THE SCHOOL DISTRICT OF PALM BEACH COUNTY

THE SCHOOL DISTRICT OF PALM BEACH COUNTY A s _Elementary School Special Session Registration re of Pa .ame Scho Special Session School Assignment Student's Date of Birth igh Risk Medical Information 1-9 0179 Legal Information on Reco : no yes (Call home school.) Student is on free lunch reduced lunch SPECIAL PROGRAM ASSIGNMENT (Check services needed.) ESOL Intensive ESOL Support ESE (Program) Other TRANSPORTATION Needed: no Z_ yes regular ESE lift) SAC# /O6 C) Special Session Bus # RECOMMENDATION FOR SPECIAL SESSION (Check all that apply.) Students in grades K-5 who are in ESOL (LEP students), Dropout Prevention, and those in ESE whose IEP includes a recommendation for Special Session. _11 Students in grades K-twho receive recommendation from the principal may attend for remediatIon purposes only. Students in grades 2-5 who received a score in quartile 1 in the reading comprehension and/or mathematics concepts and applications on the most recent norm-referenced test Students In grades 2-5 who received a score in quartile 2 in the reading comprehension and/or mathematics concepts and applications on the most recent norm-referenced test along with the recommendation of the principal. ft wi Students retained in their current grade level may be eligible for promo' lion of Special Sessign. 4k, 5gnalure of Teacher I Dal 4 Signal rk, of Pnnopal / Date rer—Sc PAFIENT/GUARDIAN NOTIFICATION 10 Yes, my child will attend the Special Session (summer school). The information on address and telephone numbers is correct or I have noted changes on my copy of the registration form. 17] No; my child will not attend the Special Session 1stimmer school). s Signature o are / Guardtan - 91/ Date Attachments to the registration form sent to the Special Session school: Parent/guardian copy - signed registration form Copy of completed ESE IEP, If appropriate Other information To be completed at the conclusion qSpecial Session: STUDENT ATTENDANCE RECORD: P& Days Present 0 Days Absent Tea 9r commes: dieldC)74e Zlefil MLa-t I 4 -e- 7 s' Signature of Spada Session Strati,/ / Date PEW 0673 FY 95 Reyisio WhitalSpecial Sudan Sohoor&4 H eila4ecwI Moms SthoogOffico 0 Days Tardy PLACEMENT DECISION Made !Wowing Special Session er Promoted 0 Administrative Placement 0 Retained /4.7 / S)-3 4- sr Signature of Home SHwol Principal / Date Pinkfrransportatioa GokliParentlGuardian then Name Sdmol CONFIDENTIAL MM08-V ZALIS-000032 3501:725-020 Page I of I EFTA 00075168 EFTA01248871