EFTA01710219

FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.03Z, 402.305, 402.313, Florida Statutes; rules 640-3.011, 65C-22.006, 65C-20.011, Florida Administrative Code LAST N FIRST NAME MI DOB (MO/DA/YR) PARENT OR GUARDIAN CHILD'S SS# (optional) STATE IMMUNIZATION IMP 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 7 th grade requirement only and has previously filed a Certificate of Immunization (DR 680, Part A-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 available from the local county health department. DOE Dose 1 VACCINE CODE %4 all‘h DTaP/DTP2 A Teti Polio' Hill MMR (Combined)' F. (Separate)° G,H,I Hepatitis B9 Varicella" Varicella Disease L Year Dose 2 Dose 3 ta III Lit II • Al . A P Dose 4 Dose 5 .a • lb . SAP • . • I The state immunization ID# is an identifier supplied by the state immunization registry (optional). 2 DTP/DTaP 5 doses required. If the 46 primary dose is administered on or after the 46 birthday a 56 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. 5 Polio 4 doses required. If the 3" dose in an all OPV or all IPV series is administered on or after the 4" birthday, a 48, dose is not required. Polio vaccine is not required for children 18 years of age or older. 6 Hib is required for child care, family day care and preschool entry and attendance only. 7 First dose valid if given on or after 1" birthday. Second dose (measles) valid if given at least I month after l" dose. A 21" dose of measles (preferably MMR) is required for students in grades K-6 and 7'h 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 (11) or single rubella vaccine (I). 9 Hepatitis B vaccine series is required for 7th grade entry and attendance effective with the 1997/1998 school year and kindergarten entry and attendance effective with 1998/1999 schoollear. In each subsequent year thereafter the next highest grades arc included. Hepatitis B vaccine series is required for preschool entry and attendance effective with the 2001/2002 school year. 10 Varicella is required for entry and attendance in child care and family day care effective July 1, 2001. 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. EFTA01710219 LAST NAME FIRST MI DOB moroArxit) , Certificate of Immunization for K-12 Eicluding 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 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, rubella and hepatitis B (for kindergarten effective with the 1998/99 school year) and varicella, varicella vaccine not indicated if history of disease either physician documented or parental recall (for kindergarten effective with the 2001/2002 school year) for school attendance as documented on the reverse side of this form. Physician or Clinic Name: Physician or (Print or stamp) Authorized Signature: Address: Date: Certificate of Immunization Supplement for Tb 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, the next highest grade will be included in the requirement.) DOE Code 8 1 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 7. grade effective with the 1997/98 school year: tetanus-diphtheria booster, hepatitis B vaccine series, and second dose of measles vaccine as docurn. Physician or Clinic Na Physician or (Print or stamp) horized Signatur Addr•• Date: --1 1 St (C)--' . 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 I certtfr that the above named child has received the immunizations documented on the reverse side of this form and has commenced a schedule to complete the required immunizations. Additional Immunizations are not medically indicated at this time. . Expiration Date: . . i Physician or Clinic Name: 05•days after next immuilization.appoiutrnent) (Print or stamp) . . _ . . . • Physician or Address: Authorized Signature: Date: 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 certifr that the physical condition alibis child is such that immunization(s) as indicated in Part C above is medically contraindicated. Physician or Clinic Name: (Print or stamp) Physician Signature: Address: Date: DH 6$0 72001, obsoletes earlier editions (Stock Number 5740-000-06SO-6) EFTA01710220 ALTH EXAMINATIONS Date Full NamllM glIllt Phone Race Address Birthdate Student' Name of Parent cr Guardian School A. HEALTH EXAMINATION Height Weight Blood Pressure (1) Normal-N; Abnormal=A N A COMMENT: Abnormal Findings, by number 1. Appearance 2. Skin/Nose 3. Head/Scalp 4. Eyes J 5. Visual Acuity (R & L) 6. Ears 7. Auditory Acuity (R & L) 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. Nutrition 22. Other B. HEALTH HISTORY (Serious Illnesses Injuries: explain) (attach narrative it additional space needed) C. LABORATORY Hemoglobin/Hematocrit Stool 1O & P) Tuberculin test: Sickle Cell Lead Authorized Signature OH 3040. 10190 (Replaces NRS-li Form 3040 which may be used) (Slack Number 5741-000-3040-2) EFTA01710221 ERs Student's Full Name Address Name of Parent or Guardian STATE OF FLORIDA DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES HEALTH EXAMINATIONS Dale if Mr - Phone Race Sex Birthdate A. HEALTH EXAM NATIO N Height Weight Blood Blood Pressure Normal=N; Abnormal-A N A COMMENT: Abnormal Findings, by number 1. Appearance 2. Skin/Nose 3.1-lead/Scalp 4. Eyes 5. Visual Acuity (R & L) 6. Ears 7. Auditory Acuity (R & L) 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 Pro b.) 16. Handicap. dirge& • other (Specify) '19. Activity Restrictions (Specify) 20. Alatise. substance/ physical / emotional 2 1.Nutrition 22. Other B. HEALTH HISTORY Serious Illnesses Injuries: explain) • (attach narrative if additional space needed) C. LABORATORY (as Indicated) mylotin/Hematocril Stool (0 &12) Tuberculin test: Lead Sickle Cell NAME: TITLE: ADDRESS: (Please Print) MRS-li Form 3040, Mar 91 (Obsoletes previous ' (Stock Minter: 5744-000-3040.2) tYP resu EFTA01710222 SUR C fleala HRS. OCl/AlliCra Of MUM, WO • FLORIDA CERTIFICATE OF IMMUNIZATION (HRS 680 - PART A) (1+) (Florida Statutes 232.032) FOR CHILDREN WHO HAVE COMPLETED ALL REQUIRED IMMUNIZATIONS FOR SCHOOL ATTENDANCE CHILD'S NAME (PRINTED) SS YR' DOCTOR: PART A OF THIS FORM IS USED ONLY IF TILE CHILD HAS RECEIVED ALL REQUIRED IMMUNIZATIONS LISTED BELOW. IF 110T. SEE REVERSE SIDE. DTP - 5 DOSES REQUIRED 110) PARENT OR GUARDIAN IF THE FOURTH PRIMARY DOSE GF DTP IS ADMINISTERED ON OR AFTER THEFOURTHRIRTHDAY, A FIFTH-DOSETS NOT REQUIF.ED. DT (PEDIATRIC) VACCINE IS ACCEPTABLE IF PERTUSSIS VACCINE-IS-MEDICALLY- CONTRAINDICATE!). (COMPLETE PART C FOR•PERTUSSIS CCNTRAINDICATION.) (V) Td (ADULT) VACCINE (A SERIES OF 3 DOSES) IS ACCEPTABLE.AND'RECOMMENDED FOR CHILOREN:.7 YEARS OF A0E.OR OLDER. (C) POLIO - 4 DOSES REQUIRED IF THE THIRD PRIMARY DOSE CF OPV IS ADMINISTERED ON OR AFTED.THE'FOURTH BIRTHDAY, A FOURTWDOSE is NOT REQUIRED. IPV IS AN ACCEPTABLE ALTERNATIVE :F OPV IS NOT INDICATED. FOLIO VACCINE IS OMITTED FROM THE REQUIRED IMMUNIZATIONS OF GIOLDREN 18 YEARS DF.A5E OR CUTER. MEASLES. MUMPS, MD RUBELLA — 2 DOSES REQUIRED FOR MEASLES 1 DOSE REQUIRED FOR MUMPS MD RUBELLA • MMR COMBINED — 1st DOSE AT 12 MONTHS OF AGE Oft OLDER.(RECOMPSENDED AT 15 MONTHS). (F*) 2nd DOSE REQUIRED PRIOR TO KINDERGARTEN:ENTRANCE , (VAUD IF GIVEN AT LEAST 30 DAYS AFTER 14;005E) MEASLES SINGLE — 1st DOSE AT 12 MONTHS OF AGE OR OLDERBECOMMENDEDAT 15 MONTHS) (G) 2nd DOSE REQUIRED PRIOR TO KINDERGARTENPJIRANCE (VALID IF GIVEN AT LEAST 30 DAYS AFRER.1g.DOSE) MUMPS SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER. (11`) • . RUBELLA SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER (P) 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 RECORDS AVAILABLE AND TO THE BEST OF MY KNOWLEDGE THE ABOVE NAMED CHILD HAS BEE DIPHTHERIA, TETANUS PERTUSSIS, POLIO, MEASLES, MUMPS, AND RUBELLA AS REQUIRE PHYSICIAN OR CLINIC NAME (PLEASE PRINT) )E AUTOMATED STUDENT DATA BASE CODES: • IMMUNIZATION STATUS CODE / 11 VACCINATION CODE EFTA01710223 DATE OF BIRTH CHILD'S NAME (PRINTED) SSO MO DOCTOR: IF THE CHILD HAS NOT RECEIVED THE REQUIRED DOSES LISTED IN PART A, PLEASE COMPLETE DA YR PARENT OR GUARDIAN PART B OR PART C, AS APPROPRIATE, AND SIGN AND DATE. TEMPORARY FOR PRESCHOOL I CERTIFY THAT THE ABOVE NAMED CHILD IMMUNIZATIONS. ADDITIONAL IMMUNIZATIONS CHILDREN HAS ARE RECEIVED NOT #1' AND THE MEDICALLY MEDICAL FOR IMMUNIZATIONS SCHOOL INDICATED EXEMPTION CHILDREN #2 LISTED AT THIS (HRS WITHOUT BELOW TIME. 680 ALL AND HAS #3 - IMMUNIZATIONS COMMENCED PART B) (21 REQUIRED A SCHEDULE #4 . IN PART A TO COMPLETE THE REQUIRED #5 TYPE VACCINE CODES' DATE (MO/DA/YR) DATE (MO/DA/YR) DATE (MO/DA/YR) DATE (MO/DA/YR) DATE (MO/DA/YR) DTP A DT B Td C POLIO D Hib E MMR F AUREOLA (MEASLES) G EXPIRATION DATE (MO/DA/YR) MUMPS H (SHOULD BE 15 DAYS AFTER NEXT APPOINTMENT) RUBELLA I • PHYSICIAN OR AUTHORIZED SIGNATURE DATE PERMANENT MEDICAL EXEMPTION (HES I CERTIFY THAT THE PHYSICAL CONDITION OF THIS CHILD IS SUCH THAT IMMUNIZATION(S) CLINICAL REASONING OR EVIDENCE FOR EXEMPTION FOR EACH VACCINE. 680 - PART C) (31 IS MEDICALLY CONTRAINDICATED. LIST VACCINE(S) AND STATE VALID PHYSICIAN OR CLINIC NAME (PLEASE PRINT) PHYSICIAN'S SIGNATURE DATE HRS Form 680. JAN 93 (Repbces Mat 91 edition which may be ized) (Stock Number 5740-000.0680-6) DOE AUTOMATED STUDENT DATA BASE CODES: ' IMMUNIZATION STATUS CODE / ' VACCINATION CODE EFTA01710224 THE SCHOOL DISTRICT OF PALM BEACH COUNTY ELEMENTARY REPORT CARD Student School Teacher Principal E - V - MARKING CODES - ACADEMIC SUBJECTS GRADES 1 and 2 Excellent S - Satisfactory Very Satisfactory N - Needs Improvement A B C D F 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 1st I 2nd I 3rd 14h M-lh=m-IicS ' care level Hdf a check) 1...ztak....!1.LJAP - o A' pr Composition Language Spelling Handwriting/Penmanship Social Studies Science/Health Grades not given this nine week FINE ARTS REPORT Art Music Marking Period 1121EIMES Physical Education PARENT/GUARDIAN/TEACHER CONFERENCE Conference conducted (Indicate date(s)) Marking Period 1st 12nd 3rd 4th Grade (.5 Year 2000-2001 SOCIAL DEVELOPMENT/CLASSROOMSTUDY HABITS Please work on the area(s) that have a check (/). Marking Period tat I 2nd I 3rd I 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 (/). Skills Checklist(s) Portfolio Audio Cassette Recording Video Recording Computer Program Standardized Test(s) Observations/Written Comments Other ATTENDANCE Regular attendance and punctuality are essential for quality education. Days Present Days Absent Days Tardy Information Included PLACEMENT Marking Period MEMZEIMIT2IMI Marking Period Billaliilla Grade A Special Session • If Special Session program is Indicated, grade placement will be determined by the home school. PBSD 0768 (Rev. 7/99) Goldenrod/1st Period Pink/2nd Period Canary/3rd Period Green/4th Period White/Office Copy EFTA01710225 THE SCHOOL DISTRICT OF PALM BEACH COUNTY 2000- ort for Grades 1-5 Se DEM GRADE 2000-2001 ACADEMIC IMPROVEMENT PLAN STATUS Your child's academic performance was at or above grade level in reading, writing, and mathematics, and an Academic Improvement Plan (AIR) was not necessary. Your child's academic performance was below grade level and an individual Academic Improvement Plan (AIP) was necessary for K reading K writing K mathematics This AIP identified remediation strategies used to assist your child this year. Your child may need another AIP next school year. Your child's academic needs were addressed through his/her Individual Education Plan (IEP), Limited English Proficient (LEP) Plan, or 504 Plan. END-OF-YEAR PERFORMANCE Your child's end-of-year performance level in reading, writing, and mathematics is identified below: TING(COMPOSITION) MATHEMATICS If less than one year below grade level has boon 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 2001.2002 school year. If more than one year below grade level has been indicated for reading, writing, and/or mathematics, you must have an LEP Plan, IEP, 504 Plan and/or AIP. You will be asked to participate in the development of a plan(s) to improve your child's academic performance. This plan(s) will be developed at the beginning of the 2001-2002 school year. PROMOTION/RETENTION DECISION As a result of your child's performance this school year, your child is being recommended for: j' Promotion to the next grade level K Promotion to the next grade level with an LEP Plan, IEP, 504 Plan and/or AIP K Good Cause Promotion from fourth grade to fifth grade with an LEP Plan, IEP, 504 Plan, and/or AIP K Retention in the same grade level SUMMER SCHOOL/EXTENDED SCHOOL YEAR RECOMMENDATIONS The promotion/retention decision for your child will be made following the completion of Summer SchooVExtended School Year. K Summer School (for Limited English Proficient students) K Extended School Year (for Exceptional Student Education students) OATE PBSO 1674 (REV. 4/262030 ORIGINAL - Cumu%6ve Folder COPY - School Use COPY - Report Card EFTA01710226 FLAT Cove5nsive Asia mutt Tell )puny 4WD Florida Comprehensive Assessment Test® Sunshine State Standards Reading Performance Task Student and Parent Report Grade 10 This report shows your results on the FCAT Reading performance tasks. Each performance task on the FCAT requires either a short response or a longer, more detailed response. Short-response tasks are scored out of 2 points and extended-response tasks are scored out of 4 points. ID One of the short-response tasks is shown below with a copy School of your answer. The number of points you earned on all District 50-PALM BEACH performance task items is also included. This task required you to read an informational passage and then answer how a blind painter's determination led to her success. Your Score 0 ,1,Marteatitereain out of 10 points On all Reading performance task responses (al-11:n d er uarit tvira tyr -to co cior ar take Ox-k 14 Ural M -C, %Ulla VG:O not- + OVA- one could do, Artie teepnCS 1/4013%-kr) W Osts %re\ -One err, src cecerre yuccaatftt.4% coot r4 ‘s rcui in rruse U tit 5 (Sit trg sold 1 ice a -true or -fists twootg., teNdq, I Z DIE. 51-1,:i1C,.? EFTA01710227 14 THE SCHOOL DISTRICT OF PALM BEACH COUNTY Grade andlor Course Change El High School 0 Middle School 4-pooLDia Documentation 0 Elementary School STUDENT NAME la test trocgo .W419 ENT NUMBER GRADE LEVEL \ SCHOOL SCHOOL. NUMBER SCH YEAR COURSE TAKEN sippiam eounEtwis Q_ 2331 CHANGE DOCUMENTATION GRADING PERIOD GRADE EXAM • CONDUCT -2: al C\ j From From From To To From_ From To To To Change course code From To Reason for change K Recalculated Grade Average K Student Completed Work CI Other (explain below) APPROVAL SIGNATURES (two of three required) Lo \ \ \Ott . DATE bh DATE DATE PBSD 0797 (REV. 511412004) ORIGINAL - Cumulative Folder DATA PROCESSOR CONFIRMATION I confirm that the grade/course change has been implemented. siGvA PRINT NAME -oc DATE Copy - Office File EFTA01710228 JOENT NAME: tai :THDATE Verified by WW1 CoAlkalis: G Yes G No a No. What Typo Verification? iTHPLACE: Dad,p, RREN lie let yL 0 4 CC 17 0973 (REV 3/20417) SCHOOL use In Lnis e until (Ins SEX: RACIAL/ETHNIC GROUP: G Mao Not Hispanic G Black Not Hispania -c Dale First Entered This ()kirk' Hispanic o can IndlanfNatIvo Alaskan G Asian/Pacific Islander O Muhl Racial OR OTHER RESPONSIBLE ADULT AT HOME: I o, PHONE NUMBER: (options!) ' OA Grader Schock Grade: School: (Pada Shoot. Grade: Selma Grade: &Moo: Year ?Etat) . Ct 1 &hoot Year 19 • Saud Year. 19 • School Mac 19 • School Year. 19 • Days Present Days Absect: s Days Piaui* Days Absent Days Present: Days Absent Days Present Days Absent: Days Present: Days Absent C 7 OPY REPORT OF CARD COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED Adra st INDCA111,1 Place Promote (P) actin (R) Special Scission (SS) INDICATE Adninisuatree Placomenl (ADMP) Picmole (P1 Nato (R) Special Swan ($S) INDICATE 1110CATE AdrrOntstadv• . Rammed (ADMP) Remote (P) Rosin (R) Spacial Session (SS) Achohlandie Reamers (ADMP) Promote (P) Borah (R) Special Session (SS) INDICATE Administrative Pimento-or (ADMP) Nandi) (P) Retain (R) Spacial Session ($5) School: Grano: Schoot Grade: School: Grans: School: Wade: Schoot I Duck: &Mod 'frac 19 • School YON 19 • School Veer 19 - School Year 19 School Year 19 • Days Present Days Absent Dais Present Days Absent Days Present Days Absent Days Present Days Absent: Days Present I Days Absent COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED INDICATE Administrative Placement (AMP) Promote (P) Rash (R) Spode] Session (5$) INDICATE AchnInlsitallve Placement IADMP) Promote (P) Retain (R) Spodel Swan (SS) INDICATE AttmlnIstratVe Nommen: (ADMP) Promote (P) Rusk (R) Special Session (SS) INDICATE ActnlaWratIve Placement (ADMP) Promote (P) Roth (R) Special knort-in ($5) INDICATE AdmInIstrerive Placement (ADMP) Promote (P) MUM (R) Special Session (SS) EFTA01710229 414OOLDIS\ THE SCHOOL DISTRICT OF PALM BEACH COUNTY (SONIC) (1) STUDENT NUMBER (2) SAC CODE (3) GRADE LEVEL 1 New and Returning Student Registration form r and axcept areas specified office use only . formation is incorrect, correct the information Writing the correct Information above it. A t, 4°° tIV A-) NEW STUDENTS: Complete all areas ontoth sides of the RETURNING STUDENTS: Review both sides. If the pre-printed by carefully and lightly crossing out the incorrect information IIIIIIMa m (S) ALSO KNOWN AS • (6) KEY/ (slab) (rbood.) Royal Aim /30ach H. 33 V// (7) INULING ADOFTESD(hease rox d abed name) OFT• no) (Nay) (31•10 NO code) (8) SOCIAL SECURITY NO. topSons9 (9) HOME TELEPHONE NO. !PM SEx e • O n RACEJETISNIC ORIGIN O I-American Indian/Alaskan Native O 8-Black, Non-Hispanic N -I-Hispanic O A-Asian/Pacific Islander O W-White. Non-Hi panic O M-Multiracial (12) DATE OF BIRTH (I 3) PLACE OF BIRTH (city, stale. counIty) AIM Y • . Ph n Aw El. ppcie govoi 04) RESIDENT STATUS O O. Foreign Exchange Student ❑O 1. Out-of-county Resident. O 2. Out-of-state Resident CI 3. In-County Resident (1 3) USA ENTRY DATE (MMODYVYY) (la)FEDERAL IMPACT SURVEY YES NO O O A. The student resides on federal property. o Ei B. The student resides In low rent housing. O O c. The parent is employed on federal property located In PS County. O 0 D. The parent is employed on low rent housing located in P8 County. O O E. The parent is in the uniformed services of the United States. O O If E. Is YES, is the parent on active duty? Check service below O Air Force O Am's, O Coast Guard O Marines O Nalional Guard O Myr/ indicate with an the longest Migrant Prekindergarten - • Prekindergarten Parent Program Applicable (17) PRESCHOOL ENROLLMENT INFOALIADON Place an X by each program attended. Also, asterisk ("the program your child was in O C. Title 1 PrekindergartenO M. • D. Pre-K Disabilities • N. None O F. Fee for Services • P. Private O H. Head Start O T. Teenage MI L. Readiness Program O Z. Not OS) Is the student a single parent? O YES O NO TRANSFER INFORMATION ("Para; 13e4ch Ft- (23) ave you ever een enrolled In Palm Beach County School? W YES O NO If yes, what school? (21) LAST ATTENDANCE DATE a - L4 - (21) DATE ATTENDED IN Pac HEALTH SCREENING INFORMATION (25 ) Students will receive non-invasive health screenings pursuant to Florida Statute § 381.0056(7Xd) Non-invasive screenings may indude vision, hearing, scoliosis, 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. If you DO NOT want your child to receive the screenings, write the words "Do not screen' here: (This exemption will cover ell typos of screenings) RS) I give permission for my child to participate in the sodium fluoride program to prevent tooth decay. O.YES D NO (Permission is valid through grade 6) an Doei your child currently have health insurance? O YES O NO If YES, indicate: O Medicaid tilitHealthy KidslKid Care O Private O Interested in receiving Information NEW STUDENTS TO PALM BEACH COUNTY (28) HOME LANGUAGE SURVEY • OYES O NO 1. Is a language other than English used In the home? If YES, what language? n S O NO 2. Does the student have a first language other than English? If YES, what language? VI YES tANO 3. Does the student most frequently speak a language ether than English? If YES, what language? (29) DISCLOSURES rikES O YES FOR ENTRY INTO P/3C SCHOOL DISTRICT NO 1. Has the student ever been expelled from school? • O YES ANO 3. Has the student ever had any juvenile NO 2. Has the student ever had an arrest resulting in a charge? Justice actions? (30) DIU LIVES WITH: (cheek one) S other O Father O Both Parents • Other (31) CUSTODY STATUS OF STUDENT(check Mother O Father O Other one) II Shared Custody (sat Is there a urt order barring either parent from removing or contacting the student during the school day? O YES NO If YES, provide the school with a copy of the court order. • PBSD 0636 (Rev. 03/19/2003) page 1 of 2 EFTA01710230 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGIS 1 ) FATHER CR LEGAL GUARDIAN (Sat 77404 int.9. 7779 (34) DATE OF BIRTH (45) DATE OF BIRTH 5 - • Oa - (.0 7 DO ADDRESS (Proof nor.844 OHL aparlmanflonbee) i 127. t 1(4, - I . . rn 6 eCL-C-il STATE 2IP CODE I - . (36) CITY STATE PP CODE (V )OCCUPATION (38) HIGHEST ED. LEVEL (CD OCCUPATGli l '.\ AI iS1-16 ST TO HIGHEST ED. LEVEL (39) PLACE OF EMPLOYMENT (50 (IN HOME TELEPHONE (4 I) BUSINESS TELEPHONE (42) Ca UPAGER NURSER (SI) HOME TELEPHONE (S2)BUSINESS TELEPHONE (5.5) CELL/PAGER NUMBER (a3) EMAIL ADDRESS (999704 (64) EMAIL ADDRESS ( EMERGENCY HEALTH AND SAFETY INFORMATION lowed to pick up student (ts) PASSWORD ami ioduracten) (62) NAME (Fat middle MG/. fast) IS (03) ADDRESS WNW comber. emelt:par:mint numb00 (64) cry STATE ZIP 000E (S5) CITY STATE 2V CODE RONC4 Palm &ash P1 -a341 (69)RELAO 0 li ef (e.n If school personnel are unable to contact you in caso may we have your permission to call your doctor or emergency services (911) for transport to the hospital? AGER NUMBER (65) RELATIONSHIP (66) TELEPHONE (67) CELUPAGER NUMBER of illness or accident. t.YES .0 NO (69) MEDICAL INIORVATION Dif sluderes Oesset, bensik.f. Seatta issues Senjot (nciutTeo stair, birds, mattes a r wapAbians). mmeasons, or caller chysical knfatioAs (70) FAMILY PHYSICIAN DI) PlifaaAN PHONE FREE OR REDUCED PRICE LUNCH (7)) Have you filled out an appricatron for free and reduced (72) HOSPITAL PREFERENCE I 41MS LOe Sr lunch? OYES • NO fAoseoslIon fa proWded with /Ms ken) PARENTS / GUARDIAN'S OTHER CHILDREN IN PALM BEACH COUNTY SCHOOLS NAME Ode, (75) SCHOOL ATTENDING (76) STUDENT NO. HOP* (TT) GRADE MOTE OF BIRTH (74) OF CHILD (Mt lasf) (79) NAME OF CHILD (KO midcto. lag) (80) SCHOOL ATTENDING (61)STUDENTN040055(47) (62)GRADE (63) DATE OF BIRTH (8A) NAME OF CHILD PR AIM*. NV (85) SCHOOL ATTENDING (OS) STUDENT NO. (opi5onal) (97)GRADE (90)DATE OF BIRTH (89) NAME oFcitto(rest midst fast) (9)) SCHOOL ATTENDING (91)STUDENT NO. WOW (92)GRSOE (93)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 (M)SCHN1 DEISROENT Na . (96)CCG (5?)aTRY CD (93) EMIG DATE MI C41. (ID)1E40131 MI OD REASSIGN CIL DOB TRANSPCRTADON 0 PI3C Bils a El Pakn Iran PR DEN VERE . 001)DCF A • 0 Pa-ent/Sludent Trans. 0 WailtEl BIN 2 3 4 5 6 7 8 9 T CZ DOD DOCUVEMAKNOECKLIST 0 Immunizations 0 Birth Records Verificeilon 0 Social Security Number 0 Physical Exams Doh) ESOL PRCGIAM OMIT CIDE (107)0ATAIDMITCCOMMEOBY DOD DATE : H , DATE PlitSO 0636 (Rev. 03/192003) page 2 of 2 EFTA01710231 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 lightly crossing out the Incorrect information and writing the correct information above it 2972222:1) DIST:2451 TCHR NBR:225 STOT: CRS:1700100 SEC:1G BLOCI:01 R1.1:175 08/12/02 (3) STUCENTS LEGAL NAME (FM . (1) ALSO KNOWN AS ( OCAL ADDRESS mouse no. 6 greet Maw* (apt noJ fait MOO (410 ado) LOXAHATCHEE FL 33470 (6) ALLLNG ADDRESS MOM no. a greet name) frig 001 (O (stale) (A0 =da) . (7) SOCIAL SECURITY NO. (0) HOME TELEPHONE NO. (0) SIX F (103 RACEIETAINC ORIGIN H 0 I-American Indian/Alaskan Native 0 Balack, Non-Hispanic H-Hispanic • kAsian/Pacific Islander 0 W-YVhie, Non-Hispanic M-Muttiracial on DATE OF BIRTH (12) PLACE (LIW00NYY) DADE COUNTY FL US FLORIDA (1D) RESIDENT STATUS 3 0 0. Foreign Exchange Student 0 1. Out-or-county Resident 0 Out Resident (14) USA ENTRY DATE (MARDEAVYYY) (15) FEDERAL IMPACT SURVEY 2. -of-slate 0 3. In-county Resident YES NO 0 0 A. The student resides on federal property. LI O B. The student resides in low rent housing. n o C. The parent Is employed on federal property located In Palm Beach County. 0 0 D. The parent Is employed on low rent housing located in Palm Beach County 0 • E. The parent is in the uniformed services of the United Slates. (i 6) PRESCHOOL ENROLLMENT INFORMATION Place an X by each program attended. Also, indicate with en asterisk (') the program your child was In the longest. 0 N. Non-subsidized Child Care 0 M. Migrant Pre-K 0 D. Pre-K Disabilthed 0 H. Headstart • I. Pre-K Early Intervention 0 C. Chapter 1 0 S. Subsidized Child Care 0 O. Other 0 0 If E. is YES, is the parent on active duty? Check service below: 0 Air Force • Army 0 Coast Guard 0 Marines 0 National Guard 0 Navy (17) ISIHE STUDENT A SNORE PARENT? NO 0 YES 0 NO Om CURRENT GRADE LEVEL 07 4TRANSEEWINEORMATION ;a6„...-Waiftt 09) NAME OF SCHOOL TRANSFERFtrio FROM (20) CITY CR LOCATION COLAcy- - (2 I) LAST ATTENDANCE DATE (22) LAST GRADE LEVEL (23) LAST PUBLIC SCHOOL ATTEACED IN PALM BEACH COutfry i (24) DATE AT1ENDIED IN PDC HEAIMESOREE listGINFORMATions . I;ie Att., 4, .s.ut 34 ,,b (25) Students will receive non-invasive health screenings pursuant to Florida Statute § 381.0356(7)(d). Non-invasive screenings may include vision, hearing, scoliosis, 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. If you DO NOT want your chid to receive the screenings, write the words "Do rot screen- here: (This exemption !ma cover el types of screenings) (26) I give permission for my child to participate In the sodium fluoride program to prevent tooth decay. ' YES 0 NO (Permission is vaNd through 6 grade) YES Medicaid 0 Healthy lOds/Kid Care 0 Private (27) Does your chid currently have health insurance? YES 0 NO if YES. indicate: Interested in receiving information SEVIMertiOENTs401PALNhBEACiiicouNTY (28) HOME LANGUAGE SURVEY YES 0 NO 1. Is a language other than English used in the home? ...pci..n ts If YES, what language? *.. If YES, at language? pa ant shh what YES 0 NO 2. Does the student have a first language other than Engbsh? OYES ANO 3. Does the student most frequently speak a language other than English? U YES, at language? ma 4. What language is spoken in the home by the parent or guardian? ct,ft t 4'1 - riled I ck (90) 5. What language is the student's first language? . pct_ r. 11S IS (31) What is the date of entry into an ESOL program? (32) STUDENT LIVESMATH. (chock coat %pother li Father xi Both Parents 0 Other (33) Oscuosunas FOR ENTRY 0/10 PSC SCHOOL DISTRICT YES NO CI rag Pi been 1. Has the student ever expelled from school? • . 4 2. Has the student ever had an arrest resulting in a charge? 0 !e1 3. Has the student ever had any gwenile justice actions? CUSTODY STATUS OF STUDENT (check oae) 0 Mother 0 Father 0 Shared Custody 0 Other pp Is there a court order barring either parent from removing or contacting the student during the school day? 0 YES NO If YES, provide the school with a copy of the court order. PBSD 0636 (REV. 02704/2002) page 1 of 2 EFTA01710232 • rtc cnern.nor- snoinnei ur rnLrvI permirn wauPil I T - New ANL, Kt I UNNINto l I ULlt.N I /Chia IS I KA I ION Into( lase PU: Y (37) MOTHER OR LEGAL GUARDIAN (kg mole label. last) PU: n umber) ADDRESS street numter ate anrbnvN numbed But ADDRESS (0044140 cry LOXAHATCHEE FL 33470 STATE 21P CODE an LOXAHATCHEE Ft. 33470 STATE ZIP CODE OCCUPATION RACE OF EMPLOYMENT OCCUPATION kAAvesTOISI CELLPAGER NUMBER CELUPAGER NUMBER :EMEMENCY: IEA43EE {tNR` afilFORMA'f Person(s) other than parent authorized to pick up student (35) PASSWORD (NM 10 characters) NAME inideN• TY lea (41) NAME PA maw India( An( ADDRESS (a9444 rumba. 4444( apatite?: number) C(FY STATE. ZIP CODE 2ocak Pa_k m P)dr‘ FJ45.3(11 STATE 2IP COCC RELATIONSHIP cart 111O1 ) EC (40) AUTHORIZED FOR El ENCY PICKUP YES El NO TELEPHONE RELATIONSHIP (42) AUTHORlaiD FOR EIAIRODCYNacuP K YES O NO (43) If school personnel are unable to contact you incase of ithess or accident, may we have you• permission to call your doctor or emergency services (911) for transport to the hospital? RYES O NO Ye) PHYSICIAN PfCtE ERI.R:NEPMN.:?. TaVAS U1/4)gi *E- :MEM/WARMAN: (49) NAME CF CHILD (Mg ant Mildkrintiel) SCNOCI. ATTEIONG STUDENT NO. (GlAbsIG GRADE DATE OF BIRTH (50) NAME CF CHILD Ma( kg mdcUoMAINO SCHOOL ATTENCANG STUDENT NO. Copilot* GRADE DATE OF BIRTH (51) NAME OF CHILD (Ng kg middleIna* WHOM ATTENDING STUDENT no. (OpboeMI) GRADE DATE CF BIRTH (52) NAME OF CHILD gas rus4 marl* nano SCHOOL ATTENDING STUDENT 10. (0P9orta0 GRADE DATE OF BIRTH Have you filled out an application for free and reduced lunch? 0 YES o NO (Application is Provided with this Thm) .:0THER:Mill:DREN)N:RALIN CH:POU (40) MEDCAL INFORMATION (bat stud sits Mnestea. behavior, heath issues. oferpin fir:Wing entries, bats. recedes of amphibiamj inedIaionr, crolhorphyskolkrolakoN PARENT/GUARDIAN SIGNATURE I verify that the information given is true and accurate to the best of my knowledge. '''''' ''' dan i ' • • • ••• ...,....... Psysot4 sk**: :(4.3?WitekkaktAtbel:l.•:::•: 6-Cr TE lte3P0R4413.f.n.TPFPiffiliSM:: :itteittf!!!!FtittriNt:641*:::::*i:•• • • ... :Wide page 2 of EFTA01710233 4 .0- tOOL Dis,>, THE SCHOOL DISTRICT OF PALM tStACH CAJUN I Y (aUhtli.i) New and Returning Student Registration 09 73 NEW STUDENTS: Complete all non-shaded areas on both sides of the form. coli I zerdoi RETURNING SUDENTS: Review both sides. If the pre-printd information is Incorrect, correct the information by carefully and lightly -, crossing out theT incorrect iriormation and wilting the correct information above II. 068C DIST:2451 TCHR:ROLAND TNBR:047 STOT: CRS:2103030 SEC:05 BLDG:01 RM:131 08/16/01 (3) STUDENTS LEGAL NAME (16.4 KraL inklello) (4) ALSO KNOWN AS (5) LOCAL ADDRESS (Aeon na et its& non) (s4 on) kW (stain) (Op cede) LOXAHATCHEE FL 33470 (8) MAILING ADDRESS (Asia na A snot ninny (ept (to) (ay) (stele) (*.code) CS SOCIAL SC-CURRY NO. (cotionen (8) HOME TELEPHONE NO. (TO SEX F (10) RACESTHMC CMOS H 0 I-American IndiarJAlaslcan Native O 6-Black Non-Hispanic OW-Hispanic ait A-AsIan/Pacific Island* O W-White, Non-Hispanic O M-Multiraclal (11) DATE OF BIRTH (1460VO/Y7110 (12) PLA DADE COUNTY FL US FLORIDA (13) RESIDENT STATUS 3 O 0. Foreign Exchange Student O 1. Out-of-county Resident O 2. Out-of-state Resident O 3. In-county Resident (II) USA ENTRY OATS faartronyyr (15) FEDERAL IMPACT SURVEY YES NO O fn. A. The student resides on federal property. • 0 B. The student resides in low rent housing. O Iii C. The parent is employed on federal property located in P.B. County. C e D. The parent is employed on low rent housing Vacated In P.B. County. C71 E The parent is in the uniformed services of the United States. O 0 if E. is YES, Is the parent on active duty? Check service below: O Air Face O Army • Coast Guard O Marines O National Guard O Navy (16) PRESCHOOL ENROLLMENT IIFORMAT)ON Place an X by each program attended. Also, indicate with an asterisk (*) the program your child was in the longest. O N. Non-subsidized Child Care O M. Migrant Pre-K O D. Pre-K Disabilities • H. Headstan O I. Pre-K Early Intervention O C. Chapter 1 O S. Subsidized Child Care • a Other (17) IS THE STUDENT A SPIGLE PARENT/ NO O YES ONO (10) CURRENT GRADE LEVEL 08 _ .. ,... . . .. . ..:1-1WISFER:INFOlkMATION'; teez........ i f (19) NAME OF SCHOCL TRANSFERRING FROM (20) CITY OR LOCATION (21) LAST antispareCE OATS (22) LAST GRADE LEVEL I (23) LAST PUBLIC SCHOOL ATTENDED RI PALM BEACH COWRY DATE ATTENDED IN PE (24) C. ,HEALTH SCREENING INFORMATION FREE OR REDUCED . _ (25) Students vvil receive non-invasive health screenings pursuant to Ronda Statute 381.0056(7)(d). Non-Invasive These be individually PRICE LUNCH v.:: R screenings may Include vision, hearing, scoliosis, height, and weight. tests may given or in groups. Parents or guardians, however, have the right to request an exemption in writing. If you DO NOT want your child to receive the screenings, write the words to not screen" here: Or) Have you bled out an application or free and (This exemption will cover al types of screenings) (76) I give permission for my child to participate in the sodium fluoride program to prevent tooth decay. O YES C NO (permission is veNd through 6th grade) YES reduced lunch? 0 YES O NO (Application is provided with this form) fi tgtaXIMIA :ttAargitA01149 1:fan. ..::.- A, . -•.v., (25) HOME LANGUAGE SURVEY YES NO 0 O 1. Is a language other than English used in the home? If YES, what language? petet LE it ti) O 2. Does the student have a first language other than English? if YES, what language? Spam( c. ii O 6 3. Does the student most frequently speak a language other than English? If YES, what language? (2$) 4. What language is spoken in the home by the parent or ggardian? cpa n Is VS- g n51(1,11 r? ail tS In prat 5. What language is the student's first language? rag What is the date of entry into ESOL program? pt) amen UVES wmt (Mann MAP K an O Mother O Father ltApoth Parents O Other (33) DISCLOSURES FOR ENTRY INTO PSC SCHOOL DISTRICT YES O HI , 1. Has the student ever been expelled from school? O 92. Has the student ever had an arrest resulting in a charge? O 3. Has the student ever had any juvenile justice actions? (31) CUSTODY STATUS OF STUDENT (chook am) O mother • Father • Shared Custody O Other (35) Is there a court order barring either parent from removing or contacting the student during the school day? O YES ari.NO If YES, provide the school with a copy of the court order. PBSD 0636 (REV. 5/29/2001) page 1 of 2 EFTA01710234 •..ten, onenar.• ••••••••••• 1 1 nine on. I tttttt •••• %I 9.06.0...1‘ I EL•0111%.* IIN"I 1%/111 (36) FATHER CR LEGA GUARDIAN .•. mi:Wto in:' bael) PU: Y on MOTHER OR LEGAL GUARDIAN (lis4 man, inatite. Last) PU: Y allinalli wter) partment number) CITY STATE ZIP CODE LOXAHATCHEE FL 33470 CITY STATE ZIP CODE LOXAHATCHEE FL 33470 OCCUPATION C I z e - 4 - a _ A t i l l ° 0 n butfor OCCUPATION HA( Qs rti I LS b PLACED PLACE OF EMPLOYMENT HOME TELevr1UNE I CELUPAGER NUMBER HOME PHO CELJPAGER NUMBER EMAIL ADDRESS (00.10.0 EWE. ADDRESS (optional) EMERGENCY REACTANNO.-SAFErt. INFORMATION : . . •I'e' ?: Person(s) other than parent authorized to pick up student (313) PASSWORD (3mit 10 characters) (39) NAME gab middle Mine. 1.140 (41) NAME rest meidl• butt ADDRESS (01064 number, street nairm. Opelfillell number) ADDRESS (shed number, street norm% apartmalt number) CITY STATE ZIP COLE CITY STATE DP CODE TELEPHONE RELATIONSHIP (40) AUTNOREED FOR EMERGENCY PICKUP 0 YES 0 NO TELEPHONE RELATIONSHIP (42) AUTHORIZED FOR EMERGENCY PCIWP • YES 0 NO (C) If school personnel are unable to contact you In case of illness or accident, may we have your permission to call your doctor or emergency lervices (91 ) for transport to the hospital? teYES 0 NO (44) MED.CAL MIFORMATION Oaf Midgets alt.tial, behavior, bath issues, eagle* medicebons. en ether physkal breations) (45) FAMILY PHYSICIAN (46) PHYSSOAN PHONE (48) Does your child currently have health insurance? IX YES 0 NO If Y S. indicate: (47) HOSPITAL PREFERENCE icaid 0 Private Healthy Kidslied Care 0 Interested in receiving information AtEat4.49.a.010000,0.01 DE .100.44101DtAD,‘D,WW3 - (49) NAME OF CHILD rot mMIM WU SCHOOL ATTENDING STUDENT NO. Mptcmd) GRADE DATE OF BIRTH (93) NAME OF CHILD Oat Map; kit) SCHOOL ATTENDNO STUDENT NO. Mauna° GRADE DATE OF &RN (51) NAVE CO CHILD fist middle. les0 SCHOOL ATTENDING STUDENT NO. (upfront.° GRADE DATE OF GIRTH (52) NAME CF CHILD rust middle. IMO SCHOC4. ATTENDING STUDENT NO. (optional) GRADE DATE OF BIRTH PARENT/GUARDIAN SIGNATURE verify that the information given is true and accurate to the best of my knowledge. IFARV,:figigEWSAten sr ols COB US 56)ENTRY CD. E01 (57)ENTRY DATE 08/14/01 MGM 06 (59)C/4- 01 (CO) TEACHER NO. (t1)REASSIGN CODE (62)TRMISPORTATION 0 P8C Bus # 0 Peke Tree 031174R711VERF. 1 2 3 459 (54) INS A • ParenVStudent Tray. 0 Walk II Bee 6 7 8 9 T BZ (65) OFtNINNTATION CHEMIST (0NG sed Me ..hen Re4886) 0 Immunizations (date) 0 Birth Records Verif. (de e) 0 Soc. Sec. No. (date) 0 Physical Exams (date) (65)LIATA ENTRY DOWLETED BY DATE PBSD 0536 (REV. W6/2001529/2001) page 2 of 2 EFTA01710235 SI14-33-H1R3 HEALTH INFORMATION 06/12/00 12.32.34 STUDENT ID LEGAL NAME: LAS CURRENT SCHOOL MEDICAL REASON IMMUNIZATION: 1 VACCINE STATUS: DTP: DT: TD: POLIO: MMR: MEASLES: MUMPS: RUBELLA: HIB: HEPATITIS B: STU ID FIRST E 04 HR SECT EFFECTIVE DATE EFFECTIVE DATE TB TEST RESULT S 408 TATUS A SEX H MIDDLE APP DATE ENTERED 08 30 / BIRTHDATE EXPIRATION DATE / / HEALTH EXAMINATION Y SCREENING FOR HEARING PROBLEMS: Y I MEDICAL ALERT PH: ( SCREENING FOR VISION PROBLEMS Y CONTACT EFTA01710236 igtecinAlt or nes H3S FLORIDA CERTIFICATE OF IMMUNIZATION (HRS 680 - PART A) (11 (Florida Statutes 232.032) FOR CHILDREN WHO HAVE COMPLETED ALL REQUIRED IMMUNIZATIONS FOR SCHOOL ATTENDANCE DATE OF BIRTH SS FKPART A OF THIS FORM IS USED ONLY IF THE CHILD HAS RECEIVED ALL REOUIRED IMMUNIZATIONS LISTED BELOW. IF NOT, SEE REVERSE SIDE. .5 DOSES REQUIRED (K) *;.>-• • IF, THE FOURTH PRIMARY DOSE OF DTP IS ADMINISTERED'ON OR'AFTER'THEEOCIATH:BIRTHDAY, A FIFTH.DOSE IS NOT REQUIRED. 5:DT (PEDIATPJC) VACCINE IS ACCEPTABLE IF PERTUSSIS VACCINE IS MEDICALLY CONTRAINDICATED. (COMPLETE PART C FOR PERTUSSE CONTRAINDICATION.) (B') : . i:eldc(AEOLT) VACCINE (A SERIES OF 3 DOSES) IS ACCEPTABLE AND.RECOMMENDED FOR CHILDREN 7 YEARS OF AGE OR OLDER. (C') PARENT OR GUARDIAN 4 BUSES REQUIRED lin rt IFTHE THIRD PRIMARY DOSE OF OPV IS ADMINISTERED. ON OR AFTER THE FOURTH BIRTHDAY, A FOURTH DOSE IS NOT REQUIRED. , -WV IS AN ACCEPTABLE ALTERNATIVE F OPV NOT-INoICATEEI: . • • • POLIO VACCINE S WITTED FROM THE REGUIREDJMMUNIZATIONB0FCHILDREN 18•YEARS OF AGE OR OLCER. CMEASLES. MUMPS. AND RUBELLA - 2 DOSES_MOMBED RIB MEASLES 1 DOSE REQUIRED FOR MEASLES RUBELLA MMR COMBINED — 1st DOSE AT 12 MONTHS OF AGE CR OLDER (REQUMMEPIDED AT 15 MONTHS) (P) 2nd DOSE REQUIRED PRIOR TO KINDERGARTEN ENTRANCE (VALID IF GIVEN AT LEAST 30 DAYS AFTER 1st DOSE) .7911- MEASLES SINGLE — 1st DOSE AT 12 MONTHS OF AGE OR'OLDER.'IRECOMMENDED AT 1.51MoNTHB); (G."•} 2nd DOSE REWIRED PRIOR TO KINDERGAMENIENTRANCE " (VALID IF GIVEN AT LEAST 30 DAYS AFTER 1st DOSE) MUMPS SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER (H') • RUBELLA SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER (I') K:r4 $.): i'APtisCFRLATE DOSES AND DATES INCLUDING BIRTHDATE MUST BE ENTERED, AND THE CERTIFICATE SIGNED BELOW BY A PHYSICIAN OR AUTHORIZED ;AND:DATED IN ORDER FOR THE CHILD TO ATTEND SCHOOL 6e:st-i• r SEWED .THE RECORDS AVAILABLE AND TO THE BEST OF MY KNOWLEDGE THE ABOVE NAMED CHILD HAS BE Rip TETANUS, PERTUSSIS, POLIO, MEASLES, MUMPS, AND RUBELLA AS REQUIRE PHYSICIAN CR CLINIC NAME (Fl FASF PRINT) ?cE"AUTOMATED STUDENT DATA BASE CODES IMMUNIZATION STATUS CODE / VACCINATION CODE EFTA01710237 11 1 Students Full Name Addre Name of Parent or Guardian *Mkt t (Jr rIS11111.0% . DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES EALTH EXAMINATIONS Date Phone Race LiifM r Sek—e— Birliadate A. HEALTH EXAMINATION Normal-N; Abnormal- A 1. Appearance N A 2. Ski/Nose a Head/Scalp 4. Eyes 5. Visual Acuity (R 8 L) 6. Ears 7. Auditory Acuity (R 8 L) 8. Nose / Throat 9. Mouth. Teeth and Gums 10. Chest / Lungs 11. Heart 12. Abdomen 13. Genitals and Anus 14. Muscuto-Skeletal 15. Neurological 16. Alertness 17. Emotional / Mental/ Behavtr Prob.I 18. Handicap. physical/ other (Specify) 19 Activity Restrictions (Specify) 20. Abuse, substance/ physical / emotional 21. Nutrition 22. Other COMMENT: Abnormal Findings, by number B. HEALTH HISTORY Serious illnesses injuries: explain, (attach riarrate's if additional space needed) C. LABORATORY (as indicated) al HemogistinrHernalocrit Stool (0 8 PI Tuberculin test: Lead Sickle Cell NAME: TITLE: ADDRESS: (Please Print) 12S-I1 Form 3040, Mar 91 (0bsotetcs previous (Stock Number: 5744.0C0.3040.2) EFTA01710238 ID: SCHOOL: DISTRICT: 50-PALM BEACH Your 2004 Reading Results Your Reading score Is on grade leveL You answered many of the questions on the FCAT comoctly. Tu califoacion de Lecture esta al niveL Respondste a rrouthas de las pregunlas del FCAT correctamento. NOILekti ou nan nivo Has la. Ou repair: eve nan kesyon FCAT yokonlitteman. 5 4 2 Spring 2004 Florida Comprehensive Assessment Test (FCAT) SSS Reading Student and Parent Report Grade 08 High Low Your 2004 Reading Content Scores Content Areas Points Earned points po *ye Percent Compared to other students IMININIEINNIONI Words/Phrases Main Idea/Purpose Comparisons ReferenCe/Research LeLow, /ADM iddle, li.HIgh 3000 2500 2000 0 O u. LL 1500 1000 500 0 Your Reading FCAT Score History Year Grade Tested Achievement Level 2001 I 2002 2003 2004 'These scores show your achievement on the day you were tested. If you were to take this same test again, it is likely that your 2004 FCAT Reading score would be between 1815 and 1967. 3 4 5 6 7 Grade Tested 10 ■ Your Score 0 On Grade Level (Achievement levels 3 and Wove aro considered on isr above grade levet) La labia de b derechs muestra los 'Welts 48 rendirriento del FCAT y bs rangos do carder-16n del FCAT porn cads nlve'. El nivel do renSirniento 3 represent° et 0-abaio"al Myer. Antes de 2002. a los ostudentes soles otorgaba ens calficackfin quo segula una escalade Iros Motes. Tablo Id adwat la monk° Nivo Rannman nan FCAT a ak Nochol Not FCAT a pou cask NNo. Nivo rannmen 3 reprezente travay 'nen Miro leas' Ia. Anvan 2002, yo to reptile ycn nechel not ki gat Ma chit laden pou ekkr yo. Chan of FCAT Achievement Levels and FCAT Scores Reading grade Level 1 Level 2 41iiiikeii; , Level{ Level 5 3 864045 1046-1197 illiiklitlie: 1489-1865 1866-2514 4 2954314 1315-1455 4450017310: 1690-1964 1965-2638 5 474-1341 13424509 ?j910;40: 1762-2056 20592713 6 539-1449 1450-1621 Ft604:10SC 1860-2125 2126-2758 7 671-1541 1542-1714 4 i$€ 1945-2180 2181-2767 a amuses iese-1881 lisg2447.; 2073-2281 2282.2790 9 772-1771 1772.1971 Itgt2k2A4.3,:; 2146-2297 2296-2943 10 8444851 1852.2067 ,iaillIficil-f !W,. 2219-2310 2311-3008 On grado4evel Prior to 2002, a th.030-dg. scale score was reported for students Reading Content —Content soores gNe more specific Information about the skills on the FCAT. Grade level expectations for students include: Callficacionos do contenido do lecture Las calificaciwes do contonide proporcionan Information 0141.5 especifica sotto las habilidedes en el FCAT. Las expectafivas al nNel del grado pars nos Not Kontnl pou Lektl Not pou koninl yo bay enfOmasyon ki pi ograk sou kcnperans el& la nan FCAT a. Men sa yo Mann do eley la dapre nivo klas la: a Words/Phrases — uses skila to determine word estudiantes Lncluyen: moaning, includng word parts and relationships • hie/Prez —Mize apthici pco doh:graben styllikasyon between words. • Palabrastrases —usa la habilidad pant determiner moyo, sa Ns di disk pall nan mo yo epi retasyon Id • Main Idea/Purpose — determines a slated or et signIdcado de una palebra. Incluyondo Lis panes genyen ant moyo. implied essential message, details. author's do patebras y las rolaciones entre patabras. • Ida PrenslpaUObjektlf — doteminen yon mesa) purpose, or plot. • Idea principal/Proposito —determine un mensal° esansyel kl degree oswa sljere, bay delay sou • Comparisons — knows smllar and different. cause esencial exprow o cmplicito, dinettes del propose* cteektif °Sera plan °to a. and died, and contrast. del outer 0 el rugumento. • Konparezon — konnen menm ak &bran, Wiz ak ate, • Reference/Research — uses information from a . Compareciones — conoce similar y dderente. Cause epi kontras. variety of sources to reach conclusions. y °facto y contrasto. .Referans/Rechech — blew enfernasyon Id soli nen • Referenciannvestigacien — usa is informacidn do rye sous pou dedwi konklizyon. Data Run Date: 0570312004 una variodad deMentes pare Heger a conclusions. NT=Nist Tested. NR•No4 Reported, NF'Not Found EFTA01710239 Spring 2004 Florida Comprehensive Assessment Test (FCAT) SSS Mathematics Student and Parent Report Grade 08 NAME: ID: SCHOOL: 1691-CRESTWOOD MIDDLE DISTRICT: 50-PALM BEACH Your 2004 Mathematics Content Scores 5 4 3 44 1 High Low Content Areas Number Sense Measurement Geometry Algebraic Thinking Data Analysis PointS Earned Pods Possitto Percent Compared to other students Your Mathematics FCAT Score History Year Grade Tested Achievement Level 2001 2002 2003 2004 'These scores show your achievement on the day you were tested. If you were to take this same test again, it is likely that your 2004 FCAT Mathematics scae would be between 1776 and 1862. 3000 2b00 2C00- 0 0 co 1500- E- LL 1000 500 7 10 Grade Tostod ■ Your Score i] On Grade Level (Acteevemem Øb 3 ond above are considered on or above grade level.) La tabla de la deecha meets bs niveles de renditriento del FCAT y los ranges de calificacta del FCAT pare cede robed. El nivel do renclimiento 3 representa el kabaleal elver. Antes de 2002, a los estudentes se lea otorgaba Lena ca.:Lac:4n qua segula ma escalade tres dines. Table ki adwat la montre film Rannman nan FCAT a ak Nedhit Nett FCAT a you chak Nivo. Nivo rannrnan 3 repramme Um•ay 'flan Mine Hass la. Anvan 2002, yo te regale yon noshed net ki gen hva chit laden pau elev yo. Chad of FCAT Achievement Levels and FCATScores Mathematics Grad* Lovell Level 2 .:14,401.8 1: Level 4 Level 5 3 375-1078 1079.1268 1269‘',1605;: 1509-1749 1760-2225 4 681-1226 1277.1443 :;144444ti. 18584862 1883-2330 5 569.1451 1452-1631 ii.193.2;1,85f: 1769-1956 19574458 8 770.1553 1554-1691 1.42-i'18W.: 1860-2018 2019.2492 7 958-1860 1661.1765 ..i1/66€1 ::. 1939-2079 2080-2572 8 10254732 17334850 .. 1,`. Sk" t7 1:1 1998- 1 209 2092-2605 9 123$4781 1782-1900 ..11#1:12S22:. 2023-2141 2142-2596 10 1068-1831 1832-1948 1)94:7p2§1W.- 2050-2192 2193-2709 On gratte4evel Prier to 2002. a throe-04R scale score was reported for students. Mathematics Content -Content scores give moro spec:fie information about the tiara on tho FCAT. Grade level expectations for students Include: Callficaciones de contentdo do matemåticas Las callicaciones do corticoid° proporebnan Informacia ma especifica solre las hat:Made, en el FCAT. Las expeciativas al nivel del gratlo pars los Net Kontnl pou Matematik NM pou kontni yo bay enfamasyon Id pi egzak sou konpetans elev la nan FCAT a. Mon sa yo atann de elev la dapre ohm Ides la: • Number sense —uses number concepts and estudiantes incluyen: computation skills. • Chlf/Sans — Kittle konSePsyon chit ak abilile pou lb • Measurement — sofas problems involving • Nermero/Sentido — usa ccnceptos num4ricos y katteli. limo. habidades de cemputo. • Meal — rozoud pwoblern ki gen mod laden, pa measurements. e.g.. weight, length, area. • Geometry — analyzes and combines shapes to solve • Medida — resuelve problemas quo incluyen egzanp, tan, pwa, longb, seas. problems. modifies. per Memplo. tiempo. peso, longilud, area. • Jewometd — andze eft konbinen fryl leworcetnk • Algebraic Thinking — analyzes papems and uses • Geometria — antra y combine formes pare pou rezoud pwoblirm. equations and Inagua! Iles. resolver problems,. • Rezonman skebrak- enlire model opl Maze • Data Analysis and Probability — uses dale analysis • Pensamlento algebraic*— anain patrons, y usa ekwasyon ak Megatao. tools to display Information, make ~Wiens and ecuadonos y desigualdades. • Melia Done ak Pwobabilite — Mize mud pou (6 make inferences. • Anållsis do dales y probabilidad — usa anallz done pou prozante entemasycn. fb herranientas de el aneksis do dittos pare meeker prediksyco ak dedatsyon. Data Run Date: 05703/2004 insormecien, hater preclicciones e inkranies. NTeNot Tested, NR•Not Reported, NF•lifet Found EFTA01710240 ,\V ir --"i Vii . c • • • if CEICEMTC1==1 Spring 2003 Florida Comprehensive Assessment Test (FCAT NORM-REFERENCED TEST GRADE 07 Student Report lee. le SO - PALM BEACH This report shows your results from the FCAT National Norm-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 Reading Comprehension Mathematics Problem Solving National Percentile Rank Stanine The Scale Score expresses your performance on the test and allows for 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 54 and 76. For Mathematics Problem Solving, your National Percentile Rank should be between 43 and 66. CONTENT SCORES Number of Questions on Test Reading Comprehension Initial Understanding Interpretation Critical Analysis Strategies Mathematics Problem Solving Measurement Estimation Problem Solving Number Relationships Number Systems Patterns & Functions Algebra Statistics Number of Correct Responses Number of Questions Attempted L Data Run Date: 04/30/2003 0154130 EFTA01710241 Ikeda cemprebaisive ASSOIMeel Test Spring 2003 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Grade 07 Student Report 5O-PALM BEACH The Flori Deprtmentot Education believes that student has the preparingearn and succeed. The purposeof the FcAT 13 to ensure that Florida's publics chools are pr0viding the best uca on possible, and students to succeed In the competitive 21St century lob market. Working with teachers, the State has developed a measurementsystem that allows you to track a student's academic achievement from year to year and determine If a years worth of learning has occurred In a years time. Tilt system also allows you to compare a student's score to a score that represents 'grade level' achievement. If a student's score is above the 'grade level' score, then they are performing at a level above their current grade. If it is below, they are in need of improvement. Using the tomcat Scores,' you are able to identity any Specific academic skills needing Improvement. Below you will find your 2OO3 FCAT Reading and Mathematics scores, as well as your scores from previous years. The chart on the right side of the page shows yo(r score compared to the score that represents grade level achievement. 2OO3 Reading Content Scores Content Areas Points Possible Points Earned Words/Phrases Main Idea/Purpose I Comparisons I Reference/Research Year Grade Tested Achievement Level FCAT Store • 2001 2002 2003 LL Reading 2500- 2000- 1500- 1000- 500- Grades' Gre • 4 re de t Grads 9 Grid+ 10 11+ ■ Your Score 0 On Grade Level 2003 Mathematics Content Scores Content Areas Points ERN Possible Number Sense I I Measurement Geometry Algebraic Thinking I I I Data Analysis I FCAT Score Mathematics • Your Score U On Grade Level • 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 boon between 1648 and 1782. Your 2003 FCAT Mathematics scores probably would have been between 1639 and 1769. NT= Not Tested NR =Not Reported NA= Data Not Available Data Run Date: 05/09/2003 0175242 EFTA01710242 FCAT Reports aparate reports are produced for the Sunshine State :andards tests in FCAT Reading and Mathematics, since, and Writing. A separate report is also printed r the norm-referenced tests in Reading and athematics. Norm-Referenced Test (NRT) Report The FCAT RT report shows reading and mathematits scores on Florida version of the SAT9 (published by Harcourt iucational Measurement). Student scores are ›mpared to a national 'norms' group, where a percentile nk store of 50 is average. inshIne State Standards (SSS) Reports The FCAT iS Reading, Mathematics, and Science reports show st scores from Florida's tests of academic standards. rese reports contain subject scores and content :ores. Subject scores describe the overall :hievement, and content scores give the number of tints earned in specific skill areas. Success on the aading and Mathematits tests can be best understood using the achievement levels where a 3 or higher Is i or above grade lavel. ;hievement Levels Five categories of achievement ›scribe the success students have with the content sted on the FCAT Reading and Mathematics. Level 5 the highest and Level 1 is the lowest. Since science :hievement levels have not been determined, science ores are ranked as to whether they fall in the lowest, iddle, or highest third of statewide student Mormance. 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. 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. 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 less successtul with questions that are the most challenging. This student has limited success with the challenging content of the Sunshine State Standards. This student has little success with the challenging content of the Sunshine State Standards. :AT Certificates Students who earn Level 5 scores or iose science scale scores are greater than 400 receive •rtificates of Achlevement. For writing, certificates are given all students with scores of 5.5 or 6 and to fourth graders with res of 5, 5.5, and 6. Certificates are not awarded based on FCAT Norm-Referenced Test scores. Informes FCAT (Spanish) Se preparan Informes separados para los examens del FCAT de lectura y matemåticas, ciencias y redacción según las normas estatales Sunshine State Standards. También se imprime otro informe por separado para los exémenes de lectura y matemåticas de acuerdo a las normas de aplicacIón nacional. Informe sobre el FCAT milda a normas de aplIcaclon nacional (NRT) El informe del FCAT NRT presenta los resultados de lectura y matemåticas en una version 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 Sunshine State Standards (SSS) Los informes según las normas estatales SSS del FCAT presentan las calificaciones de los exåmenes de lectura, matemåticas 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 åreas de habilidades especfficas. El éxito de los exåmenes de lectura y matematicas puede entenderse mejor utilizando los niveles de rendimiento en Ios que una calificacion de 3 o superior estå al nivel del grado o por encima. Niveles de rendimlento El éxito que un estudiante ha lo9rado en el contenido examinado en el FCAT de lectura y matematicas se describe por medio de tinto categorfas. El nivel 5 es el mås alto y el nivel 1 es el més baja 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 mås dit fdl de las normas Sunshine State Standards. Un estudiante del Nivel 5 responde a la mayorfa de las preguntas del examen correctamente, incluyendo las preguntas mås dit folies. 4 Este estudiante tiene éxito con el contenido difícil de las normas Sunshine State Standards. Un estudiante del Nivel 4 responde a la mayorfa de las preguntas correctamente, pero es posible que solo tenga cierto éxito con las preguntan que reflejan el contenido mås dif fot 3 Este estudiante fien un éxito parcial con el contenido difícil de las formas 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 menas éxito con las preguntas que son mås d if fciles. 2 Este estudiante tiene éxito limitado con el contenido dilla 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, redben Certificados de rendimiento. En redacción, los certificados se otorgan a lodos 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 cefiido a normas de aplicación nacional. Rapò FCAT (Rafflat) Creole) Yo prepare rapò apa pou egzamen lekti ak matematik, syans ak redaksyon FCAT bay swivan prensip Sunshine State Standards yo. Yo ekri yon rap& apa tou pou lekti ak matematik pou "modél egzamen ofisyél FCAT itilize pou fé evalyasyon" an. Rapò egzamen of isyél FCAT hilka pou fè evalyasyon (NRT) Rapò FCAT NRT a montre nät lekti ak matematik nan vésyon Florida genyen pou SAT9 la (Se Harcourt Educational Measurement ki pibiliye li.) Yo konpare nät elév la ak yon gwoup nöt yo konsidere kärr' "modél pou egzamen of Isyét" la, kote swivan klasman pa pousantaj la, nöt mwayén nan se 50. Rapò Sunshine State Standards (SSS) Rapò FCAT SSS pou lekt', matematik ak syans lan montre nät elev yo fé nan egzamen Florida bay sou prensip akademik yo. Rapò sa yo gen nät pou matyé ak nöt pou kontni ladan yo. Nät pou matyé yo dekri tout sa ek» la reyalize anJeneral epl nät pou kontni yo bay kantite pwen elév la få nan yon matyé byen detémine. Ou ka konprann kisa elev la reyalize nan egzamen lekti ak matematik la pi byen si w itilize yon nivo siksé kote 3 oswa plis se yon nät ki nan nivo klas la oswa yon nät kl pi wo pase nivo klas la. Nivo siksé elév yo Gen senk kategori siksé ki dekri nivo siksé elév 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 detéminen nivo siksé nan egzamenn syans Ian, yo klase nät pou syans Ian swivan si Ii tonbe pi ba, nan tuttan oswa pi wo yon tyé pétbmans elév toupatou nan eta a. 5 Elev sa a gen siksè nan matyé kl te gen pi plis difikilte ladan yo nan egzamen Sunshine State Standards la. Yon elev ki nan 5yém Nivo reponn pile) kesyon egzamen yo körékteman, elév la menm reponn kesyon ki gen pi plis difikilte ladan yo. 4 Elev sa a gen siksé nan matyé ki te gen difikilte ladan yo nan egzamen Sunshlne State Standards la. Yon elév ki nan 4yém Nlvo reponn pitt) kesyon egzamen yo körékteman, men li ka gen kék siksé selman nan kesyon ki sanble yo gen pi plis difikilte ladan yo. 3 Elév sa a gen enpe siksé nan matyé ki gen difikilte ladan yo nan egzamen Sunshine State Standards la, men péfämans Ian pa rete estab. Yon elév kl nan 3yém Nivo reponn anpil nan kesyon egzamen yo Ithrékteman, men anjeneral Ii gen mwens siksé ak kesyon ki sanble yo gen pi plis difikilte ladan yo. 2 Elév sa a gen siksé limita nan matyé ki gen difikilte ladan yo nan egzamen Sunshine State Standards la. 1 Elév sa a gen yon ti siksé tou piti nan matyé kl gen difikilte ladan yo nan egzamen Sunshine State Standards la. Sétifika FCAT Elev ki fe nät 5yem Nivo oswa elev ki fè gwo nät ki pi plis pase 400 nan syans ap resevwa Sétifika pou Siksé. Yo bay tout elév ki fé nät 5.5 oswa 6 ak elév klas katriyém ki fé nät 5, 5.5, ak 6 yon shtifika pou redaksyon. Yo pa bay sétifika swivan nät elev fé nan egzamen ki baze sou "modél egzamen ofisyél FCAT itilize pou ffi evalyasyon" (NRT) an. EFTA01710243 Test Record Report STAR Reading 7 Tuesday. 05101101. 11:37 AM Date Range : Al! • Page 24 , StudentNettle.: • Student ID MM. Test Grade Date Placement Class Teacher SS GE PR NCE IRL ZPD 11/14/2000 5.24 5Th Grade Read 5l1 001 5.80 5Th Grade Read Number of Tests : 2 Historical Data : Included EFTA01710244 Spring 2004 Florida Comprehensive Assessment Test (FCAT) NORM-REFERENCED TEST Grade 08 Student Report NAME: ID: SCHOOL: DISTRICT: SO -PALM BEACH This report shows your results from the FCAT National Norm-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 Reading Comprehension Mathematics Problem Solving Scale Score I I National Percentile Rank Starling Tho Scale Score describes your performance on the test and allows for comparisons from year to year. Reading Comprehension Scale Scores range from 510 to 820. Mathematics Problem Solving Scabs Scorn range from 627 to 836. The National Percentile Rank (NPR) and Shining indicate your relative standing In comparison to the national reference group. National Percentile Ranks range from 1 to 99. Tho NPR score indicates the percent of students in the national sample who scored equal to or below your score. Slanines range from Ito 9 where 1 is low and 9 is high. Stanines In the range of 46 are considered average scores. If you were to lake the lest 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 55 and 79. For Mathematics Problem Solving, your National Percentile Rank should be between 61 and 77. CONTENT SCORES Readln Corn rehension Initial Understanding Interpretation Critical Analysis Strategies Mathematics Problem Solving Measurement Estimation Problem Solving Number Relationships Number Systems Patterns & Functions Algebra Statistics Probability Geometry Number of Questions on Test Number of Questions Attempted Number of Correct Responses Data Run Cato: 04/16/2004 0077570 a EFTA01710245 FEAT Florida Comprelignsive Assessnrit Test Spring 2004 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Reading Performance Task Student Report Grade 8 This report provides your results on the FCAT 2004 Reading performance testa. 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. The 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 ancient and modern paper making. Task: If you were going to meet Soichiro Sakamoto in person, what would you already know about him from reading this article? Use details and information from the article to support your answer. FCAT 2004 READING PERFORMANCE TASKS Student Name Student Number School Name School Number District Name PALM BEACH District Number 50 Points Possible This Performance Iasi< Response I Points Earned All Routing Rerlormance Task Responses Iq 1 Wert io meek 901,:n NnICIJI(5, 0 41/4-0jad,‘\ \perm tica-\htg hasce Ott ett(;otned by thjoh %ruin rea.sem% And 4rOA iak. 23 tot, a wort/drop. Pitt In -APQ\ ntrt- is WOCtsci. ‘re. rnrateb pactr. vie ca up -to*5tax) tx-ck(c vrxxl C' /Cc:tr. n 00%0 C9SCAlel. gra -111;* ha It a ‘nsrm cot% N\ ed crirtonep in vcire mat. tre• Data Run Date: 05/04/2004 0038487 741400507 EFTA01710246 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Mathematics Performance Task Student Report Grade 8 This report provides your results on the FCAT 2004 Mathematics performance tasks. Each performance task on FCAT requires you to respond with either a short response or a bnger, 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. The number of points you earned for your answer is shown in the box to the right. FCAT 2004 MATHEMATICS PERFORMANCE TASKS Student Name Student Number School Name School Number District Name PALM BEACH District Number 50 This Performance Task Response Points Possibto Points Earned Thomas works 4 hours after school, five days a week, at the Auto Lube Shop for $6 per hour. Sometimes, the shop gets busy and he works extra hours after school and on Saturday for S8 per hour. Part A Write an equation that can be used to calculate Thomas' total weekly earnings. Let I represent Thomas' total weekly earnings, and it represent the extra hours he works during any week. rquationqh.(iiit t±,), Part B Use your equation to determine how many extra hours Thomas must work in one week to earn 4200. Show your work. Work Spare 4 are -i-w6 &L-k j r 5 D1/4 tklp Number of extra hours Al Mathematic* Performance Task Responses 2 Data Run Date: 05/04/2004 0038488 736800336 EFTA01710247 Florida Comprehensive Assessment Test Spring 2004 Florida Comprehensive Assessment Test (FCAT) Writing Grade 08 Student Report Writing to Explain NAME: ID: SCHOOL: iggi DISTRICT: SCORE: . 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 choose an invention and explain the importance of that invention. Data Run Date: 04/07/04 50-1691 EFTA01710248 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 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 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. 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, 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 1 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. 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, 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 1 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 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 arc 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, 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 arc 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 arc generally correct. 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. 1.5: 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 are often presented through lists and limited or inappropriate word choice. Frequent errors may occur in sentence construction, usage, punctuation, and spelling. U: The waiting is unrelated to the assigned topic or cannot be read. 1601409 EFTA01710249 Spring 2004 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Science Performance Task Student Report Grade Oa MS report provides your results on the FCAT 2004 Science performance tasks. Each performance task on FCAT requires you to respond with either a short response or a longer, more detailed response. Shod-response tasks are scored on a 2-point iubnc 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. The number of points you earned for your answer Is shown in the box to the right. FCAT 2004 SCIENCE PERFORMANCE TASKS Student Name Student Number School Name School Number District Name District Number PALM BEACH 50 This Performance Task Response PerfAll &ciente ormance Respons Task Responses Points Possible I Points Earned Joe dropped his book behind the dresser. He tried to move the draw but it would not we. He asked his sin to help and they wereable to move the draw mush tor Joe to get his book. Part A Wanly the tome that kept toe from moving Ike dresser himself. ice rActcol. %nab %not. (vv) =lore 6a) x ditneters CM> vv.4ci Part Et Eattein why Joe and hie sister went able to move the dresser when they worked together. lrey were at:At-to econ. -Cre Ch-votar bteate atrel ceikn r ta-co. at Arty ban nag cbitracrn -to more 4Tr arc. nrd, %rim -trey cmi had Gra do:Es-Noma. w -vo, Al; \rem Quirt wort. Azrs-tfitr -4O ritlia -tom ate Data Run Date: 04/30/2004 0030088 683500424 EFTA01710250 Spring 2004 Florida Comprehensive Asscssmcnt Test (FCAT) SSS Science Student and Parent Report Grade 08 NAME: ID: SCHOOL: DISTRICT: 504%W BEACH The Florida Department ol Education beteves that El Florida Depanment of Education (Departamento Depatman Edkasyon nan Florida kwé chak °metro every student has the abilty to team and succeed. de Educación del estado de Florida) eec que todos gen kapasite pou °brann epi gen sksé. Objektil The purpose of the FCAT is to ensure that Florida's los estucfrantes benen la capacidad de aprender y FCAT la se pou yo ka sten tekel 'oblik nan Florida public sdwols are providing the best education tener exil*. El propósito del FCAT os asegurar que ap bay pi bon edkasyon ki pearl, la epi yap prepare possble and preparing students to succeed for the las escuelas ablicas de Florida proporcionen la olév yo par yo ka gen sksé nan lavel. futura. mejor educación posble y preparen a los estudiantes para tener éxito en el futuro. Yo idantilye yon nivo konesans id elve nan syans se A high lova of science knowledge has been identihed yon bagay ki esansyél pou yon mun ka gen she as critica) for success in the contetitive 21s1 cenlury Se ha demostrado que. para el éxito en el nan konpetisyon Id genyen nan mache travay la nan job märket. Working with Florida educators. the state competitivo mercado laboral del siglo )O3. es crucial 21yårn syék la. Eta Florida a travay ansanm åk has devetoped a test b measwe a students poseer un allo nivel de aincidmientos de ciencias avolest yo pou yo devlope yon egazamen ki pérnél achievement of the imposant science slöks in the Trabajando con educadores de Florida. el estado ha yo multe rannrnan yon elév nan egzamen syans ki Sunshine State Standards. This report pro/ides your desarriseado un examen para mear los logros de un «pölen nan SunshNe State Standards la. Rapó sa students 2004 Science Score which alkorvs you to estudiante en materia de ciencias de acuerdo a tas a bay Nöt elév få nan Syans pou Ane 2004 ta epi sa contare your students performance to the normas Sunshine State Standards. Este informe pémét ou konpare oktanens elév ou yo ak pelbmans perfamance of other students in the state. In proporciona a su estudiante la calificación de Eit olév nan Eta a Anplis. nót yo kl nan repe a ode addition. the content stores hela you to identity Cencias de 2004. b que k permite comparar el ou Idantlye nan ki matye akademk elév la bezwen få acadomic skals that may need introvement rendimiento do su estudiante con la de otros estudiantes en el estado. Adeboalmente. tas calificaciones de contenido le ayudan a bankar las habildades académicas on tes que puede ser necesario mejorar. amelyorasyon. Your 2004 Science Content Scores Content Areas Physical and Chemical Earth and Spana Ute and Environmental Sdentific Thinking ROMS Eamed 1 Poinls Possible Percent Compared to Other Students Low Middle High Your 2004 FCAT Science Score Compared to Other Students Store ' Low ~die High 500 400 300 : 200 I l 100 Ill Stue.** Som Ute hymner) This acore shows your achlevement ort the day you were tested. It you were to lake this test again, it is likety that your 2004 FCAT Science store would be between 288 and 318. Science Content Contenido de ciencias Kisa kl gen nan egzamen syans lan e Physlcal and Chemical Science emlains • Ciencias listats y químicas explican la • Syans Ila& fl ohimik- esplike matyl, maner, motion, force, and energy Induding materia, el movimiento, la fuerza y la energía, mouvman, ids, sk enen', sa vie dl pwopriyete their propenies and interactions; also identifies incluyendo sus propiedades e interacciones; yo ak fason youn reyaji ak km; epi bu dantilye atoms, elements, compounds, and mixtures. también identifican los atomos, eiementos, compuestos y mezclas. atom, eleman, konpoze chimik ak melanj. • Earth and Space Science- explalns Eanh's • Syans laté ak capes- esplike dtanjman ki lét changes over time IncludIng geologin patterns, • Ciencias de la Tierre y el espacio explican sou Laté ano apve ana, sa viedi aktivite the rock cycle, minerals and weather systems; los cambios de la Tierra a través del tiempo, jewolojk, taz wöch, Sistém mineral ak sistöm atso describes the solar system and universo. incluyendo los patrones geológicos, el ciclo de las rocas, minerales y sistemas ameleyo a, epi It dekrt sistöm solé a ak inivé a. • Lite and Environmentat Science identifies meteorológicos; también describen el sistema Syans biyolojik ek anviwonman- idantilye and expains plants, animals, and the solar y el universo. • epi esplike plant, bét, ak anviwonman an, sa environment, inctuding Gle pocesses, conservation of resources, and the • Ciencias de la vida y el medio eminente vie di pwosesis blyolojk, konsövasyon resous yo, ak entédepandans ögat aksistém yo. interdependence ol organisms and systems. identifican y explican las plantas, animales y el medio ambiente, incluyendo los procesos Rezonman syantitik- itNize p•rosede syantitik • Scienttlic ThInking- appfies scientNic vitales, la conservación de recursos y la • pou rezoud pwoblém, rekonét regliarite ak prccesses to problem solving, recognizes interdependenica de organismos y sistemas. sisttim, epi korgrann enpak teknolog sou paneras and systems, and understands the lasosyete. lindad of technology on society. • Pensamiento dentalens• aplica procesos dentilicos a la resolución de problemas, reconoce patrones y sistemas, y comprende el impado de la tecnología en la soesedad. Data Run Date: 04129(2004 0032556 EFTA01710251 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2002 NORM-REFERENCED TEST • Student Report GRADE 06 This report shows your results from the FCAT National Norm-Referenced Test. istnicIt Name an 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 Reading Comprehension Mathematics Problem Solving National Percentile Rank Stanine The Scale Score expresses your performance and allows comparisons from year to year. Reading Comprehension Scale Scores range from 492 to 800. Mathematics Problem Solving Scale Scores range from 500 to 813. 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 36 and 60. For Mathematics Problem Solving, your National Percentile Rank should be between 58 and 79. CONTENT SCORES Number of Points Possible Number Number of Points of Questions Earned Attempted Read i n t Com • rehension 52 Initial Understanding 15 interpretation 21 Critical Analysis 9 Strategies 7 Mathematics Problem Solving 48 Measurement 6 Estimation 4 Problem Solving 5 Number Relationships 6 5 Number Systems Patterns & Functions 3 Algebra 3 Statistics 6 Probability 3 Geometry 7 Each question was worth 1 point. I 05/11/2002 0961160 EFTA01710252 FCAT Reports The FCAT Reading and Mathematics test results are provided In two separate reports, one for the "Sunshine State Standards" (SSS) tests and one for the "Norm-Referenced Test' (NRT) tests. At grades 4, 8, and 10, a thlrd report contains the FCAT Writing results. The FCAT "Sunshine State Standards" report presents test stores from Florida's test of academic standards. Success on this test can be best understood by usIng the achlevement levels where a 3 or higher is preferred. This report contains Subject Scores and Content Scores. Subject scores provide an overall summary of achlevement, and content scores give the number of points earned in specific skill areas. The "Norm-Referenced Test" report presents 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. Achievement Levels The achievement level is one of the subject scores on the FCAT 'Sunshine State Standards' test. These leveis describe the success a student has achieved on the Florida Sunshine State Standards tested on FCAT. Level 5 is the highest and Level 1 is the lowest. 5 Performance at this tevel bacetas that the student has success with the most chatlenaina content of the Sunshine State Standards. A level 5 student answers most of the test auestions correctly. including the most challenging questions. 4 Performance at this level indicates that the student has suersiss with the challenging centen( of the Sunshine State Standards. A level 4 student answers most of the test questions correctly, la tt rnav have ()n'y sonve success with questions that rattett the most challenging content. 3 Performance at this level indicates that the student haaGadieti success with the challenging content of the Sunshine State Standards, but performance is inconsistent. A level 3 student answers many of the test questions correct4y, but is neneraliv less successful with questions that are the most challenging. 2 Performance at this level indicates that the student has linled success with the challenging content of the Sunshine State Standards. 1 Performance at this level indicates that the student has little success with the challenging content of the Sunshine State Standards. Year-to-Year Growth The FCAT "Sunshine State Standards' tests in Reading and Malhematk:s are given In grades 3-10. Therefore, achievement across two years can be compared for grades 4-10. These comparisons are made based on changos in the students achievement leve' from one year to the next. Certificates Scores on the "Sunshine State Standards" part of FCAT are used to award students with certificates of accompllshment. For Reading and Mathematics, students who score in Achievement Level 5 receive certificates. For Writing, certificates are given to all students with scores of 5.5 and 6 and to fourth graders with scores of 5, 5.5 and 6. Certillcates are not awarded based on the Norm-Referenced Test scores. Informes del FCAT (Spanish) Los resultados de los exámenes de lectura y matemáticas del FCAT se proporcionan en dos informes por separado, uno para los exámenes según las normas estatales "Sunshine State Standard? (SSS, por sus siglas en inglés) y uno para los exámenes ceñidos a normas de aplicación nacional (NRT, por sus siglas en inglés). Un tercer informe contiene los resultados del examen de redacción del FCAT de los grados Oto, 8Y0, 10mo. El Informe según las normas estatales "Sunshine State Standard? del FCAT presenta las calificaciones del examen de las normas académicas de Florida. El éxito de este examen puede entenderse mejor utilizando los niveles de rendimiento en los que se prefiere una calificación de 3 o superior. Este informe contiene dos tipos de calificaciones (calificaciones por materia y calificaciones por contenido). Las calificaciones por materia proporcionan un resumen general del rendimiento y las calificaciones por contenido proveen el número de puntos ganados en áreas de habilidades específicas. El informe del examen ceñido a normas de aplicación nacional (Norm-Referenced Test) presenta los resultados de Lectura y Matemáticas en una versión de Florida del SAT9 publicado por (Harcourt Educational Measurement). Los resultados obtenidos por los estudiantes se comparan oon el grupo modelo o 'norma", en el que la clasificación percentil de 50 es el promedio. Niveles de rendimiento: El nivel de rendimiento es uno de los temas evaluados en el examen Sunshine State Standards del FCAT. Estos niveles describen el éxito que un estudiante ha logrado en las normas estatales Sunshine State Standards que se prueban en el FCAT. El nivel 5 es el más alto y el nivel 1 es el más bajo. 5 El rendimiento a este nivel indica que el estudiante tiene éxito con el contenido más difícil del examen Sunshine State Standards. Un estudiante del nivel 5 sr soonde la mayoría de las preguntas del examen correctamente incluyendo las preguntas más difíciles. 4 El rendimiento a este nivel indica que el estudiante gane éxitn con el contenido difícil del examen Sunshine State Standards. Un estudiante del nivel 4 responde la mayoría de las preguntas correctamente, geig gs °risible Que set() tenga atarle éxito en preguntas que reflejan el contenido más dificil. 3 El rendimiento a este nivel indica que el estudiante tiene éxito cardal con el contenido difícil del examen Sunshine State Standards pero el rendimiento no es uniforme. Un estudiante de nivel 3 responde muchas de las preguntas del examen correctamente pero oor lo general tiene menoCexitq con las preguntas quo son más difíciles. 2 El rendimiento a este nivel indica que el estudiante tiene éxito limitado en el examen Sunshine State Standards. 1 El rendimiento a este nivel indica que el estudiante gene poco éxito con el contenido difícil del examen Sunshine State Standards Evolución de un año al otro: Los exámenes Sunshine State Standards del FCAT en lectura y matemáticas se administran desde 3er a 101 ° grados. Por lo tanto, el logro en dos años puede compararse con los grados desde 4i0 hasta 10110. Estas comparaciones se hacen basadas en los cambios en el nivel de rendimiento del estudiante de un año a otro. Certificados: Las calificaciones de la parte Sunshine State Standards del FCAT se utilizan para otorgar certificados de logros a los estudiantes. Para lectura y matemáticas, los estudiantes que logran un nivel de rendimiento 5 reciben certificados. Para redacción, los certificados se otorgan a todos los estudiantes que han obtenido 5.5 y 6 puntos y a los estudiantes de ctiarto grado que han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados en los resultados de los exámenes ceñidos a normas de aplicación nacional. Rapó FCAT (Haitian Creole) Yo bay de (2) rapo apa pou rezilta egzamen lekti ak matemat FCAT la, youn se pou egzamen "Sunshlne Siete Standard az (SSS) yo, epl Itit la se pou egzamen ki be sou -modål egzame ofisyål FCAT itilize pou fé evalyasyon" (NRT) yo. Nan klas 4Yér 8Yére ak 101", yo bay yon twazyém rapo kl gen rezilta egzame redaksyon FCAT la. Rape) *Sunshine State Standard? pou FCAT la prezante nät ele yo få nan egzamen Florida bay sou prensip akademik yo. Pou ka konprann ki kantite siksé yon elév pote nan egzamen sa a, c ka itilize tablo nivo siksé elév la. Nan tablo sa a, yo pretere lé yc elév få yon nöt 3 oswa yon nät ki pi wo. Rapo a gen kit pou sfj ak nät pou kontni ladann. Nät pou sijé a bay yon rezime jenen sou tout sa elév la reyalize nan egzamen an, epi nöt pou kontni a bay kantite pwen elév la få nan yon matyé byen detémine. Rapé sou egzamen ki baze sou "modél egzamen ofisyél FC,2 itilize pou få evalyasyon' yo prezante nät pou lektl ak maternal nan vésyon SAT9 Florida bay la. Se Harcourt Education Measurement ki te pibliye vésyon sa a. Yo konpare nät elév yo a yon gwoup nät yo konsidere kbm "modål pou egzamen ofisyét I nan nivo nasyonal, kote suivan klasman pa pousantaj la, ni mwayén nan se 50. Nivo siksé elév yo - Nivo siksé eltiv yo se nät pou youn na matyé ki genyen nan egzamen sou "Sunshine State Standard pou FCAT la. Nivo sa yo dekri siksé yon elév reyalize lé ele« I pran egzamen "Sunshine State Standard? pou FCAT la. Pi gw nivo a se Nivo 5, pi piti nivo a se Nivo 1. 5 Pélibmans nan nlvo sa a demontre elév la te gen siksé nan maly ki ttgen oi pes difikilte ladan vo nan egzamen 'Sunshine Sta; Standard? la. Yon elév kl nan 5Vérn nlvo reponn cito kesvQ egzamen yo körékteman elby la menm reponn kesyon ki gen pi pl difikilte ladan yo. 4 Pélbmans nan nivo sa a demontre elev la te gen siksé nan maty ki gen difikilte ladan yg nan egzamen 'Sunshine State Standarck la. Yon elév ki nan 4Yére nivo reponn kesyon egzamen y körékteman, men li aen kék siksé selman nan kesyon ki parét ge pi plis difikilte ladan yo. 3 Péltimans nan nivo sa a demontre elév la cien enoe Ore). na matyb kl gen difikilte ladan yo nan egzamen "Sunshine Sta, Standards"la, men példmans tan pa rete stab. Yon elåv 3Yém niv reponn anpil nan kesyon egzamen yo körékteman, men anieneral. aen mwens siksé ak kesyon kl parét gen pi plis difikilte ladan yo. 2 Péltimans nan nivo sa a demontre siksé elév la limite nan matyé gen difikille ladan yo nan egzamen "Sunshine State Standards' It 1 Påfbmans nan nivo sa a demontre elöv la aen von ti siksé tou OÍ nan matyö kl gen dillkilte ludan yo nan egzamen 'Sunshine Star Standard?. Pwogré de ane an ane - Yo bay egzamen lekti ak matemati 'Sunshine State Standard? pou FCAT la depi nan klas 30/11 jisk klas Konsa, ou ka konpare sa elév yo reyalize panda dezan (2 an) depi nan klas 4Yére jiska klas 10Y". Yo baz konparezon yo sou nivo siksé elév la de ane an ane. Sétifika - Dapré nöt olé,/ yo té nan "Sunshtne Siete Standard pou FCAT la, yo ka bay yo sétifika pou sa yo akonpli. Pou lekti a Matematik, elév ki lb gwo nöt ki klase pélémans yo nan 55" nita resevwa sétifika. Pou redaksyon, tout elév ki té nöt 5.5 ak 6 ak tot elév klas 4)." kl fé nöt 5, 5.5, ak 6 resevwa yon sétifika. Yo ba sétifika yo swivan not elév yo fé nan egzamen kl baze sou "modi egzamen ofisyål FCAT itilize pou få evalyasyon' yo. EFTA01710253 Spring 2002 Florida Comprehensive Assessment Test (FCAT) Sunshine State Standards - Grade 06 S.tudent Report 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 06 Achievement Levels Scale Score Ranges Reading Mathematics Level 5: 387-500 391-500 Level 4: 339-386 354.390 Level 3: 296-338 315.353 Level 2: 265-295 283.314 Level 1: 100.264 100.282 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. Your test scores showhow 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 287 and 319. Your FCAT Mathematics scores might have been between 298 and 328. The range reflects the amount of statistical variability in the scale score. Content scores show your performance on more specula 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 1 point each. 2002 Content Scores Number of Points Possible Reading Words/Phrases Main Idea/Pur •ose Comparisons aeterenceisesearch Mathematics Number Sense Measurement Geometry Algebraic Thinking Data Analysis Number of Points Earned 2001 Achievement Levels and Scale Scores•" Grade 05 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 left shows the scale score anges for the test you took last year. Reading Mathematics Level 5: 384-500 395.500 Level 4: 331.383 355.394 Level 3: 286.330 326-354 Level 2: 266-285 288-325 Level 1: 100-255 100-287 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 improved over last year's score, and you have made good progress. Mathematics Learning Gains: Your FCAT Mathematics achievement level score improved over last year's score, and you have made progress. "k 2001 scores and learning gains are reported if matching records were found on the computer file. Data Rio Date: 03/1t/20C2 0339932 EFTA01710254 FCAT Reports The FCAT Reading and Mathematits test resuits are provided In two separata reports, one for the 'Sunshine State Standard? (SSS) tests and one for the "Norm-Referenced Tests (NRT) tests. At grades 4, 8, and 10, a third report contains the FCAT Writing resulta. The FCAT 'Sunshine State Standards' report presents test stores from Florida's test of academle standards. Success on this test can be best understood by using the achievement levels where a 3 or higher is preferred. This report contains Subject Stores and Content Scores. Subject stores provide an overall summary of achievement, and content stores give the number of points earned in specific skill areas. The "Norm-Referenced Test' report presents Reading and Mathematics stores on a Florida version of the SAT9 published by Harcourt Educational Measurement. Student stores are compared to a national "norm" group, where a percentile rank store of 50 is average. Achlevement Levels The achievement level is one of the subject stores on the FCAT "Sunshine State Standard? test. These levels describe the success a student has achieved on the Florida Sunshine State Standards tested on FCAT. Level 5 is the highest and Level 1 is the lowest. 5 Performance at this leve! indicates that the student has stams; with the most challenaina content of the Sunshine State Standards. A leve, 5 student answers most of the test ouestions correctly including the most challenging questions. 4 Performance at this leve: indicates that the student has success with the challennina tonfem of the Sunshine State Standards. A level 4 student answers most of the test questions correctly, byt may have oniv some success with questions that rediga' the most challenging content. 3 Performance at this level indicates that the student has oxmini success with the challenging content ol the Sunshine State Standards, but performance is Inconsistent. A leve) 3 student answers many of the test questions correctly, but is generaliv less successful with questions that are the most challenging. 2 Performance at this level indicates that the student has limitad sur ts with the challenging content of the Sunshine State Standards. 1 Performance at this level indicates that the student has little so= with the challenging content of the Sunshine State Standards. Year4o-Year Growth The FCAT 'Sunshine State Standard? tests in Reading and Mathematits are given in grades 3-10. Therefore, achievement across two years can be compared for grades 4-10. These comparisons are made based on changas in the students achievement leve) from one year to the next. Certificates Scores on the 'Sunshine State Standard? part of FCAT are used to award students with certificates of accompilshment. For Reading and Mathematits, students who store in Achievement Level 5 receive certificates. For Writing, certificates are given to all students with stores of 5.5 and 6 and to fourth graders with stores of 5, 5.5 and 6. Certificates are not awarded basad on the Norm-Referenced Test stores. Informes del FCAT (Spanish) Los resultados de los exámenes de lectura y matemáticas del FCAT se proporcionan en dos informes por separado, uno para los exámenes según las normas estatales "Sunshine State Standard? (SSS, por sus siglas en inglés) y uno para los exámenes ceñidos a normas de aplicación nacional (NRT, por sus siglas en inglés). Un tercer Informe contiene los resultados del examen de redacción del FCAT de los grados ‘90, 8vo, 10mo. El Informe según las normas estatales "Sunshine State Standard? del FCAT presenta las calificaciones del examen de las normas académicas de Florida. El éxito de este examen puede entenderse mejor utilizando los niveles de rendimiento en los que se prefiere una calificación de 3 o superior. Este informe contiene dos tipos de calificaciones (calificaciones por materia y calificaciones por contenido). Las calificaciones por materia proporcionan un resumen general del rendimiento y las calificaciones por contenido proveen el número de puntos ganados en áreas de habilidades especificas. El informe del examen ceñido a normas de aplicación nacional (Norm-Referenced Test) presenta los resultados de Lectura y Matemáticas en una versión de Florida del SAT9 publicado por (Harcourt Educational Measurement). Los resultados obtenidos por los estudiantes se comparan con el grupo modelo o 'norme, en el que la clasificación percentil de 50 es el promedio. Niveles de rendimiento: El nivel de rendimiento es uno de los temas evaluados en el examen Sunshine State Standards del FCAT. Estos niveles describen el éxito que un estudiante ha logrado en las normas estatales Sunshine State Standards que se prueban en el FCAT. El nivel 5 es el más alto y el nivel 1 es el más bajo. 5 El rendimiento a este nivel indica que el estudiante tiene éxito con el contenido más dificil del examen Sunshine State Standards. Un estudiante del nivel 5 responde la mavoria de las preguntas del examen correctameate incluyendo las preguntas más difíciles. 4 El rendimiento a este nivel indica que el estudiante tiene éxito con el contenido difícil del examen Sunshine State Standards. Un estudiante del nivel 4 responde la mayoria de las preguntas correctamente, 0002 es posible Que sólo tenga algún axil en preguntas que reflejan el contenido más difícil. 3 El rendimiento a este nivel indica que el estudiante tiene éxito parcial con el contenido difícil del examen Sunshine State Standards pero el rendimiento no es uniforme. Un estudiante de nivel 3 responde muchas de las preguntas del examen correctamente pero por lo generaUiene menos éxito con las preguntas que son más difíciles. 2 El rendimiento a este nivel indica que el estudiante tiene éxito limitado en el examen Sunshine State Standards. 1 El rendimiento a este nivel indica que el estudiante gene poco exile con el contenido difícil del examen Sunshine State Standards. Evolución de un año al otro: Los exámenes Sumidas State Standards del FCAT en lectura y matemáticas se administran desde 341' a 10" grados. Por lo tanto, el logro en dos años puede compararse con los grados desde 410 hasta 10Te. Estas comparaciones se hacen basadas en los cambios en el nivel de rendimiento del estudiante de un año a otro. Certificados: Las calificaciones de la parte Sunshine State Standards del FCAT se utilizan para otorgar certificados de logros a los estudiantes. Para lectura y matemáticas, los estudiantes que logran un nivel de rendimiento 5 reciben certificados. Para redacción, los certificados se otorgan a todos los estudiantes que han obtenido 5.5 y 6 puntos y a los estudiantes de cuarto grado que han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados en los resultados de los exámenes ceñidos a normas de aplicación nacional. Rapo FCAT (Haitian Crcole) Yo bay de (2) rapé apa pou rezilta egzamen lekti ak matemz FCAT la, youn se pou egzamen 'Sunshine State Standan (SSS) yo, epi lät la se pou egzamen ki baze sou "modél egzam ofisyél FCAT itilize pou fé evalyasyon' (NRT) yo. Nan klas 4v1 8vém ak 10~, yo bay yon hvazyém rapé ki gen rezilta egzam redaksyon FCAT la. Rapé 'Sunshine State Standard? pou FCAT la prezante nät el yo fé nan egzamen Florida bay sou prensip akademik yo. ka konprann kl kantite siksé yon elév pote nan egzamen sa a, ka itilize tabla nivo siksé elév la. Nan tablo sa a, yo prefere lé y elév få yon nät 3 oswa yon nät kl pi wo. Rapo a gen nät pou e ak nät pou kontni ladann. Nät pou sfié a bay yon rezime jene sou tout sa elév la reyalize nan egzamen an, epi nät pou kontni bay kantite pwen elév la té nan yon matyé byen detémine. Rape sou egzamen ki baze sou "modél egzamen ofisyél FC itilize pou té evalyasyon' yo prezante nät pou lekti ak matema nan vésyon SAT9 Florida bay la. Se Harcourt Educatiot Measurement Id te pibliye vésyon sa a. Yo konpare nät elév yo yon gwoup nät yo konsidere köm "modél pou egzamen ofisyél" nan nivo nasyonal, kote suivan klasman pa pousantaj la, mwayén nan se 50. Nivo siksé elév yo - Nivo siksé elév yo se nät pou youn n matyé ki genyen nan egzamen sou *Sunshine State Standan pou FCAT la. Nivo sa yo dekri siksé yon elév reyalize lå elév pran egzamen 'Sunshine State Standard? pou FCAT la. Pi g, nivo a se Nivo 5, pi phi nivo a se Nivo 1. 5 Pélgmans nan nivo sa a demontre elév la te aen siksé nan mal id te gen pi olis difikilte ladan vo nan egzamen "Sunshine St. Standards' la. Yon elév kl nan 5vém nivo ;vapor -, pifia kesy aganertygisgalgemen, elév la menm reponn kesyon ki gen pi g difikilte ladan yo. 4 Infamas nan nivo sa a demontre elév la te aen siksé nan mal kl gen difikilte ladan VQ nan egzamen "Sunshine State Standan la. Yon elév kl nan 4yém nivo reponn kesyon egzamen körekteman, men li gen kék seise selman nan kesyon ki parét g pi gis difikilte ladan yo. 3 PtiMmans nan nivo sa a demontre elév la pea enne siketit n matyé ki gen difikilte ladan yo nan egzamen "Sunshine St Standards" la. men påfamans lan pa rete estab. Yon elév 314" n. reponn anpil nan kesyon egzamen yo körékteman, men anjeneg aen mwens siksé ak kesyon ki paret gen pi plis difikilte ladan yo. 2 Peförnans nan nivo sa a demontre siksé elev la limite nan matyt gen difikilte ladan yo nan egzamen 'Sunshine State Standard.? 1 Pélémans nan nivo sa a demontre elév la •en vnn ti siksé tou nan malyé kl gen difikille ladan yo nan egzamen "Sunshine Sti Standards". Pwogré de ane an ane - Yo bay egzamen lekti ak materna 'Sunshine State Standard? pou FCAT la depi nan klas 3röfll jis klas 10rém. Konsa, ou ka konpare sa elév yo reyalize pand dezan (2 an) depl nan idas 40m »le klas 100m. Yo ba konparezon yo sou nivo siksé elév la de ane an ane. Sötifika • Dapré nät elév yo fé nan "Sunshine State Standar pou FCAT la, yo ka bay yo sétifika pou sa yo akonpll. Pou lekti Matematik, elév ki fé gwo nät ki klase pélibmans yo nan 5véril nis resevwa sétifika. Pou redaksyon, tout elév ki fe not 5.5 ak 6 ak tc elév klas 41"" ki fé nät 5, 5.5, ak 6 resevwa yon sétifika. Yo b sétifika yo swivan nät elév yo té nan egzamen ki baze sou "moc egzamen ofisyél FCAT itilize pou få evalyasyon" yo. EFTA01710255 :t Florida Comprehensive Assessment Test FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 NORM-REFERENCED TEST Student Report Grade 05 This report shows your results from the FCAT National Norm-Referenced Test. 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 Reading Comprehension Mathematics Problem Solving National Percentile Rank Stanine The Scale Score expresses your performance and allows comparisons from year to year. Reading Comprehension Scale Scores range from 481 to 802. Mathematics Problem Solving Scale Scores range from 467 to 781. 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 tog. 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 tall within a certain range. For Reading Comprehension, your National Percentile Rank should be between 28 and 43. For Mathematics Problem Solving, your National Percentile Rank should be between 55 and 79. CONTENT SCORES Number Number Number of Points of Points of Questions Possible Earned Attempted Readin! Com•rehension 54 Initial Understanding 12 Interpretation 24 Critical Anilysis 9 Strategies 9 Mathematics Problem Solving 48 Measurement 6 Estimation 4 Problem Solving 5 Number Relationships 6 5 Number Systems Patterns & Functions 3 Algebra 3 Statistics 6 Probability 3 Geometry 7 Each question was worth 1 point Run Date: 04/28/2001 0301319 EFTA01710256 Florida Comprehensive Assessment Test This report shows your results from Level 5: Level 4: Level 3: Level 2: Level 1: The FCAT Sunshine State Standards Test Standards. Scores on this test are one ind reading portion of FCAT have not yet been FCAT Student . Achievement Levels Scale Score Ranges Reading Mathematics • 395-500 co2 wz 355-394 off 326-354 , 288.325 O 100-287 Your scores are shown below. FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 SUNSHINE STATE STANDARDS Student Report Grade 05 the FCAT Sunshine State Standards Test District Name and Number SO - PALM BEACH measures your performance on selected benchmarks in reading and mathematics as defined by the Sunshine State ication of your achievement of the challenging content that Florida students are expected to know. Achievement levels for the determined. The table below shows the scale score ranges for each Achievement Level for the mathematics test. 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. SUBJECT SCORES CONTENT SCORES Student Achievement Level Scale Score State Comparison: Thirds Lowest Middle Highest Reading Mathematics 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 tall within a certain range. For reading, your scale score should be between 260 and 296. For mathematics, your scale score should be between 225 and 267. The check marks ( .1) show If you scored in the lowest, middle, or highest third of grade 05 Florida students who took this test. "TBD: To Be Determined Run Date: 04/26/2001 Number of Points Possible Reading Words/Phrases Main Idea/Purpose Comparisons Reference/Research Mathematics Number Sense Measurement Geometry Algebraic Thinking Data Analysis Number of Points Earned State Comparison: Thirds Lowest Middle Highest The Content chart shows the number of points possible and the number of points earned for each category. Each question on this portion of the test was worth one point. The results on your performance items will be reported Separately. 0299051 EFTA01710257 1169-J3-H1R3 DATE: 02/09/99 MIAMI-DADE COUNTY PUBLIC SCHOOLS STUDENT PERFORMANCE PLAN srum:a. ID:a.LA. ID: Ui4E: ESTATUS: A SEX: F ETHNIC: H BIRTHRATE: ADDRESS: CITY: M KIP: 33178 PHONE: LUNCH: F DROPOUT PREVENT PGMS: ATHLETIC ELIGIBILITY: N CCP: TRANSFER CRSE INFO: NO WEIGHTED GPA: WEIGHTED GPA: RANK: COHMUNITY SERVICE HOURS: 000 COMPLETED ON: / / ESOL: LEVEL 5 EXIT DATE 06/11/97 MOST RECENT PSYCHOLOGICAL CASE OPEN: SCRS REFERRALS: STANDARD DIPLCMA: TOTAL ABSENCES: 4 TOTAL TARRIES: 15 TOT DAYS SUSPEN: INDOOR: 0 OUTDOOR: 0 TOTAL ABS PREVIOUS YEAR: 7 PARENT/GUARDIAN: LAST NAME FIRST RAKE REL MIPLOYMENT PRONE PRIMARY HONE LANGUAGE TESTING INFORMATION: • 0 MN COUNTYWIDE TEST SCORES TEST DATE: 03/98 TEST GRADE: 02 TEST DATE: 03/97 TEST GRADE: 01 READING MATH COMP MATH APPL STANINE PERCENTILE SAT TEST SCORES SCORE STANINE PERCENTILE READING MATH COMP MATH APPL SPANISH ACT TEST SCORES HIGH SCHOOL COMPETENCY TEST SCORE COMMUNICATION SKILLS/SCORE VERBAL ENGLISH MATHEMATICS SKILLS/SCORE MATH MATH TSWE READING SCHOLASTIC READING INVENTORY SCIENCE REASONING DATE: 1997-98/MAY 1998-99/SEPT LEVEL: SCORE: REPORTING CYCLE: 981 CURRENT SCHOOL: IMODUREVIT GRADE: 03 SCHL TRH COURSE TITLE SP EP ROOM 1 2 3 4 FGECAB SCHL TRH COURSE TITLE SP BP ROAN 1 2 3 4 FGEC AB 5101 A LANG ARTS 0051 5101 A READING 0051 5101 A MATHMATIC 0051 5101 A SCIENCE 0051 5101 A SOC STUDY 0051 5101 A ART 51 5101 A MUSIC 51 5101 A PHIS ED 51 5101 A SPANISH -S 0051 * DENOTES INACTIVE COURSE 4 DENOTES BELOW GRADE LEVEL EXCEPTIONAL CHILD PROGRAM: PRIMARY EXCEPTIONALITY: BARN'S SIGNATURE IEP DATE: DATE EVALUATION DATE: Chi/ O 2 EFTA01710258 DADE COUNTY PUOLIC SCHOOLS Attachment C OFFICE OF EXCEPTIONAL STUDENT EDUCATION Student's Name School: ALTERNATIVE STRATEGIES AND FOLLOW-UP FORM e e (2ells air . Date and Type` of Conferences: (a? Grade:3 DOB l CST Chairperson: )( ) ( Student ID. Problem Area (Objective, Specific and Quantifiable): S faAl I el on 3r as Replacement Behavior cc" SAY on Attskc. Alternative(s) to be tried at Grade/Sehool Level (Plan) (Please note: These alternatives may be helpful with other students in the class as well). 1. r%kkAA en A- Go; 11. near +Fe Cache)' 2. Sktider1;-* t\ have tt:‘,crE'llna f#r: =Cc ed 3. -1--AO C.a Lrcf ve Ea;*tve ret (I-G./ten...GA • 4..SAuden\-- worts L,0;11-% oc peer 5. ,54-ua0\ V- 15 ,CalavelN e>1ra "Me FOLLOW-UP QUESTION: pasBM -In...pc-wed 0.l s k-al , 45 on Date of Initiation 10)/ f et 8 to tol2 Person(s) Responsible Problem Area (Objective, Specific and Quantifiable): 0...e,‘ e o) ?-si 1 q nrentyliS LP-N., 11 Co..--plc'-e. 0. SS 10 n Alternative(s) to be ttied at Grade/School Level (Plan) (Please note: These alternatives may be helpful with other students in the class as well). 1. 9k-aeA\ - Ircks ,skr.)c-k-w-ed ht tart c 2' TeaCke.i, -e rkS asS\greas kel- t nA‘,,i, llJokk y 3. 4..-O,zzi A S i; kg-1 a peter 4:1)v.€ Dorle3 fo a isio nr-neA -1-,s are Pas-N's -In 41-go chary, 5. \mos act co_vate 1-; rat 4-° co FOLLOW-UP QUESTION: p roS Date of Initiation q(f1(13 . 1 1 I CI V11 1 ge Persona) Responsible rm.5139 Ito-9-41 n-frovect on con-, \e-Ilyi ass )5),--,e4 • Type of Conferences: CST. LEP, ESE, and 504 (Over) Child Study Team Procedures 23 EFTA01710259 Mo. Day Yr. ;HOOL NO. C I DADE C6UNTY PUBLIC SCHOOLS F STUDENT c CASE MANAGEMENT REFERRAL FORM 40 SC M tl Mo. Day Yr. *UDENT NAME STUDENT ID FERRED BY REFERRED TO 1RRATIVE: (CLEARLY STATE WHY THE STUDENT IS BEING REFERRED) e4uaer.)-1- 'Per Pc:ir yy-Nance 'Plan 'Read lre and IA HOME GRADE ROOM ?im LEVEL PERIOD OF DAY INCIDENT DATE 2. I0 cri TIME PARENT CONTACT: (Gide Yes of No) 1. For This Behavior YES NO 2. For Other Misbehavior YES NO 3. Contact Attempted NO 4. Contact Made: 4A. Verbal 4B. Written YES NO NO • • fMr7hery) NTER REASON FOR REFERRAL CODES BELOW: ENTER NO MORE THAN 4 CODES) R q OTHER INCIDENT INFO = LOCATION: U CONTEXT: .NTER REFERRAL ACTION INFORMATION BELOW DATE TIME EMPLOYEE NO. INITIALS /Military) :nr NUM COMPUTER RECORDED REFERRAL ACTION CODE R_ :omments: Lgency/Case Number (If Applicable) ENTER STUDENT SERVICE INFORMATION BELOW: DATE DV Yr. TIME EMPOWER NC, INiTIALS (MihAdt y) COMPUTER RECORDED STUDENT SERV,ICE CODE. r)--ito -7/ ci / 1 C 2- 1 I t inn Ccn1 rut 178-2016 FM-2981 Rev. (05-95) FOR DATA ENTRY (ATTENDANCE),THEN FILE IN STUDENT CUMULATIVE FOLDER. EFTA01710260 . . / DADE COUNTY PUBLIC SCIR/OLS OFFICE OF EXCEPTIONAL. STUDENT EDUCATION ALTERNATIVE STRATEGIES AND FOLLOW-UP FORT[ es ee2W. C11)1 fcri Student's Name:. Date and Type' of Conferences: c'./ DOB 5 1( CST Chairperson. indent ID. # Problem Area (Objective, Specific and Quantifiable): Replacement Behavior. Alternative(s) to be tried at Grade/School Level (Plan) (news note: These alternatives may be helpful with other students in the class as welt) Date of Initiation 2. )..c.(:• /'LC 3. 7/ - 4. 5. Person (s) Responsible FOLLOW-UP QUESTION: - i Problem Area (Obj iwe a Quantifiable): / .Spe a , ere Aa dr r Replacement Behavior An t4A-.1.9/1 262---fe— A-014-4-cet-I GE/ ,...gAst. /lead °Ca a-trt„ &Int. - Date of Initiation ( /01 - 1 Persouls) Responsible 'tat/ Alternative(s) to be tried at Grade/Scbool Level (Plan) Olean note: These alternatives may be helpful with other students !he e.bIsAlapelb. I. MLfre /44:, .1 /61.-- - btleri-. elA e&a 2. orair ka ..iii - rorrnn at t‘c6o. v a( c& - -4 4 Ole. _ Ina a vileati, 7i) 64.2,nttn‘ , e /01 _ cif .1. Chat - eitt t'C'' d ilif in t Wrirda? Lti-eceed /01 - (11 _i(e4c.t-\_ ..t d Z ei tSier FOLLOW-UP 21JESTPIN:4:4 47S a fr /A/O ''-1- AMA 1>t, , • Type of Conferences: CST, LEP, ESE, and 504 Child Siudy Team Procedures • eeaAS-t ‘0441-1,- Gadeffotte anfilinal 12/07 (Over) F.4.n.11/ 026441 23 EFTA01710261 DADE COUNTY PeBUC SCHOOLS Attachment E OFFICE OF EXCEPTIONAL STUDENT Ei)UCATION Mathematic Oral Expression Organ zation Paying Attention Reading Content Material Reading Specific Information CST STUDENT INVENTORY (Elementary Level) .(Adspeal trot CISktfillk devslopeet by R.1.IR Ceasehums) Doc Type: 4096 a 'h. .• • ART • I • Date (talIDDIYY): =rim Student ID. N Teacher(s) D.O.B. lerbrammiciwyvaltil!mmaill ESOL Lcvetcr School: 11102212al Math Levet treng :• I• t • • • • INFORMATION INPUT (Ho. Stticieot Inns) Textbook Worksheet/Workbooks Oral Presentations Discussion AN Materials Hand-On Experience Observation Boudwork Reference Material Computers Teacher-Directed Activity Peer Tutors Independent Work With An Adult In A Small Group With The Whole Class Other , 0 Weakness in regular class settings INFORMATION OUTPUT. (14en Sauciest Respoods) Essay Written Reports Short Answer Creative Weida", Worloheetsigrorkbooks Multiple Choice/Matching True/False Math Word Problems Computation Derno/Lab Projects. Art or Media Projects Maps, Charts or Graphs Oral Responses Group Discussion ts Boardwork Oral Reports fr Other LEARNING AND BEHAVIOR PROBLEMS (Check only items or the hishest priority. iquistom or S"). • ' g Questions in Class . 61 tegoriiing 96 lass DiSCUSSit3tt 26 Ittpleting Assignments- 25 ollowing Directions 23, 57 letting Started 44 adependent Work Skills 18 anting from Demonstrations 102 earning from Oral Presentations 29 arising from Tape Recordings 46 • Letting 31, 56 34 42 38 8 44) 16 93 .Aemembering (general 11, 49 Seeing. Relationships 35 Staying on Task Study Skills dc 106 Learning Strategies 108 Taking Notes 47, 109 Taking Tens 92 Thinking Skills Transferring 17 Information or Skills 55, 64, 75 28 51, 103 Oilier Other Pus • sasat.ors rdar a eisma Intn• Swes44 ••• FM-4ft. Understanding Content Vocabulary Working in Groups Writing EFTA01710262 DADE COUNTY PUBLIC SCHOOLS 57\ rk- t Attachment E CE OF EXCEPTIONAL STUDENT EDUCATION )14-7l fatAbl " - CST STUDENT INVENTORY (Elementary Level) 'IT? (MAPcsd from esiscriak liCY•k•ptd by RUE Coesestimi) Dee Type: 4496 Student's Name: Antiwar:TA temirgari Reading Levet + Strengths (commensurate with peers) INFORMATION INPUT (Hoer Studeat Leered) Textbook Worksheet/Workbooks Oral Presentations Discussion A-V Materials Hand-On Experience Observation Boardwork Reference Material . Computers Teacher-Directed Activity Peer Tutors Independent Work With An Adult In A Small Group With The Whole Class Other Date (MM/DD Student ID. N Age: ESOL Level:( Math Levet • (7 Weakness in regular class settings INFORMATION OUTPUT, (How Stucker Responds) Worksheets/Workbooks Creative Writing Written Reports Short Answer • Essay Multiple Choice/Matching True/False Math Word Problems Computation Demo./Lab Project_ Art or Media Maps, Charts o Projects r Graphs Oral Responses Group Discussion Report Boardwork Oral Repo fr Other •. LEARNING AND BEHAVIOR PROBLEMS a (Check only hems or the highest priority. Marina of 5). Asking Questions in pass Categorizing Class Discussion Completing Assigamentr Following Directions 23, 57 Getting Started 44 Independent Work Skills 18 Learning from Demonstrations 102 Learning from Oral Presentations 29 Learning from Tape Recordings 46 17 Listening 31, 56 Mathematics 34 Oral Expression 42 Organization 38 Paying Attention Reading Content Material Reading Specific Information 16 • 61 93 96 11, 49 26 35 25 106 108 47, 109 92 55, 64, 75 28 51, 103 8 Oilier 4O Other .Remembering (general skills) Seeing Relationships Staying on Task Study Skills & Learning Strategies , Taking Notes Taking Testa Thinking Skills Transferring Information or Skills Understanding Content Vocabulary Working in Groups Writing Nip I diodes it w tesarddl Ildrood M.T.Y. ad FM-4n d (ID-ti) EFTA01710263 5008 33 -R2G' net ICD ENGL i'MCY COIR1S.c.t; 02/03/13 11...!2.1•2 StUDENT ID FI A CM ID SIAI tr. A SIX f ITEN1C H LEGAL NAM:: LAS rIRS 14100LE R IIICACC CURREN' SSIIDUI GRAM' 02 Ilk STGI 20I DA1I. Ern EPTD 04/4,!/42 SURVEY: DAIE 11 '13 Y T Y f•ARENf/GUAfdllON LANG SP IfU LANG 1' ASSFCSMFM1: PAU 11 / 0-; / 45 OLPS Saki 13 lfF (TAO N f SCI 1.1W! YE fRONLEf AN: GRADE RAW SCORE: RDG LAE NERCr.Nr (LE: ROC LW COPY DM. 1: / Oi i 9t, RACIC Of FN1RY A ILIOI GINICUR 9:: HU SfRV1fxS If EXIT DACE 06 / 11 / 97 3ASLS ur EXIf A ALPS ::CURE 1? IITTROPOI IlArn MADE PAR SCOPE: roc I A% PERE!. ILE RDG AVG REC.LISSIRICALION DA / SEW ERSE DIP IIRS/IE M1M/1411 DEIII CPS! UV 114/14I1 11111/191 HUM NUM NUN NUii Lai FRANC Dor 04/12"7.7 ;IF* PI AN DA1F 06/12/9? (SUIuva Ul 06/1 2/47 EFTA01710264 S112- C2-R2111111111 COHNIYLEIDI I r SI SCOUf 5 02/02/90 14,24 SO 5 O JOEN r n) CIA f £0 5 f A fUS A 5J.X C:r11NCC H t rwA. NAME I ASI ftS1 not r Mrzer PI r APP COP2EN r scHOOL CRAHC O. CN f 2Y OA (C 09/02/9/ ei eR runn fCST YCAR (52A0::) 9/ 01 ) ) I ) ) i C.5•1 OPTION 4 •• •• SIM' ei:. CDL: 15Iári 7 COg !CAM' 7 CO% I Cl A9 7 Cl.* IS] A9 7 CE»! 12C(U) COMP I I i MAI H COMP I I I MA ril APP i MA nl i 1 I i ANG mr CH / r Ntd. 1SH I I I NO20 :5 r MOY I I I WORD Pt AO I or no voc i i I CONC NáR I I I SOTENLV I I I SOC SCI 1 : I - - -.__-.. __ T OPTION5- 0) HOF ni:1mph Of nc2 (l) MOF l";,.3 ra) 2CCAU5C C5.5 S) CXFCNOCO F [MC • Sc.0 1 ) I Liflt D PO: i St 4) NOI 11SI f D ni cAuta 1 L P CUM( F ol Dr k r OP K pora Z) rt,....uen :Alf t.CP ) {cri iTn áLi f .:5C ANI) I_CP Li fl) : APst Ntripts czut At: CODE v, C ai u / . .1)1 )1/4/(1 EFTA01710265 DADE COUNTY PUBUC SCHOOLS INFORMATION INPUT (How Siidect Lzaros) INFORMATION OUTPUT, (How Stu:Scat Rr.spoods) Print Stu. Teacher( Class/Course: School: _EL Attachment E OFFICE OF EXCEPTIONAL STUDENT EDUCATION CST STUDENT INVENTORY (Elementary Level) (A4apue4 trout Catiak devolopa4 by MR Commtuuue) Doc Type: 4996 Demographic Information en Textbook Worksheet/Workbooks Oral Presentations Discussion A-V Materials Hand-Oa Experience Observation Boardwork Reference Material Computers Teacher-Directed Activity Peer Tutors Independent Work With An Adult In A Small Group With The Whole Class Ocher Grade: Reading Level: Date ( A 4iLf IDDIYY): Student. ID. N Age: ESOL Level:(5 -- Math Level- /12- 0 Weakness in regular class settings Essay Written Reports. Short. Answer Creative Writint Worksheets/Workbooks Multiple Choice/Matching True/False Math Word Problems Computation Demo./Lab Projects. Art or Media Projects Maps, Charts or Graphs Oral Responses Group Discussion Boardwork Oral Report Other LEARNING AND BEHAVIOR PROBLEMS (Cheri only items of the highest priority. Madman or 5). • • Asking Questions in Clam tegorizing C ass Discussion Completing Assignmentr F°Bowing Directions Getting Started Independent Work Skills Learning front Demonstrations Learning from Oral Presentations 29 Learning from Tape Recordings 46 31, 56 34 42 38 Listening Mathematics Oral Expression Organization Paying Attention Reading Content Material Reading Specific Information • • 61 96 26 25 23, 57 44 18 102 8 40 16 93.4 itemembering (general skills) 11, 49 Seeing. Relationships 35 • Staying on Task Study Skills & 106 Learning Strategies 108 Taking Notes 47. 109 Taking Tests 92 Thinking Skills Transferring 17 Information or Skills 55, 64, 75 28 51, 103 Other Other rm. • ••••-•• ,at 14 tlaAl ten" Mat. P74-41/4 (10-r1) Understanding Content Vocabulary Working in Groups Writin EFTA01710266 DADE COUNTY PUBLIC SCHOOLS OFFICE OF EXCEPTIONAL STUDENT EDUCATION ALTERNATIVE STRATEGIES AND FOLLOW-UP FORM Student's Nam Grade: DOB Date and Types of Conferences: ( 01 ( 1 t 9 (//g/I)1 ) ( 2 CST Chairperson: Student ID. 4 . PM/ Objective, SpiecifIc and Quant4Ible): N t L. On-- reiCtjA, trathcii ail° tej -1-ALF r Replacement Itehavioni se 11110 $0h 6115 i thivol41--- Alternative(s) to be tried at Grade/School Level (Plan) ' (Please note: These alternatives may be he • I with other students in the class as well). 1. t , Date Initiation of Person(s) • , Ma f MW) 'Wtt, yn ,p ° 'L i r( l' ry 1( 5 3. u (,) ,900iltor asrt viten Itil3ifi it . et . 5. FOLLOW-U R ,QUESTION: WI th,Lilitiaiii 020% 0 iiijeci-InufAI-4/16‘514- 47151C antirmitne, a $ 4 qies In silbree a keel? P blem Area (Obi dive , c and Qua tifiable R acentent Behaviol Via/Lae, ekt litAl etiAd dial) n et 'el DA .22,0 Alternative(s) to be tried at Grade/School Level (Plan) (Please note: These ternatives may be helpful with other students in the class as well). 1. 5hTh e Alid a1/2'/N9nrytp..yrk—leae Date of Initiation c golfer Person(s) tk_s ava G i t t/t . t i t, critto,id e 1 de vi es 41)195 t, I f . ,,. P Ore • FOLLOW-UP QUESTI0W: Wit( *trio Aay) impavtivten,* am y-ti5ektri6miei tes Mei k cid ene-q i cil 4 514. el rr-4.S. • Type of Conferences: CST, LEP, ESE, and 504 (Over) dfrAptiv e vaete gag' )(AM- ' FM-5239 M6-94) EFTA01710267 cp) STUDENT CASE MANAGEMENT REFERRED BY: 878.2164 SCHOOL NO. STUDENT S EMPLOYEE NO. EMPLOYEE NAME STUDENT ID COMMENTS: STUDENT NAME DATE TIME SERVICE CODE Mo. Cray Yr. /Military) GR/SECT 3 eat- — 747 /0(- *olte4 t s f • SCM# vi Vv Lej COMPUTER RECORDED /01 08' It ill 02- IV 111 /2- iqf 1/1/9 98 /2403 I9Sk 624 O/ ITS/ // I 02_19/ /1 I omf 19"8 // 12.3 19g WHITE - For Data Entry (Attendance), Then Student Cum Folder; YELLOW • To Administrator GREEN • To Relaying Party; PINK • To Servke Provider rev 70-e) 11,00 /Lap liao /70o 2(30 r:00 3 3 3 1_ 4- V I FM-3673 REV. (04-87) COMMENTS. /5 _c -G _ cs,ocesi ) H/02_ henc-e,2"te eallc-Q4nA? erer"7 f1/43 03 - WHITE - For Data Entry (Attendance), Then Student Cum Folder; YELLOW - To Administrator 878-2164 GREEN • To Referring Party; PINK - To Service Provider FM-3873 REV. (0487) EFTA01710268 4-31-R2G DENT RECORD/SUBJECTS 12/03/98 11.15.55 WIT ID SCHOOL In GRADE 03 HR 38L PRO ST SCHL CD iE SEX F EFH H ADDSCH.CD 2THDATE iT SUS UPDT 09/23/98 RECORD UFOT 11/08/98 LAST GRD UPDT 09/23/98 REPORTING CYCLE 981 GRADING PERIOD CYCLE TOTAL ABSENCES 002 CYCLE TOTAL TARRIES 009 PROGRAM NO. 05 1/2DE 03 HR 3BL F W-DISEC CRS M MULE ROOM TEACHER 1234 G 1 A04 01 510009032 ALANC ARTS 1 E03 01 510009021 A READING 1 GO3 01 510009007 A.MATHMATIC 1 H04 01 510009063 ASCIENDE 1 I04 01 510009012 A SOC STUDY 1 J04 01 510009015 A ART P3 1 KO4 01 510009016 A MUSIC P3 1 LO4 01 510009017 A PHYS ED P3 1 N0401510009020 A SPN1ISH-S KEY DESIRED GRADING PER EFTA01710269 8-33-R254 LIMITED Y COURSES 12/03/98 12.12.01 DENT MIMI FLA STU ID STATUS A SEX F EGAL WM! LAST MEN KIDDIE ■ BIRMATE SENT WWII. GRADE 03 HR SECT 3EL DATE WSW VEY: DATE 1 /-07 / 95 RESPONSESYYYPARNT/GUARDIAM LANG SP STU LANG SP ESSEN!: DATE 11 / 07 / 95 OLPS SCORE 13 LB, (Y/NU H ESQ. LEVEL 5 ROPOLITNN GRADE RAN SCORE! RD5 LANG PERCENTILE: ROE LANG RY DATE 11 / 07 / 95 BASIS OF ENTRY A ESCL SEMESTER 03 LEP SERVICES LE T DATE 06 / 11 / 97 BASIS OF EXITA OLFS SCORE 19 ROPOLITAN: GRACE RAW SCORE! ROG LANG PERCENTILE! ROE LANG lASSIFICATION DATE / / SCHL CRSE EMP 111S/ITY, MIN/WK SEAL ERSE EMT HRSAC MINAE IRRI NUM NUM NUM I' TRANS DATE 06/12/97 LEP PLAN DATE 06/12/97 ESOL LEVEL UPDATE 06/12/97 EFTA01710270 S169-f-H1R3 DATE: 02;09/99 es' MIAMI-DADE COUNTY PUBLIC SCHOOLS STUDENT PERKRHANCE PLAN MID:ISA. ID: =INANE: STATUS: A SEX: F ETHNIC: H BIRTHDATE: ADDRESS: CITY: H ZIP: 33176 PHONE: LUNCH: F DROPOUT PREVENT N-HS: ATHLETIC ELIGIBILITY: H CCP: TRANSFER CRSE INFO: NO INWEIGHTED GPA: WEIGHTED GPA: RANK: 'OM/UNITY SERVICE HOURS: 000 COMPLETED ON: / ESOL: LEVEL 5 EXIT DATE 06/11/97 MOST RECENT PSYCHOLOGICAL CASE OPEN: SCHS REFERRALS: STANDARD DIPLOMA: TOTAL ABSENCES: 4 TOTAL TARDIES: 15 TOT DAYS SUSPEN: INDOOR: 0 OUTDOOR: 0 TOTAL ABS PREVIOUS YEAR: 7 PARENT/GUARDIAN: LAST NAME FIRST NAME REL DIPLOYMERT PHONE PRIMARY HOME LANGUAGE SPANISH TESTING INFORMATION: COUNTYWIDE TEST SCORES TEST DATE: 03/96 TEST GRADE: 02 TEST DATE: 03/91 TEST GRADE: 01 STANINE PERCENTILE READING 5 48 READING MATH COMP 7 77 MATH COMP MATH APPL MATH APPL SAT TEST SCORES STANINE PERCENTILE ACT TEST SCORES HIGH SCHOOL COMPETENCY TEST SCORE SCORE COMMUNICATION SKILLS/SCORE VERBAL EtQLISH MATHEMATICS SKILLS/SCORE MATH MATH TSNE READING SCHOLASTIC READING INVENTORY SCIENCE REASONING DATE: 1997-98/MAY 1998-99/SEPT LEVEL: SCORE: REPORTING CYCLE: 981 CURREN? SCHOOL: IN CURRENT GRADE: 03 SCHL TRH COURSE TITLE SP EP RON 1 2 3 4 FGEC163 SCHL TRH COURSE TITLE S? EP ROOK 1 2 3 4 FGEC AB 5101 A LANG EaS 0051 5101 A READING 0051 5101 A MATH TIC 0051 5101 A SCIENCE 0051 5101 A SOC STUDY 0051 5101 A ART 51 5101 A MUSIC 51 5101 A PHYS ED 51 5101 A SPANISH-S 0051 DENOTES INACTIVE COURSE 2CEPTIOHAL CW2:5 EOGRAM: PRIMARY EXCETIONALITY: ?ARENT'S SIGUA12: i DENOTES BELOW GRADE LEVEL IE? DATE: DATE EVALUATION DATE: 600 y EFTA01710271 /ADE COUNTY PUBLIC SCHOOLS OFFICE OT EXCEITIONAL STUDENT EDUCATION ALTERNATIVE STRATEGIES AND FOLLOW-UP FORM (1$j etv Olvitsuit Date and Ty e• of Conferences: 07 ( )( CST Chairperson: !roblem Area (Objective, Specific and Quantifiable): SA—0. ,A) I r, on *cksV-• Replacement Behavio Lom s\-oot e\--as1C. Alternative(s) to be tried at Grade/School Level (Plan) (Please note: Thcsc alternatives may be helpful with other students in the daze as awn). Sena-- tA; I.\ A-- near -ti-e +-eacker SALkienVuA;t1 have Limr!Cctsg‘agect wt; Men nn -n-e eat readel 0viCs ea;Ative rein-eiften--4244 4- Skuclor\- worts isdim cc peer SAQC\ - CR, \S gi,Jen e Ara cline Person(s) onsible FOLLOW-UP QUESTION: IACLS '1e-primed aft A...1 on Ao-s Y-- Problem Area (Objective, Specific and Quantifiable): ao r ,—,to \ e c, en Ass; 0 n nneri4S Replacement Behavio `‘‘ Conp\C \-e, o. Ss leni—cfrks Alternative(s) to be tried at Grade/School Level (Plan) (Please note: These alternatives may be helpful with other students in the class as well). I. 9 1-)C.Ve)r - if -t.5 a\ ,S*TtiCAO red hOne L.trt Ck61+ Date of Initiation q I I [ CO -+' Person(s) Responsible 2. Te ac k ej-, _to if v,z, ns a s_s ‘ 43 ,-,..e,,A, .4„, key I nA,,,, (Lemlly to t i i ci 3 1 SALACAA- ,,D, A La; A-1,Th & ()eer tot, 148 4. D kbe D a4C S fot- _0.3‘.6tru--,04.4 of-C ea.s-kca v-, 4-1-,& (-Dorn cilia ke 5. .S. \--t-Ci eA+ \mos acteifra+e ft, ,, A-O CO n3o\ tk a331 fi nano nA-.S cil ia lie FOLLOW-UP QUESTION: t S n-feWeCt on • Cont 1E-Lin ass )ore.44. • Type of Conferences: CST, LEP, ESE, sod 50.4 (Over) Child Study Team Procedures FM-$1}v (Ill.-941 23 EFTA01710272 Student's Name: FOLLOW-UP DATES 1 School ID# FOLLOW-UP OUTCOMES AND COMMENTS (Schedule next follow-up in• (Note ate es: Alternatives, Date or initiation or Person(s) Rap Ohl i IS) 1'415 rie# in-graved on .5 t +ay Pisa k, has ricDV (no ra veal on CtSS N4jnr-•faitS COnyoie / " ir ..) et /tut t I ceN ( it: ,.c t.( j. ,tt • reit, .7.1 5c. (-OP- • ta r ( — ',.. • • ' Date Eualpati•a Assistance Requested: i le q& n Alfter alternatives arc found to be ineffective orobvious handicapping condition is present 24 1 _ I:M-5239 (116.91) Child Study Team Procedures EFTA01710273 DADE JUNTY PUBLIC SCHOOLS IOOL NO. C STUDENT CASE MANAGEMENT REFERRAL FORM s cm # 01 DENT JAME ERRED BY i RATIVE: (C e4ucAer4 Mo. Day Yr. TIME NO NO NO NO NO STUDENT ID REFERRED HOME GRADE PERIOD INCIDENT ROOM .3D3 LEVEL OF DAY DATE 2. 10 PARENT CONTACT: (Circle Yes or No) 1. For This Behavior YES 2. For Other Misbehavior YES 3. Contact Attempted ta 4. Contact Made: k 4 Verbal 48. Written (2' rmitinwn TO 'Plan UDENT IS BEING REFERRED) Per QDr yy \ance 'Read Ins 0r13 \\A aA-In TER REASON FOR REFERRAL CODES BELOW: RER NO MORE THAN 4 CODES) OTHER INCIDENT INFO = LOCATION: /TER REFERRAL ACTION INFORMATION BELOW: DATE o. Day Yr. TIME (Military) te EMPLOYEE NO. CONTEXT: INITIALS MIME MOO MUNI In'.. COMPUTER RECORDED REFERRAL ACTION CODE R_ ENTER STUDENT SERVICE INgOViMATION r ATF. Mj. Dm; / iJ I I I TIME (tiblitisy) J- CP4,.,41,11 RAY. 105.951 EFTA01710274 AE COUNTY rInst.tC sainot.S OFFICE. OF EXCEPTIONAL STUDENT EDUCATION ALTERNATIVE STRATEGIES AND FOLLOW-UP FORM es 7 eerg,4) (0).. fic i Name: Date and Type of Conferences: (;) 3 ) ( ) ( ) ( Grade: DOI CST Chairperson: *Went (D. A' objem Area (Objective, Specific and Qumitifiabler . Replacement Behavior: Alternativefs) to be tried at Grade/School Level (Plan) (Please note: These alternatives may be helpful wilt outlet students in the elms as welly I. Date of Initiation Person(s) Responsible , 2. -CC.% I ' LCXl . . . vs — - • 5. FOLLOW-UP QUESTION: • Problem Areat(O2tive Spec* a Quantifiable): _.- i i re t t" Ce eg OC cz--te__- _ pt...-Ole $ 'Cc Replacement B5havior: /7zeic 4.54,--tcepr AI 4"4-Ayeaci Allernative(s) to be ttied at Grade/School Level (Plan) (Please note: These alternatives may be belga' with other students )'p the iilassAewell). I. Mite 744.4•1 /764.--• letron4-- kl:1 as t -ea& al/ Date of Initiation 70_7 _ 6/ r Person(s) Responsible Jena.dote/ 2. am „mi. ,n4A4-eir kviA erne - rgv-)-( adtf,69 a( . Ir-eat4 sAcegi4-74 79 6(4-eI i na?" 74 /9-/ - (if /Pack." 4. Chat - AterMC' dastit - "I 5. ari/Zettm,a-L-7Ctii-e-et ., 0-/-91 Xeici, oae,/ p ,....e Fou_ow.uf2turzTA 4A4_, ei win A...eetaeme-t , • Type of Conferences: CST. LEP. ESE, and 504 fluid Study Team Procedures &Oa, '2W-t oadi rat° 4/;71,11-enkenne/a - /Q/ 3 /97 Myer/ FM-5239 «i/.Vs) 23 EFTA01710275 ,..77A.:FmtN7 DADE COCNTY PCBLIC SCHOOLS Oral Language Proficiency Scale Interview with Guidelines SCORING SHEET SCUOOL SS0L LEVEL EXAMIN RAW SCCRE :,?at:- S---ENT's RES PONSES I S Lt C 2 3 S I S I it b 1 C 1,11 ? O T 0 !R X R 0 P 0 A M R C la la T 0 . 7 1.4 I C t R A l t N t R : A S Y • 1: i I 0 EFTA01710276 :a '1 12 13a b e d l • C 4 a t i k N / 4 14 1S 16 17 1$ 194 b e 20a b C d • Subtotal Individual Lanquaq• Skill IDOL L•v•1 RAW SCORES ESOL LEVEL 04 - OS 06 - oa 10 - 13 14 - 17 16 - 20 !Sot ISM RAN SO713 EFTA01710277 77AC7`4FNT D /UDE COUNTY PUBLIC SCHOOLS Oral Language Proficiency Scale Interview with Guidelines ScOFtLNG SHEET S:'-=ENT' S EXAMINER SCHOOL RESPONSES .1,AL'E K.. RAW SCORE ESOL LEVEL Q cr S I O N 3 4 I s I ' 7 C O X R N I O a b C d I • I . EFTA01710278 rbr RAW SCORES 04 OS 04 - 0, la 14 - 17 I4 - 20 MThtota 1 Individual La nguag, Ski 11 ISOL Laval Ego; LiVIL !SOL LIVIL RAN 3COu 1 4 EFTA01710279 D&DE COUNTY PUBLIC SCHOOLS Oral Language Proficiency Scale Interview with Guidelines SCORLNG SHEET G I j; - - --, 5A (- 021/4.L1- ;')(1 t. 1/4. 7 $ I a I . b i C I a I e 1, 1 r O. t'i i) r I - f,4/1 CA KO I-Or c i i be 36- EFTA01710280 DADE COUNTTPUBLIC SCHOOL FULL SERVICE SCHOOLS MR. ROGER C. CUEVAS SUPERINTENDENT OF SCHOOLS MR. JOSEPH H. MATHOS CEPUTY SUPERINTENDENT DR. FRED C. RODGERS DISTRICT DIRECTOR Dear Parent(s): • 1500 BISCAYNE BOULEVARD, SUITE 128 • MIAMI, FLORIDA 33132 HEARING SCREENING REFERRAL LETTER DADE COUNTY SCHOOL BO DR. SOLOMON C. STINSON, C MR. DEMETRIO PEREZ, JR.. VICE.0 MR. G. HOLMES BRADS MR. RENTER DIAZ DE LA PORT MS. BETSY H. KAI OR. MICHAEL M. I MS. MANTY SABATES M' MS. TABARES-HANT MS. FREDERICA S. Wit The hearing scree School indical that your child, in need of further evaluation. This does r necessarily mean th t your c ild has a anng pro em, ut It does mean that he/she should have an examinati by an ear specialist. Hearing disorders can often be corrected, or at least be prevented from progressii Therefore, we urge you to give this your immediate attention. If you do not have an ear specialist, your child may be examined at the ENT Conservation of Fleecing Clinic Jackson Memorial Hospital. Should you choose to have your child examined at the clinic, you must complete I attached postage paid card and mail it. You will then be contacted for an appointment. All of the appointments on Wednesday, and there is a minimum charge of $75. If you have any questions, or need additional information, please contact the Speech-Language Pathologist at y( child's school. Pl EASE HAVE YOUR DOCTOR COMPLETE THE INFORMATION BELOW, AND. RETURN THIS FORM TO TH SPEECH-LANGUAGE PATHOLOGIST AT YOUR CHILD'S SCHOOL. Dear Doctor: LEFT RIGHT Comments: 500 Hz 500 • Hz 1000 Hz 1000 Hz 2000 Hz 2000 Hz 4000 Hz 4000 Hz Please note your findings and recommendations: Signature of Ear Specialist Date FM-4196 Rev. 108 EFTA01710281 ESCUELA PUBLICAS DEL CONDADO DE DADE OFICINA DE EDUCACION DE ESTUDIANTES EXCEPCIONALES ~din de tindilded• DOC TYPE 4960S hoidi 0.490ITY) dimwd diond/boodc:n aV Eitud•d. _7.4 NOTIFICACION INFORMATIVA DE LA ELEGIBILIDAD PARA PROGRAMAS DE EDUCACIOM nr-reli"A'uTt^ EXCEPCIONALES AL LOS PADRES O EL GUARDIAN DE El Convite de Elegibilidad para la Educación de Estudiantes Excepcionales (ESE) se reunió el 7% 3/ff y reviso los resultados del rendimiento de u hipl I lo si i tes i strum tos de evaluad 'n y los reportes de laevaluacion. I SC PYT (JO Basado en la información previa y después de revisar las opciones y servicios ofrecidos en el programa ESE, el Comité de Elegibilidad determinó que su hijo (a): no satisface el criterio de elegibilidad para el programa ESE. CI si satisface el criterio de elegibilidad del (de los) siguiente (S) Programals) especial(es): Las demas opciones fueron recharadas porque su hijo (a) si satisface el criterio de un programa de ESE. no satisface el criterio de elegibilidad de un programa de ESE. Si otros factores que pudieron ser pertinentes en la determinación de este comité, se relacionaban con: resultados de una audiencia administrativa ti revisión de los resultados disciplinarios U determinaciones previas de elegibilidad O datos de una agencia comunitaria U Otro (D'Indique con una IV) si el estudiante fue encontrado elegible para ubicación en un programa de estudiantes excepcionales atreves de procedimientos de Asignación Temporal para Estudantes Excepcionales, transferidos a este condado. (Vombrelfiducsonl !No mbee/Poicion I Si usted tiene alguna pregunta relacionada con esta decisión o con sus derechos, como estan especificados en las Protecciones de los . Procedimientos Disponibles a los P s a esta noti ntacto con: (Nonti 878-1125 Copia Blanca : Director, despues Archivo Cumulativo Copia Amarilla: Padres FM-49808 (09-951 EFTA01710282 DADE COUNTY PUBLIC SCHOOLS GARANTIAS PROCESALES A LA DISPOSICION DE LOS PADRES DE LOS ESTUDIANTES EXCEPCIONALES . NOTICIA Coma padres. Ustedes tienen derecho a: • Cure ee les n'ebeje. en un lapso de tiempo razonable antes de que l• escuela' la/ identifique. evalúe o *digno • su Mota) • vn program de educación pera estudiantes excepcionales; MI cambie una identificación. °n'yacen c signan& que ya se hoye regirse° o (cl rehuse su petición pase que se tomar dichas medidas • rectir por inatto loe inewoir pertinentes en el lenguaje que hablen y Comprenden mejor. Si hey padres cuyo modo primario de corremicaca6n nc es el lenguaje eterno. los funcionarios escolares deberán peeigurared de que: (al st les ~lema el aviso verbMmente o en une forme de cumurececión pub elloe puedan comprender, lb) que comprenden la información que es lee ha proporcionado que se •videncle por escrito que este requinto ha sido cumplido. • que se les notifique en cuento e cada uno de los procedimientos de evaluación, pilabas, expedientes o informes que la escuela Utolv•fla corno base pera tomar cualquier decisión sobre su hijo(*) • una descripción de cualquier opción en cuanto a programes que hayan " o considerados por la escuela y del porqué dichas opciones fueron descartadas • se les informe de cualquiera otros factores apropiado* que loe funcionarios escolares consideraron para tomar su dilución de recomendar o (echase,. • une notificación que incluya una explicación completa de todas las garantir.s procesales a la disposición de los padres según estipula le Ley de Educación de Individuos Disahabildedes. EL CONSENTIMIENTO Es (donan° que ustedes den su consentimiento por escoto antes de que la escuela pueda • someter individualmente a su N'ola) pruebes a las que generalment no se somete a le ntayorfa de los otro. estudiantes antes de que se e asigne al programe de educación para estudiantes excepcionales • asignar • su (estola) a un programa de educación exceponnal por pnmera vez. Antes de que ustedes den su consentimiento la escuela debe explicarles lo que han aprobado en al idioma u otro modo de comunicación que ustedes utilizan generalment y deben asegurarse de que han comprendido. El formulan d lineal d be descnbir lo que ustedes han aprobado. detallar cuates de los expedientes de su N'oral *oren —*rodee • e01100e. y especificar quienes los recibirán. Si ustedes no dan su consentimiento, su negativa no afectará • los derechos básicos da su Sola) en cuanto • asistir a cines y participar en- los actividades escolares. ' • • • • Si usted retiene o rehusa dar su consentimiento para la evaluación o le asignación, las agendas pueden utilizar procedimientos informales patri obtener consentimiento escrito. Si los procedimiento, informales no resultan en el conerentirmento y pueden pedir una audiencia imparcial pare resolver la manido. Si la orden del oficial de le auckncia ea • favor ck la escuela, la escuela puede actuar ein el consentimiento. Usted puede moler la decisión del oficial de audiencia Usted debe dai su consentimiento libremente. y en cualquier niornento puede retirarlo pero el Colegio puede pedir uno reunión para ~mar su retiro del consentimiento y las necesidades educacionales de su herblal. Si la Cuestión no se puede resolver por medios infoimales, una audiencia imparcial se puede resolver LAS EVALUACIONES EDUCACIONALES INDEPENOIENTES Si no están de acuerdo con la evaluación proporcionada por te escuela •-• o sea, si no piensan que se han *l'herido las pruebas adecuadas o que se he Negado e la conduelan correcta -- ustedes tienen derecho • solicitar una evaluación educacional independiente costeada por fondos públicos Une "evaluación educacional independiente" significa que las pruebes de su beata' las realizará une persona caMicisda que no sea empleado« da le junta escolar del distrito. El tilittrtte pegará l• evaluación privada o Ami los arreglos pennentes pare proporcionarte una fin costo alguno pare sartedee. Sin embargo, el distrito también tiene derecho e una audiencia pera demostrai que su °veludo:6n es adecuada. SI al oficial a cargo de le me:beocio dee2e Ti. 5 escinde •s adecuada, iarT tendrán al deriati ieVididiCall- lbeluCeCi0044 .inñappeen pero no cateada poi fondos_puMmen. 'Cateada per fondo* publica' significa que el distrito escolar o pega el coro total de la evaluación o garantiza que le evaluación se lleve • cabo ion costo alguno para los padres El detrito deben informarles donde se pueden obtener les evatuciones educacionales independientes, si ustedes ad lo solicitan. Si procuran una evaluación educacional pagada por ustedes los resultados de dicha evaluación- • deben ser tornados en consideración poi el distrito el tomar cualquier decisión concerniente a la educación de so heolal • deben ser presentados como evidencia en la audiencia formal (véase la sección sobre 'La Audiencias"). Si el oficial a cargo de la audiencia soleas una evaluación educacional independiente corno parte del "proceso legal debido'. dicha evaluación deberá ser costeada por fondos públicos Las evaluaciones educacionales independientes deberán ajustarle • las mismas normas len cuanto • las crilificsaones del •xeminisdor) que les realizadas por la escuela. LOS EXPEDIENTES Usted tiene el derecho de • recibir, cuando oil lo soliciten, una lista de los tipos de expedientes educacionales que se mantienen sobre h 01 1 donde se archivan, y de como pueden lograr acceso a los mismos • inspeccionar y vindicar cualquiera de los expedientes de su hpoIal. La escuela deberá responder • su solicitud al respecto. • sin demoras innecesarias • entes de una reunión o audiencia sobré el Plan Educacional Individual IIEP) anal fórmelo de 45 ollas. La escuela no podrá cobrar por procurar o recopilar la información • • ' Usted tiene derecho a. • que alguien en le escuela de su hii0M) lea esplique o les interprete cualquier detalle que conste en el expediente de *u Nota) • rscitir copies del expediente si ese es el único modo de garantizar que puedan recitarlo e inspeccionarte le escuela podrá cobiaries por las copies, si el hacerlo no les impide inspeccionado o revisarlo. • que una persona los represente, Inspeccione y revise el expediente La escuela tiene la responsabilidad de proteger e! carácter confidencial de los expedienteo educacionales de su /mol& del siguiente modo • permitiéndole* vos solamente lo información relacionad', con su Renta) cuando los expedientes contienen información relacionada con mas de unid] ~letal • mantener un registro dele; personas que obtienen acceso el expediente educacional (excepto • los padres del menee y • hm empleado* Con autorización de las agencias participantes) incluyendo el nombre, la fecha de acceso y al propósito. Le escuela debe prestan,' que ustedes tienen sialcirlded para inspeccionar Y revisar for emelqntes de su Micra] Manos quia se lea baya mamado que no time deseche debido. pot ejemplo, • d'e...cree legelea coma le paz pctested letztonciad que. según reir km,. /e• padre* tienen sobre tus hijos menores de edad' La audiencia no necesandiriente sigue al proceso descrito en la sección titulada 'tes Audiencias' de esta explicación de demohos. La audiencia puede ser conducida poi cualquier oficial del detrito que no tonga intereses directos en el resultado de la misma Si le derriben tonudo en le audiencia les favorece. los funcionarios escolares deben cambiar le información • intOrtnarle del cambio Si se encuentra que le inlonnación de le escuela es <bada y se toma la decisión de no cambiar le información. ustedes tienen el derecho da añadir su propia declaración al expediente Su declaración debe ser mantenida en el expediente todo el trompo que la pene en cuestión se mantenga en el expediente general. Su decir/mida deben ser incluida s. se muestra e alguien dicho expediente LAS AUDIENCIAS Si en cualquier momento no pueden llegar a un acuerdo con la escuela en cuanto a le educación de su Njo(a), tienen el derecho de solicitar una audiencia imparcial Se podrá celebrar una audiencia aobre cualquier asunto relacionado con la identificación, evaluación o asignación de su tejerla) y el aseguramiento de una "educación pública adecuada gratis'. La audiencia deberá ser conducida por una agencia educacional estatal en concordancia con los estatutos del estado y los reglamentos de la Junte Escolar Para lograr una audiencia, deben presentar una solicitud escrita al Clerk of the School Board ISecretanolal de la Junta Escolar), Dada County Public Schoot; (Escuelas Pütikcist del Condado de Dadel. 1450 N E Second Avenue, Miami, Ronda 33132. LOS OFICIALES DE AUDIENCIAS Se asignará a un oficial de audiencias imparcial para que presida dichas audiencias y eme que tome una decisión len cuanto si caso) Para garantizar la impercialided, al oficial de audiencias no debe ser. a empleado de ama nena., pública &reme escotar, institución. etc 1 que participe en la educación o cuidado de su • cualquiera que tenga un interés personal e profesional Que pudiere estar en conflicto con la °Convidad de la audiencia Une persone que de otro modo retina fas calificaciones para conducir una 'audiencia en Concordancia con las directrices previamente consignadas no será considerada empleada de la agencie simplemente porque la agencia le paga POr actuar como ohcial de audiencias Cada una de las actor rice deben mantener una lista de les personas que sirven como oficiales de audiencias, y sus calificaciones LOS DERECHOS RELACIONADOS CON LAS AUDIENCIAS Loe derechos que. tanto ustedes corno el distrito, tienen, incluyen el derecho de. • sets, Komp••••40 y •••••••do per el *tordo Y Pon ~ambas con be, coreCseminlo repare' W es probiema• de bs erba mirribrab004 • prii•enta. evidentes. inlarropm y tercer • in tangos • que anoten e le *Sane. • preht.• le grikentecen da cadencias ea no hayan arde da rdeedrir • isitielia• e id dismto • "f ree como ti,ss Imite de la audieMia. • teCitior, ecu incito o en pescan. w 'aireen literal Matad poi cintra) de la • recibir Une relación por escoto da las initpanonst y de las ~senas tomad.. sn re •derse. Ustedes ternbin terrecer ~Pene de - • as la amuela e el date lee Mimen donde se rueda menee atinaras Ispd lintre • necee batos. La secsine e el aneto debe onspercemile eer. insernmedn en «saque momento •• que la sol c • e curdo ea baya • esebrar sine asdenca • que su honi asiste • re admita, a asile deba. • qua le ~enea se leve • cabo din 5.-4 raen • lugar que les asan nuonittdement fe ue taps de 45 des • Pan. dol recree de su *04404 de *.reno* en W ~lamen debei4 llapa, • une bocee* delatora y enviarl•il • cepa de ie mema por corre*. ti &cal de audiencia podrá otorgar Un* Preireni de seis museo de ir encauf ee cusiennir de In das ~tes la monde ee eche Mesa de ~nos •••• domine • menos pus tensen e el dimde deciden Pele. E: n.o-ni, pudor. atarear, reme arte da les gestee iariannes, ei ato de honorares rredbo• de .atea • b• mar•• o tutoras da urda! ansia, mineviiiderel 0.• haya gamas si pinto APELACIONES Si su buchete II. Pavada • cebo por al estado mgao ~armar', b• ...ramos minen y urdathe re talán satisfechos con la decisión. pueden ese T muna 4e ~ea del Dirimo y/o osen interne w acodn aalces( Civa en los tribunales ;*;teles e barril**. Derrota al lempo en el que •• desarrolle L• audiencia y se lleve • cabo el proceso de apelación. su he01•1 piemnsniecná ' en su asignación educacional aterró. Sita que Intede• e et distrito muerden ie centrare. 5. le diana se ~ene con el normo ami su bel*, • Lana amura pera. entonces. con su consentimiento. se ie maznará en un Inquina d. las momea Miela. hasta qua es teme. si orases,. LOSIASI PADRES/MADRES SUSTITUTOS(ASI Cada una de las escuelas debe garantizar que los derechos de los niños sean protegidos cuando: • no se pueda identificar • los padres • 'no se conozca el paradero de uno de los padres. • cuando el niño está bajo la tutela del estado. Es el deber del distnto escolar el nombrar • unta) representante o • unlal Padre/madre sustituto(a) o procurar que se nombre. Su distrito escolar deberá tener un método para deternenar si 011a) niñeta) necesita unlal Padrelmsdre sustitutolal y un método para asignar a dichos pailrearmsdres sustitutoslas) la escuela deberá seleccionar a unid/ sustauto(el en cualquiera de los modos permitidos por las leyes °Mieles. pero deben ~guiarse de que la persona seleccionada. • no tenga un conflicto de n'ateces • esté calificadolal pare representar ella IN ninolal • no sea empleadola) de une agencia pública involucrada en la educación o el tuededo dellde tal niñolit) Iflo *e debe considerar conto empkadola) a una persone solarnente porque sirve como sualdutola).1 Fiad) cuetituto(e) podrá representar ella la) rigola! en asuntos relacionados con la identificación, Id evaluación. la asignación y la provisión de una educación pública adecuada gratuita EFTA01710283 TYPE 5522S DADE COUNTY PUBLIC SCHOOLS OFFICF OF EXCFPTIONAL STUOENT EDUCATION DATE (EALVDD/YY) I Pn/DT LTUOCNT NOTIFICACION DE REUNI N (NOTIFICATION OF MEETING) STUODIT D.NO. L1 personal dc la acuda debe usar esta planilla para infamar • In< padres de la reunión del Fio;po Profesion A LOS PADRES O TUTORES DE Les informamos de una reunión relacionada coa c Tfi —~w23 (Fecha) Se invitaron a asistir a las siguientes personas: -- .1, 'he la *ion Cle•hs (Si cs necesario, favor de adjuntar otra hoja.) (NOMBRE/PUESTO) (NOMBRE/PUESTO) Ps cit.0-€0 kta- Marque con una palomita ( 1 ) todos los cuadritos necesarios pan indicar el propósito de esta planilla. D revisar cl progreso de conducta y/o el académico de su hijo. O considerar revisiones a las estrategias previamente desarrolladas para ayudar a su hijo. 7 1 --3/4discutir los resultados de la evaluación y considerar la calificación para cl Programa de Educación para Estudiantes Excepcionales. NOTA: 1. Si se determina que su hijo califica para el Program de Educación para Estudiantes Excepcionales, se desarrollan un Plan Educativo Individualizado (IEP), y los Procedimientos para Padres de Estudiantes Excepcionales se revisará y una copia se le proporcionará. A su hijo se le extendeta una invitación a dicha reunión siempre y cuando tenga 16 años de edad y este ubicado en el octavo grado. 2. Si se determina que su hijo no es elegible para el Program de Educacion pan Estudiantes Excepcionales, se considerará si es elegible bajo la Swelon SO4, y se le informará a usted de los Procedimientos Debidos que le corresponden bajo dicha sección. O otro: ES DE SUMA IMPORTANCIA QUE UD. ASISTA A LA REUNIÓN. Si no ;cede asistir a la reunión en la fecha indicada, tiene la opción de cambiar dicha fecha. Al terminar de llenar la sección de los padrea Iver la copia rosada a: (Pasma ale muno rrcmawr Favor de retener la copia amarilla para sus archivos. ESTA SECCIÓN ES PARA LOS PADRES O TUTORES INSTRUCCIONES: Favor dc indicar ceo una palomita ( 1 ) los cuadritos apropiados. firme* y escriba la facha en el espacio. O Participaré en la reunión señalada. O Necesitaré los servicios de un intérprete o traductor. Especifique el bloom o método de comunicación: N Yo deseo fijar la reunión para otra fecha. Por favor póngase en contacto conmigo llamando al teléfono o Necesito cambiar la fecha de la reunión. No obstante, si se determina que mi hijo es elegible para el Programa de Educación para Estudiantes Excepcionales, por favor pónganse en contacto conmigo al teléfono para señalar una reunión del EE. • Firma del padre o tutor Fecha india copy: Pi* CaVY: Yelkiw Copy: 878-2717 Cumulativa Record Cautive Record (Mach se 'Ad< copy if parcattauudiati rebana vid. a sigan:un) Parem FM-6522S (10-96) EFTA01710284 MIAMI-DADE COUNTY PUBLIC SCHOOLS DIVISION OF STUDENT SERVICES CASE MULTI-DISCIPLINARY TEAM REPORT Initial Evaluation STUDENT'S NAME SEX: female DATE OF BIRTH: ADDRESS: STUDENT ID NUMBER: PARENT/GUARDIAN: SCHOOL: GRADE: 3rd ETHNIC ORIGIN: H HOME PHONE: DATE OF CURRENT EVALUATION: 5-26-99 ASSESSMENT AREAS ADAPTIVE BEHAVIOR/SOCIAL HISTORY PSYCHO-EDUCATIONAL VISION HEARING SPEECH/LANGUAGE OBSERVATIONS REFERRAL INFORMATION REFERRAL FORM/STRATEGIES ATTACHMENTS EXAMINER- DATE COMPLETED 11-24-98 5-26-99 11-23-98 6-4-99 2-9-99 2-9-99 12-3-98 11-2-98 CST 11-6-98 PERMISSION TO CONDUCT AN EVALUATION 11-6-98 EFTA01710285 Miami-Dade County Public Schools - Division of Student Services PSYCHOLOGICAL EVALUATION DATA SUMMARY Student's Name: C.A.: 8-11 Schoo INTELLECTUAL: Elementary Case #.al Grade: 3rd Language Assessed in: English Wechsler Intelligence Scale for Children-Third Edition (VVISC-Ill) Mean = 100; Standard Deviation = 15 Scale Scores: Mean = 10; Standard Deviation =3 Verbal IQ: Performance IQ: Full Scale 10: Verbal Comprehension: Perceptual Organization: Freedom from Distractibility: Processing Speed: Verbal Subtests Information: Similarities: Arithmetic: Vocabulary: Comprehension: (Digit Span): Performance Subtests Picture Completion: Coding: Picture Arrangement: Block Design: Object Assembly: (Symbol Search): ACADEMIC: Kaufman Test of Educational Achievement (2-9-99) Subtest Mathematics Applications Reading Decoding Spelling Reading Comprehension Mathematics Computation PROCESS: Peabody Picture Vocabulary Test-Ill SS: 75 AE: 6-1 Expressive Vocabulary Test SS: 86 PERSONALITY: Anecdotal Records Behavior Assessment System for Children House-Tree-Person (HTP) Kinetic Family Drawing (KFD) Post Drawing Interrogation EFTA01710286 1 CASE #11M Psychological Evaluation REASON FOR EVALUATION REQUEST was demonstrating behavioral problems in the classroom. Her teacher requested this psychoeducational evaluation for in order to determine any intellectual, processing, academic, and/or emotional factors that could be interfering with her progress. SOCIO-DEVELOPMENTAL HISTORY A Socio-developmental history was obtained on November 24, 1998. For more detailed information please see attached report compiled by BACKGROUND INFORMATION EFTA01710287 CASE PSYCHOEDUCATIONAL EVALUATION TESTS ADMINISTERED Weschler Intelligence Scale for Children-Third Edition Bender Visual Motor Gestalt Test House-Tree-Person Technique Kinetic Family Drawing EFTA01710288 3 CASE EIM Anecdotal Records Incomplete Sentence Behavior Assessment System for Children BEHAVIORAL OBSERVATIONS TEST INTERPRETATIONS t Intellectual EFTA01710289 4 CAS' EFTA01710290 5 CASE a EFTA01710291 6 CASE #: ) PSYCHOLOGICAL EVALUATION BY: Licensed School Psychologist Region Ill EFTA01710292 MIAMI-DADE COUNTY PUBLIC SCHOOLS DIVISION OF EXCEPTIONAL STUDENT EDUCATION BILINGUAL/ESOL ESE PROGRAM LANGUAGE PROFICIENCY/DOMINANCE ASSESSMENT REPORT. STUDENT: CHRONOLOGICAL AGE: 8-8 STUDENT SCHOOL: GRADE: 3rd DATE OF LANGUAGE PROFICIENCY/DOMINANCE ASSESSMENT INSTRUMENTS ADMINISTERED: oOral Language Proficiency Scale-Elementary Level (OLPS) °Narrative Development Assessment oBrigance Diagnostic Assessment of Basic Skills-Spanish Edition °Kaufman Test of Educational Achievement-Comprehensive Form REASON FOR REFERRAL: BACKGROUND INFORMATION: BEHAVIORAL OBSERVATIONS: EFTA01710293 TESTS RESULTS: Analysis of=erformance profile reflected the following findings: INSTRUCTIONAL/LANGUAGE DOMINANCE ASSESSMENT INTERPRETATION: Social Language EFTA01710294 ivision oExceptional Student Education EFTA01710295 fiLe 4witeAdv Alas--€ A A P bi; tc, Developmental History A.17; Name File Name Interviewed Prepared for : Region III Completed by Sex Age : Female : 11/24/98 Date of Report : 12/02/98 Presenting Problem Personal Information and Family Background Early Developmental History EFTA01710296 PAGE 2 Educational History Medical History and Health Status an an EFTA01710297 PAGE 3 Family History Current Behavior and Relationships EFTA01710298 PAGE 4 EFTA01710299 Dade County Public Schools INDIVIDUAL LEP STUDENT PLAN ARY Name I.D. Number (Last First) (Middle) Date of Birth lace of Birth itt tut Studerittanguage Parent/Guardian Language Minimum Instructional Time Requirements 7 --ESOL Level I 2 hrs. daily ESOL Levels II - IV 1 hr. daily CCHL Levels I/II CCE/ESOL Levels 111/IV 45 rain. daily as appropriate Home Language Arts Levels I - IV 150 min. weekly rn Entry Date DCPS ///07/97 School Year 9J-i9 9,6 9‘_19 -19 tH 14-1991 Initial Placement Information: Entry Date 0 7- fir •AurallOral Assessment Date /1— 07 — 9cr DCOLPS Score •Reading/VVriting (Grades 4-5/6) Stanford Achievement Test Reading Subtest %ile Writing Subtest %ile ESOL Level Metropolitan Achievement Test Reading Subtest %ile Writing Subtest %ile ESQL.Zeacher(s) Recommendation fr"- Continue Exit ESOL Teacher(s) Continue 6 / 7 R endation ✓• Exit ESOL Teacher(s) Recommendation Continue Exit Date Teacher's Signature 7 School Date 67 q/6 Date EM-4649 Rev. (09-941 ri^14-,14', Kr. .1 tak<i EFTA01710300 unci upoate Date Grade 7—o7- 41- I Ilevel oc Instrument f'S en_ (5 at' Program Participation (Completed at entry into program and updated yearly or upon transferring) Basic ESOL I99rI99k ESOL ai na Materials Grade K I4:1932 Grade I EVIL Instructipl Materials n VP% 0.14 ' ii:S4 Vida DI CV 19 -I9 ESOL Instructional Materials Book Level Grade 19 -I9 ESOL Instructional Materials Book Level Grade Alternative/Home Language Arts (i.e., Spanish-S and Haitian-Creole) I 9SCI 94 Grade // car HLA Inst ctional Matekts _, , , 629— anbe2,47, /asap Book el /g t9gh -1952 Grade / st: HLA Instructi7I Materials/ . O,t d 1 ait-/-; //aim: Book Level *cid 4 n /// -yr ^ i lb -19 iti fl az griovpiateii/ls s 1 Cti Boo Level Grade A ItaclUY Grade ' ' Igistrua A. ortal wrists C2-0-C-read.4-51....ren.4 ;-. Bor . y .1-4-0271, r Basic Subject Areas Identify with an X the strategies used for program.delivery: Home Language Strategies (CCHL) or ESOL S rategies (CCE/ESOL) Basic Subjects Grads/ 19 96 19 /7 Grade: 19 - 19_ Grade: 19 - 19_ CCHL CCE/ ESOL CCHL CC& CCHL CCE/ ESOL ESOL CCHL CCE/ ESOL Science Mathematics Social Studies Computer Literacy FM-4649 Row. 109.94) EFTA01710301 reriormance Standards* U Level I or HAM! LESS than two years trl an approved program 12: (Not Met* (refer to the attached Student Performance Plan) Intervention required Retained "' Q Met ______ Promoted Teachers Signature Grade g 1.101._ Date LW___1 7 O Level I or II AND LESS than two years in an ' approved program Teacher's Signature CI Not Met* (refer to the attached Student Performance Plan) Intervention required Retained " Grade Q Met'. Date Promoted O Level I or Il AND LESS than two years in art approved program Teacher's Signature 0 Not Met* (refer to the attached Student Performance Plan) Intervention required Retained ** Grade Q Met Promoted Date CI Level I or II AND LESS than two -:ears in an approved program ED Not Met* (refer to the attached Student Performance Plan) Intervention required Retained " Q Met Teacher's Signature Grade Date Promoted EtIrient Performance Plan is to be ompleted for all ESOL Levels IA and IV studer.:s who arc not meeting the established icz performance standards for Language Ans/ Reading/Writing and/or Mathem atics regardless of number of years of arsrn participation. &fttir two full years of program pa cipation. Student Performance Plan is to be cc npleted for all students (including Levels !!) who are not meeting the established district performance standards for 1.1..5uage Ans/ Reading/Writing and/or teased on district-establ Studeitt ferie::-.srtan Standards is only at; :231.t students who have completed . . • . in an ESOL no.anan EFTA01710302 tlit; claw'. v :1,111•Wi... ALTERNATIVE STRATEGIES AND FOLLOW-UP FORM C (fora). cep frt er N sow Date and Type' of Conferences: (a ) ) ( ) ( ) ( Grade: DOII: CST Chairperson: Student II). # ohlem Area (Objective. Specific and Quantifiable) . Replacement Behavior . Alternative(s) to be tried at Grade/School Level (Plan) mai. note: Th ee alternatives say be helpful with nthcr stacienn in the class as well) I Date of Initiation ---.. Person(s) Responsible 2. (.. '' 1 ) cc /1, ( 7 ..)li ti • ' —1:2 — • 3. vs vc ' 4. -I 5. FOLLOW-UP QUESTION: Problem Area (014retive Spec' to a t-v pd Quantifiable): a Replacement Behavior //e " AA& k...4 a„ ,(041 Allernative(s) to be tried at Grade/School Level (Plan) (r/ (Please note: These allernatires may be helpful fl it other stadenuip the deists nil) I.7/044 Alet:V1 /1k-frt.= 141-0 - • is 2. 441,1 4.frt reir 1"O71-vn u 3.7-creac-4 SI'al /5) to-, eraen 4 ccW wv-rda, 4:44,,t) 711-4-t /44 Lt-e-?‘ cfi r / Cle* -etaa Pt-t- a6e 4 r 4 0 , 672; 1 ' 41. Date of Initiation FOLLOW-Ur y mc'e& Pc d Zlettlell'L • Type of Conferences: CST. Ltr, ESE, and SO4 'hill .Guth Trim Procedur c.; bted Lt":-. (Over) 1:44-0A-4, Person(s) Responsible ate& 71e a c ri.b5239 nl ?„.7 /Al 42/3/c/7 EFTA01710303 D(OLPS Score / (Grao'C'S K-5/6) ESOL Level__ ' Stanford Achievement Test (Grades 4-5/6) Metropolitan Achievement Test (Grades 4-5/6) Reading Subtest %Ile Reading Subtest %ile Writing Subtest %Ile Writing Subtest %ile Post Program Review f' amf aQ; af Witigg ere Making appropriate progress/continue in regular program 1 Signa = = = End of First Semester after exiting Exit Date_ 0a/g7 Making appropriate progresstemainue in regular program I1 gigscritsar art w__.as • es& making appropriate Progress/continue in regular program I signs ==== nd f Se03 Making appropriate progresskontinue in regular program I I Signatu = = = Refer to LEP Committee Refer to LEP Committee I Tale ZS Other (specify) Date 1.1- of -9- 7 Other (specify) Da:x.0A OP-: V Refer to LEP Committee I I Date 4 / 9 Refer to LEP Committee I I -rile igeleilf% Other (specify) Date ci FM-4649 R•Y. 109-94) EFTA01710304 Dade County Public Schools LEP COMMITTEE Grade: 62J Date: ii-m- 97 me;rbers: Admin,:strator ESOL Te:cicher •BSHL TeaLher Teacher _1 Counselor Parent Other Recommendations: Continue [ 1 Exit Request for Assistance CST** Reclassified as ESOL Level IV M[ I Grade: Members: Administrator ESOL Teacher •BSHL Teacher Teacher Counselor Parent Other Recommendations: Date; Continue [ 1 Exit I I Request for Assistance CST** Reclassified as ESOL Level IV [ Grade: Date: Members: Administrator ESOL Teacher * BSI IL Tcachcr Teacher Counselor Parent Other Recommendations: Continue [ Exit I Request for Assistance CST** Reclassified as ESOL Level IV [ ) 1BasicSkills in the Home Language **thili Study—Team FM•4649 Rev. I09.' EFTA01710305 Roger C. Cuevas, Superint dent M-DCPS -.Robert L. entornas, Superintendent, Region III .1(ü bie 3fin l'cclia Estimados padres Con el (in de cubrir todas las nensidades linguiticas de sus hijos y acorde con las disposiciones estatales de la Florida. se ha creado un comité escolar Committee). El mismo tiene como objetivo fundamental analizar el desarrollo del aprendizaje del ingles como segunda lengua de los alumnos, y a su vez desatollar planes de estudio y estrategias educacionales en los casos que asno requieran. Cl Comité' de L.L'-.P. se reunida dia b a las len la. oficina de nuestra escuela para analizar el caso de •u hijo/a. Por este medio e bacanos formal invitación a dicha reunion. Ate " Por favor. fume esta carta y devuélvala a la maestra de su hijola si decide asistir. S, No 11111111111111 / 3/ff fecha EFTA01710306 SEMINOLE ELEMENTARY - LEP COMMITTEE Date: 11 — 1 3 - 77. Child's Nam, Dear Mr./Mrs. This is to inform you that we are monitoring your child's academic progress and wish to invite you to participate in a meeting geared towards this progress. Thank you for your cooperation, fRirgiii-enikketet o'n person', ) lea Fecha. Nombre del Estudiante: Estimados Sr./Sra. •••••••• Por este medio, le invitamos a formar parte de un comite con el proposito de estudiar el progreso academico de su hijo/a. Gracias por su cooperacion, Administrador Maestra de ESOL (ESOL.LET) EFTA01710307 FOR REGION USE ONLY: TO: DADE COUNTY PUBLIC SCHOOLS OFFICE OF EXCEPTIONAL STUDENT EDUCATION REQUEST FOR EVALUATION (Documentation of Screening and Prereferral Activities) DATE OPENED: DATE CLOSED: CASE NO.: DOC TYPE 2561 DEMOGRAPHIC INFORMATION PRINT STUD (RIO 71 ADDRESS: SCHOOL: PARENT OR GUARDIA PALI DATE (PAIWDDTYY) STUDENT D. MO. / qS 0 IQ 1-1_ILIN, e GRADE: SEX: Fr - ETHNIC ORIGIN (circle one): W 8 I AC M WORK PHONE: Requir activities for la}11la Study Team meetingls) were conducted. Parents were invited to attend. Student Inventory/Cooperative Consultation Concerns/Information and Alternative Strategies and Follow-Up forms wen completed. (Attached) O Social History attached. (Previous psychological, medical, and/or other evaluative data reviewed, if available.) Two Observation of Student Behaviors forms or two anecdotal records were completed. At least one must be from professional other than the referring source. Anecdotal records are directly related to the reasons for the request and mus• e d over a minimum of two weeks. (Attached) id,......jlen Attendance records were reviewed. (Excessive absenteeism was investigated, if needed.) O Se sorb, functions were screened when required. Request for further sensory evaluation, if needed, has occurred. (Attached) Procedural Safeguards Available to Parents of Exceptional Students have been received and were explained to the parent(s) or g rdian(s) of the student. av y a A Notice of Intent and Parental/Guardian Consent to Conduct on Evaluation form has been reviewed and signed. (Attached) O Teacher Nomination Form, Gifted Programs - Rating Scale is attached, if needed. For limited English proficient students, only: 0 K The CST has reviewed the Individual LEP Student Plan including the ESOL level The Home Language Screening Questionnaire form was completed prior to CST. Section IX of the Observation of Student Behaviors form was complete. (Attached) Bilingual testing: Yes o Language(s; to be use o CST Members: Ongens: cumulative Record 8781516 Copy Region Office a r nea e1/4:2 A zzd ei FM-2561 Rev. (09-95) EFTA01710308 ESCUELAS PUBUCAS DEL CONDADO DE DADE OFICINA DE EDUCACION DE ESTUDIANTES EXCEPCIONALES LØ.cs Istullorrt• En La* OF ~4 DOC TYPE 4961$ FECHA CFAHIADO/YY1 // -97 I i Mime* de LAHHI &salda ar IFFEFEHHE NOTIFICACIÓN DEL PROPOSITO Y CONSENTIMIENTO DE PADRES/GUARDIÁN PARA LLEVAR A CABO UNA EVALUACION A LOS PADRES O EL GUARDIÁN DE Después de una idadosa revisión del expediente ucacional de su hijo(a) de poner en prrategias para ayudar a su hijo(c para repasar I información previa tal como, Observasiones del Aura LJ Anccdotales Exámenes Basados en el Programo Estudios Exámenes hechos por cilla) Maestro(a) K Otro(s): , el Estudio del Nino(a) de la escuela su hijo(a) ha recomendado que se administren exámenes adicionales que contribuyan a conocer las necesidades de su hijo(a determinar la posible necesidad de servicios educacionales especiales. Otros factores pertinentes a este informe, pueden ser: Opciones educacionales que fueron consideradas y rechazadas por ser insuficientes al presente o fueron utilizadas previamente coi hijo(a incluyen: El Prevención de U Control de conducta Cambio en nivel de ensenanca u Remisión a Agencia Comunitaria deserción escolar O Consejería WCambios en metodos de u Tutoría 1:1 Otro(s): ensenanca Con su consentimiento, un grupo de profesionales, incluyendo una evaluación especialista (e.j., sicólogo escolar, patólogo del habla) seleccionara examenes específicos y otros instrumentos de evaluación en las siguientes areas: ❑Asesoramiento del desarollo: La comunicación, la inteligencia, y las destrezas sociales. ¡'Asesoramiento sito educacionales: Destrezas academices, de percepción, de comportamiento, social o de lenguaje. ErrAsesoramiento de la vista: Asesoramiento de la habiridada visual. ie sesoramnto Audiológico: Asesoramiento de la habilidad auditiva Ertksesoramiento de destrezas del habla y lenguaje: Destrezas de comunicación, habilidad del habla, destrezas de articulacidir P/I2 lidad de la voz. sesoramiento Social: destrezas sociales y de comportamiento a Asesoramiento Motórico/Fisico: destrezas rnotericas finas y gruesas. K Asesoramiento Médico: status físico que pudiera influenciar el aprendizaje y pudiera incluir una evaluación pediatra, siquiatrica, física o neurológica jj neCe.SicirP/ d , 4)0,7 all/E irt"“--e— te Un repone sera escoto que contenga los resultados de estas evaluaciones y otra información educacional. Usted sera invitadolal asistir a una reunión para revisar este reporte y ayudar el desarrollo de un program educacional apropiado para su hijo(a). Usted tier derechos específicos ccn relación a este informe que se encuentra descritos en las Protecciones de los Procedimientos Disponibles Padres de Estudiantes Excepcionales, que están adjunta a esta notificación. Porf v antes de devolver la planilla marque todas las respuestas que le apliquen. Si No Yo/nosotros comprendolemosl las razones de esta evaluación. Si No Yo/nosotros solicitolamos) una reunión para discutir la propuesta evaluación / N, CONSENTIMIENTO: Por favor devuelva la copia blanca de este tormurano y ruja c los Procedimientos a: a u tescuelauireccion ow abajo) n / 06 Af 9 (Fecha) nf arme o sobre las Protecciones d, ti A (Posición/ c".67-?0 97, (Teléfono) 878-1150 Copia Blanca: Archivo Cumulativo FM-49615 (09-9 Copia Amarilla: Padres EFTA01710309 ce,LX/47' . DADE COUNTY PUBLIC SCHOOLS EXCEPTIONAL STUDENT EDUCATION ()641-2 14-'4 tCre-ck..1 s - M-TEAM REFERRAL REPORT Ot _12 VISION SCREENING RT VISION SCREENING RE NAME OF STUDENT _ ADDRESS TELEPHON SCHOOL PARENT/GMIRITAll BIRTHDATE City SEX /:=7 State ETHNICITY Zip Code GRADE 3 TEACHER Reason for referral: Visual Acuity without glasses: Visual Acuity with present glasses: Visual Acuity with prescription recommended: Title Form f 878-1273 MIS-12125 (08-78) EFTA01710310 MIAMI, FLORIDA 33144 Phone: Fax: ThIncbal 1, s- en; ern t 1-1 11.e s AC t vP et (66:.; 95' i evz Acz ccit. en) P )1 (lf pet ft 114 e: .4 1 l• ei i fl).-C jaa ift-et k . 17 c"--1 et6: t eeni A11 P- Supairdenient 0•01MOtrity Mtge 5:11cob / 7 '! e if A— p 4A j ef ,149 c iz a- -14 et- ; I I ji,7 741ttif hilw4 h it( AVI C 1 49.69 / 711 ( 7 44 Ilse et. vie...a-Le. 6 EFTA01710311 Evaluation Date Name DADE COUNTY PUBLIC SCHOOLS giving our students the world EXCEPTIONAL STUDENT EDUCATION ge-Hearing Re ort/M-Team Referral . D.O.B. 0evelop./Perform. Score Age F Grade/ESE 3 Student's Native Language/Dialect Examiner Verbal IO Evaluation Conducted in (language) MEMO TO: FROM: DATE: /O7 -3 - ir SUBJECT: is- e-cci u ent Services 444/ O9 -enNet, 212) NM/ C 57- - elvv‘ 6, / egg, 7 6=4,7-- Fe °a," y '7, woo d, 1404 K O d • 0 Recommendations: O Refer for eligibility staffing: (circle) Articulation Fluency Voice O Additional testing needed: (circle) Bilingual ESOL Psychometric o No further testing needed Comments: is L it ij 11 1 ji I tf0 -ID II MI *20 -t aininieol•C Language de u0 Whit. SPOICh Flit 878.1397 Yellow - Referred Pink — Corn Folder FM.1544 Rev. 110-891 EFTA01710312 DADE COUNTY PUBLIC SCHOOLS giving our students the world NarncS -Hearing D.O.B Evaluation Dated.. .1 9..(1tviahtli Examine Develop./Perform. scorelto ?co CC'S EXCEPTIONAL STUDENT EDUCATION I. Report/M-Team Referral Ag2 -11 Grade/ESE!...3 C• • • uA • r i.lecl-ice... (r . Verbal 'Din prOctSS Evaluation Conducted in Etril (language) Audiometric Screening atca5..dB. Threshold Testing Results: R L Referred: PASS O FAIL (Agency or Private) Articulation/Phonology (Severity Rating): Test call" k -tzt r" .phe. Test Intelligibility (Connected Speech): t WNL WNL MILD MODERATE SEVERE Results.noimita.ctc...s..Q9÷,-- - 4 t I • Results GOOD FAIR POOR Fluency (Severity Rating): Test iftettki..7.O..a.irolit WNL .......MILD MODE AT Results..{M:f.A SEVERE, r'ttlEd- Supportive Data: YES ...... Voice (Sovority Rating) . . Wt& MILD MODERATE SEVEFIE Medical Clearance YES to PENANG Supportive Data: YES tO Diagnosis: Language (Severity Rating): WNL Receptive WNL Expressive WNL Pragmatics Wit MILD MILD MILD MODERATE SEVERE MODERATE SEVERE MODERATE SEVERE ••••4001 ?, 1. dithtula4 —1— L be01•11•4 1 —7 I I I Son vp 410 -10 •IA 4I 010 alt halms I 111111h4j61001•r i Recommendations: O Refer for eligibility staffing: (circle) Articulation Fluenc E —Additional testing needed: (circle) Bilingual ESOL O No further testing needed Language Comments: 'R /toll Aitct-ia /2.-t714.4..) - Speech rile V ell creV— Referral  Pink --turn Folder 878•1307 FM•1 544 Rev. (10-89) EFTA01710313 Dade County Public Schools - Miami. Florida Office of Exceptional Student Education OBSERVATION OF STUDENT BEHAVIORS Students/ am Birtlidate: School: / Grade 3 Obse/er: Sub Date of Completion• 1/ - Z- 8 0% 1-10% 11.30% 31-50% Over 50% ATTENDING BEHAVIORS Seems to have difficulty staying in seal Does not correlate tasks. Has shod attention span. Is easily distracted. Appears to daydream. Exhbits impulsive behavior (blurts out. etc.). Appears h eractivs/overactive Never Seldom Sometimes Often Exceeelvel II. INTERPERSONAL BEHAVIORS Tries to dominate others Is easily led, influenced by others. Prefers solitary activity. Avoids competitive activities Avoids verbal communication. Does not participate in class activities. Is ridiculed by peers. Is ignored by peers. Sexually aggressive toward sther students. Physically aggressive. hitsiocks/biles/etc. Threatens teachers/students with bodily harm. Prefers activities with opposite sex. COMMENTS: TAT -- DISRUPTIVE/INAPPROPRIATE BEHAVIORS Exhbits perseveratincirrepetitNe behaviors (roadng, tapping. etc.). Has temper tantrums. Exhbits self-injurious behavior (specify below). ter Uses profane language. Lacks self-control (specify below). Cries inappropriately. Demonstrates moods. Takes things belonging to others. Makes untrue statements. Imitates site sex. is is . COMMENT Never Seldom Sometimes • Seldom er_50% Often Excessively Ma692 Rev for 94) EFTA01710314 Dade County Public Schools - Miami, Florida Office of Exceptional Student Education OBSERVATION OF STUDENT BEHAVIORS mel Student's Na Pg. 2 School. 0% 1-10% 11.30% 31.50% Over 50% IV. INDICATORS OF ANXIETY Appears nervous. jurrpy. . ..... ,r rffr iMill MIMI M:4 ;I'S: '. ' Seems to worry. ' Seems unhappy. ...-.. .:..z. •••,, Appears to stutter. Reluctant to speak in group situations. Seems tense, unable to relax. Seems easily frustrated and confused. i-..:,-; "? •astts:II: •S'eftstxt' Appears self-conscious, easily turbarrassed. shy. Manifests fear of school (specify below). ..o. . Bites fingernails, sucks thumb/lingers. Compu - • COMMENTS: 0% 1.10% 11-30% 31-50% Over 50% V. COGNITIVE SKILLS/PERCEPTUAL MOTOR Never Seldom Sometimes Often Excessivel e '' \- Has efifficulty copying from chalkboard. _ I I 1, . Has difficulty reproducing dravkigs,lonem. numbers or written words. . -4,.. ,:1,5iry..,.;,,r. Exhbits •oor.rose motor skills (. oc" below). Seems to have difficulty with visual tracking: slaps foes, words, word endi .s. etc. s. ' below . Exhbits poor perception of spatial relationships (letter/number reversals. spacing). " i - Has deist remembering (speciy below). - - 0% 1-10% 11-30% 11.50%, Over 50% VI. ',....:4. As PSYCHO-PHYSIOLOGICAL Has need to use bathroom excessively, Never Seldom Sometimes Often Excessively Speaks unsteady in native language. Exaggerates physical complaints (headaches, stomach ashes, etc.). Rubs eyes. eyelids/eyes inflamed. Holds material close to lace. Tums head to one side listeningiworking. Wets clothes. Exhibits muscle spasms (hvitchesrlicks) Becomes ill when upset or frustrated. COMMENTS: PM 1692 Rev (01.911 rOU‘Sri onlanCIEUMO EFTA01710315