident, but lapses may occur. Some supporting ideas contain
specifics and details, but others arc not developed. Word choice is adequate. Sentences vary
somewhat in structure, though many arc simple. Punctuation, capitalization, and spelling are
usually correct.
3.5: The writing was given a 3 by one reader and a 4 by the other reader.
3.0: The writing generally focuses on the topic. though it may contain extraneous information. An
organizational pattern has been attempted, but lapses may occur. Some of the supporting ideas
or examples may not be developed. Word choice is adequate. Sentences vary somewhat in
structure, though many are simple. Punctuation and capitalization are sometimes incorrect, hut
most commonly used words arc spelled correctly.
2.5:
The writing was given a 2 by one reader and a 3 by the other reader.
2.0:
The writing may be slightly related to the topic or offer little relevant information and few
supporting ideas or examples. There is little evidence of an organizational pattern. Word choice
may be limited or immature. Sentences may be limited to simple constructions. Frequent errors
may occur in punctuation, capitalization, and spelling.
1.5:
The writing was given a I by one reader and a 2 by the other reader.
1.0:
The writing may only minimally address the topic because there is little or no development of
supporting ideas or examples. No organizational pattern is evident. Ideas are provided through lists,
and word choice is limited or immature. Unrelated information may be included. Frequent errors in
punctuation, capitalization, and spelling may impede communication.
U:
The writing is unrelated to the assigned topic or cannot he read, or there is no response.
Your Student's Score
Dear Parents or Guardians:
The paper your student wrote in January as part of the Florida Writing
Assessment Program has been read independently by two people trained
to score this test. Each reader judged the paper against a set of
standards and gave it an overall score. Your student's final score is the
average of the two readers' scores.
This writing score will help you, your student, and the teacher
understand how well your student performed on this statewide writing
test. A description of each possible score is printed on the left side of
this report.
Students were given 45 minutes to read the assigned topic, plan what to
write, and then write their responses. The conditions under which your
student writes papers in class or at home may not be the same as those
for this test; therefore, the writing may not be the same. You and the
teacher should consider the score on this test along with all of your
student's other writing when planning activities to continue developing
your student's writing skills.
DESCRIPTION OF THE TOPIC:
Students were asked to explain why one
place is their favorite.
RUN DATE: 04/25/98
50-2141-000000410
EFTA01709641
EVALUACION DE SECRITURA DE LA FLORIDA
PRIMAVERA DE 1998
REPORTE ESTUDIANTIL
INFORMES DE LOS ESTUDIANTES DE 4' GRADO
Descripción de las Notas de Redacción
6.0.
La redacción se concentra en el tema, está lógicamente organizada e incluye un
amplio desarrollo de las ideas o ejemplos fundamentales. Demuestra un dominio maduro del
idioma, incluyendo precisión en la elección de términos. Las oraciones varían en su estructura.
La puntuación, uso de mayúsculas y ortografía son generalmente correctas.
5.5:
La redacción recibió un 5 por parte de un lector y un 6 por parte del otro lector.
5.0:
La redacción se concentra en el tema y tiene un desarrollo adecuado de las ideas o
ejemplos fundamentales. Tiene una estructura organizada, aunque haya algunos lapsos. La
elección de términos es adecuada. Las oraciones varían en su estructura. La puntuación, uso
de mayúsculas y ortografia son generalmente correctas.
4.5:
La redacción recibió un 4 per parte de un lector y un 5 por parte del otro lector.
4.0:
La redacción se concentra en el terna, aunque puede contener información ajena al
mismo. Es evidente una estructura organizada, aunque puede haber algunos lapsos. Algunas
ideas fundamentales contienen datos específicos y detalles, pero otras no están desarrolladas.
La elección de términos es adecuada. Las oraciones varían algo en su estructura, aunque la
mayoría son simples. La puntuación, uso de mayúsculas y ortografia son generalmente
correctas.
3.5:
La redacción recibió un 3 por parte de un lector y un 4 por parte del otro lector.
3.0:
La redacción se concentra generalmente en el tema, aunque contiene información
ajena al mismo. Se intentó una estructura organizada, aunque puede haber algunos lapsos.
Algunas de las ideas o ejemplos fundamentales pueden no estar desarrollados. La elección de
términos es adecuada. Las oraciones varían algo en su estructura, aunque la mayoría son
simples. la puntuación y la ortografia son a veces incorrectas pero las palabras más
comunmente usadas están escritas correctamente.
2.5:
La redacción recibió un 2 por parte de un lector y un 3 por parte del otro lector.
2.0:
La redacción está apenas relacionada con el tema u ofrece poca información
relevante, así como pocas Ideas o ejemplos fundamentales. Hay poca evidencia de una
estructura organizada. La elección de términos puede ser limitada o inmadura. Las oraciones
se limitan a construcciones simples. Pueden encontrarse errores frecuentes de puntuación, uso
de mayúsculas y ortografía.
1.5:
La redacción recibió un I por parte de un lector y un 1 por parte del otro lector.
1.0:
La redacción considera mínimamente el tema porque no hay o hay muy poco
desarrollo de las ideas o ejemplos fundamentales. No hay evidencia de una estructura
organizada. Las ideas aparecen enumeradas en listas y la elección de términos es limitada o
inmadura. Puede aparecer información no relacionada con el tema. Los errores frecuentes de
puntuación, uso de mayúsculas y ortografia pueden impedir una comunicación efectiva.
U:
La redacción no tiene relación con el tema asignado, no puede leerse o no obtuvo
respuesta.
Estimados padres o tutores:
La prueba escrita por su niño(a) en enero como parte del Programa de
Evaluación de Redacción de Florida, fue leida independientemente por dos
personas capacitadas para evaluarla. Cada lector juzgó la prueba en relación
a un conjunto de normas y la calificó con una nota general. La nota final de
su niño(a) es el promedio de las notas otorgadas por los dos lectores.
Esta nota de redacción le ayudará a usted, a su niño(a) y a los maestros a
comprender cómo se desempeñó su niño(a) en esta prueba de redacción
realizada en todo el estado. Una descripción de cada una de las notas
posibles aparece en el lado izquierdo del Informe.
Los estudiantes dispusieron de 45 minutos para leer el tema asignado,
planificar lo que iban a escribir y escribir sus respuestas. Las condiciones
bajo las cuales los estudiantes redactan otras pruebas en clase o en el hogar
pueden ser diferentes a las empleadas en esta prueba; por lo tanto, la
redacción puede ser diferente. Ustedes y los maestros deben considerar la
nota de esta prueba junto con todas las otras redacciones del estudiante, al
planear actividades para continuar desarrollando las habilidades de
redacción del estudiante.
EFTA01709642
6/8/98 12:38pm
LEVEL & COURSE PERFORMANCE
End of Year Report
Course
Total
Time
Total
Corr/Att
Exercises
Total
Percent
Correct
Enroll
Level
IPM
Level
Current
Level
Gain
4302
(Enroll Date
8/26/97) Class 406
FAB
0:29
N/A
N/A
N/A
N/A
WRI
0:29
N/A
N/A
N/A
N/A
MCS
2:24
98/254
39
3.49
2.51
2.53
0.02
RW
1:41
203/366
55
3.50
3.06
3.09
0.03
MI
38:59
N/A
N/A
N/A
N/A
RA
0/0
0
N/A
N/A
N/A
N/A
DE
0:20
**/21
71
--
--
RI
0:14
16/45
36
--
__.
EFTA01709643
5/16/97 12:54pm
COURSE PERFORMANCE ALL
Page
Class(es) :
Student(s) : 3109
Course(s) : MCS,IR,RW
Total
Total
Total
Corr/Att Percent
Enroll
IPM
Current
Course Time
Exercises Correct
Level
Level
Level
Gain
3109
Enroll Date - 8/22/96
MCS
11:50
914/1023
89
2.79
2.80
3.69
0.89
RW
7:05
703/836
84
4.53
5.09
5.34
0.25
GRAND TOTAL RECORDS = 1
Copyright (c) 1991-94 by Computer Curriculum Corporation.
All Rights Reserved. If the format of this report is altered by the customer,
CCC shall not be held liable for any inaccuracies that may occur in the report
as a result of such alterations.
EFTA01709644
Teaching
4uestions
for
tomorrow's
answers
March 1, 1994
Dear Parent,
The State of Florida has asked that we obtain the following
information on all students in kindergarten:
Has your kindergarten child had pre-kindergarten experience?
Yes
No
ye"
If yes, please answer the following:
The program my child attended was
Public School
ArIvate Pre-school
Home-based Day Care
Other
Student '§ Name
Please state other.
Teacher s Name
Parent s signature
Please return this form to your child's classroom teacher by
Friday, March 4th.
Sincerely
Data Processor
EFTA01709645
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ter
EFTA01709646
Teaching
44estions
for
tomorrow's
answers
Dear Parent,
March 1, 1994
Phil p
P.,,
The State of Florida has asked that we obtain the following
information on all students in kindergarten:
Has your kindergarten child had pre-kindergarten experience?
Yes
No
If yes, please answer the following:
The program my child attended was
Public School
Pub\,C,
Privet° Pre-school
Home-based Day Care
Other
Please state other.
Studeht'S Name
Teacher's Name
Parent's Signature
Please return this form to your child's classroom teacher by
Friday, March 4th.
•
Sincerely,
Data Processor
EFTA01709647
EFTA01709648
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EFTA01709649
Ku/7-
READING
'
I
S
I
DIRECTIONS. This article is about Walt Disney. Read the article.
Then answer questions 16-26.
WALT DISNEY (1901-1966)
by Jean Marzollo
Walt Disney was born in Chicago, but his family moved to a
farm in Missouri when he was young. As a child, he enjoyed
drawing. When he was 16, Walt went back to Chicago to study art.
At the age of 19, he started making cartoon ads to be shown in
movie theaters. He didn't earn much money, but he liked the work.
When he was 22, Walt Disney moved to Los Angeles,
California. He was fascinated by cartoons. Cartoons are made by
drawing many pictures and showing them one after another, so
quickly that the pictures are animated, or seem to move.
Disney drew cartoons in his garage. He liked to make characters
do funny things. When he was 27, he created Mickey Mouse. In
the next ten years, Walt Disney invented Donald Duck, Goofy,
Pluto, and other cartoon characters that are still famous today.
Many people went to movie theaters to see his short cartoons. At
last, Walt Disney was successful.
But Disney didn't want to make only short cartoons. He wanted
to make a full length animated film. He settled down to work and
made the first long cartoon movie ever: Snow White and the Seven
Dwarfs. He hired talented people to help him make the thousands
of drawings needed for the movie. It was a hit. Walt Disney then
made more long cartoons: Pinocchio, Fantasia, Dumbo, Bambi,
Cinderella, Alice in Wonderland, Peter Pan, Lady and the Tramp, 101
Dalmatians, and The Jungle Booh.
Notes
Grade 4 • End-of-Year Test
11
EFTA01709650
Notes
So many movies! So much success! Yet Walt Disney had even
more ideas. He created Mary Poppins, a movie with cartoons and
people. His comp.any today employs many people and continues to
make imaginative movies like Beauty and the Beast and The Little
Mermaid.
Walt Disney had another brainstorm. He wanted to make
enormous amusement parks where people could enjoy themselves.
When this idea came true, he named the parks after himself:
Disneyland and Walt Disney World.
MIME Grade 4 • End-of-Year Test
EFTA01709651
DIRECTIONS. Choose the best answer to each question and fill in the
bubble beside the answer you choose. Or, write your answer on the
lines.
16. What happened first?
C) Walt Disney drew cartoons in his garage.
® Walt Disney made Snow White and the Seven Dwarfs.
41 Walt Disney's family moved to a farm in Missouri.
(1) Walt Disney created Mary Poppins.
17. Just after Walt Disney became successful at last, he wanted to:
C) create Mickey Mouse.
C) open an amusement park.
6 make full-length animated films.
® print his cartoons in the newspaper.
18. Describe how Snow White and the Seven Dwarfs is different from the
cartoons Walt Disney had made before.
Nat,)
ci(t5
ck-r(4 ii
,c1,1*19
co:ma -ten' ‘t I M I (tar{
-his
rnr-f-onas bacq,
wra2 short
CQr lc 000 s_
19. Write a summary of the important ideas in this article.
co
0
z
c
k
Wird -t- Gyic Kcisilm -Fat
Ace
;12.9
ha art-70 t--{P
hQ
iocavne (floc& srbc-s4265---ce4//,
Grade 4 • End-of-Year Test
13
EFTA01709652
20. Which sentence best describes the author's view of Walt Disney?
0
He was creative.
C) He was .unhappy.
C) His work was not understood.
C) He wanted to keep things from changing.
21. Which word from the article is a compound word?
(1) thousands
C) company
(I) cartoons
brainstorm
22. Read the first paragraph of this article again. Then write a paraphrase of
the paragraph.
2
W 01/4
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't 6 M:,55-son r.'
(4/7
6 ft_
wrt 5
y o A fiji_
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ell
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14
Grade 4 • End-of-Year Test
EFTA01709653
DIRECTIONS. Choose the meaning of the underlined word in each
sentence below.
A
2
artoons are made by drawing many pictures and showing them one
after another, so quickly that the pictures are animated or seem to
move.
C) Lively
• Colorful
® Carefully drawn
® Comical
24. He wanted to make enormous amusement parks where people enjoyed
themselves.
® After the amusing
® Before amusing
•
A means of amusing
® Not amusing
25. His company today employs many people and continues to make
imaginative movies like Beauty and the Beast and The Little Mermaid.
® Talks to
•
Gives jobs to
® Draws
® Interests
26. The movie Snow White and the Seven Dwarfs was a hit.
® A slap
et To ask
A success
® To strike a ball
Grade 4 • End-of-Year Test
15
EFTA01709654
DIRECTIONS. Choose the word that has the same meaning as the underlined word
in each sentence below.
27. She bent the twig into a circular shape.
® Cracked
® Ruined
C) Shortened
O Curved
28. Gerald hoisted the flag.
® Opened
® Twirled
4!) Lifted
® Folded
DIRECTIONS. Choose the word that means the OPPOSITE of the underlined word
in each sentence below.
29. Sharon thought that riding a bike withoUt a helmet was dangerous.
@ Hard
® Silly
O Safe
® Rough
30. Abdul entered the store.
C) Opened
O Exited
® Passed
® Closed
16
Grade 4 • End-of-Year Test
EFTA01709655
3
Fill in the circle of the correct answer.
Choose the answer. (2.3,2.5)
‘i. q6 + 302 + 77
C.
145
C) 203
•
475
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2030
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$2 A4 14
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Date
2. 971 — 643
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332
328
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Choose the product. [6.3: t2.3(
7. 2 x 3401
(46)
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OO.C. Heath and Company
161
Page 1 of 7
at
EFTA01709656
Name
Final Test
Divide. [7.2,7.3.13.21
Date
ts. $49A5 + 5
C) $9.09
•
$9.89
© $9.90
© $9.91
16. 1463 + 2
® 730
0
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•
731 R1
17. $59.78 + 7
.
0
$8.11
0
$8.31
a $8.54
© $8.58
19. 2820+ 8
•
352 R4
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© 350 R4
© 350 R2
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C) 904
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•
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© 200
© 300
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778 R4
21418+11
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4...615+ 35
741 + 57
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Complete each number sentence. 02)
27.g- = • 3
28.
■
3
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30. 2
•
= -6-
0
4
® 6
•
4
1
5
•
4
8
C) 2
•
6
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12
C) 4
10
© 2
O
16
6
Choose the answer. Use objects or draw a picture to check your answer. [8.4)
31.
of 36
4
*, 3 of 18
® 12
*-41t.)io of 20
C) 2
5
34.
of 15
3
C) 6
® 9.
C) 4
5
•
9
12
ID 6
@ 3
© 5
•
10
4(91 10
•
15
O.C. Heath and Company
162
Page 2 of 7
(4)
EFTA01709657
Name
Date
Final Test
i f
II
II
Choose >, <, or =.
it helps. [83)
®
>
4.41 <
O
=
Use fraction bars when
Choose the fractions that are ordered
from least to greatest. (8.3]
7 1
3 1
8' 4' 8' 2'
5
1 2
3
10' 51 g, 15
1 1
2
3
5'
g
1 1
4
5
5' 6'
g
3 1
1
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4 2' 8
1 1
7
4
g, 5 12 , 6
5 1
1
3
g, 6' 9' 6
5 1
3
1
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Choose the answer. 9.1.9.4)
39.
3
2
8 + 5
C) I
o l
to I
@. I
40. 1
2
-g + 5
„
o I
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11
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41. m -
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• 76
O
78
2
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0
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© 4
Use the grid at the right to answer questions 47 and 48. [5.3)
47. Which figure is at point (2, 3)?
O circle
star
6
square
5
4
triangle
3
0
2
0
48. Which figure is at point (5, 5)?
1
circle
0
1 2 3 4 5 6
triangle
square
star
O D.C. Heath and Company
163
Page 3 of 7
I
EFTA01709658
Name
Date
Final Test
Choose the name of the figure at each of the following points. (5.31
49. D5
fa triangle
® star
© circle
QD
square
50. A3
circle
© star
© square
C) triangle
6
5
4
3
2
1
0 ABCDEF
Choose the perimeter. poi)
51.
52.
2ft
4}n
C) 9; ft
•
13ft
© 13;ft
© 14ft
sin.
.C) 19 in.
© 20 in.
•
27 in.
® 56 in.
53.
San
C) 18; cm
© 21 cm
4) 36 cm
® 37 cm
3 yd
2 yd
•
22 yd
© 20 yd
© 17 yd
C) 10 yd
Choose the length of each to the nearest centimeter or millimeter. (10.21
55.
56
9 centimeters
8 centimeters
7 centimeters
6 centimeters
95 millimeters
100 millimeters
105 millimeters
110 millimeters
C Heath and Company
164
Page 4 Of 7
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EFTA01709659
Name
Date
$
Final Test
Choose the better estimate. (1U)
57. height of a per5on
e 6 ft
C) 6 yd
58. capacity of a sink
e 20 L
© 20 mL
59. you could wear shorts outdoors
C) 26°F
•
26°C
so. you would need a scarf outdoors
4) 30°F
© 30°C
Choose the elapsed time. [10.6]
61.
9:05 A.M.
62.
6:30 P.M.
63. 7:45 P.M.
2:03 A.M.
11:20 A.M.
10:55 P.M.
1:15 A.M.
2:56 A.M.
C) 1 h 15 min
C) 3 h 5 min
® 8h
C) 36 min
C) 1 h 25 min
C) 3 h 25 min
© 6 h 45 min
© 53 min
2h 15 min
.
4 h 10 min
14 5 h 30min
© 56 min
© 2 h25min
e 4 h 25 min
© 5h 15min
59 min
Choose the value of the underlined digit.
65. 37.48
® 4 hundredths
•
4 tenths
© 4 ones
•
4 hundreds
(11.2)
66. 11.07
•
7 hundredths
© 7 tenths
© 7 ones
•
7 hundreds
67. 261.53
® 1 hundredth
•
1 tenth
•
1 one
© 1 hundred
68. 905.$6
C) 8 hundredths
410 8 tenths
© 8 ones
•
8 hundreds
C D.C. Heath anti Company
165
Page 5 et 7
EFTA01709660
Name
Date
Final rest
Choose the answer. 11.4, 11.5)
69.
41
+ 28.5
70.
36.01
®
0
©
se
— 9.3
45.31
45.07
26.98
26.71
71. 67.58 + 29.4
® 38.18
0
38.54
© 96.62
OD 96.98
72.
88.9
- 31.06
® 12.5
0
27.5
© 41.5
to 69.5
C
® 119.96
© 119.15
41 57.84
© 5.78
73.
52.4
25.66
+
6.7
lk
23.11
4.8
+ 90.72
117.53
118.63
119.62
127.63
75. 0.3 - 0.2
® 1.0
C) 0.6
© 0.5
•
0.1
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® 2.0
•
2.2
© 15.7
© 32.2
•
84.76
© 83.66
© 78.76
© 73.76
®
©
•
©
Find the average of each set of numbers. (13.3)
n. $16, $24, $7, $15, $13
® $13
® $14
(0 $15
© $16
78. $74, $52, $31, $71
® $228
C) $75
•
$57
© $47
79.134,99,64,105,65,53,87,98,114
O 81
® 89
O 90
*
91
80. 700, 612, 1000, 6477422, 5807659-
•
660
C) 666
© 760
© 776
0 D.C. Heath and Company
166
Page 6 of 7
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EFTA01709661
Name
Final Test
Solve each problem.
A trolley travels 1005 feet in 1 minute.
How far will the trolley travel in 4 minutes?
2010 ft
2050 ft
4002 ft
4020 ft
83. Pam plans to ride her bicycle 1 mile over
the weekend. She rides a mile Saturday
morning and -1 mile Saturday afternoon.
How far does Pam ride on Saturday?
1
1
2
4
1
3
4 mile
4 mile
-4
0
2
5
3
4
mile
mile
Date
y
Chad is selling raffle tickets for the
school Special Olympics. The raffle
tickets cost $5 per book. On Friday,
Chad sells 45 books. On Saturday, he
sells 110 books. How much money does
Chad raise for the two days?
C) $775
@ $780
0
$825
© $875
84. Mickey collects stamps from foreign
countries. One half of the stamps are
from Canada, ands of the stamps are
from France. What part of the stamps
are from Canada or France?
as. Rachel has saved $93.67 to buy a tape
recorder. The recorder costs $120.98 on
sale. How much more money does
Rachel need to buy the tape recorder?
® $25.31
•
$27.31
(1) $137.61
© $214.65
87. The planetarium is open 195 days out
of the year. On each of those days,
a special film is shown that lasts for
60 minutes. How many minutes are
films shown over the year?
® 1350 minutes
fe 6375 pounds
© 8100 minutes
© 6355 pounds
© 11,400 minutes
© 6275 pounds
11,700 minutes
© 440 pounds
86. Mr. Townes spends $15.49 for a set
of earphones and $3.65 for a blank
cassette. How much money does
Mr. Townes spend altogether?
C) $11.84
$19.14
© $46.14
© $51.99
88. City planners ordered 425 bags of
-
chipped bark to help beautify parts of the
city. Each bag has 15 pounds of chipped
bark. How many pounds of bark did the
city planners order?
0 D.C. Heath and Company
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167
Page 7 of 7
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EFTA01709662
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EFTA01709665
At recess y u o un things. Pretending is fun. Pretend you
are a tennis shoe.
Before you begin writing, think about what your tennis shoe //
experiences each day at recess .
Now tell about your recess experience as a tennis shoe.
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EFTA01709668
Li
Sometimes we do things that we were told not to
do and then find ourselves in trouble with no one
around to help. Then we have to figure out how to
solve the problem on our own.
()
Read this story about Tamaqua and the bear. In
the story, an Indian boy named Tamaqua finds
himself with a very big problem - a big bear that is
threatening his life. Tamaqua is trapped, and there
seems to be no way that he can get away. The story
stops just as the bear seems about to catch
Tamaqua. However, Tamaqua manages to escape.
After reading the story, write an ending that tells how
Tamaqua escapes from the bear.
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EFTA01709671
Everyone has a place that is special to them. This place
may be anywhere you would like it to be.
Before you begin writing, think about your special place .§:
Now explain why this place is so special to you.
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Name
Date
e
r
Student Attitude Assessment
•
1. Color the circle that shows how you feel.
2. Make a math award for
yourself. Write what you
Agree
Disagree
do well in math.
I like math.
I use math almost every day.
Math is hard.
Mathis important to me.
Math scares me.
Math can be fun.
3. Circle your favorite subject.
Put an X on the one you like least.
h
Science
4. Make a word map to show how you feel about math. Write
a feelingin each circle. Make more circles if you need to.
5. Circle your favorite subject.
Put an X on the one you like least.
MVh WD Social Studies
(c) D.C. Heath and Company
15
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EFTA01709674
FEAT
Raids Caw*Mauva Assossmett
Spring 2004
NAME:
Florida Comprehensive Assessment Test (FCAT)
ID:
SCHOOL:
NORM-REFERENCED TEST
DISTRICT:
50 PALM BEACH
Grade 10 Student Report
This report shows your results from the FCAT National Nonn-Referenced Test.
The FCAT Norm-Referenced Test measures your achievement on a test that was given to a national
sample of students. Your norm-referenced scores in Reading Comprehension and in Mathematics
Problem Solving describe your performance in relation to the performance of students throughout the
nation. Your scores are shown below.
SUBJECT SCORES
Scale
Score
National
Percentile
Rank
Stanine
Reading
Comprehension
799
99
9
Mathematics
726
81
7
The seale Score describes your performance on the lest and allows for comparisons from year to year.
Reading Comprehension Scale Scores range from 527 to 817.
Mathematics Scale Scores range from 568 to 863.
The National Percentile Rank (NPR) and &lanais indicate your relative standing in comparison to the national
reference group. National Percentile Ranks range from 1 to 99. The NPR score indicates the percent of students in
the national sample wh0 scored equal to or below your score. Slanines range from 1 to 9 where 1 is low and 9 is
high. Stanines In the range of 4-6 are considered average scores.
If you were to take the test again, your National Percentile Rank might be slightly higher or lower. However, your
National Percentile Rank would probably fall within a certain range.
For Reading Comprehension, your National Percentile Rank should be between 94 and 99.
For Mathematics, your National Percentile Rank should be between 73 and 87.
CONTENT SCORES
Number of
Questions
on Test
Number of
Questions
Attempted
Number of
Correct
Responses
Reading Comprehension
51
51
50
Initial Understanding
8
8
8
Interpretation
22
22
22
Critical Analysis
9
9
8
Strategies
12
12
12
Mathematics
48
48
31
Problem Solving
6
6
0
Algebra
6
6
6
Statistics
6
6
5
Probability
5
5
5
Functions
5
5
4
Geometry-Synthetic
7
7
6
Geometry-Algebraic
4
4
3
Trigonometry
3
3
0
Discrete Math
3
3
2
Pre calculus
3
3
0
Data Run Date: 04/16/2004
0140442
EFTA01709675
Fear
florid" Compreliessive Atte; fan ho
Spring 2004
Florida Comprehensive Assessment Test (FCAT)
SUNSHINE STATE STANDARDS
Reading Performance Task Student Report
Grade 10
This report provides your results on the FCAT 2004 Reading
performance tasks. Each performance task on FCAT requires you
to respond with either a short response or a longer, more detailed
response. Short-response tasks are scored on a 2-point rubric and
extended-response tasks are scored on a 4-point rubric.
One of the short-response tasks is shown below with a copy of your
answer. Tho number of points you earned for your answer is shown
in the box to the right.
This task required you to read an article about a young man who
creates a successful business by salvaging lost golf balls.
Task: Select one of the following personality traits and show how it
helped Jim Reid build a successful career. Use details and
information from the article to support your response.
Daring
Hardworking
Imaginative
FCAT 2004
READING PERFORMANCE TASKS
Student Name
Student Number
School Name
School Number
District Name
PALM BEACH
District Number
50
This Perform
Task Response
Al Reading
ance
Performance Task
Responses
Points Possible
2
10
Points Earned
2
5
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EFTA01709676
Read the article "Turtle Alert" and then answer Numbers 1 through 8
in your Answer Book.
'Cup-rye AL eg rr
The sun is just coming up in
Florida. Most kids are still in bed,
but net 15-year-old Chris Miller.
For the last seven years, Chris
has been a member of a local sea
turtle patrol. Twice a day, during the
May to October turtle nesting season,
he patrols a stretch of beach near his
home.
"I follow the tracks back to the
sea turtles' nests;' Chris says. "Then
I check the nests to make sure they're
protected."
And there's lots to protect the
turtles from. Like the high tide, for
instance. "High tides can bury the
nests and drown the turtles!" Chris
explains. "So I dig out the eggs and
rebury them in a safer place."
Neighborhood dogs who eat
turtle eggs are also a big problem.
Even when the turtles hatch, there
are dangers. For example, the baby
turtles can get trapped under the
weight of their hatched eggshells. "I
try to rescue them before they die;'
Chris says. "Then I release them in
the ocean:'
Over the last seven years, Chris
figures he has helped 14,000 baby
sea turtles make it safely to the
ocean! "The babies wouldn't have
survived without help," he admits.
"Sea turtles are endangered. So I feel
like I'm really giving something
back to the Earth!"
Baby turtles sense the direction in which they
must travel to reach the sea from the nest.
Natural light on the ocean water shows them the
way. When many buildings and houses are built
in an area, the streetlights or house lights can
confuse the baby turtles.
Now turn to page 15 in your Answer Book.
Page 1 1
EFTA01709677
FLAT Reading
price. "I know who will take care of you,
little bird," the man whispers.
When he arrives home, he carries the
cliff swallow in its rattan cage to the
room where his daughter lies sleeping.
Rather than wake her, he places the caged
bird on her bedside table. As he leaves
the room the little bird coos, "Oh, please
let me fly under the rice moon tonight!"
But the man does not understand the
swallow's language.
When the girl wakes suddenly in the
middle of the night, the first thing she
sees through her fever is a small cliff
swallow blinking at her from behind the
bars of a rattan cage. She knows too well
how terrible it is to be kept inside.
"I know what you need, little bird,"
she murmurs. But the swallow no longer
believes what people say.
Slowly, the sickly girl rises from her
bed and carries the cage to the open
window. Unlatching the rattan door, the
girl asks, "Will you fly for me, too, little
bird?" And her language is one that the
swallow understands.
For a moment, the bird studies the
open cage door uncertainly. Then it steps
to the ledge, carefully spreads its small
wings, and flies away.
Although the cliff swallow now can
fly anywhere it chooses, it always passes
by the little girl's bedroom window each
night. And each night, for a little while,
both the bird and the girl are free under
the rice moon.
ri
mmall ow turn to page 19 in your Answer Book.
Page 13
EFTA01709678
#
e AL eg -r
Now answer Numbers 1 through 8. Base your answers on the article
"Turtle Alert."
CO
Think about what Chris does. Then read this sentence from the article.
Twice a day, during the May to October turtle nesting season, he
patrols a stretch of beach near his home.
What does patrols mean?
O
cleans up
runs on
•
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C) writes about
Why did the author write the article "Turtle Alert"?
0
to tell about the lives of sea turtles
©
to persuade people to join turtle patrols
0
to persuade people to keep their dogs on leashes
•
to tell about one person's work to save sea turtles
Page 15
EFTA01709679
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FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001
NORM-REFERENCED TEST
Student Report
Grade 07
This report shows your results from the FCAT National Norm-Referenced Test.
Lid nt
m
Student Number
School Name and Number
District Name and Number
60 - PALM BEACH
The FCAT Norm-Referenced Test measures your achievement on a test that was given to a national sample of students. Your norm-referenced scores in
Reading Comprehension and in Mathematics Problem Solving describe your performance in relation to the performance of students throughout the nation.
Your scores are shown below.
SUBJECT SCORES
Scale
Score
National
Percentile
Rank
Stanine
Reading
Comprehension
735
94
8
Mathematics
Problem Solving
716
92
8
-
The Scale Score expresses your performance and allows comparisons from year to year.
Reading Comprehension Scale Scores range from 490 to 819. Mathematics Problem Solving
Scale Scores range from 517 to 830.
The National Percentile Rank and Stanine Indicate your relative standing In comparison to the
national reference group. National Percentile Ranks range from 1 to 99. Stanines range from
1 to 9.
If you took the test again, your National Percentile Rank might be slightly higher or lower than
stated here. However, your National Percentile Rank would probably fall within a certain range.
For Reading Comprehension, your National Percentile Rank should be between 87 and 97. For
Mathematics Problem Solving, your National Percentile Rank should be between 84 and 98.
CONTENT SCORES
Number
of Points
Possible
Number
of Points
Earned
Number
of Questions
Attempted
Reading Comprehension
54
49
54
Initial Understanding
10
9
10
Interpretation
24
22
24
Critical Analysis
10
10
10
Strategies
10
8
10
Mathematics Problem Solving
50
40
50
Measurement
5
2
5
Estimation
6
5
6
Problem Solving
5
5
5
Number Relationships
6
4
6
Number Systems
4
3
4
Patterns & Functions
3
3
3
Algebra
4
4
4
Statistics
5
4
5
Probability
3
2
3
Geometry
9
8
9
Each question was worth 1 point.
Run Date: 04/28/2001
0350834
EFTA01709691
Florida Com irehensive Assessment Test
FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001
SUNSHINE STATE STANDARDS
Student Report
Grade 07
Student Name
IMO
School Name and Number
District Name and Number
50 - PALM BEACH
This report shows your results from the FCAT Sunshine State Standards Test.
The FCAT Sunshine State Standards Test measures your performance on selected benchmarks in reading and mathematics as defined by the Sunshine State
Standards. Scores on this test are one indication of your achievement of the challenging content that Florida students are expected to know. Achievement levels for this
portion of FCAT have not yet been determined.
Student Achievement Level Descriptions
LEVEL 5: Performance at this level indicates that the student has success with the most challenging content of the Sunshine State Standards. A Level 5
student answers most of the test questions correctly, Including the most challenging questions.
LEVEL 4: Performance at this level Indicates that the student has success with the challenging content of the Sunshine State Standards. A Level 4 student
answers most of the questions correctly but may have only some success with questions that reflect the most challenging content.
LEVEL 3: Performance at this level Indicates that the student has partial success with the challenging content of the Sunshine State Standards, but
performance Is inconsistent. A Level 3 student answers many of the questions correctly but is generally less successful with questions that are
most challenging.
LEVEL 2: Performance at this level indicates that the student has limited success with the challenging content of the Sunshine State Standards.
LEVEL 1: Performance at this level Indicates that the student has little success with the challenging content of the Sunshine State Standards.
Your scores are shown below.
SUBJECT SCORES
Student
Achievement
Level
Scale
Score
State
Comparison:
Thirds
Lowest
Middle
Highest
Reading
TBD
348
1
Mathematics
TBD
334
1
Sunshine State Standards Reading and Mathematics Scale Scores range from 100 to 500.
If you took the test again, your scores might be slightly higher or lower than the scores on
this report. However, your scores would probably fall within a certain range. For reading,
your scale score should be between 330 and 366. For mathematics, your scale score should
be between 321 and 347.
The check marks (1 ) show if you scored in the lowest, middle, or highest third of grade 07
Florida students who took this test.
"*TBD: To Be Determined
CONTENT SCORES
Number of
Points
Possible
Number of
Points
Earned
State
Comparison:
Thirds
Reading
Lowest
Middle
Highest
Words/Phrases
8
8
1
Main Idea/Purpose
17
14
1
Comparisons
15
13
1
Reference/Research
5
5
1
Mathematics
Number Sense
9
3
I
Measurement
9
5
1
Geometry
8
6
I
Algebraic Thinking
9
6
1
Data Analysis
9
7
I
The Content chart shows the number of points possible and the number of points earned
for each category. Each question was worth 1 point.
Run Date: 04/26/2001
0347932
EFTA01709692
. (3.
Florida Comprebenstve Assessment Test
FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2002
NORM-REFERENCED TEST
Student Report
GRADE 08
This report shows your results from the FCAT National Norm-Referenced Test.
10001.1fl
District Name and Number
50 - PALM BEACH
The FCAT Norm-Referenced Test measures your achievement on a test that was given to a national sample of students. Your norm-referenced scores in
Reading Comprehension and in Mathematics Problem Solving describe your performance in relation to the performance of students throughout the nation.
Your scores are shown below.
SUBJECT SCORES
Scale
Score
National
Percentile
Rank
Stanine
Reading
Comprehension
732
88
7
Mathematics
Problem Solving
729
93
8
The Scale Score expresses your performance and allows comparisons from year to year.
Reading Comprehension Scale Scores range from 510 to 820. Mathematics Problem Solving
Scale Stores range from 527 to 836.
The National Percentile Rank and Stanine Indicate your relative standing In comparison to the
national reference group. National Percentile Ranks range from 1 to 99. Stanlnes range from
1 to a
If you took the test again, your.National Percentile Rank might be slightly higher or lower than
stated here. However, your National Percentile Rank would probably fall within a certain range.
For Reading Comprehension, your National Percentile Rank should be between 77 and 94. For
Mathematics Problem Solving, your National Percentile Rank should be between 87 and 96.
CONTENT SCORES
Number
of Points
Possible
Number
of Points
Earned
Number
of Questions
Attempted
Reading Comprehension
54
48
54
Initial Understanding
8
8
8
Interpretation
27
25
27
Critical Analysis
7
5
7
Strategies
12
10
12
Mathematics Problem Solving
52
43
52
Measurement
5
5
5
Estimation .
5
4
5
Problem Solving
6
4
6
Number Relationships
6
4
6
Number Systems
4
4
4
Patterns & Functions
3.
2
3
Algebra
6
6
6
Statistics
4
3
4
Probability
4
3
4
Geometry
9
8
9
Each question was worth 1 point.
Dab Run Dale: 05/11/2002
0343813
EFTA01709693
north Co
kursive Assessment Test
Spring 2002 Florida Comprehensive Assessment Test (FCAT)
Sunshine State Standards - Grade 08 Student Report
Satinbei
Dis'del Name and Number
50 - PALM BEACH
The FCAT is a test developed in Florida to measure student achievement of the Sunshine State Standards (SSS) for reading, mathematics and writing. The test
is one measure of how much students have learned and how prepared they are for more challenging work. The standards tested on FCAT were developed by
groups of teachers and Identify the knowledge and skills students should achieve as they move from grade to grade. The A+ Plan for Education established
an annual assessment of student learning in grades three through ten as well as regular reports to parents. This report provides parents with independent
information about the achievement and learning gains of their students.
2002 Achievement Levels and Scale Scores
Grade 08
Achievement Levels
Scale Score Ranges
Reading Mathematics
Level 5: 394500
371.500
Level 4: 350-393
347.370
Level 3: 310.349
310.346
Level 2: 271.309
280.309
Level 1: 100.270
100.279
2002 compared to 2001
Your FCAT score is reported In several ways. The
Scale Score Is a score between 100 and 500. The
Achievement Level score Is one of five success
levels described on the back of this report.
Scale
Score
Achievement
Level
Reading
325
3
Mathematics.
350
4
Your test scores show how you performed on the day you took the test. If you had taken this test
numerous times, most of your scales scores would likely have fallen between two scores. Your
FCAT Reading scores might have been between 309 and 341. Your FCAT Mathematics scores
might have been between 341 and 359. The range reflects the amount of statistical variability in
the scale score.
Content scores show your
performance on more specific
areas of the Reading and
Mathematics tests
The table shows the number
of points possible and the
•
number you earned for each
category. Questions on this
test were worth from 1 to 4
points.
2002 Content Scores
Number of
Points
Possible
Number of
Points
Earned
Reading
Words/Phrases
8
8
Main Idea/Purpose
22
18
Comparisons
10
5
Reference/Research
10
8
Mathematics
Number Sense
12
9
Measurement
12
9
Geometry -
12
6
Algebraic Thinking
.12
10
Data Analysis
12
7
2001 Achievement Levels and Scale Scorer*
Grade 07
Achievement Levels
Scale Score Ranges
This section of the report shows the scale scores
and achievement level scores you earned last
year. The table on the ten shows the scale score
ranges for the test you took last year.
Reading Mathematics
Level 5:
389-500
379-500
Level 4:
344-388
344-378
Level 3: 300-343
306-343
Level 2:
267-299
275.305
Level 1:
100-266
• 100.274
Scale
Score
Achievement
Level
Reading
348
4
,Mathematics
334
3
2001 to 2002 Learning Gains*"
The Learning Gains section of this report shows an estimate of your progress
from 2001 to 2002. Your learning gains are based on a comparison of your
Achievement Level scores from year to year.
Reading Learning Gains:
Your FCAT Reading achievement level score is lower this year
than last year, but your overall achievement is satisfactory.
Mathematics Learning Gains:
Your FCAT Mathematics achievement level score improved over
last years score, and you have made good progress.
2
""" 2001 scores and learning gains are reported if matching records were found
on the computer file.
Ilato Ron naen• asnirunn,
EFTA01709694
Florida Comprehensive Assessment Test
FCAT WRITING
STUDENT REPORT
2002
Grade 8
WRITING TO CONVINCE
Student Name:
Student I.D. No.:
School:
District:
ALM B •AC
N
SCORE: 4.5
How Papers Are Scored.
The student responses are scored by trained readers using the holistic method to evaluate
a piece of writing for its overall quality. The readers consider four elements: focus,
organization, support, and conventions. In this type of scoring, readers make a judgment
about the entire response and do not focus on any one aspect of the writing.
Focus refers to how clearly the paper presents and maintains a clear main idea,
theme, or unifying point. Papers representing the higher end of the point scale
demonstrate a consistent awareness of the topic and do not contain extraneous
information.
Organization refers to the structure or plan of development (beginning, middle,
and end) and whether the points are logically related to one another. Organization
also refers to (I) the use of transitional devices to relate the supporting ideas to the
main idea, theme, or unifying point and (2) the evidence of a connection between
sentences. Papers representing the higher end of the point scale use transitions to
signal the plan or text structure and end with summary or concluding statements.
Support refers to the quality of the details used to explain, clarify, or define. The
quality of the support depends on word choice, specificity, depth, and
thoroughness. Papers representing the higher end of the point scale provide
examples and illustrations in which the relationship between the supporting ideas
and the topic is clear.
Conventions refers to punctuation, capitalization, spelling, and variation in
sentence structure used in the paper. The conventions are basic writing skills
included in Florida's Sunshine State Standards. Papers representing the higher end
of the point scale follow, with few exceptions, the conventions of punctuation,
capitalization, and spelling and use a variety of sentence structures to present
ideas.
Dear Student
The paper you wrote in February as part of the FCAT has been read
independently by two people trained to score this test. Each reader
judged the paper against a set of standards and gave it an overall
score. Your score is the average of the two readers' scores.
This writing score will help you, your parents or guardians, and your
teachers understand how well you performed on this statewide writing
test. A description of how papers are scored is printed on the left
side of this report. A description of each possible score is printed
on the back of this report.
Remember, you were given 45 minutes to read the assigned topic,
plan what to write, and then write your response. The conditions
under which you write papers in class or at home may not be the
same as those for this test; therefore, the writing may not be the
same. You and your teachers should consider the score on this test
along with all of your other writing when planning activities to
continue developing your writing skills.
DESCRIPTION OF THE TOPIC:
You were asked to convince the reader to accept
your opinion on teenagers having jobs or chores.
RUN DATE 04/11/02
50-2451
EFTA01709695
FCAT
flocida Competent... Assessment Test
FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2002
READING SUNSHINE STATE STANDARDS PERFORMANCE TASKS
Student Report
Grade 8
This report provides your results on the FCAT 2002 Reading
performance tasks. Each performance task on FCAT requires you
to respond with either a short response or a longer, more detailed
response. The short-response tasks are worth up to two points
and the extended-response tasks are worth up to four points.
One of the short-response tasks is shown below with a copy of
your answer. The number of points you earned for your answer Is
shown in the box to the right.
There were four performance tasks on this year's test. The
highest number of points possible on all four tasks was 10 points.
The total number of points you earned is also shown in the box to
the right.
This task required you to read an informational passage about
survival skills that can be used under several adverse conditions.
How are the survival skills needed for extreme
heat and extreme cold similar? Use details
and information from the article to support
your answer.
FCAT 2002
READING PERFORMANCE TASKS
POINTS EARNED
Student Name
ID Number
School Number
School Name
District Number od
District Name
PALM BEACH
Points earned for answer shown below 0
Total number of points you earned:
5
ity ettfielledi men:t-
ater& earl ore Carat31. eau\ ome cc
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tro& anne scetatt‘
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reatskidet.
1e, sx.teat
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ti
Data Run Date: 05/05/2002
0075729
7€9000149
EFTA01709696
THE SCHOOL DISTRICT OF PALM BEACH COUNTY
Graduation Intent
Students and parents/legal guardians must return the completed Graduation Intent to the student's school
Guidance Department. If the signed Graduation Intent is not returned to the school by September 2, 2003.
the student shall be considered to have selected the general requirements for the four-year graduation
option Option A.
Students choosing Option B or Potion Q who do not meet their graduation requirements at the end of
three years. will then be required to meet the 24 credit option, Option A and would attend high school a
fourth year.
If you have questions. contact your school Guidance Department.
Student Name
Student ID Number
School
Current Grade
I have reviewed the requirements of the three standard diploma graduation options listed below, in
accordance with Florida Statute § 1003.429. I realize my choice of programs may affect the
post-secondary options available to me.
I am aware of credit opportunities that may enhance my education, such as dual enrollment, advanced
placement, early admission to college, International Baccalaureate, magnet programs, career academies
and Tech Prep programs.
I am aware that advanced course work in high school is the best predictor of success after high school. I
realize that meeting the minimum admissions requirements for the Florida State University System does
not guarantee acceptance by a university, in or out of the state system.
I plan to graduate by meeting the requirements of:
El OPTION A- Four-year, 24 credit General Graduation Program
0Wrriou B - Three-year, 18 credit Standard College Preparatory Program
K OPTION C - Three-year, 18 credit Standard Career Preparatory Program
I am aware that I should review my graduation option choice with my school counselor on a regular basis.
to- a0-of
_intletrorteS
PRSCI 2034 (Nov 8/4/2003)
ORIGINAL - School Guidance Counselor
EFTA01709697
Media Specialist*
Assistant Principals
Occupational Spc:
Counselor/Stdt Serv:
Data Processor/Date:
-
/
/
Wa:
Form# PEISO 0756 (Rev. 9/90)
13.0'15.
EFTA01709698
Rprt-Tsrsrm
es “sulem-swav,.....
ene
utsLr ILL ul rdom owaL” •-uunty
SECONDARY STUDENT WITHDRAWAL FORM
School Year 05/06
This is NOT an official
transcript. Please send
request to school center
for an official transcript.
Race
20648804
MIMMIIIII
WHITE
Grade Sex
Birth
-
wi
l Date Code Reason
12
FEMALE
G-Eb
EACH TEACHER: mark grades to present date. Record number of unexcused absences
in upper left half of absence box; record total absences in lower right half
of absence box. Collect book(s) and note return. Do all work in ink.
Prds Course
Sec
Bldg-rm
Title
01
8301620 001 WORK EXP 2
04-108
Signature of IM=p
02
1001400 015 ENG IV
03-209
Signature of
03
1206330 201 ANLY GEOMETRY
04-223
Signature of
04
2106450 004 AMER POLITICAL S
02-221
Signature of
05
8301650C 001 WORK EXP-O3T
OC-O3T
Signature of Ems gimp
06
83016508 001 WORK EXP-O7T
OC-COT
Signature offing mom
07
8301650A 001 WORK EXP-OJT
OC-COT
Signature of
Isms.
1st Abs 2nd Abs Ex 3rd Abs 4th Abs Book
Gr Ex/Un Gr Ex/Un Gr Gr Ex/Un Gr Ex/U Rt'd
I
11/
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//
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//
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9/
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0/N
0/N
(..)/N
Title of books not returned Book* Condition Price Other Outstanding Obligations
EFTA01709699
Technical Artifacts (26)
View in Artifacts BrowserEmail addresses, URLs, phone numbers, and other technical indicators extracted from this document.
Flight #
WN01Phone
2100010Phone
2106450Phone
2410592Phone
2968131Phone
3016508Phone
381.0056Phone
4712004Phone
5000618Phone
5140400Phone
5420490Phone
5807659Phone
6477422Phone
697-8000Phone
7200360Phone
8301620Phone
9000149SWIFT/BIC
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