EFTA Document EFTA01710036

STUDENT SCORE REPORT CCollegeBoard SAT WHAT ARE THE AVERAGE SCORES? For college-bound seniors in the class of 2005, the average critical reading score was 508 and the average math score was 520. • WHAT DOES YOUR SCORE RANGE MEAN? Your performance is best represented by the score ranges above. To consider one score better than another, there must be a difference of 60 points between your critical reading and math scores, 80 points between your critical reading and writing scores, and 80 points between your math and writing scores. HOW DO YOU COMPARE WITH COLLEGE-BOUND SENIORS? The national percentile for your critical reading score of 530 is 56 , indicating that you did better than 56% of the national group of college-bound seniors. The national percentile for your math score of 550 Is 59, Indicating you did better than 59% of the national group of college-bound seniors. ' Percentile, average score, and score change information for the writing section are not available. The test must be given to students for a full year before this information can bo provided. See reverse side for additional score details. ADDITIONAL SCORE INFORMATION eg Visit vernmcollogeboardoom for detailed Information about your scores and to view your essay. SUMMARY OF SCORES SAT Reasoning Test SAT Sub) ct Tests' ;;51 ..rgt,ATig ielplicir 1;%3 X" 4. ki h.. nie, WS . . c: . 4 .--z -. e • fli 500 490 52 52 i Oa 06 ,T i -r1/4 ' 45.....w ter -t. ,. I - • 71 .1* tr./ c( at • Aar ' > cliira TqWeill M' gl# A,":rre..cmi,,oek t i li a l'. , ^I; - ) -1 tig., it • to: 1 i- TTil' a \ TeiltiA . :.*m. UV Ne Stare limo 05 Kay 05 12 11 530 520 550 490 REPORT DATE: 12/16/05 ( HIGH SCHOOL COPY - 101493 ) ROYAL PALM BEACH FL 33411 WILL YOUR SCORES CHANGE IF YOU TAKE THE TEST AGAIN? Among students with critical reading scores of 530, 55% score higher on a second testing, 35% score lower, and 9% receive the same score. On average, a person with a critical reading score of 530 gains 11 beings) on a second testing. Among students with math scores of 550, 57% score higher on a second testing, 34% score lower, and 9% receive the same score. On average, a person with a math score of 550 gains 13 facings) on a second testing. • ADDITIONAL SCORE REPORT INFORMATION To learn more about colleges, universities, and scholarship programs and to send additional score reports, visit www.collegeboard.com. Prior to LI rch 203. Usecrtikti mad ag section cop 'Hot a 1 tints Items subscorm. kr."'" 3: he corral 54.6°"' San" roil these tw° 'Stier s ft m %As SAT Subject Test In Writing and th writing motion on the SAT Poisoning Tom ars not demperabla. sect one are conctrab 9. ID INFORMATION Register online to take the SAT again. If you do not have access to online registration, you can re-register via mai or phone. YOU Will need the registration number below and the test date. . .lt4t ,;$ 445%; :mturgies* 4"(grelli.talk --iftiolitio*•• ir'6084 1-Pk - 0 7 ~. etriA:zrolember ;Tat Center.; ,c , ,...v t„ -4, .T.--es.,7*.ttgo siztq,c.rit,,-ap ,,,,,,,- ..,-f.p.ora... , ,;:tr • ...taitiont4emoi;- Yr " !.....ete-n • . . . Lej.iii,$) F 10735 ROYAL PALM BEACH COMMUNITY HS 101493 EFTA01710036 I. • fr ta .461 ..14.1" 4 e'at 44 S Florida SU Tallahassee, FL CONE 5219 Florida Atlantic U Soca Raton, FL CODE 5229 U Control Florida Orlando, FL CODE 5233 Fleglor C St Augustine, FL CODE 5235 xe, 1 ., •::':':Ite I • • 'Iktp,:.!,: t t. 4-yr College kali* Geed 4-yr. public university 4-yr. public university 4-yr. public university 4-yr. private liberal torts college f.dt ?s. e'bc 'a :..at Cs. ..44 • • 0 '441.:,JkZ:TA Undecided 29,820 undergraduates 19,610 undergraduates 34,940 undergraduates 2,106 undergraduates VOI{101-41-44., -.1:,-..A-/. : Medium city In state Urban campus in snail city Suburban teapot in swell city Suburban campus in very largo city Suburban campus in large town : . . , N07461: A/4%W .. . art,‘J tilifl,f/41/21.4P . .g.. ktt...'Itstr'. s. .. : es. .. A 4' 4 1rP7V" r FL resident US Citizen Mite No housing plans 132 out oi state 542 live In college housing 92 out of stato 502 live in college housing 62 out of state 662 live in college housing 322 out of state 812 live in college housing 4; ,¢ .5' gt I ;A; • " ') Ce 962 of freshmen had GPA of 3.0 or higher SO2 of froshann hod GPA of 3.0 or higher 952 of froshnon had CPA of 3.0 or higher 782 of froshoon had GPA of 3.0 or higher 0 • 1 J.V 1"& 10-1-e-- IS 19 units [repeated 3 times] 16 (20) units I'l 'Iri(0 . 33... al . ' Oligglzt htlalligE4 001951 I ' NO eiigi2, -.1 4 English 2 Foreign Lang. 2 Math 2 Natural Sd. 3 Social Science 2 Arts, Music 4 Engl 2 Fortan 3 (4) Math 3 (4) Soi 2 Sac St Additional course requirements; chock with college 4 Engl 2 ForLan 3 Math 3 Sci 1 Soc St Additional course requirements; chock with college 4 Engl 2 Forlan 3 Math 3 Sei 3 Sac St Additional course requirements; check with college 4 Engl (2) Fortran 3 (4) Math 2 (3) Sol 3 (4) Sec St Additional course requirements; check with college 6 e',....1,ek 0: 5•Ass... 4k t#1g."-/e/St7r I (fIre'a:A ‘:4fick . 1:.;:;•.q. '''."14/7.7 fili- 4,:1 w. ;,, I%-s----a...,.s.s....... School record, test scores, activities, rocomaendetiens, essay School record, test scores, activities, reccommendations, essay School record, test scores, interview, activities, recommendations, efgAV School record, test scores, interview, activities, recommendations, CISSAV 4' • ii 4 t's V COG t: • ., SAT REAS occoptod SAT PEAS by 3/1 SAT PEAS accepted SAT PEAS by 6/1 SAT REAS accepted SAT REAS by 3/1 SAT PEAS accepted SAT PEAS by 3/1 ; tv:e ROjkif • tea ,A .iP hri,Ska:' d' • ' tic: e ‘f I ' . r SAT Crit. Read. 530 - 630 SAT Math 540 - 630 SAT Crit. Read. 460 - 560 SAT Math 460 - 560 SAT Grit. Read. 520 - 620 SAT Math 530 - 630 SAT Crit. Road. 540 - 620 SAT Math 520 - 600 , Atfriiktion,Ritt. 652 of applicants 662 of applicants 552 of applicants 302 of applicants k. a , '..t, _'Application , Deadline ,'_. :2 12/31 priority 3/1 closing date 6/1 closing data 1/1 priority 5/1 closing date 1/15 priority 3/1 closing date al a n TE Vi yot 2005-08Apfwol ExP01 0PP:f4%) 312,789 (out-of state add'1) 013,708 (out-of state add'l) 515,111 (out-of I stato add'1) 618,490 FinanclOhNif: . On average 832 of On average 722 of need cut On avorate 752 of nuud mot need mot FlnanciatAaid : , Deadling>.: -.31 2/15 priority No closing date 3/1 priority No closing date 3/1 priority 6/30 closing date 5/1 priority He c is information you provided. Fir t Langua • only Telephore: Religion Presbyterian Church (U.S.A. ) Student Search Service: YES EFTA01710037 CCollegeBoard SAT YOUR SCORES Test Date: DECEMBER 2005 STUDENT SCORE REPORT REPORT DATE: 12/16/05 ( HIGH SCHOOL COPY - 101493 ) Seer-tit" c:PercentUes. 0 4 89.8;hottNiSentiltis ROYAL PALM BEACH FL 33411 500-560 56 61 520-580, 59 68 460-540 a a Pet'l cS:#1;".*1'S v4ROTeR intliM Avrittnt,4*.m.,..c4 400{iliat4143 reniv 530 550 500 52 06 WHAT DOES YOUR SCORE RANGE MEAN? Your performance is best represented by the score ranges above. To consider one score better than another, there must be a difference of 60 points between your critical reading and math scores 80 points between your critical reading and writing scores, and 80 points between your math and writing scores. HOW DO YOU COMPARE WITH COLLEGE-BOUND SENIORS? The national percentile for your critical reading score of 530 IS 56 , Indicating that you did better than 58% of the national group of college-bound seniors. The national percentile for your math score of 550 13 59, indicating you did better than 59% of the national group of college-bound seniors. • a Percentile, average score, and score change information for the writing section are not available. The test must be given to students for a full year before this Information can be provided. See reverse side for additional score details. ADDITIONAL SCORE INFORMATION Visit twrivcollegeboard.com for detailed Information about your scores and to view your essay. SUMMARY OF SCORES SAT Reasoning Test SAT Subject Tests 2 " • '. P int a.r•iR. - 'I Si) kg? tiki ;44t ifi ,.,z#Cisatzi,),.-iti r ' • I kAzgeii i • . • a t Et '' SUS ' t'.... la 1 re'ita 1. • ptb.. '4*firpt it...0,I,, t> mewil e f elt& S. 1 . ' •• V .: .: Pnro . Doe 05 Nay 05 12 11 536 520 550 490 510 490 52 52 06 06 Prior to M rch 003, the critical road nor section was 'Not II t. to have subbcons. knownasthe verbal section. 522222 from Dane 112° 'Scar s from the SAT Subject Test in Writ nq and th writing &eche on the SAT Reasoning Test are not comparable. geCtlOrts aro comparable. WHAT ARE THE AVERAGE SCORES? For college-bound seniors in the class of 2005, the average critical reading score was 508 and the average math score was 520. • WILL YOUR SCORES CHANGE IF YOU TAKE THE TEST AGAIN? Among students with critical reading scores of 530, 55% score higher on a second testing, 35% score lower, and 9% receive the same score. On average, a person with a critical reading score of 530 gains 11 point(s) on a second testing. Among students with math scores of 550,57% score higher on a second testing, 34% score lower, and 9% receive the same score. On average, a person with a math score of 550 gains 13 points) on a second testing. • ADDITIONAL SCORE REPORT INFORMATION To learn more about colleges, universities, and scholarship programs and to send additional score reports, visit veinveollegeboard.com. ID INFORMATION Register online to take the SAT again. If you do not have access to online registration, you can re-register via mai or phone. You will need the registration number below and the test date. ilnIM I:75g44422, WrC il, -1, f54/13,0 23 t;Ornii#40 t(r/ 4.Avetrisi flaRRIST6tiorr-:;itag; fAvAiiiiiit wrttigterlk . It. arcg - r1 apr .414 , p.I t talitreltkin ' F 10735 ROYAL PALM BEACH COMMUNITY HS 101493 www.collegeboard.com or refer to the SAT Program Handbook for irterprotive informa 0 EFTA01710038 PERSONAL AND COLLEGE PROFILES r ,...:s.sy.tvk:-;,..-.1-, .vr,,,,•At -,:. ,u-sctev.1",!::-_,..io,tiOlobiled*ttigffilnuits:ung§itat i5iviNg! , • tif,4 4::,7, t„, .y,;:.4...S, 'E,I;;F:'itCkiliilabaliadFaYaiieSifitsiaidinrin*ittitirttsiTHr. Xrat. • I . , ,Thotellegtacii4,0Mositindbeek I's?: 7" 2,;;;4.7 :ii:iciaitaitince talliciediii414,:loikilostraimitiliaterial:rs U South Florida Tampa, FL CODE 5828 tolivots010;ThIp*nevw....),,"-tt 2005:infpripiicionpftrilia•:)'-'4t No college/scholarship was designated to receive a report. :i .1X.:2;ZC:+24: ; No college/scholarship was designated to receive a report. a U North Florida Jacksonville, FL 000E 5490 ?V t/lng14k ;') 1.71 :f ,. Itt ,C..4/..) i d' f4'..:V;.t ?..Ifi :( 44:4 4-)!r College Pltilo Coed 4-Yr. public university unive 4-yr. public univorsity imv-Itett,..ôP i W a ,1C41:4 ?pr; w!: • . : 1.647. , Undecided 12,237 undorgradeatos 32,458 undergraduates i 4 .41A I) i.:,..54. A. - ' y 'V -,. Medium city In state Urban campus- in vary largo city Urban commas in very large city ' . Fl , v i."': :14 ry ::ti 1 resident US Citizen White No housing plans 4X out of state 852 live In collage housing n out of state 542 live in collage housing 'Artc ak.c. • .e15l1 .4 ft C+ 82% of freshmen had CPA of 3.0 or higher 912 of freshmen had CPA of 3.0 or higher 5 tr . 4,0;t1..tt% 1- -7thltraill$AinG" certakiitS.V2Z,Z ya g h-..;t4Urio$ ..:...1».;*3 , 4 li54)1,14i'7X t; 15 19 units 19 units 14094,IT!AWal P. ,1 4. ,.. - IyibliftWgi -h. 1 4-",.. i 4 i:c.., V . . k ' v,. td , r , 4 English 2 Foreign Lang. 2 Math 2 Natural Sal. 3 Social Science 2 Arts, Music 4 En91 2 Forlan 3 Math 3 Sol 3 Sac St Additional course roquirozents; chock with college 4 Engl 2 Forlan 3 Math 3 Sot 3 Sac St Additional course roquirooentsi chock with college FR aHMA,P?:AD!fil.SSjtj,f&‘atirV141 ' /. . j'. 4.' Tr! /41.44t kti v 4 School record, test scores, activities, reconnandations, essay School record, test seems, activities, recommendations, essay ii'apMekc..r,. YlE4641•:(t•:l . 1 r•C•V‘..ar SAT REAS accepted SAT REAS by 7/15 SAT REAS accepted SAT REAS by 4/15 43i:tidal somlp.ob gi ,iii.g Fros8pl!mti, SAT Crit. Rood. SOO - 600 SAT Math SOO - 600 SAT Crit. Road. 500 - 600 SAT Math SID - 600 4'1194.000M 692 of applicants 512 of applicants ,94$10410K ,;t ,D1dilho. f' 11/14 priority 7/2 closing date 4/15 priority No closing date :68.Itifillil; $13,888 (out-of state odd•1) 611,896 (out-of state add•l) 4.000;o6 , ' - On overage 752 of need met On overage 322 of need seat s 10. , • ' . i, 1-pdg: . el Opp : .: 4/1 priority 3/1 priority No closing date Here Is Information you provided: First Lang • only Telephone: Religion: Presbyterian Church (U.S.A.) Student Search Service: YES EFTA01710039 DIST: 2331 TCHRIM D NBR: 128 STDT: 24998585 CRS: 2003340 SEC:002 BLDG:04 RM: 220 08/01/05 L ati ) New and Returning Student Registration el THE SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) Complete ALL AREAS on both sides of the form (except areas in gray). Correct any preprinted information. Do not leave any 6- STUDENT LEGAL NAME NH Ent. medals ALSO KNOWN AS SOCIAL SECURITY NO. rowashx9 LOCAL ADDRESS (house mate( and 8 We name epartment nitrite, city, slate. *code/ NAME CC MUSING CEVELCPMENT (if appkebNO ROYAL PALM BEACH FL 33411 • MAILING ADDRESS (house slumber end semi ming epietnseel number, city, stale. :in code) IMMO NOME TELEPHONE NUMBER DAY TWE TELEPHONE NUMBER EVENING TELEPHONE NUMBER A LUPAGER NUMBER so: (Ms, F ItACEIETHrriCoexrlN w 0 A - Aslan.IPacific Islander II I - American Indlan/Alaslcan Native D B - Black, Non-Hispanic 0 H - Hispanic 0 W - White, Non-Hispanic 0 M Multiracial DATE CC BIRTH EnmiddiWyy) PLACE OF BIRTH (cfty, state, stone)) MUNSTER IN US INDIANA RESIDENT STATUS 3 0 a Foreign Exchange Student 0 1. Out-of-county Resident 0 2. Out-of-state Resident a3. In-county Resident USA ENTRY DATE 1. Federal Impact Survey A The student resides on federal property. 0 Yes gNo B. The student resides In low rent housing. 0 Yes %No C. The parent Is employed on federal property located in Palm Beach County. 0 Yes j21lo D. The parent is employed on low rent housing located in Palm Beach County. 0 Yes A P No E. The parent is in the uniformed services of the United States. 0 Yes a No If "E" Is YES, Is the parent on active duty? 0 Yes 0 No (check service below) 0 Air Force 0 Army 0 Coast Guard 0 National Guard 0 Navy 0 Marines 2. Preschool Enrollment Information (Check each program attended. Indicate with an asterisk fl the program your child was in the longest.) 0 Fee for Services 0 Head Start 0 Pre-K Disabilities 0 Private Pre-K 0 School-based (Pre-K) 0 Teenage Parent Program 0 None 3. Is the student who Is enrolling in school a single parent? 0 Yes 0 No N 4. Students will receive non-Invasive health screenings pursuant to Florida Statute § 381.0056(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. (This exemption will cover all types of screenings.) If you DO NOT want your child to receive the screenings, write the words " Do not screen" here: 5. I give permission for my child to participate in the sodium fluoride program to prevent tooth decay. NO 0 Yes (Permission is void through grade 5.) 0 No 6. Does your child currently have health Insurance? ;Yes Q No p If YES, check insurance plan: 0 Medicaid 0 Healthy Kids/Kid Care IXPrivate K Interested in receiving information 7. All new students to Palm Beach County are required to answer the following home language survey questions. A. Is a language other than English used in the home? K Yes (language) 0 No B. Does the student have a first language other than English? 0 Yes (language) 0 No C. Does the student most frequently speak a language other than English? 0 Yes (language) 0 No 8. Name of the last school attended A City State B. County Country C. Last grade level completed Last attendance date D. Does your child have 0 Individual Education Plan (/EP) [ADDRESS REDACTED]an [ADDRESS REDACTED]an? (if checked provide a copy) PBSD 0636 (Rev. 01/26/2005) page 1 of [ADDRESS REDACTED]UDENT LEGAL NAME MN Rat middle) 9. Disclosures for entry into Palm Beach County School District (check all that apply) O The student has had Juvenile Justice actions taken against him/her. [ADDRESS REDACTED]udent has been expelled from School O The student has been arrested resulting in a charge. Ef Not applicable 10. Indicate with whom the student lives (check one only) Both Parents 0 Mother 0 Father 0 Foster 0 Group Home 0 Student is ward of the state O Other 11. IMPORTANT, EVERYONE MUST ANSWER THIS QUESTION. A Is there a visitation order or other court order barring either parent from removing the student during the school day or coming Into contact with the student? If Yes, provide school with a copy of court order. 0 Yes l i r No B. Parents DO NOT have shared parental responsibility 0 If checked provide school with copy of court order. 12. Provide the following parent/legal guardian information MOUE TELEPHONE BUSIPNSS TELEPHONE PARENT OR LC-GAL GVARWN OW Amt. middle Wag) HOME TEL CROWE BUSINE TEL_ PriON:r ROYAL PALM BEACH FL 33411 Ertialmmov i AI L: SS IF NOT Ts E SAME AS STUDENT(haus* ovonber end street name. spartmont sugo, zp code) • OVAL PALM BEACH FL 33411 • 13. List names and date of birth of parent's I legal guardian's other children enrofled in Palm Beach County schools. 14. Provide the name(s) of person(s), other than the parent, allowed to pick up the student. 15. Provide a password the person allowed to pick up the student will use. (limited to 10 characters) L. soy 16. Does the student have any allergies? (if yes specify) f'Yes 0 No Allergy 1 18. Physician Name 1 J c•12,n APIA. 01/4.A Telephone Number Parental Consent for Release of Student Information I hereby give permission for the school or District to use my chikfs photograph, video Image, writing, voice recording, name, grade level, school name, participation in officially recognized activities and sports, we:ght and height as a member of an athletic team, dates of attendance, diplomas and awards received, date and place of birth, and most recent previous school attended, in annual yearbooks, graduation programs, playbills, school productions, web sites, etc. and/or similar school-or District-sponsored publications or in school or District-approved news meda interviews and photographs. I understand without my signature my child's name and photograph cannot and will net be included in any publications or presentations. I also understand and agree that my child's medical records or other medical information that I provide to the school, and treatment records or other medical records created by health care personnel at the hoot will be shared with school officials who have a legitimate educational purpose for accessing sr.../m PBSD 0636 (Rev. 01/26/2005) g 1)11 05 /LEGAL GUARDIAN DATE Verification of Student Registration Information I verify that the information given on this student registration is true and accurate to the best of my k ow TURE OF PARENT/ GUARDIAN DATE Registration is not valid without a verification signature and date. fog page 2 of 2 EFTA01710041 23F) Test Date: Nov 22, 2004 Royal Palm Beach I-Is Royal Palm B FL Pam 19.0003 ASVAB SUM ARMED SERVICES VOCATIONAL. APTITUDE BATTERY ARY RESULTS ASVAB Results — 11th Standard Scores 11th Grade Standard Score Bands Percentile llth Made Females Scores ITO Gads Mat 11th Grade Students Career Exploration Scores 1 10 2) 30 90 60 60 70 80 90 99 Verbal Skills 55 69 [repeated 3 times] Math Skills 58 — — 80 [repeated 3 times] Science and Technical Skills 46 42 24 33 ASVAB Tests General Science (GS) 50 -- - -- 57 48 52 Arithmetic Reasoning (AR) 58 81 77 79 Word Knowledge (WM 51 55 51 53 Paragraph Comprehension (PC) 59 79 86 82 Mathematics Knowledge (MK) 58 . ME 77 80 79 Electronics Informations (El) 50 62 38 50 Auto and Shop Information (AS) 44 45 20 32 Mechanical Comprehension (MC) 39 16 11 14 Military Careers Score 3 to so 30 40 BO BO 70 BO 90 99 Military Entrance Score (AFOT) 66 EXPLANATION OF YOUR ASVAB STANDARD SCORES Your ASVAB results aremported asstandardscores in the above graph. Your score on each test Is identified by the '1r in the corresponding bar graph.You should view thesescores as intimate-sof your true skill level in that area. If you took the test again, you probably would receive a somewhat different score. Many thino., such as how you were feeling during testing,tontribute to this difference. This difference is shown with gray score bands in the graph of your results. Your standard scores are based on the ASVAB tests and composites based on your grade level. The score bands provide a way to identify some of your strengths. Overlapping score bands mean your true skill level is similar in both areas, so the real difference between specific scores might not be meaningful. If the score bands do not overlap, you probably are stronger in the area that has the higher score band. YOUR ASVAB PERCENTILE SCORES Your ASVAB results are reported as percentile scores in the three columns to the right of the graph. Percentile scores show how you compare to other students - males and females, and for all students - in your grade. For example, a percentile score of CS for an 11th grade female would mean she scored the same or better than OS outof every100 females in the 11th grade. For purposes of career planning, knowing your relative standing in these comparison groups is important. Being male or female does not limit your career or educational choices. There are noticeable differences in how men and women score in some areas. Viewing your scores in light of your relative standing both to men and women may encourage you to explore areas that you might otherwise overlook. You can use the Career Exploration Scores to evaluate your knowledge and skills in three gert eral areas (Verbal, Math, and Science and Technical Skills). You can use the ASVAB Test Scores to gather information on specific skill areas. Together, these scores provide a snapshot of pray cunent knowledge and skills. This information will help you develop and review your career goals and plans. The ASVAB is an aptitude test. It is neither an absolute measure of your skills and abilities nor a perfect predictor of your success or failure. A high score does not guarantee success, and a low score does not guarantee failure, in a future educational program or occupation. For example, if you have never worked with shop equipment or cars, you may not be familiar with the terms and concepts assessed by the Auto and Shop Hennadon test. Taking a course or obtaining a part- time job in this area would increase your knowledge and improve your score if you were to take it again. USING ASVAB RESULTS IN CAREER EXPLORATION Your career and educational plans may change over time as you gain more experience and learn more about your interests. &Florin:Careers: The ASVAB Career Exploration Guide can help you learn more about yourself and the world of work, to identifyand explore potential goals, and develop an effective strategy to realize yourgoals.The Guidewill help you identify occupations in line with your interests and skills. As you explore potentially satisfying careera,you will develop your career exploration and planning skills. Meanwhile, your ASVAB results can help you in making well-informed choices about future high school courses. We encourage you to discuss your ASVAB results with a teacher, counselor, parent, family member or other interested adult. These individuals can help you to view your ASVAB results in light of other important inforntation, such as your interests, school grades,.motiva- tion, and personal goals. MILITARY CAREERS AND ENTRANCE SCORES Two more scores can be especially useful to you. The Military Careers Score is a composite of the ASVAB verbal, math, mechanical, and electronics tests. The Military Careers Score provides a link to occupations described in Military Careers:You will be able to see how well your skills, abilities, and career interests match those of Service personnel currently working in military occupations. Military Careers provides you with a clear image of whit workers do in these occupations, as well as other useful information about the occupations. The Military Entrance Score (also called , wWit stands fr the Arm Forces AFQT Qualification Test is the score used to determine your qualifications for entry into any branch of the United States Armed Forces or the CoastGuard. The Military Entrance Score predicts in a general way how wellyou might do in training and on the job in military occupations. Your score reflects your stand- ing compared to American men and women Ili to 23 years of age. USE OF INFORMATION Personal identity information (name, social security number, street address, and telephone number) and test scores will not be released to anpp a ency outside of Tr t:Z eni artment of (DoD), the Forces, the Coast Guard, and your school. Your school or local school system can determine any further release of information. The DoD will use your scores for recruiting and research purposes for up to two years. After that the information will be used by the DoD for research purposes only. Visit: www.asvabprogram.com Use Access Code: Access code expires: July 1st SEE YOUR COUNSELOR FOR FURTHER INFORMATION 00 FORM 1304-5,1 JUL 02 -PREVIOUS FO:TION4 OF THIS FORM ME OBSOLETE EFTA01710042 ASVAB SCORE AND TEST DESCRIPTIONS Verbal Skills is a general measure of language and reading skills which combines the Word Knowledge and Paragraph Comprehension tests. People with high scores tend to do well in tasks that require good language or reading skills, while people with low scores have more difficulty with such tasks. Math Skills is a general measure of mathematics skills which combines the Mathematics Knowledge and Arithmetic Reasoning tests. People with high scores tend to do well in tasks that require a knowledge of mathematics, while people with low scores have more difficulty with these kinds of tasks. Science and Technical Skills is a general measure of science and technical skills which combines the General Science, Electronics Information, and Mechanical Comprehension tests. People with high scores tend to do well in tasks that require scientific thinking or technical skills, while people with low scores have more difficulty with such tasks. General Science tests the ability to answer questions on a variety of science topics drawn from courses taught in most high schools. The life science items cover botany, zoology, anatomy and physiology, and ecology. The earth and space science items are based on astronomy, geology, meteorology, and oceanography. The physical science items measure force and motion me- chanics, energy, fluids, atomic structure, and chemistry. Arithmetic Reasoning tests the ability to solve basic arithmetic problems one encounters in everyday life. One-step and multi-step word problems require addition, subtraction, multiplication, and division, and choosing the correct order of operations when more than one step is necessary. The items include operations with whole numbers, operations with rational numbers, ratio and proportion, interest and percentage, and measurement. Arithmetic reasoning is one factor that helps characterize mathematics comprehension and it also assesses logical thinking. Word Knowledge tests the ability to understand the meaning of words through synonyms - words having the same or nearly the same meaning as other words. The test is a measure of one component of reading comprehen- sion since vocabulary is one of many factors that characterize reading comprehension. Paragraph Comprehension tests the ability to obtain information from written material. Students read different types of passages of varying lengths and respond to questions based on information presented in each passage. Concepts include identifying stated and reworded facts, determining a sequence of events, drawing conclusions, identifying main ideas, determin- ing the author's purpose and tone, and identifying style and technique. Mathematics Knowledge tests the ability to solve problems by applying knowledge of mathematical concepts and. applications. The problems focus on concepts and algorithms and involve number theory, numeration, alge- braic operations and equations, geometry and measurement, and probabil- ity. Mathematics knowledge is one factor that characterizes mathematics comprehension; it also assesses logical thinking. Electronics Information tests understanding of electrical current, circuits, devices, and systems. Electronics information topics include electrical cir- cuits, electrical and electronic systems, electrical currents, electrical tools, symbols, devices, and materials. Auto and Shop Information tests aptitude for automotive maintenance and repair and wood and metal shop practices. The test covers several areas commonly included in most high school auto and shop courses such as automotive components, automotive systems, automotive tools, trouble- shooting and repair, shop tools, building materials, and building and con- struction procedures. Mechanical Comprehension tests understanding of the principles of me- chanical devices, structural support, and properties of materials. Mechanical comprehension topics include simple machines, compound machines, me- chanical motion, and fluid dynamics. Military Careers Score is a composite of the verbal, math, Mechanical Comprehension, and Electronics Information tests. It compares your skills in these areas to the skills of military personnel currently employed in a number of occupations. The score is used with the publication MilitaryCareerswhich highlights and describes a number of military occupations. Military Entrance Score (AFQT) is the score used if an individual decides to enter any of the armed services. See your local recruiter for details. 0 I I0 AnVFRNELKKIT P11047000 ,010. 2C0.0110 EFTA01710043 needs (engrebensise Assessment Test October 2004 Florida Comprehensive Assessment Test (FCAT) SSS Reading and SSS Mathematics Retake Tests Grade 11 Student Report NAME: tD: SCHOOL: 2331-ROYAL PALM BEACH HIGH DISTRICT: 60-PALM BEACH This report shows your results from the Grade 10 FCAT Retake test(s). Passing both the Grade 10 Reading and Mathematics Tests is a requirement for a standard Florida high school diploma. Students must earn an FCAT Score of 1926 or better in Reading and 1889 or better in Mathematics to meet the graduation requirement. The FCAT measures your performance on selected benchmarks in reading and mathematics as defined by the Sunshine State Standards. Scores on this test are one indication of your achievement of the challencjng contort that Florida students are expected to know. Your Reading Results You have passed the Grade 10 FCAT Reading lost. Your Reading Content Content Areas Ports Earned Points Possible Words/Phrases 11 13 Main Idea/Purpose 15 I8 Comparisons 11 14 Ftelerence/Reserach 7 9 Reading Content - Content scores give more specific information about the skills on the FCAT. Grade level expectations for students include: • Words and Phrases -uses skills to determine word meaning, including word parts and relationships between words. • Main IdearPuiposo -determines a stated or Implied essential message, details, author's purpose, or plot. • Comparisons -knows similar and different, cause and effect, and contrast. • Reference:Research -uses information from a variety of sources to reach conclusions. Your Reading FCAT Score FCAT Score Achievement Level Passed 2186 3 YES 3000 2400 1800 MO 600 0 *This score you were test again score would , Swans shows tested. it is licely be between Snore Passing your Schleversigni on If you wore to take the that your 2005 Reading 2105 and 2267. Scots the day same Your Mathematics Results You have passed the Grade 10 FCAT Mathematics test. Your Mathematics Content Content Areas Penis Earned Points Possinto Number Sense 7 10 Measurement 6 10 Geometry 8 14 Algebraic Thinking 12 14 Data Analysis 8 10 Mathematics Content- Content scores give more specific information about the skills on the FCAT. Grade level expectations for students Include: • Number Sense -uses number concepts and computation skills. • Measurement -solves problems involving measurements, e.g., time, length, area. a Geometry - analyzes and combines shapes to solve problems. • Algebraic Thinking -analyzes patterns and uses equations and inequalities. • Data Analysis and Probability -uses data analysis toots to display information, make predictions and make inferences. Your Mathematics FCAT Score FCAT Score' Achievement Level Passed 2110 4 YES 3000 2100 1800 1200 600 0 'This score you were test again score would Sgent Scars Passing Score shows your achievement on the day tested. If you were to take the same S is likely that your 2035 Mathematics be between 2091 and 2139. NT-Not Tested NR-Not Reported Data Run Date: 11/22/2004 0115144 EFTA01710044 Run Dt: 07-30-03 Lake Central High School 8400 Wicker Ave St. John, IN 46373 219-365-8551 H.S.: 153-112 Withdrew: 06-06-03 063003 L"PCWin~Z7fL~ IN 46307 Principal: COURSE TITLE CRED GR-S FG Par/Guard: Telephone: Birthdate: Soc Sec #: COURSE TIT a CnS sl: Sex: F Gr: 09 RED GR-S FG Cmp Kybd 2 B20800 1.00 09-2 A- I M81410 1.00 09-1 C- * Dept - BUSINESS 1.00 *TOT Al Alg I M81410 09-2 F *g Dept - MATH 1.00 *TOT Fo* oDept 2 - CON/FAMSC C63200 09-2 F *TOT PE Pool 1 Health I P40100 P44100 1.00 . 08-3 A- 08-3 B+ Eng 9 E31210 1.00 09-1 C+ PE Gym 1 P40300 . 0 09-1 B Eng 9 E31210 1.00 09-2 C * Dept - PHYS ED 2.500 *TOT * Dept - ENGLISH 2.00 *TOT Int Cm/Ph 585610 1.00 09-1 C+ Span I 8 F76010 1.00 08-1 B- Int Cm/Ph 585610 09-2 F Span I 8 F76010 1.00 08-2 C+ * Dept - SCIENCE 1.00 *TOT Span II 9 F72010 1.00 09-1 D * Dept - FOR LANG 3.00 *TOT Intro Jour T30710 1.00 09-1 C Am Geog 1 H50100 1.00 09-1 C+ Intro Jour * Dept - T30710 FINE ARTS 1.00 2.00 *TOT 09 - C Wld Geog 2 H50400 09-2 F * Dept - SOC STUD 1.00 *TOT 01/02-1 Cum Credit- 1.00 GPA= 2.6700. 01/02-2 Cum Credit= 2.00 GPA= 2.5000. 01/02-3 Cum Credit= 3.50 GPA= 2.9028. 02/03-1 Cum credit= 10.00 GPA= 2.3320. 02/03-2 Cum Credit= 13.00 GPA= 1.8229. Graduation Qualifying Examination Passed Pending Waived EFTA01710045 Florida Carrprehensire Assessmrnl Test Spring 2004 Florida Comprehensive Assessment Test (FCAT) NORM-REFERENCED TEST Grade 09 Student Report NAME: ID: SCHOOL: 2331 -ROYAL PALM BEACH HIGH DISTRICT: 50 • PALM BEACH This report shows your results from the FCAT National Norm-Referenced Test. The FCAT Non-Referenced Test measures your achievement on a test that was given to a national sample of students. Your norm-referenced scores in Reading Comprehension and in Mathematics Problem Solving describe your performance in relation to the performance of students throughout the nation. Your scores are shown below. SUBJECT SCORES Scale Score National Percentile Rank Stanine Reading Comprehension 727 78 7 Mathematics 713 75 6 The Scale Score descrbes your performance on the lest and allows for comparisons from year to year. Reading Comprehension Scale Scores range from 519 to 830. Mathematics Scale Scores range from 553 to 858. The National Percenlile Rank (NPR) and Stanine Indicate your relative standing In comparison to the national reference group. National Percentile Ranks range from 1 to 99. The NPR score Indicates the percent of students in the national sample who scored equal to or below your score. Stanines range from 1 to 9 where 1 is low and 9 is high. StaNnas In the range of 4-6 are considered average scores. It 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 Readng Comprehension, your National Percentile Rank should be between 66 and 88. For Mathematics, your National Percentile Rank should be between 65 and 83. CONTENT SCORES Number of Questions on Test Number of Questions Attempted Number of Correct Responses Reading Comprehension 51 50 43 Initial Understanding 10 10 9 Interpretation 22 22 20 Critical Analysis 9 [repeated 3 times] Strategies 10 9 5 Mathematics 48 48 30 Problem Solving 6 6 0 Algebra 6 [repeated 3 times] Statistics 5 5 4 Probability 6 6 3 Functions 5 5 4 Geometry-Synthetic 6 [repeated 3 times] Geometry-Algebraic 5 5 2 Trigonometry 3 3 2 Discrete Math 3 3 2 Pre calculus 3 3 1 Data Run Date: 04/16/2004 0139667 5 EFTA01710046 STUDENT NO SY T COUR O# rasoo3I0 AOC Ino3to ACADEMIC HISTORY RECORD STUDENT NAME_ PREVIOUS COURSES COMPLETED COURSE TITLE SA CREDIT [repeated 3 times] FINAL FLGS HC PS TAKEN DS CODE ATTP EARN GRADE SCHL 2_3 I a o9bao —3 5 r bt icaOciDa0 -"B 5-r R.t aociba-0 -BST VO A .a /006,50o !Q- /00 (23()U -.)Oarn -1" r R000bio Aot,aitoo P DATE: 1(14(0 3 EFTA01710047 -sa STUDENT NO: ACADEMIC HISTORY RECORD STUDENT NAME: PREVIOUS COURSES COMPLETED C/NYWYI- " / SY T COURSE NO# COURSE TITLE SA CREDIT [repeated 3 times] FINAL FLGS I-IC PS TAKEN DS CODE ATTP EARN ' GRADE SCHL a .. j /OO /3,0 C-- — - 67c15,0 z 6 /a005/0 17 a ib '5 3ba 0___ — /O 0 6 "360 e---, /50034 .eci•i 14- — — t•)90, 2_.t) 13 5-7- C.-- MO ::OUNSELO F [repeated 3 times] DATE: ? - SeR-0.3 DP: , DATE: ?-2-'63 EFTA01710048 Run Dt.: 10-07-03 Lake Central High School 8400 Wicker Ave St. John, IN 46373 219-365-8551 H.S.: 153-112 Withdrew: 06-06-03 0630031 Principal: COURSE TITLE Crown Point, IN 4 4 07 Cmp Kybd 2 B20800 * Dept - BUSINESS Foods I 2 C63200 * Dept - CON/FAM SC Eng 9 EI: gDpt - Span I 8 Span I 8 SRageN E31210 E31210 ENGLISH F76010 F76010 F72010 FOR LANG Am Geog 1 H50100 Wld Geog 2 H50400 * Dept - SOC STUD Par/Guard: Telephone: Birthdate: Soc Sec it: CRED GR-S FG COURSE TIT 1.00 1.00 09-2 A- *TOT Alg I Alg M81410 M81410 1.00 09-1 C- *TOT -2 F DI * ept - MATH 1.00 09-2 F *TOT PE Pool 1 P40100 .50 08-3 A- Health I P44100 1.00 08-3 B+ 1.00 09-1 C+ P Gym E 1 P40300 .50 09-1 B 1.00 09-2 C * Dept - PHYS ED 2.00 *TOT 2.00 *TOT 1.00 08-1 B- I m nt nt C Cm//Ph Ph 885610 S85610 1.00 09-1 09-2 C+ F 1.00 08-2 CD+ * Dept - SCIENCE 1.00 *TOT 1.00 09OT -1 3.00 *T Intro .lour T30710 1.00 09-1 C Intro Jour T30710 1.00 09-2 C 1.00 09-1 C+ * Dept - FINE ARTS 2.00 *TOT 09-2 F 1.00 *TOT Cnsl: Sex: F CRED GR-S FG 01/02-1 Cum Credit= 1.00 GPA= 2.6700. 01/02-2 Cum Credit= 2.00 GPA= 2.5000. 01/02-3 Cum Credit= 3.50 GPA= 2.9028. 02/03-1 Cum Credit= 10.00 GPA= 2.3320. Ranked 477 of 695. 02/03-2 Cum Credit= 13.00 GPA= 1.8229. Ranked 543 of 672. 02/03-3 Cum Credit= 13.00 GPA= 1.8229. Graduation Qualifying Examination Passed Pending Waived Counselor Date- EFTA01710049 Lake Central Middle School Academic Record -- School AND BIRTH DATE / / EXPL. ART GERMAN i B 0.250 J—TOTAtcutwrr 1 0.250 I 14.000 HOME EC. B 0.250 an n M -51- LANG ARTS C+ 1.000 106 / 301 LIT 8+ 1 1.000 rat TOW MATH L000 3.00 . 0 PHYS. ED. :A 0.250 SthOol Year SCIENCE SOCIAL STUDIES B+ 1.000 : 1.000 1999-2000 55,-.0oNotnoocroa-o -an -ir000sootioocpcorti<NN .• ctoon000tinoo -a 0 )000.0000cocainoa. ) • 666.i N a 6 6 a0000000nu-nnin 0000000mmion-o o .r.4 .4..-$.-0.-$ I E .Z 1-4 OW ocammaistcomo< c) NC G003 PS In 1-• . An 4. 5- 4.zr, e> 5- ..c w a$ C-0_.-$ 434 < 0 u+, 4a.c.c< CI 'M am 7++ Li >g=u7t,74J-Q8 88 mmauomowc.xm JEwwwmoil-wo.ei -6 66 IP cJ O • 66666t r.oNo- -0 0 00000000r)(94 66 000000C1M11-0 0 0 • 0 I + O =moo tEtzna< til 4-, { iIQ - 003 (1)O1O f••w ZO• wp dptC MC mraw tarn -4000 > 4.) ni•••• • u E 01400 to au 0 0 w ,<ct • JEcommmonior , ^ cc a ni a co DAYS ABSENT ML il-i-$OOIN.1"--OOO(1O.-$ Oa ..-$0004)..0000 1:00 0-C OM m-00. O 666596cr . ow, Li_r) (3.n 6r. 000000000tnin U) in 00000001001011-0C . . . . . . . . mOC 11.,--I-i.-4.-4.-47-I E 1-1<t- Y I [repeated 3 times] I 6 et Z C-)C3fDS.Wetitit It it Mei' CDC to 4., zda O f- c w v u taCtl ED Q tn LLIIIMI cf.° C Cli 4O in 0.• 0 O• O C.LA ron-i u c mye ELLIC• Z mmmuom.cowM • JEMWMBITCLEMor.: MP rnn - int .00 DAYS ABSENT II I I O-4OOONOOO1-“0.4 Nr NM000,00 00NMNCIO. MO. . . O •-$6,-$ 6(114. ..411.2: 0 ,0 Ca( • 00000000ncre) u2 0000000MM-0C • .= ezi :IC In u4 CEO C a; -a tntlitn000 C Mi400 M▪ CmuCam=c.cm 0 JE WWWCLALLOK .- : cu Coa o mcs• 0 0 IHN:c Z 1 1 a)cocamo<acitt UT nu. m (04-a < U, Z0)O 'O0-•-$G CE EFTA01710050 Middle School Test Record Student Terrallova CTBS CB FORM/ SCORE LEVEL NP NORMS DATEi 3996 A-17 NO QUARTER HONTMi 06 GRADE GE PATTERN (IRT) 7.1 NCE DATE M832520[SSN REDACTED]1 09/00 School READIN READ I VOC CMP LANGUAGE LANG MECH CMP MATHEMATICS MATE COMP CMP TOIL SCOR SC! SOC STDV OPEL 91 66 83 93 71 85 91 66 83 84 94 82 65 - 8 6 7 8 6 7 8 6 7 7 8 7 6 - 12.8 8.7 10.4 12.♦ 9.7 10.8 10.7 7.9 9.4 10.3 12.+ 10.2 8.3 - 78 58 70 80 62 72 79 S9 70 71 83 69 58 - Birth Date / / EFTA01710051 Lake Central Elementary School Academic Record — Name Birth Cm Birth / / BANb sz"LlnYoli5r947r7"-='-' COMPUTER FRENCH HEALTH HOME EC. LANG ARTS LIT MATH SCIENCE SOCIAL STUDIES A 0.250 : TOTALW 0.250: • 7.000 D.250 • Rank in Class of 0.250 88 / 300 1.000 ' Absence Tardies • 1.000 I 1.50 : 0 1.000 School Year 1.000 1999-2000 1.000 ' Sahli 3 • A B [repeated 4 times] - Year 199.4 9/ 414- 95 (995-910 94 97 iffr — ref' 7i Y i Semester 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Grade K l< I t 2 2. 3 —g /re g ..! -___C Days Present 07 $ 7.5 in 814 26 8.1 : ga it 5 n Ai V/ %L Days-Absent / 4.5 2. i 3 LI I ..C.C.31 -6- 0 '1 Times Tardy 0 (7 o Co 0 I O d e) O n () Reading Q-- )Q± if' A /F. iii English 4 J3 ,514 R-- ---- Mt- Spelling azz ip h ,.D4- Handwriting . 5 S Mathematics ge 6 A 'Social Studies A a- Aci- ,81" Ertl C Science / 5 5 S *Sri— ,r4 Health 4, a a- a- /7- Music 5. 5 sst- ,..5.4 5 II- ...0-: Art 5 SI,54- S )e--- .5/— Physical Education 5 5 -.5' S. C f Promoted or Retained Teacher 2 4, (7‘ EFTA01710052 Elementary Test Record Student CTBS/4 FORM/ LEVEL A-11 GRADE • 1.6 DATE 3/95 CTSS/4 FORM/ LEVEL A-12 GRADE 2.6 DATE 3/96 ISTEP4 GRADE 3 DATE 9/96 os."Kes READING VOC COMP TOTL LANGUAGE MECH EXPR TOTL MATHEMATICS COMP CLA TOTL TOTL BATT WORD ANLNe SCORES NP 88 98 95 88 88 89 70 77 75 91 * 94 NS 7 9 a 7 [repeated 3 times] 6 [repeated 3 times] 8 9 GE 2.5 4.2 3.1 2.7 2.6 2.6 1.8 2.2 2.0 2.5 X NCE 75 92 85 75 74 76 61 66 64 78 99 School WATSON SCHOQL READING VOC COMP TOM LANGUAGE MECH EXPR TOTL MATHEMATICS COMP CAA TOTL TOTL BATT WORD ANLV SPEL SCORES NP NS 81 7 95 a 91 8 478 99 9 899 93 6 682 99 9 796 66 7 373 94 8 583 92 a 379 96 9 4 90 8 X 59 5 2.7 GE NCE 68 368 685 85 78 99 82 96 73 83 79 87 77 55 AANCE 90 93 94 78 96 88 72 76 75 89 82 86 READING VOC COMP TOTL LANGUAGE MECH EXPR TOTL MATHEMATICS COMP CAA TOTL TOTL BATT SCORES NP 73 * 99 99 66 * 99 92 66 87 81 95 GE NCE 63 463 1299 99 97 797 459 59 1096 96 680 80 358 58 573 73 468 68 504 04 AANCE 74 74 75 75 74 77 81 80 83 81 Birth Date O CS/ T TEST 2 COI SCORES NVREI MEM VRB TOT C T 122 / S LEVEL AGE-11 NPA I 82 11 *99 91 1 7 2 T • TEST CS! • TC8/ 134 AGE 8- 5 2 TTSSena CS Nova C READIN READ VOC LANGUAGE MATHEMATICS COP LANG MECH CMP MATH COMP COP TOTL SCOR SOC STDV FORM/ SCORES LEVEL A-14 GRADE 4.1 NP NS GE NCE NORMS DATE: 1996 QUARTER MONTH: 06 PATTERN (IRT) DATE 09/97 M832520[SSN REDACTED]5 jgrrallow LTBS CB FORM/ LEVEL NORMS DA ' i ••••511 Quaaraa M PATTERN (IRT) M008016001-0S -05471 NORMS DATE; 1996 QUARTER MONTH: 06 PATTERN (IRT) M832520[SSN REDACTED]9 A-15 GRADE 5.1 DATE 09/98 QUARTER MONTH: 05 NO06002[SSN REDACTED]0 SCORES READING READ VOC CRP LANGUAGE LANG MECH CMP MATHEMATICS MATH COMP COP TOTL SCOR 8 C1 SOC STDV SPEL 82 81 83 72 68 71 88 81 87 81 91 92 73 - NP NS 7 [repeated 3 times] 6 [repeated 3 times] 7 [repeated 4 times] 8 8 6 - GE 9.0 7.9 8.6 8.1 7.0 7.5 7.7 6.5 7.1 8.0 9.3 9.2 6.6 - NCE 70 68 70 63 60 62 74 68 73 68 78 80 63 - O TEST TCS/2 CBI 115 SCORES OEQ lANA NVRB NEN VRB NPA 411 921 731 60 94 / 8 AGE 11 6 2 ISTEP• SCO NP GRADE 6 AA GE NC DATE 10/99 ES READING READ VOC COP LANGUAGE LANG MEP* COP MATHEMATICS MATH COMP CMP TOTL SCOR ISTEPi RESULTS E/LA MATH CE 71 9.1 65 70 67 7.4 59 69 72 8.2 63 70 85 10.7 72 68 61 7.3 56 64 76 9.0 65 67 82 8.3 69 62 29 5.2 38 57 59 6.6 53 60 70 8.0 61 68 STANDARD OBTAINED CATEGORY 480 523 ABOVE 479 528 ABOVE EFTA01710053 NM Terrablova CMS FORM/ SCORE 2 !.. .. LEVEL NP NORMS DATE' 1996 • A-19 NS QUARTER MONTH; 03 GRADE OE PATTERN (IRT) 9.0 NCE DATE N832520[SSN REDACTED]1 09/02 READING READ VOC CMP LANGUAGE LANG NECK CMP MATHEMATICS MATH COMP CMP TOIL SCOR SCI SOC STD? SPEL 1 60 64 62 62 74 69 87 72 82 72 15 30 61 - 6 [repeated 6 times] 7 6 7 6 3 4 6 - 10.3 10.2 10.2 10.6 12.0 10.8 12.4 11.8 12.2 10.9 5.1 6.6 10.3 - 55 57 [repeated 3 times] 64 61 73 62 69 62 29 39 56 - EFTA01710054 liC SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) pu..04-A 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 waling the correct infomiation above ft (2) SACO:00E /a 612 (4) ALSO KNOW?: AS , (its) fit °p a) Rol, g i- f_ (,,)se, ,flIRACEEMNICCAIGIN O I-American Indian/Alaskan Native O 8-fliark, Non-Hispanic U H-Hispanic O kAsian/Pacilic Islander -ESW-White, Non-Hispanic O M-Multiracial i ElPIKEOR ORM (SI St M um 3 fir I -1±1 aunts Lt. ko _ c o wily 03) RESIDENT STA= O O. Foreign Exchange Student K • O I.OUL-0(COUlty Resident O Oa Resident 00 USA ENTRY DATE dedVOMYYY) OS) IMPACT SURVEY 2. -of-state YES NO S 3. In-county Resident O KI A. The student resides on federal property. o Er B. The student resides in low rent housing. O O C. The parent is employed on federal property located In PE County. O gl D. The parent Is employed on low rent housing located In P5 County. O El E The parent is in the urdorrned services of the United States. (IS)PAESCI4COLENFIOUJIENt WIFORMATON Place an z by each program attendee. Also, ingrate with ea seen* p) the worm you child ...az in ti• longed. O N. Non-subsidized Chad Care O M. Migrant Pre-K O D. Pre-( Diabaties O H. Headstan O I. Pre-K Eady Interventon O C. Chapter I Os. Subsidized Chid Care O 0. Other O O If E. is YES. is the parent on active duty? Check senice below: 0 Mt Fate ['Army • Coast Gird Oma,‘,... O 'atonal Guard O Navy On IS TIE STUDENT A SINGL PARDT O E YES O NO C el) CURRENT GRADE LEVEL BITIANSEXMINEORMAT1ON net wet L 0Ckt or SCHOOL Centre IRANSFEFdetoG FROM h School ROI CIIT OR LOCADON CT INT( ISt ..1 .hk_. fi l--K1 LLOCt ejtvid -5, pa LAST AT DATE 03 sawn AlT0400a IN MAIMACH COMM /* (Q DATE ATTENDED m PBC EA •EENING NEORmATION os )Students wilt receive non-invasive health screenings pursuant to ROdda Stituta § 381.0056(7)(0 Noninvasive screenings may Include vision. hearing. scoliosis. height, and weight These tests may be given Individually Or in grail's. Parent or wardens, however, have the right to request an exemption in writing. If you DO NOT want your clod to receive the saeenings, write the words 'Do not screen' hero: (Ins exemption wIll COM all t)1es of screenings) pent give permission for my chid to participate in the sedan fluoride program to prevent tooth decay. 0 YES O NO (Permission Is valid through grade 6) I j27) DOES yours:hid currently have health Insurance? lit YES O NO If YES. Indicate: • Medicaid O Healthy Kidsti0d Care liZI Private . O Interested In receiving information itiaitIsTAZENtslirsoiattitENCHP0UNtx ON) tIONE CA./ ACC SURVEY 1.3 YES BI NO 1. Is a language other than English used in the home? If YES, what Language? O YES 14 NO 2 Doti the student have a first language other than English? If YES, what language? O YES 0 NO 3. Does the student most frequently speak a language other than English? If YES. what language? (22) 4. What language Is spoken in the home by the parent or guardian? t a 15 I i 11 CM 6. What-language is the students first language? I I sn (31)What C the date of entry ha ESOL program? (32) Moan DYES VIM-1: Wed or) O Mother U Father Parents ,(!caoth pal asougSusEs FOR ENtRY MO PSC SCHOOL DGTRICT O Other YES O [repeated 3 times] 1. Has the student ever been expelled from school? 2. Has the student ever had an arrest resulting in a charge? 3. Has the student ever had any juvenile justice rations? (34) CUSTODY spays or sTuCCHT (used awe O Mother O Father O Shared Custody MI Other (34) Is there If YES, a court order barring either parent from removing or contacting the student during the school day? U YES Wil0 provide the sotto& with a copy of the court order. PBSD 0636 (REV. 02/04/2002) page t o12 EFTA01710055 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION v - ! -. an k C A- t STATE ZIP COCE pa d 6. FL d3V I1 On l0Jtii Palm STATE ZIP CODE PL 334 1 ' 0OCUPATON nr, ecse4 nr ATION bit nu, mak ix &• 1;3 41) PLACE OF BIAPLOWENT NOSE m.DIC1IE NUSINESS TaDNON CELLNAGER NOUSCR IOW VEUNIINNE NUOINESSTELEPIONE CEDPOER Marna (MAX ADDRESS (ooRRAO EMAIL ADDRESS (cptiol) E GEt MN Person(s) other than parent authorized to pick up student pet PASSWORD I rottaiono &LS e- NAME (fest Nab Neat are . • .• ADDRESS Orve senNw. ..at apart remlon no MAW Fist male Mist WU ADC41= RAnDic MN( 1.90.-mmni ......, sainismisi gimingieri E . _ STATE zp,... I I I nib, 6 F • 3,3 Vl i ON STATE MADE e. (-- 414 Wo i_ L.-- ' ' 33(1108 pg AMNON.= TN CPins AO.ATIONAaP (Az) ALITHOTEZED TOR DISCO( POOR YES • NO PICKUP YES • NO (RD NEW' II INFOraMTION (Pa studeces Arnevun. bane, Matt (t3) If school personnel are unable lo contact you In case of ilness or' eccklent; may we have your pennissicn to cal your doctor.or. 'emergency services (91 I) for transport to the • rile!? IN YES O NO bean a.** feioltgrev *S.W. birde. Main Co PAPAMEAM AndradOIS• or ohm filysical intatkat) psi Friar PHYSICIAN MAINCISICIME NOE EreirftED E-• CD+P C ALL U G Have fated out an (4.5) you application for free end reduced lunch? n YES Ns( rio 11 Yn,S tUOSI- (4pp:calico is provide w1.1 this brm) • — 1;iiiia1 4 W P N W 11-***1 411 - ii .. .. .F ...g.1 5:Aa (NA NAME OF CHILD ANA maxAN ) 1. SCNO0 All — ENGING SFUCENT NO. letialiN GRACE DATEOTORTil Opt NAME or awl) (Inc an*. CO 031. ATTENDING SIOCCHT NO MS'n$ WWI( DATE OF ',MTN (Si) NAME OF OND (int /NAM ittu SCI001 ATTENDING STUDENT NO. (cpoona9 GRADE DATE OF DIM (52) NAME OF CHAD Oat "Aida WO SO-DO. ATTENDING STUDENT 113. (optarisO GRADE DATE OF OATH PARENT/GUARDIAN SIGNATURE I verify that the information given RIO S cs3):04,0 (SODOM ICI. DECO. ca WRY CO OT DOM DAN MI GALre ON CA4_ Is true and accurate to the best of my knowledge. WI TFADER NI EIREASSOICOIN otatarianteurica O PBC Bus s O Palm Tran WON MiTIE !WC A O PirelWSNIeferlan. O Waill OSIke , 2 3 4 5 0 2 6 7 8 9 T' AS) OCOMEMATIONOLIOW Atami toMMI, onon malice O Immursita6ons (date) O Bath Records Venl. (date) 0 SOC. Sec. No. (tire) O Physical Exams (date) gii 63 9GNATLAIE OF PARENT /GUARDIAN DATE INNATA WPM MINATO PT DAIL I PBS0 0636 (REV. 02/04/2002) page 2 of 2 EFTA01710056 Principal GRADE REPORT 02/03 F!£KLUV 4 219-S65-8551 Homeroom: 9217 0630031 F Counselor: MAY Gr: SUBJECT COU GP GP EX FG GP GP EX FG CRED CRED TEACHER COMMENT 1 2 3 4 SEMI SEM2 09 ABS GP4 Cmp Kybd 2 B20800 MMERWRIMPOMMEMO A B B+ A- 1.00 Foods I 2 C63200 D- F F F Poor test/quiz scores Does not complete work mmilimilimillmmi31210 C C 8+ C+ C- C A- C 1.00 1.00 Snan II 9 F72010 C- D+ F D 1.00 ..ai H50100 C+ C+ C C+ 1.00 Wld Geoa 2 H50400 D- F F F Alg I M81410 C C- C C- F C F 1.00 w ripi P40300 A C B .50 Tnt Cm/Ph S85610 B C F- C+ F F F F 1.00 Does not complete work Intro Jour T30710 D+ C B C B D C- C 1.00 1.00 Qtr. #4 GPA: 1.142 Days Absent: 0 (9.5 YTD) Cur. Sem. GPA: 1.095 Class Rank: 543 of 672 Cum. Sem. GPA: 1.822 Lake Central High School 8400 Wicker Ave St. John, IN 46373 TO THE PARENTS OF: Crown Point, IN 46307 GRADE KEY A - Superior B - Good C - Average D - Below Average F - Failure P - Pass N - No Grade Given WF - Withdraw Fail I - Incomplete W - Withdraw CUMULATIVE CREDITS: 13.00 EFTA01710057 YOUR SOCIAL SECURITY CARD Detach the card below and sign it in ink immediately. Do not laminate your card. Carry it in your purse or wallet. tecord your number elsewhere for ea new application and submit ou may also have to submit aai Security office immediately to d card with the same number. i make sure your employer copies anted correctly. eordkeeping purposes. Such use's on's Social Security number by r between the organization and the is to get information from your -our number must tell you whether testing the number, and tell you w to work in mis moony. your Social immigration officials will be ast a year or more. —to sign up for Medicare. EFTA01710058 VILLAGE UTILITIES OF ROYAL F . 1050 Poyat Pain Reach RNA ,toyet P:00) • ACCOUNT NUMBER 45394-25005 RVI ADDRCSS SERVICE PER 6/23/03 To' 7/25/03 Service Curr Read Prey WA LOW 33 Description Of Charges WA WATER SW SEWER CD SANITATION VILLAGE TAX CYi *nut DATE Appt IFS TO CURRENT CHARGES ONLy TOTAL CURRENT CHARGES PREVIOUS BALANCE TOTAL DUE t o Florida Power Light Company Miami, PO Box 025576 33102 PPL B 4,8 4203 7 IBWNDJNQ *** AUTO **CO 113809618 i3613343BC11574061 1 ROYAL PALM BE IFFL 33411-6806 IdlndluLdn 1111 Read 26 'EP" I> E 9/01/03 J1.4lith :AYS Usage 32 Amount ROYAL PALM BEA 25.90 26.71 7.03 2.59 Aftaa (.9 :-1 'tali* 74 EMMITInIrreirlerr H cia„;; 41,1 3ILt DATE 0 / i" 03 TOTAL DUE • DATE C /15/, , GTE', 05-2 62. 00 000(.......000622 3 67: :23 • P DUE ,A11- • , 1111htla:11:ii:M illeif la /flit if ifii:ii Ifilii Messages 27 30 Please request changes on me back. I added my donation for the Care to Share Energy Fund Notes on the front will not be detected. to help those In need. (Fill In or other amount) 0 [repeated 5 times] $1 $2 $5 $10 other PLEASE ENTER TOTAL AMOUNT PAID Make check payable to FPL In U.S. funds and mall along with this coupon to: FPL GENERAL MAIL FACILITY MIAMI FL 33188.0001 NEW Charges Past Due Total Now Due AUG 21 2003 $228.20 EFTA01710059 I' FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.032, 402.305, 402.313, Florida Statutes; rules 640-3.011.65C-22.006, 65C-20.01I, Florida Administrative Code LAST NAME PARENT OR GUARDIAN 11 1.1O15 (MO/DA/Vit) CHILD'S SS# (optional) STATE IMMUNIZATION 10k' Directions: • Enter all appropriate doses and dates below. • Sign and date appropriate certificate (A-I, A-2, B, or C) on reverse side of form. • If the child is presenting for the 7' grade requirement only and has previously filed a Certificate of Immunization (DH 680, Part A-I) with their current Florida school, fill in boxed areas below and complete Part A-2 on the reverse side of this form. • For additional information: Sec Immunization Guidelines for School and Child Care Facilities for information and instructions on form completion and immunization requirements. Guidelines arc available from the local county health department. I The state immunization ID# is an identifier supplied by the state immunization registry (optional). 2 DTP/DTaP 5 doses required. If the 4' primary dose is administered on or after the 4* birthday a 51" dose is not required. 3 UT (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 3t' dose in an all OPV or all WV series is administered on or after the 4th birthday, a 4" dose is no 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 atter I" birthday. Second dose (measles) valid if given at least I month after Is dose. A 2n° dose of measle (preferably MMR) is required for students in grades K-6 and 7"' grade entry and attendance effective with the 1997/1998 schoo year. In each subsequent year thereafter, the next highest grades are included. 8 Includes single measles vaccine (U), single mumps vaccine (11) or single rubella vaccine (I). 9 Hepatitis B vaccine series is required for Th grade entry and attendance effective with the 1997/1998 school year and kindergartei entry and attendance effective with 1998/1999 school year. In each subsequent year thereafter the next highest grades ar 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 I, 2001. Varicella vaccine is require, for entry and attendance in preschool and kindergarten effective with the 2001/2002 school year. In each subsequent year thereato the next highest grades are included. Susceptible children 13 years of age or older should receive 2 doses, given at least 4 week apart. Varicella vaccine is not required if child has documentation of history of varicella disease. EFTA01710060 LAST NAME FIRST MI DOB (MO/DA/YR) Certificate of Immunization for K-12 Excluding 7th Grade Requirements PART A-1 (Immunizations are complete for school entry and attendance grades kindergarten through 12 with the exception of the 7th grade requirement.) DOE Code I I have reviewed the records available and to the best of my knowledge. the above named child has been adequately immunized against diphtheria. tetanus. pertussis, polio, measles, mumps. rubella and hepatitis El (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 (fork' i year) for school attendance as documented on the reverse side of this form. Physician or Clinic Na Physician or (Print or stamp) Authorized Signatu Add Date: Df~ 1)-3 Certificate of Immunization Supplement for 7th Grade Requirement PART A-2 (Immunizations are complete for students who enter or attend the 7th grade after the beginning of the 1997/98 school year. Each subsequent year thereafter, the next highest grade will be included in the requirement.) DOE Code 8 I have reviewed the records available, and to the best of my knowledge, the above named child has received the following immunizations required for entry and attendance in 7$ grade effective with the 1997/98 school year: tetanus-diphtheria booster, hepatitis B vaccine series, and second dose of measles vaccine as documented on the reverse side of this form (boxed areas). Physician or Clinic Name: Physician or (Print or stamp) Authorized Signature: Address: Date: 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 certifr 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. Physician or Clinic Name: Expiration Date: (Print or sump) (15 days after next immunization appointment) 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 / certify that the physical condition of this 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 680 7/2601. °WW1 tuba editions (Stock Nunties: S740-000-06804) EFTA01710061 LAST NAME FIRST MI DOB (mainAnt) Certificate of Immunization for K-12 Excluding 71° 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 / 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)? (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 200//7002 school year) for school attendance as documented on the reverse side of this form. Physician or Clinic Physician or (Print or stamp) uthorized Signatur Ad Date: Certificate of Immunization Supplement for 7ib 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 8 vaccine series, and second dose of measles vaccine as documented on the reverse side of this form (bused areas). Physician or Clinic Name: Physician or (Print or stamp) Address: Authorized Signature: Date: Temporary Medical Exemption PART B (For children in child cart, family day care, preschool and grades kindergarten through 12 who are incomplete for immunizations in Part A-1 or A-2.) Invalid without expiration date. DOE Code 2 I certify that the above named child has received the immunizations documented on the reverse side of this form and has commenced a schedule to complete the required imn:unizatinns Additional immunizations are not medically indicated at this time Expiration Date: (15 days after next immunization appointment) Physician or Clinic Name: (Print or stamp) Address: Physician ur 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 certify that the physical condition of this chili as such that immunization(S) as indicated in Part C above is medically contraindicated. Physician or Clinic Name: (Print or stamp) Physician Signature: Address: Date: DU 680 7/2001. obsoletes ea-Itcr cdttIons (Steck Number: 5740-000-0680-6) EFTA01710062 FLORIDA DFPARChegr OP SALT FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.032, 402.305, 402.313, Florida Statutes; rules 64D-3.0 I I, 65C-22.006, 65C-20.011, Florida Administrative Code LAST NAME 1RST NAME MI TOH O/DA/YR) PARENT OR GUARDIAN CHILD'S SS# (optional) STATE IMMUNIZATION ID#' Directions: • Enter all appropriate doses and dates below. • Sign and date appropriate certificate (A-I, A-2, B. or C) on reverse side of form. • If the child is presenting for the 7' grade requirement pnly and has previously filed a Certificate of Immunization (DH 680, Part A-I) with their current Florida school, fill in boxed areas below and complete Part A-2 on the reverse side of this form. • For additional information: See Immunization Guidelines for School and Child Care Facilities for information and instructions on form completion and immunization requirements. Guidelines are available from the local county health department. DTaI DT Td' Polio MMI Hepa Varic Vs I The state immunization IDN is an identifier supplied by the state immunization registry (optional). 2 DTP/DTaP 5 doses required. If the 4' primary dose is administered on or alter the 4' birthday a 5' 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 4' dose is not required. Polio vaccine is not required for children 18 years of age or older. Hib is required for child care, family day care and preschool entry and attendance only. First dose valid if given on or after I" birthday. Second dose (measles) valid if given at least I month after I" dose. A 2i0 dose of measles (preferably MMR) is required for students in grades K-6 and 7' 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 (O). single mumps vaccine (H) or single rubella vaccine (1). 9 Hepatitis B vaccine series is required for 7' grade entry and attendance effective with the 1997/1998 school year and kindergarten entry and attendance effective with 1998/1999 school year. In each subsequent year thereafter the next highest grades are included. Hepatitis B vaccine series is required for preschool entry and attendance effective with the 2001/2002 school year. 10 Varicella is required for entry and attendance in child care and family day care effective July I, 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 arc 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. EFTA01710063 EASkf NAME DOB 0110/DANR) Certificate of immunization for K-12 Excluding 716 Grade Requirements PART A-1 (Immunizations are complete for school entry and attendance grades kindergarten through 12 with the exception of the 7h grade requirement.) DOE Code I 1 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 8 (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 kindergar r effective with t 1/2002 school year) for school auendance as documented on the reverse side of this form. Physician or Clinic N Physician or (Print or stamp) Authorized Signaitir Add Date: c4024 3 Certificate of Immunization Supplement for "Pb Grade Requirement PART A-2 (Immunizations arc 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 I have reviewed she records available. and to the hest of my knowledge, the above named child has received the following immunizations required far entry and attendance in 7' grade effective with the 1997/98 school year: tetanus-diphtheria booster, hepatitis B vaccine series, and second dose measles vaccine as documented on the reverse side of this form (boxed areas). Physician or Clinic Name: Physician or (Print or stamp) Authorized Signature: of Address: Date: Temporary Medical Exemption PART B (For children in child care, family day care, preschool and grades kindergarten immunizations in Part A-I or A-2.) Invalid without expiration date. DOE Code I certifr that the above named child has received the immunizations documented on the complete the required immunizations. Additional immunizations are not medically indicated Physician or Clinic Name: (Print or stamp) through 12 who are incomplete for 2 reverse side of this form and has commenced a schedule at this time. to Expiration Date: (IS days after next immunization appointment) Physician Address: Authorized Signature: or 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 1 certify that the physical condition of this 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: DM 080 1/2001. obioleits culla editions iSitxk Number 5740-0110-IX.80-6) EFTA01710064 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.032, 402.305, 402.313, Florida Statutes; rules 641)-3.011, 65C-22.006, 65C-20.011, Florida Administrative Code LASTNAME FIRQ:fri r TA-NiE MI 1.1O11 (MO/DANR) PARENT OR GUARDIAN CHILD'S SS# (optional) STATE IMMUNIZATION ID#' 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* grade requirement only and has previously filed a Certificate of Immunization (DH 680, Part A-I) with their cunent 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. DTaPilD DT' Tdi Polio' Nib. MN1R Hepatit Varicell Vatic 1 Th 2 DTP/DTaP 5 doses required. If the 4* primary dose is administered on or after the 4* birthday a 5' dose is not required. 3 DT (pediatric) is acceptable if pcnussis 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 3r° dose in an all OPV or all IPV series is administered on or after the 4" birthday, a 4th dose is not required. Polio vaccine is not required for children 18 years of age or older. 6 Nib is required for child care, family day care and preschool entry and attendance only. 7 First dose valid if given on or after Is' birthday. Second dose (measles) valid if given at least I month after rdose. A 2"d dose of measles (preferably MMR) is required for students in grades K-6 and 7th grade entry and attendance effective with the 1997/1998 school year. In each subsequent year thereafter, the next highest grades are included. 8 Includes single measles vaccine (G), single mumps vaccine (H) or single rubella vaccine (1). 9 Hepatitis B vaccine series is required for 7" grade entry and attendance effective with the 1997/1998 school year and kindergarten entry and attendance effective with 1998/1999 school year. In each subsequent year thereafter the next highest grades are included. Ilcpatitis 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. EFTA01710065 HEALT School itntry Health hxam Page 2 of 2 Name Child il-tst Piro %%idle rif 11/4 PART II — MEDICAL EVALUATION To be completed and signed by the Health Care Provider ONLY: The child named above has had a complete history and physical exam on the following date: (Elam must he Mithin one year of ennillment Birth Date! Screcnin -7 74 —air, lay Y ear 'S Ilcig Lead: Urinalysis: Right 20/_ Left 201 Passed 134 Vision - Without Glasses Hearing — Right Passed$ Failed n Referred K Vision - With Glasses Right '0/ 2s2._ Left 10/ fin_ Failed Referred 0 Fl l fearing — Left Passed/ 9j Failed n Referred K Gross dental (teeth and gums) [3-Normal E Abnormal Refer/Tx: Head/scalp/skin izr Normal E Abnormal Refer/Tx: Eyes/Fars/Noce/Throat [J' Normal D Abnormal Refer/Tx: Chest/Lungs/Heart g- Normal D Abnormal Refer/Tx: Abdomen [no Nomial D Abnormal Refer/Tx: Postural assessment R....Normal 7 Abnormal Refer/Tx: TB risk assessment done 3- - (Please review lbrgeted Testing Guidelines listed below.) This child has the following problems that may impact the educational experience: D Vision 0 Hearing K Speech/Language K Physical Specify: 0 Social/Behavioral Cognitive n This child has a health condition that may require emergency action at school. e.g. seitures, allergies. Specify below. (This form will be stored in the child's Cumulative Health Folder and mar be accessed by both school and health personnel) Recommendations (Attach additional sheet if necessary): (Please Check One) Di chis child may participate fully in school activities including physical education. 0 This child may participate in school activities including physical education with the following resuictionladaptation. (Specify reason and restriction) Signature/Tkle of Health Care Provider Da amt Please print or stamp xLIN-ms... I ailaritn1 lltberculosis Targeted Testing Guidelines for Health Care Presiders Thberculosis Infection Risk: Review the following risks and administer a hfantoux TB skin test if child is in one or more categories. The 1B lest is administered contldentiallv as pan of the health examination. Do not recant administration of any TB test or related information on this form. • Recent immigrant (< 5 years), frequent visitor to TB endemic areas • Close contact to active TR case • Frequent contact with adults at high-risk for disease, HIV+, homeless, incarcerated, illicit drug user • HIV+ or have other medical conditions that increase the risk to progress from infection to disease. e.g.. chronic renal failure, diabetes. hematologic or any other malignancy. weight loss > l0k of ideal body weight, on immunosuppressive medications /tense TB Disease Risk; • Does the child exhibit signs/symptoms of tuberculosis (e.g. cough for three weeks or longer. weight loss. loss of appetite)? • If symptoms are present, work-up or refer for TB disease evaluation. DH 3040, 6/02 (Obsoletes previous nektons which may not be used) Stock Number 5744-000-3040-2 EFTA01710066 IHEALMI) STALE OF ittOlUL1A School Entry Health Exam Page 1 of 2 lb Parent/Guardbn: Please complete and sign Pan I - Child's Medical History. State law for school entry requires a health examination by a legally qualified professional. Additional requirements may be determined by local school districts. (Please Print) antioaseirtrasrmawmm EMINIPPIRMIN tc ■iTirritilTrIregielni kirt.11.31r. PART I — CHILD'S MEDICAL HISTORY lb ParenUGuardian: Please check answers to questions I through 8 below in the column on the left (Please explain any "Yes" answers in the space pm;ideil below.) 1. Yes 0 No N. Any concerns about general health (eating and sleeping habits, weight. etc.)? 2. Yes No 0 Any other specific illness or social/emotional or behavioral problems? ja 3. Yes No af Any glIergjes (food, insects, medication, etc.)? 4. Yes No 0 Any prescription medication (daily or occasionally)? No 0 Any problems with vision, hearing, or speech (glasses, contacts, car tubes, hearing aids)? No oAny hospitalization, operation, or major illness (specify problem)? Any significant injury or accident (specify problem)? Would you like to discuss anything about your child's health with a school nurse? To Parent/Guardian: Please explain any "Yes" answers from above. I am the parent/guardian of the child named above. I give permission for the information on PARTS I and II of this form provided about my child to be reviewed and utilized only by the staff of this school and any school health personnel providing school health services in the district for the limited nernosit of meeting any child's health and educational needs. IX> g /5 / 6:).3 Signature of Parentfliardlan Partnership for School Readiness Recommendations for Prekindergarten and Kindergarten To Parent/Guardian: Please obtain the services Hued below in order to find any problems. Please work with your health care provider to correct or treat any problems that may reduce your child's ability to learn in school. (These services are recommended but not required.) 1. Comprehensive Vision Examination (3-5 years of age) Date of Exam: Please describe any corrective action for any problems detected and any accommodations required. Results of Exam: Health Care Provider: (check one) Optometrist • Ophthahnologisin 2. Comprehensive Dental Examination Date of Exam: Please describe any corrective action for any problems detected and any accommodations required. Results of Exam: Dentist: 3. Hearing Screening Date of Exam: Please describe any corrective action for any problems detected and any accommodations required. Results of Exam: Health Care Provider: DH 3040. 6/02 (Obscaetes previous editions which may not be used) Stock Number 5744-000-3040-2 EFTA01710067 TEST RECORD INFORMATION FLORIDA COMPREHENSIVE ASSESSMENT TEST IFCAT) OCTOBER 2004 SUNSHINE STATE STANDARDS STUDENT:l.p.... GRADE: 11 DISTRICT: SID: SCHOOL: 2331 ROYAL PALM BEACH HIG DOB: READING SS: 348 PASSED MATH SS: 354 PASSED READING DSS: 2186 MATH DSS: 2110 FRT PBSD D280 (REV. 7/15/97) EFTA01710068 TEST DATE SAT DE C 05 c1P2ADI COP SA' Program I he College Board S A 550 T I 1 SAT w 500 SAT MC 52 SAT (MY 06 EFTA01710069 Nam STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES CUMULATIVE SCHOOL HEALTH RECORD (This form Is not Intended for physician's usc) Address Date of Birth Place of Birt Immunization Certification: Special Immunization Programs A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES Sex g School Father's Name Mother's Name erg 14 Yes 0 Non Birth Recorded: YES O No El Screening and Assessment Grades K-3 I< 1 2 3 Screening Date T.1 :i3 '71) E Outcome Screening Date To t <I) c. Et Outcome co c 'E 4) CD CO 22 0 —'t CT> o CE E 8 0 Screening Date 0 to cc Outcome Vision Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Physical Assessment Dther Dther Screening and Assessment Grades 4.8 4 5 6 7 8 c O) C O 0 7, t oO Referral Outcome c a c _ 0 arm mO co t co 15 CC Outcome F C 0 O "t is mO co To tz O o ii Outcome c =m in to mO ci) To ,-- 0 7,5 E co Outcome c c To =a 0 to mO c. Ts <D (1) E Outcome /ision -fearing -leight. Weight & Graphing lutrition )ental Health dental Health ;ommunicable Disease lecords Review 'hysical Assessment ;coliosis )ther )they IRS,14 Rum Ar1d1 MAY rcionioroo nra.6nu. etA;4;•••••• •••...11 \Ara I nn.. EFTA01710070