EFTA Document EFTA01710073

? ..44 ".an 3/41..7.0 .".4, 4 1:S; 143;S . iep•••067. 3n./444A--:,-fr:Ccrew.954.1.3,-..;-Woo...a.-• ••••••”Arre.:4•••, #••-•..4... r. • EFTA01710073 A j ogi • A 1 EFTA01710074 DIST:2331 TCHR NBR:114 STDT CRS:1001400 SEC:004 BLDG:03 RM:221 08/01/05 ° IA THE SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) New and Returning Student Registration SP.:0.7, 4TNULIf FP mem SAC COI GlLua! Si ENTRY DALE EN CD 1o6A1 i2 o8/t0/05 got Complete ALL AREAS on both sides of the form (except areas in gray). Correct any preprinted information. Do not leave any area unanswered. ALL students MUST COMPLETE a registration form ANNUALLY. AL KNOWN AS SCalliiiillii sed Of as egetwari mate. atc is *cab) MEd' MUSING DEVELOPMENT ftepplbable) L0XAMTCHIll FL 3/3470 , MAWS ADDRESS faun mate ord steal on. sportiniolmomte; a t arch zip co: Is) HOME TELEPHONE NUMBER I DAY ENE TELEPHONE NUMBER EVENNOTREPHPIE NUMBER PARENT CELUPAGER NUMBER SEX 649 F RAGGED/MC ORb3M w O A - Asian/Racilic Islander O i - American Indian/Alaskan Native O B - Black Non-Hispanic O H - Hispanic O W - Whke, Non-Hispanic O M - Mutiracial DATE OF BIRTH nw< OF °MTH (alas a S cowly) 'PLACE 3 RESCE PA' STATUS O O. Fcgreign Exchange Student O 1. Out-d-courtyReeldent O 2. Out-of-state Resident O 3.in-county Resident USA ENTRY DATE 1. Federal Impact Survey A. The student resides on federal property. O Yes O No B. The student resides in low rent housing. O Yes O No C. The parent is employed on federal property-located in Palm Beach County. O Yes O No D. The parent is employed on low rent housing located in Palm Beach County. O Yes O No E. The parent is in the uniformed services of the United States. O Yes O No If "E" is YES, is the parent on active duty? O Yes O No (check service below) O Air Force O Army O Coast Guard O National Guard O Navy O Marines 2. Preschool Enrollment Information N (Check each program attended. Indicate wth an asterisk lithe program your chid was in the longest.) O Fee for Services O Head Start O Pre-K Disabilities O Private Pre-K O School-based (Pre-K) O Teenage Parent Program O None 3. Is the student who is enrolling in school a single parent? O Yes O No N 4. Students will receive non-invasive health screenings pursuant to Florida Statute § 381.0058(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 WI 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. YES K Yes (Pemission is void through grade 5.) O No 6. Does your child currently have health insurance? )es D No If YES, check insurance plan: O Medicaid O Healthy Kids/Kid Care rivate O 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? O Yes (language) 1/4-6. B. Does the student have a first language other than English? O Yes (language) C. Does the student most frequentlygal?5anguage of er than EnglishkO Yes (language) 8. Name of the last schoo attended . / 6 4 CatO A City State B. County Pet alearC-nt C. Last grade level completed / Last attendance date ? dry (A IS or ev? D. Does your child have O Individual Education Plan (IEP) O 504 Plan Other Plan? (I Medi& provides copy) P650 0636 (Rev. oit2smos) pap 1 of 2 EFTA01710075 LEGAL NAME pea( 6* t .,, fS " b. Disclosures for entry into Palm Beach County School District (check all that apply) 0 The student has had juvenile justice actions taken against him/her. 011ie student has been expelled from school. 0 The student has been arrested resulting in a charge. of applicable 10. AInd with whom the student lives (check one only) te Both Parents 0 Mother 0 Father 0 Foster 0 Group Home 0 Student is ward of the state 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 th day or coming into contact with the student? If Yes, provide school with a copy of court order. Yes B. Parents DO NOT have shared parental responsibility 0 If checked provide school with copy of court order. 12. Providethe following parentilegal guardian Information school No PAM:WOG] M BGAPrIAN OFR RA middle NIOPECI F NOT DC SAME AS STUDENT(bows Amber and *vet nano. apartment no. city, 'PP, v0 0:40) NEWTON IC NOME TELEPHONE I BUSINESS TELEPHOtE AN Rest Ant mid* indie0 CEU. NUFEER E-MAIL ADCRESSRP90W AS SPKIENT(ors number end *oaf name. aparlmont no, any, slab, zip cot) FL 33470 TFIEPHOW aUSWFSS TFI FPNO CELL MJFAEII3 RAMIL ADORES S(oFbasi) 13 I ist names and data of birth of oaranre tonal onartflan's der Beach County schools. 14. Provide the name(s) of person(s), other than the parent, allowed to pick up the student. NAME Ms miles RELATIONSHP TO STUDENT IELSONE GELUPAGER WAFER I OTHER 15. Provide a password th (limited to 10 characters 16. Does the student have any allergies? (if yes specify) ID Yes No Allergy. 17. List students illnesses, behavior issues, medications or physical limitations. student will use. 18. Physician Name Telephone Number Parental Consent for Release of Student Information I hereby give permission for the school or District to use my chid's photograph, video image, varkig, voice recording, name, grade level, school name, participation in officially recognized activities and sports, weight 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)cx similar school-or District-sponsored publcations or In schoolor District-approved news media Interviews and photographs. I understand without my signature my chlds name and photograph cannot and wM not be included in any pubications or presertations. lets° understand and agree that my chdds medical records or other medical Information that I provide to the school, and treatment records or other rnedcal records created by health care personnel at a legitimate educational pur for accessing d-> OA Verification of Student Registration Information I verify that the information given on this student registration is true and accurate to the best of my Registration i‘not valid without a verification signature and date. page 2 of 2 EFTA01710076 Date: 11/02/05 Student Reading & Mathematics Report Fail 2005-Retake This report shows your results from the retake of the Grade 10 Florida Comprehensive Assessment Testis). Passing both the Grade 10 Reading and Mathematics tests is a requirement for a standard Florida high school diploma. 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 on the challenging content that Florida students are expected to know. Your Scores and Performance Levels Reading Level 5 2311-3008 Level 3 2068-2218 Level 1 844-1851 You have passed the FCAT Reading Retake test. Your FCAT score is which is in achievement Level' for Reading. This score shows your achievement on the day you were tested. If you were to take the same test a aln, It is like) that your Reading score would be between ID School 2331-ROYAL PALM BEACH HIGH District SO-PALM BEACH Grade 12 Mathematics You do not have a Mathematics score for the following reason: NT (Not Tested) If you took the test but did not receive a score, be sure to contact your school about locating your Mathematics FCAT score. EFTA01710077 F880- Podia heortlerohr assiamtai ku Student Report Fall 2005-Retake Page 2 Your Reading Content Scores You have passed the Reading section of the FCAT Content areas Points you earned Points possible Words/Phrases Main Idea/Purpose 22 Comparisons 15 Reference/Research 8 Your Mathematics Content Scores You do not have a score in this assessment for the following reason: NT (Not Tested) Content areas Points you earned Points possible Number Sense Measurement Geometry Algebraic Thinking Data Analysis and Probability School 2331—ROYAL PALM BEACH HIGH District 50—PALM BEACH Grade 12 The chart to the left gives more specific information about your performance on the content areas tested by the FCAT. For each content area, students should be able to do the following: Words and Phrases in Context Selects and uses strategies to understand words and text; makes and confirms inferences from a reading text; Interprets data presentations (e.g. maps, diagrams, graphs, and statistical illustrations). Main Idea, Plot, and Purpose Determines stated or implied main idea; identifies relevant details; identifies methods of development; determines author's purpose and point of view; identifies devices of persuasion and methods of appeal; identifies and analyzes complex elements of plot le.g. setting, tone, major events, and conflicts and resolutions). Comparisons and Cause/Effect Recognizes the use of comparison and contrast; recognizes cause-and-effect relationships. Reference and Research Locates, gathers, analyzes, and evaluates information for a variety of purposes; selects and uses appropriate study and research skills and tools according to the type of Information being gathered or organized; analyzes the validity and reliability of primary source Information and uses the information appropriately; synthesizes information from multiple sources to draw conclusions. The chart to the left gives more specific information about your performance on the content areas tested by the FCAT. For each content area, students should be able to do the following: Number Sense, Concepts, and Operations Identifies operations x, +) and the effects of operations; determines estimates; knows how numbers are represented and used. Measurement Recognizes measurements and units of measurement; compares, contrasts, and converts measurements. Geometry and Spatial Sense Describes, draws, identifies, and analyzes two-and three-dimensional shapes; visualizes and illustrates changes in shapes; uses coordinate geometry. Algebraic Thinking Describes, analyzes, and generalizes patterns, relations, and functions; writes and uses expressions, equations, inequalities, graphs, and formulas. Data Analysis and Probability Analyzes, organizes, and interprets data; Identifies patterns and makes predictions, Inferences, and valid conclusions; uses probability and statistics. If you need to retake the FCAT Talk to your guidance counselor. Many school districts have specialized programs to help students in earning passing scores on tffe FCAT, including before and after school programs, summer school, tutoring, intensive reading or mathematics classes, and computer-assisted instruction. Sign up for an intensive reading or mathematics class to sharpen your skills with extra instruction-to strengthen your weak areas. These classes count as electives to help you meet your minimum credit requirement for graduation. Visit FLAT Explorer at www.fcatexplorer.com. This site offers FCAT-like practice in reading and mathematics to help you prepare for retaking the FCAT. Log in using your sign-in name and password or call 1388.750.FCAT. Stay in the Loop Make sure you receive a copy of the Stay In the Loop flyer distributed by your school to all students who have not passed the FCAT. Stay in the Loop contains tips, ideas, and recommendations for retaking the FCAT and earning your high school degree. You can also access the flyer online at http://www.fim.edu/doe/commhome/12grade/twelhome.him. Facts.org Provided free to students by the Florida Department of Education, www.Facts.org is Florida's official online student advising system. You can start thinking about careers, evaluate your progress through high school, learn about higher education opportunities in Florida, and more. Copyright 0 MK State of fkriela Department ol State C0:51-24-953 EFTA01710078 Florida Compreherobe Assersmelt Its! Spring 2005 Florida Comprehensive Assessment Test (FCAT) SSS Reading and SSS Mathematics Retake Tests Grade 11 Student Report NAME: ID: SCHOOL: 2331-ROYAL PALM BEACH HIGH DISTRICT: 50-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 dploma. 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 challenging content that Florida students are expected to know. Your Reading Results You did not pass the Grade 10 FCAT Reading test. Talk to youi teacher or guidance counselor to find out about ways to improve and when you may retake the test. Your Reading Content Content Areas Points Earned Fonts Possible Words/Phrases 13 Main Idea/Purpose 20 Comparisons 12 Reference/Research 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. • Ahin Idea/Purpose -determines a stated or implied essential message, details, author's purpose; or plot. • Conliarlions -knows similar and different, cause and effect, and contrast. Reference/Research-uses information from a varietyof sources le reach conclusions. Your Reading FCAT Score FCAT Score' Achievement Level Passed I • 3000 2400 1800 1200 600 0 'This score you were test again score would Swam Soon PassnsiScore shows your achievement on rho day tested. II you were to Wes tho same a is likely that your 2005 Reading be between 1786 and 1948. Your Mathematics Results We were unable to find a Mathematics adore that matched your student identification number. If you took the test this year, be sure to contact your school about locating your FCAT test scores. Your Mathematics Content Content Areas Points Earned Points Possible Number Sense Measurement Geometry Algebraic Thinking Data Analysis Mathematics Content • Content scores give more specific information about the skits on the FCAT. Grade level expectations for students include: • Number Sense •uses number concepts and computation • Measurement-solves problems involving measurements, e.g., tine, length, area. • Geometry - analyzes and combines shapes to solve problemi. • Algebraic Thinking -analyzes patterns and uses equations and inequardies. • Data Analysts and Probability -uses data analysis tools to cfsplay information, make predictions and make inferences. Your Mathematics FCAT Score FLAT Score' Achievement Level Passed NT NT 3000 2400 1800 1200 600 0 StreientScore PassingSeem NT=Not Tested NR=Not Reported Data Run Date: 04/21/2C05 0010583 EFTA01710079 SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) New and Returning Student Registration NEW STUDENTS: Complete all areas on both sides of the form except areas specified. 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. Complete any areas that are blank. (I) STLOENT NUAIBER CI) SAC CODE (3) GRADE LEVEL 106A . 11 DIST:2331 TCHR (4 SRICENEGAL EMT= (5) ALSO KNOWN AS (e) LOCAL ADDRESS (house na a drool name) ON no.) (44') (state) (ao <caw LOXAHATCHEE FL 33470 (7) ALARM ADDRESS (hoes* no. 6 'Minn) (apt no) feed (slate) RIP cod. (a) SOCIAL SECURITY NO (ophone0 (9) HOME TELEPHONE NO. (12) DATE Of MTH (13) MACE OF BIRTH (city, LS ceneery) (11MAXWYYY) (1C) SE:1 F (11) RACE/Ell-RICORIGIN Native 0 B-Black, Non-Hispanic 0 W-White, Non-Hispanic • I-American Indian/Alaskan • H-Hispanic 0 A-Asian/Pacific Islander 0 M-Multiraclal (14) 0 RESIDENT STATUS 0. Foreign Exchange3 Student 1. Out-of-county Resident 2. Out-of-slate Resident 3. In-county Resident (1S) USA ENTRY DATE (MAADONYYY) • • 0 0 (1s) FEDERAL IMPACT SURVEY YES NO located located the United Check service 0 National in PB County. in PB County. States. below: N indicate with an he longest. Prekindergarten Prekindergarten Parent Program Applicable 0 • A. The student resides on federal property. (17) PRESCHOOL ENROLLMENT INFCRIAATION Place on X by each program attended. Also, asterisk () the program your child was in 0 C. Title I Prekindergarten 0 M. Migrant 0 D. Pre-K Disabilities 0 N. None 0 F. Fee for Services 0 P. Private 0 H. Head Start 0 T. Teenage Program 0 Z. Not 0 L. Readiness K • 0 B. The student resides in low rent housing. 0 0 C. The parent is employed on federal property 0 0 D. The parent is employed on low rent housing 0 0 E. The parent is in the uniformed services of 0 0 If E. IS YES, Is the parent on active duty? 0 Air Force 0 Army 0 Coast Guard 0 Marines Guard • Navy on Is the student a Single parent? N 0 YES 0 NO TRANSFER STUDENT Only students transferring from another school complete this section (19) NAME Cf SCHOOL TRANSFERRING FROM (20) WWI STATE I COUNTY =WRY (21) LAST ATTENDANCE DATE (22) LAST GRADE LEVEL (23) Have you ever been enrolled In a Palm Beach County School? DYES 0 NO If yes, what school? (21) DATE ATTENDED IN PBC All new and returning students compete the remaining form including page 2 rzsi Students will receive non-Invasive health screenings pursuant to Florida vision, heating, scoliosb, height, and weight These tests may be given individually right to request an exemption in writing. If you DO NOT want your child (This exemption war cover at types Statute § 381.0056(7)(d). Non-Invasive screenings may include or in groups. Parents or guardians, however, have the to receive the screenings, write the words "Do not screen" hue: of screenings) to prevent tooth decay. 0 YES 0 NO 0 Interested in receiving information CM • I give permission for my child to participate in the sodium fluoride program (Permission is valid (hmugh grade 6) YES (27) Does your child currently have health insurance? 0 YES 0 NO If YES, indicate: 0 Medicaid 0 Healthy Kids/Kid Care 0 Private (29) NOME LANGUAGE SURVEY (Chock so that Appy) 0 A language other than English Is used in the home. 0 The student has a first language other than English. 0 The student most frequently speaks a language other than English. What language? What language? What language? (2a) OSCLOSURES FOR ENTRY INTO PSC SCHOOL DISTRICT (cheek ell Mel epohi) had juvenile justice actions taken against himtner. • The student has been expelled from school. 0 The student has • The student has arrested resulting in a charge. (33) STUDENT LNES WITH: (check one) C31) CUSTODY STATUS OF STUDENT (check One) 0 Mother 0 Father 0 Shared Custody 0 Other 0 Mother 0 Father 0 Seth Parents 0 Foster • Group Home 0 Other NBR:012 STDT CRS:1000410 .SEC:006 BLDG:03 F04:210 08/11/04 IMPORTANT INFORMATION - MUST BE COMPLETED (32) is there a court order barring either parent from removing or contacting the student during the school day? K Yes it No If YES, provide the school with a copy of the court order. PBSD 0636 (Rev. 03/17/2004) page 1 of 2 EFTA01710080 PARENT/LEGAL GUARDIAN INFORMATION c FATHER CR LEGAL GUARDAN (PA ISOM RMS.. 1140 (34) DAN OF BIRTH (M) MOTHER OR LEGAL GUARDIAN RR mUdIelneSe4 bat) (45) DATE 0 F BIRTH (35) ADDRESS (43•444 number. alit Iipletbrent number) ADDRESS Net ramie stvM aparlmen! number) (38) CITY STATE OP CODE NEWTON NC (47) CITY STATE OP CCOE LOXAHATCHEE FL 33470 (37) CCCUP ANON (38)HCHEST ED. LEVEL (44 OCCUPATION (43) HOE ST ED. LEVEL C (39) PLACE OF EMPLOYMENT (50) RACE OF EMPLOYMENT (40) HOME TELEPHONE (4 I) BUSINESS TELEPHONE (42) CEWPAGER MIAMI SI HOME TELEPHONE S3 BUSINESS TELEPHONE CELUPAGER NUMBER (43) EMAIL ADDRESS (optena0 (54) EMAIL ADDRESS (xRGAs0 EMERGENCY HEALTH AND SAFETY INFORMATION Provide name(s) of person(s), other than parent, allowed to pick up student. 11%) PASSWORD (lime locharecan) 111111111 02) NAME fa=t mid:Nina( WI) 163) ADDRESS (street numbs; fleet apstmool numboul (58) CRY STATE ZP CCOE LOXAHATCHEE FL 33470 (84) CITY STATE ZP CCOE (59) RELATION:MR PO) TEIEPHONE (On) CaLPAGER NUMBER 835) RBATONSNP OTHER (DO TELERCHE (S) CELUPAGER MADER OTHER . mg stunerrs ALLERGIES (c43NR Orme apply and specify) O None O Animals O Binds O Replies O Amphibian O Plants O Food O Other Specify CR PHYSCAL UMITATIONS (70) FAMILY RDSICIAN (69) UST srucerrs MAWS. BEHAVIOR ISSUES, MEDCATONS (71) PHYSICIAN PHONE NAMES OF PARENTS/LEGAL GUARDIAN'S OTHER CHILDREN (722NME CR CHAD (fist onside blatlas0 (73) SOCOL AMONG \ ON al %%Cr) W ‘r) (7RsTuceilNakano (75)GRADE la r . • . I • • (78) SCHOC4. ATTENCING 01 rta1rn !1/21 Y) (79) STUDENT NO. (Rfons0 (80) GRADE 4 int 013)9ptOl ATTBCING Nome S.,(Thed (64 STUDENT NO. DRion80 PS) GRADE q DATE OF BIRTH INFORMATION VERIFICATION I verify that the information given is true and accurate to the best of my knowledge. PARENT/GUARDIAN CONSENT I understand and agree that all educational records of rry chid may be shared with the Districts health care partners and other govemmental and social agencies Jointly seeing the child or having a legitimate Interest In the records, as needed to provide and evaluate health services and government/social services to students. I also rrederstand and agree that my child's medical records or other metal information that I provide to the schod, and treatment records or other medical records created by health care p who have a leg kimate educational purpos Documei COB US CAI TeacherNo. O Irwin SI. Entry Code EU I Reassign. Code K arth RecadeVerifcalion ❑,Pain Tran St. Entry Dale MU 11/04 Beth Venicalon ESOI Entry Date DCF O Social Security Welber aParentiSluderaTraworiaticn O Physical Exams O Wak O Bike O Address Vreificalicn PBSD 06:36 (REV. 03/17/2004) page 2 of 2 EFTA01710081 FCAT Score Spring 2003 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Grade 09 Student Report 2331-RIPA1.7 2d AtglnigEACH HIGH District Number and Name: 50-PALM BEACH The Florida Departmentof Education believesthat evegy student has the ability to learn and succeed. The purposeof the FCAT is to ensure that Florida's public schools are providing the best education possible, and preparing students to succeed in the competitive 21st Century Job market. Working with teachers, the State has developeda measurement system that allows you to track a students academic achievement from year to year and determine if a year's worth of learning has occurred in a year's time. This system also allows you to compare a student's score to a Score that represents 'grade level' achievement if a students score is above the 'grade lever score, then they are performingat a level above their current grade. If it is below, they are In need of Improvement Using the 'Content Scores,' you are ablelo Identify any Specific academic skills needing Improvement. Below you will find your 2003 FCAT Reading and Mathematics scores,as well as your scores from previous years. The chart on the right side of the page shows your score compared to the score that represents grade level achievement. Your Reading score Is on grade level. You have answered many of the questions on FCAT correctly. 2003 Reading Content Scores Content Areas Points Possible Points Earned vioraswnrases 7 I Main Idea/Purpose 78 Comparisons 10 Reference/Research 10 Year 2001 2002 2003 Grade Tested Achievement Level FCAT Store • Your Mathematics score is on grade level. You have answered many of the questions on FCAT correctly. 2003 Mathematics Content Scores Points Points Content Areas Possible Earned Number Sense 8 Measurement 7 Geometry 11 Algebraic Thinking 10 Data Analysis 8 Grade Tested Achievement Level FCAT Score • 3000 Reading 2500- 200C- 1000- 500- Grade 3 Grad ad 10 it Grade Grades ■ Your Score O On Grade Level Mathematics Ortie 3 Orris Gado Cade Grad 10' 11 • Yratr score o 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 probabl would have been between Your 2003 FCAT Mathematics scores probably would have been between NT= Not Tested NR on Not Reported NA= Data Not Available Data Run Date 05/09/2003 0162395 EFTA01710082 FCAT Reports Separate reports are produced for the Sunshine State Standards tests in FCAT Reading and Mathematics, Science, and Writing. A separate report is also printed for the norm-referenced tests in Reading and Mathematics. FCAT Norm-Referenced Test (NRT) Report The FCAT NRT report shows reading and mathematics scores on a Florida version of the SAT9 (published by Harcourt Educational Measurement). Student scores are compared to a national "norm" group, where a percentile rank score of 50 is average. Sunshine State Standards (SSS) Reports The FCAT SSS Reading, Mathematics, and Science reports show test scores from Florida's tests of academic standards. These reports contain subject scores and content scores. Subject scores describe the overall achievement, and content scores give the number of points earned in specific skill areas. Success on the Reading and Mathematics tests can be best understood by using the achievement leveis where a 3 or higher is on or aboye grade levei. Achievement Leveis Five categories of achievement describe the success students have with the content testad on the FCAT Reading and Mathematics. Level 5 is the highest and Level 1 is the lowest. Since science achievement leveis have not been determined, science scores are ranked as to whether they fali in the lowest, middle, or highest third of statewide student performance. 5 This student has success with the most challenging content of the Sunshine State Standards. A student scoring In Level 5 answers most of the test questions correctly, including the most challenging questions. 4 This student has success with the challenging content of the Sunshine State Standards. A student scoring in Level 4 answers most of the test questions correctly, but may have only some success with questions that reflect the most challenging content. 3 This student has partial success with the challenging content of lhe Sunshlne State Standards, but performance is inconsistent. A student scoring in Levei 3 answers many of the test questions correctly, but is generally less successful with questions that are the most challenging. 2 This student has limited success with the challenging content of the Sunshine State Standards. 1 This student has little success with the challenging content of the Sunshlne State Standards. FCAT Certificates Students who earn Level 5 scores or whose science scale scores are greater than 400 receive Certificates of Achievement. For writing, certificates are given to ali students with soores of 5.5 or 6 and to fourth graders with scores of 5, 5.5, and 6. Certlficates are not awarded based on the FCAT Norm-Referenced Test scores. Informes FCAT (Spanish) Se preparan informes separados para los exámenes del FCAT de lectura y matemáticas, ciencias y redacción según las normas estatales Sunshine State Standards. También se imprime otro informe por separado para los exámenes de lectura y matemáticas de acuerdo a las normas de aplicación nacional. Informe sobre el FCAT ceñido a normas de aplicación nacional (NRT) El informe del FCAT NRT presenta los resultados de lectura y matemáticas en una versión del estado de Florida del SAT9 (publicada por Harcourt Educational Measurement). Los resultados obtenidos por los estudiantes se comparan con el grupo modelo o "normas, en el que la clasificación es de un 50% del promedio. Informes según las normas estatales Sunshlne State Standards (SSS) Los informes según las normas estatales SSS del FCAT presentan las calificaciones de los exámenes de lectura, matemáticas y ciencias de las normas académicas de Florida. Estos informes contienen calificaciones por materias y calificaciones por contenido. Las calificaciones por materia proporcionan un resumen general del rendimiento y las calificaciones por contenido que proveen el número de puntos obtenidos en áreas de habilidades específicas. El éxito de los exámenes de lectura y matemáticas puede entenderse mejor utilizando los niveles de rendimiento en los que una calificación de 3 o superior está al nivel del grado o por encima. Niveles de rendimiento El éxito que un estudiante ha logrado en el contenido examinado en el FCAT de lectura y matemáticas se describe por medio de cinco categorías. El nivel 5 es el más alto y el nivel 1 es el más bajo. Como los niveles de rendimiento en ciencias no se han determinado, las calificaciones de ciencias se clasifican con respecto a si entran dentro del tercio inferior, medio o superior del rendimiento estudiantil a nivel estatal. 5 Este estudiante tiene éxito con el contenido más difícil de las normas Sunshlne State Standards. Un estudiante del Nivel 5 responde a la mayoría de las preguntas del examen correctamente, incluyendo las preguntas más difíciles. 4 Este estudiante tiene éxito con el contenido difícil de las normas Sunshine State Standards. Un estudiante del Nivel 4 responde a la mayoría de las preguntas correctamente, pero es posible que sólo tenga cierto éxito con las preguntan que reflejan el contenido más difícil. 3 Este estudiante tiene un éxito parcial con el contenido difícil de las normas Sunshine State Standards, pero su rendimiento es inconsistente. Un estudiante del Nivel 3 responde muchas de las preguntas del examen correctamente, pero por lo general tiene menos éxito con las preguntas que son más difíciles. 2 Este estudiante tiene éxito limitado con el contenido difícil de las normas Sunshine State Standards. 1 Este estudiante tiene poco éxito con el contenido difícil de las normas Sunshine State Standards. Certificados del FCAT Los estudiantes que se clasifiquen en el Nivel 5 o cuyos resultados de ciencias sean superiores a 400, reciben Certificados de rendimiento. En redacción, los certificados se otorgan a todos los estudiantes que han obtenido calificaciones de 5.5 y 6, y a los estudiantes de cuarto grado que han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados en los resultados del FCAT ceñido a normas de aplicación nacional. Rapó FCAT (Haitian Creole) Yo prepare rapó apa pou egzamen lekti ak matematik, syans ak redaksyon FCAT bay swivan prensip Sunshine State Standards yo. Yo ekri yon rapó apa tou pou lekti ak matematik pou "model egzamen ofisyèl FCAT itilize pou fè evalyasyon" an. Rapó egzamen ofisyèl FCAT itilize pou fè evalyasyon (NRT) Rapo FCAT NRT a montre nót lekti ak matematik nan vifisyon Florida genyen pou SAT9 Ia (Se Harcourt Educational Measurement ki pibdiye li.) Yo konpare no( elèv la ak yon gwoup nót yo konsidere kom "modèl pou egzamen ofisyèl" la, kote swivan klasman pa pousantaj la, nót mwayèn nan se 50. Rapó Sunshine State Standards (SSS) Rapó FCAT SSS pou lekti, matematik ak syans lan montre nót elèv yo fè nan egzamen Florida bay sou prensip akademik yo. Rapó sa yo gen nót pou matyè ak nót pou kontni ladan yo. Nót pou matyè yo dekri tout sa elèv la reyallze anjeneral epi nót pou kontnl yo bay kantite pwen elèv la fè nan yon matyè byen detèmine. Ou ka konprann kisa elèv la reyalize nan egzamen lekti ak matematik la pi byen si w itilize yon nivo siksè kote 3 oswa plis se yon nót kl nan nivo klas la oswa yon not ki pi wo pase nivo Idas la. Nivo siksè elèv yo Gen senk kategori siksè ki dekri nivo siksè elèv yo pote nan kontni yo teste nan egzamen lekti ak matematik FCAT la. Pi gwo nivo a se nivo 5 epi pi piti nivo a se nivo 1. Piske yo poko detèmlnen n'yo siksè nan egzamenn syans lan, yo klase nót pou syans lan swivan si li tonbe pi ba, nan mitan oswa pi wo yon tyè pèfómans elèv toupatou nan eta a. 5 Elèv sa a gen siksè nan matyè ki te gen pi plis difikilte ladan yo nan egzamen Sunshine State Standards la. Yon elèv ki nan 5yem Nivo reponn pitó kesyon egzamen yo kdreldeman, elèv la menm reponn kesyon kl gen pi plis difikilte ladan yo. 4 Ello/ sa a gen siksè nan matyè ki te gen difikilte ladan yo nan egzamen Sunshine State Standards la. Yon elèv ki nan 4yem Nivo reponn pitó kesyon egzamen yo ktnekteman, men li ka gen kek slksè sèlman nan kesyon ki sanble yo gen pi plis difikilte ladan yo. 3 Elèv sa a gen enpe siksè nan matyè ki gen difikilte ladan yo nan egzamen Sunshine State Standards la, men pètómans lan pa rete estab. Yon elèv ki nan 3yèrn Nivo reponn anpil nan kesyon egzamen yo kóritskteman, men anjeneral li gen mwens siksè ak kesyon kl sanble yo gen pi plis difikilte ladan yo. 2 Elèv sa a gen siksè limite nan matyè ki gen difikilte ladan yo nan egzamen Sunshlne State Standards la. 1 Elèv sa a gen yon ti siksè tou piti nan matyè Id gen difikilte ladan yo nan egzamen Sunshine State Standards la. Sètifika FCAT Elèv ki fè nót 5yem Nivo oswa elèv ki fè gwo not ki pi plis pase 400 nan syans ap resevwa Sètifika pou Siksè. Yo bay tout elèv ki fè nót 5.5 oswa 6 ak elèv klas katriyèm ki té nót 5, 5.5, ak 6 yon sètifika pou redaksyon. Yo pa bay sèfifika swivan nót elèv fè nan egzamen ki bazo sou "modèl egzamen ofisyèl FCAT itilize pou fè evalyasyon" (NRT) an. EFTA01710083 Hui ba;:iPatiniv; ses- stes Th It; I Spring 2004 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Science Performance Task Student Report Grade 10 This report provides your results on the FCAT 2004 Science performance tasks. Each performance task on FCAT requires you to respond with either a short response or a longer, more detailed response. Shed-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. Ike Nam diva Is owed Magian' plats that awned Wend with ea el Gahm ;Nor Ter tonte plebs GM* Wald Dewar a poker erect ant a mole& fortnatIon that cm row when plate cralide. \4r ern WAes rt.n ram ink a (Tv: e;;Olono . at NM ).4 a die FCAT 2004 SCIENCE PERFORMANCE TASKS Student Name Student Number School Name School Number District Name District Number ROYAL PALM BEACH HIGH 2331 PALM BEACH 50 1h* Pert rnian co Tass Response All Scienat Performance Task Responses Points Possible 2 10 Points Earned I I Data Run Dale: 0413072004 0054490 685000916 EFTA01710084 Spring 2004 NAME: . , Florida Comprehensive Assessment Test (FCAT) ID: Meth CompreM1ensl.ee Assessment Test SSS Science Student and Parent Report Grade 10 SCHOOL: DISTRICT: 2331•ROYAL PALM BEACH HIGH 50-PALM BEACH The Florida Department of Education believes that El Florida Department of Education (Depanamento Depatman Edkasyon nan Florida kwe chat limoun every student has the ability to learn and succeed. de Education del wads de Florida) see que todos gen kapashe pou aprann epi gen sine. Objektif The purpose of the FCAT is to ensure that Florida's bs estudantes lienen la capaddad de spender y FCAT la se pou yo ka seten lekol piblik nan Florida public schools are providing the best education toner exits. El proposito del FCAT os asegurar que ap bay pi bon edkasyon ki posb Is epi yap prepare Potable and preparing students to succeed for the Las escuelas pub/Gas de Florida prOpOrtionen la el& yo you yo ka gen same nan lavni. future. major education posble y preparen a bs estudiantes pare tenor exits en el future Yo identify° yon nivo konesans ki elve nan Syans se A high level of science knowledge has been identified yon baggy ki esansyll pou yen moon ka gen same as Clftbal for success in the competitive 21st century Se ha demostrado quo. Para el exile en el nan konpotisyon ki genyen nan (might travay la nan job market Yanking with Florida educators, the state Gormand.* mercado labors.' del siglo X)0. es crucial 2lyem bre* La. Eta Florida a travay ansanm Sc has developed a test to measure a student's poser un alto nivel tie conocimientos do ciencias pwofesii yo pou yo devlope yon egnamen ki pemet achievement of the important science skills in the Trabajendo con educadores de Florida. el estado ha yo moths ranninan yon elin nan egzamen syans ki Sunshine State Standards. This report provides your desamollado un examen pare rnedr los logros de un enpMan nan Sunshine State Standards la. Rapti sa student's 2004 Science Score which Slows you to °Studien!e en materia de ciencias de acuerdo a las a bay Not cloy to nan Syans pou An* 2004 la epi sa compare your students performance to the rtormas Sunshine Slate Standards. Este inforrne pained ou konpare pbbmans elev ou yo ak paltimans performance of other students in the state. In proportIona a su °studente la caked& de tat clew nan Eta a. Anplis, not yo Id nan rape a cdo addition. the content scores help you to identify ciencias de 2004, lo que le permite corrparar el ou idantiye nan ki rialye akademk ettif la bezwon to acadom'c skills that may need improvement rendimiento de su estudiante con la de otros estudantes en el estado. Adicionalmente. as calFicaciones de contenido le ayudan a Identifies as hank:lades academicas en las que puede ser nooesario mejorar. amolyorasyon. Your 2004 Science Content Scores Content Areas Physical and Chemical Earth and Space Life and Environmental Scientific Thinking Points Earned Points Possible Percent Compared to Other Students Low Middle High Your 2004 FCAT Science Score Compared to Other Students Score • Low Middle High 500 403 300 200 100 Students Score Stotrerkeworia This score shows your achievement on the day you were tested. If you were to take this test again, It is likely that your 2004 FCAT Science score would be between 258 and 288. Science Content Contenido de ciencias Kisa Id gen nan egzamen syans Ian • Physical and Chemical Science- explains matter, motion, force, and energy including their properties and interactions; also identifies • Cienclas 1 biros y quimicas -explican la materia, el movimlento, la rueaa y la energfa, inctuyenoo sus propiedades e Interactions; • Syans I izik ak chimik. esplike malYe, mouvman, Ids, ak enep, sa vie di pwopriyete yo ak lam youn nsyak ak l0t; epi lou Idantilye atoms, elements, compounds, and mixtures. tambien identitican los Stomos, elementos, compuestos y mezcias: atom, eleman, konpoze chimik ak melanj. • Earth and Space Science- explains Earth's • Syans late ak espos• esplike charilman Id lel changes over time including geologic patterns, the rock cycle, minerals and weather systems; also describes the solar system and universe. • acacias de la Tierra y el espacio explican los camblos de la Tierra a 'raves del tempo, Incluyendo bs patronesgeologicos, el clef° de las rocas, minerateS y SIStemaS sou Late ane apre ane. sa vie dl arolivile jewolojik, faz with, &stem mineral ak ststem ameteyo a, epi II deka sistern sole a ak neve a. • Life and Environmental Science- identifies rreteorot0gicos; tamblen descnben el &sterna Syans biyolojik ak anviwonman idantif ye and explains plants, animals, and the solar y el universo. • clot esplike plant, bet, ak anviwonman an, sa environment, Including life processes, conservation of resources, and the • Ciencias de la vide y el medic ambient° vle dl pwosesls toryoloirk, konsevasyon resous yo, ak entedepandans &can's ak sistern yo. interdependence el organisms and systems. identifican y explican las plantas, animates y el medic ambiente, Incloyendo los procesos Rezonman syanlifik- lake pwosede syantilik ll Scientific Thinking- applies scientific vitales, la conservation de recursos y la • pou rezoud pwobkm, rekonet regilarite ak processes to problem solving, recognizes interdependenica de organismos y astemas. cistern, epl konprann enpak teknoloji sou patterns and systems, and understands the lasosyete. Impact of technology on society. • Pensaniento cientifico- apace procesos cientificos a la resolution de problemas, reconoce patrones y sislemas, y comprende el impacts de la tecnologia en la socreoact. Data Run Date: 04/2912004 0057835 EFTA01710085 Spring 2004 Florida Comprehensive Assessment Test (FCAT) NORM-REFERENCED TEST Grade 10 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 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 National Percentile Rank Stanine The Scale Score describes your performance on the test and allows for comparisons from year to year. Reading Comprehensbn Scale Scores range from 527 to 817. Mathematics Scale Scores range from 568 to 863. The National Percentile Rank (NPR) and Stanine indicate your relative standing in comparison to the national reference group. National Percentile Ranks range from 1 to 99. The PR score indicates the percent or students in the national sample who scored equal to or below your score. Starines range from I to 9 where I Is low and 9 is high. Stanines in the range of 4-6 are considered average scores. II you were to take the test again, your National Percentile Rank might be slightly higher or lower. However, your National Percentie Rank would probably fall within a certain range. For Reading Comprehension, your National Percentile Rank should be between 27 and 51. For Mathematics, your National Percentile Rank should be between 26 and 56. CONTENT SCORES Number of Questions on Test Number of Questions Attempted Number of Correct Responses Reading Comprehension 51 51 Inaial Understanding 8 8 Interpretation 22 22 Critical Analysis 9 9 Strategies 12 12 Mathematics 48 48 Problem Solving 6 6 Algebra 6 6 Statistics 6 6 Probability 5 5 Functions 5 5 Geometry-Synthetic 7 Geometryalgebralc 4 4 Trigonometry 3 3 Discrete Math 3 3 Pre calculus 3 3 Data Run Date: 04/16/2004 0140635 EFTA01710086 FCAT florkle(omethessiveAssessmier lot Spring 2004 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Reading Performance Task Student Report Grade 10 This report provides your results on the FCAT 2O04 Reading performance tasks. Each performance task on FCAT requires you to respond with either a short response or a longer, more detailed response. Short-response tasks are scored on a 2-point rubric and extendec-response tasks are scored on a 4-point rubric. One of II a a/tor-response tasks is shown below with a copy of you arswer. The number of points you earned 'or you• answer is shown in the box to the right. This task required you to read an article about a young man who creates a successful business by salvaging lost golf balls. Task: Select one of the following personality traits and show how it helped Jim Reid build a successful career. Use details and information from the article to support your response. Daring Hardworking Imagnative FCAT 2004 READING PERFORMANCE TASKS Student Name Student Number School Name School Number District Name District Numoer ROYAL PALM BEACH HIGH 2331 PALM BEACH 50 This Performance Task Response All Reading Performance Task Respoinies Points Possible 2 10 Points Earned -3,OTh tc2C'S a \Jell afteirmor Malt When hP c.r.)\- cb‘okt \ Pa \f"Iv- (Greer, eNtryone \ "t3Jt ht 1/4.0CA-9 %)..)ei f bt,4 reyCY ty4 up. In Ira\ c. 'pee% es \ breed oC 9e e \ be &Aar% SA-ere .13r \-e-An \he &A% toil.1-% tnokes and eel-)— and \IRA rnra V -1011 on 1.4 %col', h;m a io!i. gsx-rseWirts Vitia also hyl by le\-M-Oca 1.3\-06 isncienvoiet Oala Run Date. 05/04/2004 0073095 737200623 EFTA01710087 FCAT (tarifa fceprehernire Asses:min! lest Spring 2004 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Mathematics Performance Task Student Report Grade 10 This report provides your results on the FCAT 2004 Mathematics performance tasks. Each performance task on FCAT requires you to respond with ether a short response or a longer, more detailed response. Short response tasks are scored on a 2-point rubric and extendoC-response tasks are scored on a 4-point rubric. One of the short-response tasks s snown below oath 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 District Number ROYAL PALM BEACH HIGH 2331 PALM BEACH 50 This PerfermanCe Task Response NI Mathematics PerformanCe Tank Responses Points Possible 2 16 Points Earned The cause of the monorail at an arrusemert peek must be changed to make coon for a new puking lot Engineers have decided that only the main supporting Otiturn located at point C on the gnat below should be relocated. They have also decided that the rebuilt course should be in the sluipe of a parriE4ogram. Pan A Plot the new location of the supporting colony% and write Its oondlnitea label the new tor-abort C. MONORAIL COURSE U to i z 6 4 2 0 2 4 4 a JO a. 12 14 14 Poll( Use the definitket a properties of a parallelogram to verily Out the new monorail count is a pratlelogram. You must use the alaia of the sides, the kngdui of die *Ilea or both to help verify your amwec Ike onto ton (4Oxt A 4° ti. 1. ..) IA*. 540* 1toin D I.x C. Data Run Date: 05/04/2004 0072096 737300E03 EFTA01710088 FCAT Florida Comprehensive Assessment Test Spring 2004 Florida Comprehensive Assessment Test (FCAT) Writing Grade 10 Student Report Writing to Explain NAME ID SCHOOL: 233I-ROYAL PALM BEACH HIGH DISTRICT: 50-PALM REACH I 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 (1) 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 a job and explain why you would not like to have this job. Data Run OS 04/07/04 50-2331 EFTA01710089 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 ate generally correct. 5.5: The writing was given a 5 by one reader aad 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 am 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 cutaneous information. An organizational µstern 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 we 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 arc simple. Punctuation and capitalization arc sometimes incorrect. but nest commonly used words arc spelled correctly. 2.5: The writing was given a 2 by one reader and a 3 by the other reader. 2.0: The writing may be slightly related to the topic or offer little relevant information and few supporting ideas or examples. There is little evidence of an organizational pattern. Word choice may be limited or immature. Sentences may be limited to simple constructions. Ftequcnt non may occur in pallslUaliali. capitalization, and spelling 13: The writing was given a I by one reader and a 2 by the other reader. 1.0: The writing may only minimally address the topic because there is little or no development of supporting Ideas or examples. No organizational pattern is evident. Ideas am 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 S 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: Ilse 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 nature command of language. Sentences vary in structure. Punctuation. capitalization, and spelling are generally comet. 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 wrung 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 bccn amcmµed, but lapses may occur. Some of the supporting ideas or examples may not he 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 ot IIIIIILalUIC. Sentences may be limited to simple constructions. Frequent errors may occur in punctuation, capitalization, and spelling. 1.5: The writing was given a I by one reader and a 2 by the other reader. 1.0: The wasting 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. caprulization, and spelling may impede communication. Description of Grade 10 Writing Scores 6.0: The writing focuses on the topic, is logically organized. and includes substantial development of supporting ideas or examples. It demonstrates a mature command of language with freshness of expression. Sentences vary in structure. There arc few, if any, usage, punctuation. or spelling mots. 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 are generally correct. 4.5: The writing was given a 4 by one reader and a 5 by me other reader. 4.0: The writing focuses on the topic, though it may contain loosely related infixwation. An organizational pattern is apparent. Some of the supporting ideas contain specifies and details, hut others do not. Word choice is adequate. Sentences vary• in structure. Usage, punctuation, and spelling are generally COMM 33: The writing was given a 3 by one reader and a 4 by the other reader. 3.0: The writing generally focuses on the topic, though it may contain loosely related information. An organizational pattern is demonstrated. Development of the supporting ideas may be uneven. Word choice is adequate. There is some vanation sentence structure. Usage, punctuation. and spelling arc generally correct. 2.5: The wrung was given a 2 by on: 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 urgamizational 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 lay 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 conuruction, usage. punctuation, and spelling. U: The writing is unrelated to the assigned topic or cannot be read U: The writing is unrelated to the assigned topic or cannot he read. ISDI400 EFTA01710090 4tIOOL et,:\ k THE SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) O W 1 New and Returning Student Registration NEW STUDENTS: Complete all non-shaded areas on both sides of the form. RETURNING STUDENTS. Review both aides If the li e-printed information is nonted correct the information by carefully and lightly crossing out the incorrect information and writing the correct informaton above i DIST:1891 TORS TN8R:107 STDT (3) STUDENTS LEGAL NAME Rog Int iluddir) (4) ALSO KNOWN AS (S) LOCAL ADCRCSS (haunt.° 4 *ORR name) (apt no) RAH (star) OM For) LOXAMATCHEE FL 33470 . ._ . (0) MAILING ADDRESS Douse no 8 street non* (apt no, (cdy1 (3a) (pc CCOO DI SOCIAL SEQ)RRY ND (cot ) (8)IIOME TELEPHONE NO SEX F 113) RACEETHLC ORrinu W 0 I-American IndianrAlaslcan Native 0 B-Black, Nm-Hispanic 0 H-Hispartic 0 A-AseNPaci(ic Islander 0 W-White, Non-Hispanc 0 M-Multiracial 0 ii DATE OF BRTH Yr 02) PLACE OF BRTH (cety stab tan) (13) RESIDENT STATUS 3 U 0. Foreign Exchange Student (II) USA ENTRY DATE (MAVDCNTY V) 0 1. Cut-of-county Resident 0 (151 FEDERAL OAPAST SURVEY 2. Cut-or-state Resident D 3 Jr-county Resident YES NO 0 0 R. The student resides on federal property 0 0 B. The student resides n low rent housing U U C. The parent is employed on federal property located in P.B. County 0 3 D. The parent is employed on low rent housing located n P B. County 0 o E. The parent is in the uniformed services of the Unted States ic) NICSCIOOL CulOL.NICNT iNrCRAJAMON pj Place an X by each program attended Als5 indicate with an asterisk C) the program you chid was in the longest. LJ N Non-subsidized Child Care U M. Migrant Pre-K El D. Pre-K Disabilities M H. Headstart 0 I Pre-K Early Intervention 0 C. Chapter 1 0 S. Subsidized Chid Care 0 0. Other 0 0 If E. is YES, s the parent on active duty? Check service below' 8 Air Force D Army Coast Guard 0 Marines 0 National Guard 0 Navy 17) iS THE STUDENT A SI LE PARENT, NO 0 YES 0 NO (IL) CURRENT CRAM LEVEL 08 TRANSFER INFORMATION (zo)C01. OR LOCATION (211 LAST ATTE/OO.CE 0ATE (2Z LAST ORACC LC 'JCL HEALTH SCREENING (23) LAST FLOCK SCHOOL ATTCNDCD IN PALM MAGI COUNTY INFORMATION (24) DATE ATTChOCD Di PDS FREE OR REDUCED as Students will receive non-invasive health screenings pursuant to Florida Statute 381.0066(7)(d) Non-invasive PRICE LUNCH inCude hearing, height, and These tests be individually screenings may vision scolosis, weight. may given or in groups. Parents or guardians, however, have the right to request an exemption in wrking. If you DO NOT want your child to receive the screenings. wnte ine words -Do not screen- here: Have you filled out an application foe free and (This exemption wit cover aN types or screenings) C26 I give permission for my child to participeae in the sodium fluoride program to prevent tooth decay. 0 YES 0 NO (permission .s vac, through 6th grade) YES reduced lunch? 0 YES 0 NO Application is provided with this form) NEW STUDENTS TO PALM BEACH COUNTY (20; HOVE LANSUA GE SURVEY YES NO 0 0 1. Is a language other than English used in the home? If YES. vnat language? • • 2. Does the student nave a first language other than English? If vES, vnat language? 0 0 3. Does the student most frequently speak a language other than English? If xES. vinet language? cm 4. What language is spoken in the home by the parent or guardian? 00 5. What language is the students fist language? rot what IS the date of entry into an ESOL program? 02) STUDENT LIVES W1TH (Meek one' 0 Mother 0 Father 0 Both Parents 0 Other pa: OISCLCSURES FOR ENTRY NTO PBC SCHOOL D5TRIL. I YEs No 0 0 1. Has the student ever been expeled from school? 0 0 2 Has the student ever had an arrest resulting in a charge? 0 0 3. Has the student ever had any juvenile justice actions? 04)CoSTODY Straus OF STUDENT (checA one) 0 Mother 3 Father 0 Shared Custody 0 Other as: Is thero a court order barring other parer* from removing or contacting the student during the school day? 0 YES 0 NO If YES, provide the school with a copy of the court order L(1) STUDENT NUMBER (2) SAO axe 100A CRS:1400000 SEC:05 BLDG:00 RM:GUID 08/07/01 PBSD 0636 (REV 5/292001) page 1 of 2 \!<„:/ElEAGIC0LES I EFTA01710091 f HE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION _iSi FATHER OR LEGAL GUARDIAN C'. . - . - - . , 4.0 MOTHER CR LEGAL GUARDAN tmedlis m4*t 1441) PU: Y PU: Y ADDRESS new number. Sniff ire velment matted mnr numbs) Car STATE ZIP CODE CITY STATE ZIP CODE LOXAHATCHEE FL 33470 OCCUPAnON OCCUPATION Pt ACE OF FisPtOymENT MACE OF EmP.OyuENT HOME TELEPHONE BJS1NESS TELEPHONE CELJPASER NUMBER HCME TELEPHONE BUSINESS ItEPHON. CELUPAGER NUMBER EMNL ADDRESS (orboado WAIL ADDRESS foobons0 EMERGENCY HEALTH AND SAFETY INFORMATION Person(s) other than parent authorized to pick up student no PASSWORD 0117Y( 10 characters) (39. NAME rest mad* dreSat kist, (0 I) NAME fest mdfle nubs, bro FRIEND EIGHBORS ADDRESS NH* none nay nam• optimal: ntinb00 ADDRESS cmniw numbs. ilnOt name. awhile& weer) CfT( STATE ZIP CODE CRY STATE ZIP COLE TELEPHONE RELAIONSHIP AO) AUTHCRZED FOR TELEPHONE Ramooratro (az AUTHORIZED PCP OTHER EMERGENCY PICKUP 0 YES 0 NO T OTHER EMERGENCv PICKUP 0 TES 0 NO T (43) It school personnel are unable to contact you in may we have your permission to call your doctor emergency Services (91 ) for transport to the case of illness or accident, or hospital? 0 YES 0 NO (44) MEDICAL INFORMATION OW Hydro 'P direAses, b•hera. sew, 64604 *Ines ensicettots. aoffice pgyscill &Moons; (4s) FAMILY PHYSICIAN (46) PHYSICIAN PHONE 46) Does your Child currently have health insurance? CI YES 0 NO It YES. indcatet (47) ICSPITAL PREFERENCE 0 Medicaid • Private 0 Healthy Kids/Kid Care 0 Interested in receiving information PARENT'S/GUARDIAN'S OTHER CHILDREN IN PALM BEACH COUNTY SCHOOLS KHCOL ATTESDPNG STLDEP:T NO (canons) GRADE DATE OF BIR-H kkA\ ?CAM trl (3h \D\ X.LIC ATTE/Ct.:3 CS1,5\j ike_r STUDENT NO foasonsr) GRADE 48. 11111 S.,C0I. ATTEND.* I \ RAttn it i ln fijATTEMDING STUDENT NO (canons/ GRADE (4 C SE' -‘te,C0A tt,V\e. STUDENT NO (apbeni) GRADE Co FOR OFFICE USE ONLY I verify that the information given is true and accurate to the best of 1531SO4 ND 1691 ( . I'S) COB US SO ENVY CO E0i (62) ENTRY uTE 08/14/01 De ot Dv O8 (SI EA 01 DO) WO NO 41) REASDON CODE (62 TRANSPORTATON 0 PfiC PAS li 0 Palm Iran (En WADI ARE 1 2 3 4 5 MR id4S A 0 Pareni/Stuowl Tram 0 'Nat 0 Bke 6 7 8 97 8Z (55)DOCIMENTAT)ON CHECK ST (that al de* sten recove0 0 ETIMMLZatiOnS (date) 0 Birth Records Verif (da e) 0 Soc Sec. No. (date) 0 Physical Exams (date) D6) Cars E MIRY =atm BY DATE page 2 oft EFTA01710092 STUDS Legal - _ SEX RACIAL/ETHNIC GROUP 0 Hispanic STUDENT NUMBER IX White, Not Hispanic 0 American Indian Native Alaskan F 0 Black, Nol Hispanic 0 Asran/Pac 'tic Islander MS BIRTHDATE: Verified by Birth Certificate 0 Yea If Not, What Type Verification? I, 3-44t3 L GUARDIAN OR OTHER RESPONSIBLE ADULT AT HOME: P G OA CURRENT S HO L (use pencil in this space, until final.) Name Street Dee First Entered This District 48 — a s - q 3 Withdrawal Date 1-1 1-9 4 '7 ; dr ewal4pare cal q rii i y, .h t CA. Withdrawal Date City • 33415 FLORIDA PERMANENT RECORD CARD CATEGORY A - Education Records GRADES K-5 od W C req ./ e P; a a Grade: K School: Ao rer9 'gaps Grade: I.5 t Vet I a.eALS! Grade. 2. Schoot Alta laic VC-cl Grade: 5' scs`70yonei311e9sAi •19 Grads/ A,aditi -1$ School Year' 19- 33 -19 14._ School Year 19 3__q_ •19 2,. School Year 19 is , -19 qi. School Year: 19 AL-If/R:7_ Days Present Days Absent Days Pr t 11 Days Absent: 0 Days Present. Days Absent Days Present Days Absent: / 7 9 / 1 70 /0 Oa 7 / 7-5 - Days Present: Days rA a i: Subje:t Teacher Mark Subject Teacher Mark Subject Teacher Mart Subject Teacher Mar S !tact Teacher Mark MATHEMATICS 7z. .) MATHEMATICS MATHEMATICS MATHEMATICS READING MATHEMATICS READING READING READING READING I LANGUAGE LANGUAGE LANGUAGE LANGUAGE LANGUAGE I SPFI LING I SPELLING SPELLING SPELLING SPELLING I HANDWRITING -- - HANDWRITING HANDWRITING HANDWRITING I HANDWRITING I IA SCIENCE and HEALTH I L_ es LA T el O SCIENCE and " SIC allIF F1 e II. SCIENCE and HEALTH Ielliff-MtalI/N14- SCIENCE and H LTH ICAUIFFIlllella. HEASCIENCE and LTH I L BEHAVIOR CODE BEHAVIOR CODE AV RA BEHAVIOR CODE AV RA BEHAVIOR CODE I BEHAVIOR CODE A R I AV RA Indicate Promote IPI Rota n IR1 Summer SChOOI (SS) 9 Itsthcate Promote IPI Retain (R) Summer SCkOOIISS! p Indicate Indicate- Promos IP) Retain (RI Summer SChgel (SS) e Indicate' Promote IP) Retain IlD Summer Scheel IS 4i "") Promote (P) Ratan, IR) Skimmer School 155) School Grade. School Grade: School. Grade School Grade. School Grade School year 19. .19 School Year 19 -19 School Year 19 -19_ School Year' 19 -19_ School Year 19 -19 Days Present: Days Absent: Days Present: Days Absent Days Present DaysAbsent Days Present - Days Absent: Days Present Days Absent. Subject Teacher Mark Subject Teacher Mark Subject Teacher Mart Subject Teacher Mark Subject Teacher Mark MATHEMATICS MATHEMATICS MATHEMATICS MATHEMATICS MATHEMATICS READING READING READING READING READING LANGUAGE LANGUAGE LANGUAGE LANGUAGE LANGUAGE SPEI LING SPELLING SPELLING SPELLING SPELLING HANDWRITING HANDWRITING HANDWRITING HANDWRITING HANDWRITING SOCIALSTUDIES SOCIAL STUDIES SOCIAL STUDIES SOCIAL. STUDIES SOCIAL STUDIES SCIENCE and HEALTH SCIENCE and HEALTH SCIENCE and HEALTH SCIENCE and HEALTH SCIENCE and HEALTH BEHAVIOR CODE AVERAGE_ BEHAVIOR CODE AVERAGE BEHAVIOR CODE AVERAGE BEHAVIOR CODE AVERAGE BEHAVIOR CODE AVERAGE Indicate Promote (P) Retain (RI Summer Scoop 155) Indicate Promote IP) Retain Or) Summer SC1)OO(1551 Indicate Promote (P) Ramon (RI Summer School 155) Indicate Promote (P) Retain(R) Summer School ISS) Indicate. Promote IP/ Retain (R) Summer School (SS) PBSD0932 VN 01-9340 EFTA01710093 STUDENT NAME. SEX RACIAL/ETHNIC GROUP K White. Not Hispanic El Black, Not Hispan c K Hispanic K American Indian/Native Alaskan K Asian/Pacific Islander STUDENT NUMBER CURRENT SCHOOL (use pencil in this space, until final.) Name Street City ADDRESS. BIRTHOATE 0 op (co_ 0 oc2 z Wg8 2 . Q < W co > cc < 4* 0 0 0W (CIL° U. a School Grade School Year 19. .19 Days Present Days Absent. Subject Teethe, Mark MATHEMATICS READING ANGUAGF L P83130932 Subject Teacher Mark SPELLING HANDWRITING SOCIAL STUDIES SCIENCE and HEALTH BEHAVIOR CODE AVERAGE Indicate Promote (PI Retain (RI Summer School ISSI 3._ School Grade School Yost 19. .19 Days Present Days Absent Subject Teacher Mark MATHEMATCS READING ANGUAGF Subject Teacher Mark PF t i INC) HANDWRITING SOCIAL STUDIES SCIENCE and HEALTH BEHAVIOR CODE AVERAGE Indicate Promote (P) Retain (RI Summer School ISS) VII 01-9340 EFTA01710094 ‘.) 4 oat " TN,b School District of Palm Beach County ) A;ts NEW/RETURNING STUDENTS IQ .' kr REGISTRATION .`"", I 4.' VERIFICATION FOR NEW'/RETURNING STUDENTS: TO THE PARENTS OR GUARDIANS: NEW STUDENTS: Comploto all non-shaded arm:. RETURNING STUDENTS. Please review both sides for correctness of typed information shown below and on the \ Cr" suck. c RIP' IT ION: 1441 TCHR : NETTUND, C TNBR: 017 other side. If the information printed is incorrect please 17 correct it by carefully and lightly incor-ect .... 0An 5/09/96 STD crossing out the information and writing the correct information above it. ) u N 12) ALSO KNOWN AS ; IA kW LO Al ADORISS le itAitinctiONSS tit C--k--- , n . KM.' IA Ia' AAA( a, .., WEST PALM BEACH FL 33413 nt . Ltett 1... (SI STUCENTS SOCIAL SEE UM TT NO. 161 HOME PHONE NJ. (OPTIONAL) 0/ SLR F 0 „tome IlD R CE V 0 INDIANC" 0 A ASIAN psLANorq 9 W Zia rr-LISPANIC I MALI I g oNt....e_nmspaic 9 H HISPANIC 0 M IAA Ti -RACIAL !SI OA MTN I {Ill RESIDENT STATUS 1121 ENTRY DATE 3 Li ). FOREIGN EXCHANGE STUDENT INTO USA „.. 0 I OUT-Or -COUNTY NESIDEN, 'IT/ FFOIRAL IMPACT AID SURVIY Ill APPLICABIFI (CHICK THE LETTER COM FOR ONE CODE Oar A. SX;earyeiniV ii ans Iyindiegnepircticiriepareni amployet on m enial 1111 HAS THIS CHID 'MI IMMO in MY PRESCHOOL? N O 2. CUT-OF -STATE RESIDENT 0 .i. IN-COUNTY RESIDENT 08 23 93 O O i with St; . pl.. . sidta an lideral reper4. parent rot on I carrel ... rire ri J btrewit tesms in low lent lloutIRe paint not employe, or I ..... I prowl', Please (lace Macleod Ifol by each regain sr Also. intact,. an sue sk I * I nip grogram year child wag in me Mood sal / O r COPY! i D M MICRANT PRF-i II St IS lit SI WINE A SINCE, 0AIIMITt NO O US O NU I3 ' Sin""esi4416fi nonfederal PrCiPen)' "re" "P" " felt"' proaert, in Pala Bench Coonlv o 0 slut., j: sideft i Int I/snit:en] propel. n: v.! on so., d.:. .. DO. PFIE-IL Lit Oh. ISM3ItrTIES CI N NON-SU3SICIIEC CHU CARE RE- AFLY INTERVENTION ID 0 OTFIR fADSTART O S. SUBSIDIZED NIRO CAM (IS/ GRACE LEVEL 02 TRANSFER INFORMATION: I 117` WAIF U 'CHM. - RANSF.FRRIRC Fun. l. I I. i 115. TAT; LII LAST %IMMO/14M (201 We O 1 t ItVLI •211 LAST P.IBLI: SCHOLL AT Et RUE U IN PALM BE AC‘ LUUN IT 122) DATE ATTENOID FREE OR REDUCED PRICE LUNCH AND HEALTH INFORMATION: (23) NATE YOU FILLED OUT AN APPLICATION FOR F FE I or FEOU:E(I tUN:11? lAsplicatiot is world*, with tars Regollini an Entrn IMI IMI ail (24) HEALTH SCREENINGS: NO I sun pereitti011 ICI my child ma, be onto iaditidtallly or in I] TE4 to be given health screenings 'raise tit:: gtozps _ IC — 1251 SDOIUM FLUORIDE. No I give permissicte lot in, child to to pima, dental deer,. Permission outlaying is the Sofitm Fluoride Propmen I' is valid !flog) grade sin — ❑NO — NEW STUDENTS TO PALM REACH COUNTY: HOME :.LANGUAGE • SURVEY :To be fi.loo oat by now ctudontt. ON-Y)!, •26, Aal7 .erri.t...11i IS 'Jur., ,,, TYE !WE FP n6 P.t- t.,• c. GEE:Arch :, vo,', imitil CI :II Cilliiih P. 1HE , E;!IE E , ME $1-t:ES'' lle. ill TE OF ENTRY iNTO THE (SOL NDGF.Y.. (23) 2 Gams •.. Ruda.. wawa • oar manual,. uurw• wan entat.n, D - 0 ,-. FOR OFFICE USE ONLY: ----. IUD) 9[600[ NO 1311 STUDENT fiwt..6EP .3216110W LAP:LI:ACE EN 03, COS (341 ENTRY CODE E01 (351 ENTRY 0A11 08 23 95 (36 :AC COD — 159A (17) PALENTrtusikOilli ;ANCVAI≥E 1381 OWE LEVEL 1351 CALENDAR 140 If atsfll NO. 1441 IIIIIIII/ EN US 02 01 017 F41) Aff$315/110.NT CV El A• kVA El Eis( 32/ 104NSPORT4TICN N 9 IS 0 NO 1 471 VIRIFINTICA 0, BIRTH .. I4412 ,41S 45) DOCUMENTATION OrCtaIST (M( AND OA'F WHEN RECEIVI 0.6[£410) Ova rt./Army/J.11MS 9 MOP vCctfiCATiON Of BIRTH aitcOMOS 0 6•FSOI. M ,Mat 0 1 2 3 4 5 6 1 3 4 5 A 7 ,8 9 T A 6 2 A. Fu"`V n Bon S0LI St u on PKYSICAt. EXAMI 146) OLT:. WRY COMPI£T10 11,: GATE) 471 I VERIFY THAT THE INIORMATIIN ;WEI IS ME ./ iii.v m AND L CURA I TO THE GIST Of MY MONTE( CI MO 0636 ilfv. 3'96 RATE FRONT EFTA01710095 •••••••• 14ii STLIOCRT WES WITH (OEM ONO 0 10TH ~WS *WEN E IA HER a SHARED EUSToOy 1.. ''' ,iti- p. Cantet (AIII INDISPONno NV S:sdant wdl b. Has go /Oa te Am b., .,.. ri ,,,,, 'ha duaal) /ye_e•V-i-r --- ( 411 it THkRE A COURT ORDER RAIIII.NL EITHEA PARENT SHIM RCI,O s vIN A CONTACTING THE STUDER' DURING THE SCHOOI DAY) , 1 • • TES fro IF YES, PLEASE PROvIDE THE SCHOOL WITH A COPT OF TIE COUR1 ORDER /50 •C iGuARoso. DOL: e ATHER NA CUSTODY) U S 11 I LI DIM/GUARD AN DOES ',OTHER HAVE CUSTODY? Ci TES CI NO NO YES LAST wIR f iJeOrN) ró31 YAgF a I .\ ' LAO Loaf pall MOOS EST PALM BEACH FL 33413 . is era, ZS exd C - ( 1 - 1 i . - O ma« OTT Ven lA cow i Ve-mt- r )9t. K • ótim....0. 0. Cif 10,~111TY 133rlikelarr Irdr. CLF-EGUEATOk t algETE5 EiSbriáLts0 A 9 OSOOITAKT SOTOCa B E ,............ c [5<tt..bra MAW ... Sean li•O• D D r.......----- ........ E K co ea. M: 154 RICHES LEVEL Of EDLKAT1ON COMPLETED (OPTOLLAO _ A .... soca e Li so., son too* C isl itlewita • • C•TSL *.ia D SC•it IOST.IIKOPOw, E 9 :,,...,,—.^—_—"...,...,`" ~it n ore.aiNatiel 551 LEGAL GUARDIAN (IF WM DOES (EGA( GUARDIAN HAVE CUSTO 'n YES [ NO LAST ~LI , "O-, '.." aYtna.l VT. OAR 2. MY eraerc• .,, c, i .„,,-„, •-••••e” ....... BMBNGENCY -HEALTH AND SAFETY INFORMATION 56) PAFi~ Puaodil *Inc ' or o••••1 ..1.,..ne T. p... .,p tr.,tr. IS)J PASSWORD , PH I) tATtONSHtPts. /4-14 r( . /choir / la I — ;LS N Do -fi, YES 0 NO 0 YES 0 ivo 0 YES ]],,0 .. NO 11 PART it in I. •ble t• . .... . •••• • ;0 ••• .. nt:d•it. .sy • I«. yin.. ~inn t• ma yew "at III Seraey Sraell Inn NMI %ISMS/. N. ...» lim WT SONO I) FAMILY DOCTOR 165 PHONE VIC 6 (66) COMM PREFOtEla f V) tk?.._ ( ( C nticv---, 71 AS P t" SI SE ...At or, h€ASE tin .. R. F,_ ,._ (- OTHER PALM BEACH COL1NTY SCHOOLS: L_ 169) SCHOCt /MEAD', e25Lar k_ajte Dl S uCENT NO lOPTIONAll (71) GRADE V7) ORTH DATE inehielke4 _.,12/IteM kitt6t. 3 EFTA01710096 EFTA01710097 H1 Students Full Name — STATE OF FLORIDA DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES " %rarr LTH EXAMINATIONS 'hone Address Rrthcate Name of Parent or Guard.a.. Date Race _ Blood Pressure A. HEALTH EXAMINATION VA-Y3h I (1) Narmal=N; AbnormalaA A COMMENT: Abnormal Findings. by number 1. Appearance 2. Skin/Nose 3. Head/Scalp 4. Eyes 5 Visual Acuity (R d L.' 6 Ears 7. Auditory Acuiy (r) 8 Li 8. Nose ' Throat 9. Mcuth Teeth arc Grms 10. Chest / Lungs 11 Heart 12. Abdomen 13. Genitals and Anus 14. Musculo-Skeletal 15. Neurological 16. Alertness 1' Em0bona1 / Mental Behavior Prob t8. Handicap. "seal. other (Specify) 19. Actrvty Restrictions (Specify' 20. Abuse. substance/ physcal / emotional 21 Nitrition 22 °the- B. HEALTH HISTOR(if (Serous Illnesses Injur•es explain) (attach narrative if additional snipe needed) C. LABORATORY (as indicated) It. He-nOglobtrilklematocrit Stool 1O 8 P) d Tuberculin test. Lead Sickle tell r NAME: TITLE: ADDRESS: • (Please Print) A MRS -N Form 5040, Mar 91 (0bsotetes previous editions LIM Oat am EFTA01710098 D i r e c t i o n g FLORIDA CERTIFICATION OF IMMUNIZATION .006, F.A.C. MO/DNYIt SS# (optional) STATE IMMUNIZATION ID#' • Enter all appropriate doses and dates below. • Sign and date appropriate certificate (A-I, A-2, 8, or C) on reverse side of form. • If the child is presenting for the 7th grade requirement only and has previously filed a Certificaamutization (680A or 68014) with their current Florida school, flu in boxed areas below and complete A- the reverse side of this form. • For additional information: See Immunization Guidelines for School Care Facilities for information and instructions on form completion and immunization requirements. &Una are updated annually and are available from the local county health department. VACCINE DOE CODE DTaP/DTP2 A DT3 Td' Polio' MMR (Combined)' F (Separate)e G.H.I Hepatitis B9 Dose I MOMANR Dose 3 Dose 4 Dose 5 /YR% MO/DA/YR mom A/YR MARIA/YR Measles Measles (dose 2) Mwrips Rubella The state immunization ID# is an identifier supplied by the state immunization registry (optional). DTP 5 doses required. If the fourth primary dose is administered on or after the fourth birthday a fifth dose is not required. DTaP is an acceptable alternative for one or more doses of DTP. 3 DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) • Td (Adult) Vaccine is recommended for children 7 years of age or older. Polio 4 doses required. If the third dose is administered on or after the fourth birthday. a fourth dose is not required. IPV is an acceptable alternative for one or more doses of OPV. Polio vaccine is not required for children 18 years of age or older. 6 Hib is required for child care and preschool entry and attendance only. • 1st dose valid if given on or after 1st birthday. Second dose (measles) valid if given at least 1 month after 1st dose. A second dose of measles (preferably MMR) is required for students in grades K-4 in the 1997-98 school year, and 7th grade entry and attendance effective with the 1997/98 school year. In each subsequent year thereafter, the next highest grades are included. s Includes single measles vaccine (C), single mumps vaccine (FI) or single rubella vaccine (1). 9 Hepatitis B vaccine series is required for seventh grade entry and attendance effective with the 1997-98 school year and kinder- garten entry and attendance effective with the 1998-99 school' year. In each subsequent year thereafter, the next highest grades are included. EFTA01710099 Certificate of Immunization for K-12 Excluding7th 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 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) 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 7th 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 the records available, and to the best of my knowledge. the above named child has received the following immunizations required for entry and attendance in 7th grade effective with the 1997)98srhool 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 preschool children, children in day care and school children who are incomplete for immunizations in Part A-I or A-2.) Invalid without expiration date. DOE Code 2 certify that the above twined child has received the immunizations documented on the reverse side of this form and has commenced a schedule to complete the required immunizations. .4 endel:a! immunizations are not medically indicated at this time Physician or Clinic Nabial Beach County Health Department (Print or Stamp) Community immtmlfation Service Address: Riviera Bea L 33404 Phone: Expiration Date: (IS days after next Physician or Authorized Signatu A. 41/21-4goo/ w 7 3.0) •, 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 he physical condition of this child is such that immunizations) as indicated in Part C above is medically contraindicated. Physician or Clinic Name: (Pratt tit Stalltp) Address. Physician Signature- DII , replace. earlier editions !Stock Number: 5740.00046SO-61 Date. EFTA01710100 isliftt 14.•••• AIM FLORIDA CERTIFICATE OF IMMUNIZATION (HRS 680 - PART A) (Florida Statues 232.032) FOR CHILDREN WHO HAVE COMPLETED ALL REQUIRED IMMUNIZATIONS FOR SCHOOL ATTENDANCE DATE OF BIRTH 1,111LO-b NAME I MO DA YR DOCTOR: PART A CF HIS FORM IS USED ONLY IF THE :HILO HAS RECEIVED ALL RQUIRED IMMUNIZATIONS LISTED BELOW. IF NOT, SEE REVERSE SIDE. DTP — 5 USES REQUITED #1 PARENT CR GUARDIAN ^ raet• IF THE FOURTH PRIMARY DCSE OF OTP IS ADMINISTERED irik7 ON o ER-THEIOUfflirtimmpAy. A EIFTWOOBgtNOT RECkJIRED. DT (PEDIATRIC) VACCINE IS ACCEPTABLE I: PERTU§SISVACDINEJS MEDIC4OWIRAINOCATED,LCOMF't*7:FiTT pj0P4RITUSsiS CDNTRALNDCAnoN) Td (ADULT; VACCINE (A SERIES OF 3 DOSES) IS ACCEPJABUE:ANCEFECOMMEiND ILDREN7 YEA S.,;0 t F„OIRIAER., • POLIO DOPY) - 4 DOSES REQUIRED -L. IF THE THIRD PRIMARY DOSE CT: TOPV IS ADMINISTERED:ON' POLIO VACCINE IS OMITTED FROM THE REQUIRED IMMU MEASLES, MUMPS. AND RUBELLA - 1 DOSE REQUITED • `; MMR COMBINED - 1 DOSE AT 12 MONTHS DRAGE.OR OLDER MEASLES SINGLE - 1 DOSE AT 12 MONTHS MUMPS SINGLE — 1 DOSE AT 12 MONTHS OF AGE ORv4E RUBELLA SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER DA : YR 7.o.C7 :MO BIRT,DAY, A EOURTH,D0 °F; : rz tORIAtER:(R,(hyAtcip CrE4 A 'it W I tit , N. Svc, c .4;1 - yir A. BY MO DA YR MD DA YR MD DA YR 1 MD DA YR 1 YE 1 MO DA ALL APPROPRIATE DOSES AND DATES INCLUDING BIRTHDATE MUST BE ENTERED, AND THE CERTIFICATE SIGNED BELOW BY A PHYSICIAN OR AUTHORIZED PERSON AND DATED IN ORDER FCR THE CHILD TO ATTEND SCHOOL , I. I HAVE REVIEWED THE RECORDS AVAILABLE AND TO THE BEST OF MY KNOWLEDGE T DIPHTHERIA, TETANUS, PER RUBELLA AS REQUI PHYSICIAN OR CONIC NAME (PLEASE PRINT) JATELY IMMUNIZED AGAINST 'DANCE. -//,1/2,73 DATE EFTA01710101 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, a 10D-3.088, F.A.C. and S. 10M-12, F.A.C. ATE PARENT OR GUARDIAN FIRS I MI DOB moinAnta Child's 5Stt (optional) STATE IMMUNIZATION MOO Directions: • Enter all appropriate doses and dates below. • Sign and date appropriate certificate (A-1, A-2, B, or C) on reverse side of form. • If the child is presenting for the 7th grade requirement only and has previously filed a Certificate of Immunization (680A or 680A-1) with their current Florida school, fill in boxed areas below and complete Part A-2 on the reserse side of this form. • For additional information: See Immunization Guidelines for School and Child Care Facilities for information and instructions on form completion and immunization requirements. Guidelines are updated annually and are available from the local county health department. VACCINE DOE CODE DTaP/DTP2 A DT' Td' Polio' MMR (Combined)? (Separate)5 G, H, I Hepatitis B9 The state immunization ID# is an identified supplied by the state immunization registry (optional). 2 DTP 5 doses required. If the fourth primary dose is administered on or after the fourth birthday a fifth dose is not required. DTaP is an acceptable alternative for one or more doses of DTP. s DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated (Complete Part C for Pertussis contraindication ) ▪ Td (Adult) Vaccine is recommended for children 7 years of age or older. Polio 4 doses required. If the third dose is administered on or after the fourth birthday, a fourth dose is not required. IPV is an acceptable alternative for one or more doses of OPV. Polio vaccine is not required for children 18 years of age or older. 6 Hib is required for child care and preschool entry and attendance only. 7 1st dose valid if given on or after 1st birthday. Second dose (measles) valid if given at least 1 month after Ist dose. A second dose of measles (preferably MINER) is required for students in grades K-4 in the 1997-98 school year, and 7th grade entry and attendance effective with the 1997/98 school year. In each subsequent year thereafter, the next highest grades are included. s Includes single measles vaccine (G), single mumps vaccine (H) or single rubella vaccine (I). 7 Hepatitis B vaccine series is required for seventh grade entry and attendance effective with the 1997-98 school year and kindergarten entry and attendance effective with the 1998-99 school year. In each subsequent year thereafter, the next highest grades arc included. Dose J/DAIYR Dose 2 MD;DA/ "R. Dose 1 1.1O/12.VY Dose 4 :lose S MO/DNYR Mon EFTA01710102 LAST NAME FIRST MI DOB (MO/DA/YR) Certificate of Immunization for K-12 Excluding 7th Grade Requirements PART A-1 (Immunizations arc complete for school entry and attendance grades kindergarten through 12 with the exception of the 7th grade requirement.) DOE Code 1 I have reviewed the records available, and to the best of my, knowledge, the above named child has been adequately immunized against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella and hepatitis B (for kindergarten effective with the 1998199 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 7th 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 the records available, and to the best of my knowledge, the above named child has received the following Immunisanors required for miry and attendance in 7th grade effective with the 1997/93 school ;ear: tetaius-diphthena booster, hepatitis B vaccine series, and second dose of measles vaccine as documented on the reverse side of this fonts (boxed areas). Physician or Clinic Name: Physician or (Print or stamp) Authorized Signature: Address: Date: Temporary Medical Exemption PART B (For preschool children, children in day care and school children who are incomplete for immunizations in Part A-I 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 immunizations. Additional immunizations are not medically indicated at this time. Physician or Clinic Name: (Print or stamp) Address: Expiration Date: (15 days after men lerentankadoa a Physician or Authorized Signature: Date: J Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 I certify that the physical condition of this child is such that immunization(s) as indicated in Part C above i$ medically contraindicated. Physician or Clinic Name: (Print or stamp) Physician Signature: Address: DH 6$0, 1196. otookas either adttan (Swck Number 574)-000-0(80-6) Date: EFTA01710103 PARENT OR GUARDIAN ..------...--v-W, FLORIDA Ott'AKI'MENT VI- t--- ) ? HEALTHl FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.032, 402.305, 402.313, Florida Statutes; rules 64D-3.01 I, 65C-22.006, 65C-20.01 I, Florida Administrative Code DOB MO/DA/YR CHILD'S SS# (optional) STATE IMMUNIZATION ID# Directions: • Enter all appropriate doses and dates below. • Sign and date appropriate certificate (A-I. A-2. B. or C) on reverse side of form. • If the child is presenting for the 7th grade requirement only and has previously filed a Certificate of Immunization (DH 680, Part A-1) with their current Florida school, fill in boxed areas below and complete Part 42 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. VACCINE DOE CODE DTaP/DTP2 DT' Td' Polio' D Hib° MMR (Combined) (Separate)" G. H. I Hepatitis B' Varicella" Varicella Disease 1. Dose I Dose 2 Dose 3 Dose 4 Dose 5 The state immunization ID# is an identifier supplied by the state inununimtion registry (optional). 2 DTP/DTaP 5 doses required. If the 4th primary dose is administered on or after the 4th birthday a 5th 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'd dose in an all OPV or all IPV series is administered on or after the 4th birthday, a 4th dose is not required. Polio vaccine is not required for children 18 years of age or older. 6 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 2'd dose of measles (preferably MMR) is required for students in grades K-6 and t 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 (H) or single rubella vaccine (I). 9 Hepatitis B vaccine senes is required for 7th grade entry and attendance effective with the 1997-1998 school year and kindergarten entry and attendance effective with the 1998-1999 school year. In each subsequent year thereafter the next highest grades are included. Hepatitis B vaccine series is required for preschool entry and attendance effective with the 2001/2002 school year. 10 Varicella vaccine is required for entry and attendance in preschool and kindergarten effective with the 2001/2002 school year. In each subsequent year thereafter, the next highest grades 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. EFTA01710104 LAS1 NAME t lliAl MI DUD (MINDA/YR) Certificate of Immunization for K-12 Excluding 7th Grade Requirements PART A-I (immunizations arc complete for school entry and attendance grades kindergarten through 12 with the exception of the 7th grade requirement.) DOE Code 1 1 have reviewed the records available, and to the best of my knowledge, the above named child has been adequately immunised against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella and hepatitis 8 (for kindergarten effective with the 1998:99 school year) and vancella, variceUa 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 Nam cs (Print or stamp) Fake Beach County Health Department tfrommunity immunization Service H v1611 ono, n. au. 4 Phone: Address: Physician or Authorized Signatu Date: 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 1 have rniewed the records available, and to the hest of my knowledge, the above named child has received the following immunizations required for entry and attendance in 7th grade effective with the 1997/98 school year: tetanus-diphtheria booster. hepatitis 8 vaccine series. and second dose of measles vaccine as documented on the revene side of this form (boxed areas). Physician or Clinic NamePalln Beach County Health Department Physician or (Print or stamp) community Immunization Service Authorized Signature: Addresk: Riviera Beach. FL 334C4 Phone: Date: iyiat -o/ 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-1 or A-2.) Invalid without expiration date. DOE Code 2 cemfy 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: (Print or stamp) Address: Expiration Date: (15 Jays after next lmmunDation appointment) Physician or 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 1 cent that the physical condition of this child is such that immunization(s) as indicated in Pan C above is medically contraindicated. Physician or Clinic Name: (Print or stamp) Physician Signature: Address: DH 680, 8/2000, obsoktm tallitt C.C1b0t3 (Stock Numb= S740.0D-0680-6) Date EFTA01710105 AutharOcermMetallamde cikViVseP,4 RESTWOOD COMMUNITY MIDDLE SCHOOL Vera C. Garcia, Principal • dte Dear Parent/Guardian o A review of your child's health records shows that they are out of compliance with the health requirements necessary for school attendance. Please provide documentation of the items checked below. YOUR CHILD HAY NOT ATTEND SCHOOL UNTIL THIS INFORMATION HAS BEEN PROVIDED. 1. T.B. Test 2. Physical Examination 3. Hepatitis B 4. DPT/ OT 5. Polio 6. MMR - 1st , 2nd 3rd . For the safety and protection of your child and the school system, school records must be complete. If you have any questions, please contact•the school or one of the public health units listed below. Glades Health Center - (561) 996-1600 Jupiter Health Center - (561) 746-6751 West Palm Beach Health Center - (561) 653-2000 N.E. Health Center - (561) 844-3561 Lantana Health Center - (561) 547-C800 inn 64 Sparrow Drive, Royal Palm Beach, Florida 33411 (561) 753-5000 / Fax (561) 753-5035 EFTA01710106 - • aiSailtWialoi**Sitasievia:SatiiitaiSSISKS Appointment Date Cc ksa c75 At 3:30 A6 j m.D., Y.A. pecia is, In Lompictc Family Health Care e l k WoM, FL 774o3 EFTA01710107 1 .••••••••••m...m.••••••••••.".....n... New York State Department of Health Albany, N. Y. 12237 Ohrtificatr of ISirtii legistration This certifies that a certificate of birth has been filed under the name of: Female Born on: At: Name of lather:. Maiden name of mother: Date filed: Date issued: Local Registration No.: Registrar of Vital Statistics Address: This notice is void if if contains any erasures or corrections. 005000000666 00000000000g6 Keep this stub with your personal records. The other side contains important nformation. aCYNTUN BCH FL 33435 Clarence, N. Y. YOUR SOCIAL SECURITY CARI Detach the card below and sign it in ink immediate Do not laminate your card. Carry it in your purse or wallet. EFTA01710108 4$00t. 0/: THE SCHOOL DISTRICT OF PALM BEACH COUNTY 9-12 Academic Improvement Plan (AIP) SY: 06 DOB; FNRT FCAT: - MAP: PRIM: READ= OSS LEP; PIM PALM BEA 12 ABS: 6 RET: MATH: DSSMATH: R-FI 504: SCI : M-ZF S-ZZ RRR: O READING O WRITING O MATHEMATICS O SCIENCE 0 Textbook Asse.ssreerts K EOL K FCAT Diagnostic I Practipa Tests O Diagnostic Software O Other (see attached) O Palm Beach Wntes O Pallas° O Performance Assessments K FCAT Diagnostc/Practce Tests O Diagnostic Software O Other (see attached) O Textbook Assessments K Portfolio O Performance Assessments O FCAT DiagnosticiPractice Tests O Diagnostic Software O Other (see attached) O Textbook Assessments O Portfolio O Perfomiance Assessments K FCAT Diagrostic/Practce Tests O Diagnostic Software O Other (see attached) Phonemic Awareness K Rhyming E Syllabcatpon O Segmenting/Blending Phonics K Sound/Symbd Correspondence K DecocIngnooding Fluency K High Frequency Wads O Rate Vocabulary K Structural Analysis O Word Meaning Text Comprehension O Questioning K Strnmarinng Types of Writing O Word/Sentence writing O Paragraph Writing O Composition Wilting Awareness /Application of FCAT Writing Rubric K Focus Li Support O Organization O Conventions Compositions O Narrative D Expository O Persuasive o Number Sense. Concepts and Orerallons [1 Measurement O Geometry K Algebraic Punting O Data Analysis and Probability O Reading in Cement Area Specifc Concepts I: The Nature of Matter O Energy O Force and Motion O Processes that Shape the Earth O Earth and Space O Processes of Lite [ How Living Things Interact with their Environment O The Nature of Science concepts O Reading in Content Area Specific Concepts Tutoring K During Smoot Day O After/Before School / Saturday Instructional Alternatives El Temporary Skill Groups O Cooperative Learning Groups O Guided ReadngliVriting Groups jg-Technology K Other (see stacked) Assignment Alternative O Time O Quantity K Product Requirements K Child Study Referrals O Instructional Reading Tutoring O During School Day K Aftedielore School / Saturday instructional Alternatives O Temporary Skin Groups K Cooperative Learning Grays O Guided Realiricifirihng Groups O Technology O Other (see attached) Assignment Alternative O Time O Quantity O Product Requirements O Child Study Referrals O Instructional Language Arts Tutoring K During School Day K After!Belore School / Saturday Instructional Alternatives O Temporary Skill Groups O Cooperative Learning Groups Doth iff:reattached) Assignment Alternative O Time O Quantity O Product Requirements O Chid Study Referrals K Instrottional Mathematics Adoring U During School Day K AfterrBefore School / Saturday Instructional Alternatives O Temporary Skin Groups K Cooperative Learning Groups O Guided ReadingNVriting Groups O Technology O Other (see attached) Assignment Alternative O Time K Quantity D Product Requirements O Child Study Referrals O Instructional Reading Student progress will be monitored throughout the school year, and student progress will be reflected on the report card. p O Successfully Remediated O Requires New AIP Next School Year El Special Services / Placement O Other (see attached) O Successfully Remediated . K Requires New AIP Next School Yew O Special Services / Placement O Other (see attached) O Deficiencies due to non-attendance (refer to Attendance Specials ParentiGuardian CommItment/ContributIon Check all that appty. O Monitor Attendance / Tardles K Encourage Reading at Home O Attend Parent Conferences K Attend Parent Curriculum/ Information Meetings K Successfuly Remediated O Requires New AIP Next School Year O Successfully Remediated O Requires New AIP Next School Yew 1171S111/121SIIIINCES_LaThellea_iaSOLCiaLSIIII/C85 / Placement ached) O Check Homework O Reinforce Skills O Sign DaiyAVeekly Notes 54NATuRE O PFINC PAL SiGNATuRE Or TEACHER SGNATURE OP TEACHER PBSD 1687 (REV. 8/12/2003) ORIGINAL • Cumulatve Folder COPY - Teacher COPY - ParentiGuardian TE DATE DATE DATE EFTA01710109 THE SCHOOL DISTRICT OF STUDENT NUMBER: z.,.,,,,,,,9NEW/RETURNING 4 T. r MLITI (z. .n.ri l".1%.111 I I , STUDENTS VERIFICATION FOR NEW/RETURNING STUDENTS: TO THE PARENTS OR GUARDIANS: new TO Complete all non-shaded ran al both sides of form REGISTRATION RETURNI NG STUDENTS: Please review both Bidos for correctness of typed information. If the information ...N. printed Is incorrect, Please correct it by carefully and lightly crossing out the incorrect information and writing the correct information above it. —, (3) i ) MAILING ADDRESS c,..... a AT, V WI I , IM i E 5 soon Poem NO. U/ HOME PHONE NO (CPTIONAU (II I SEX lAALE MALE MS I I Alf I riAVArstur,r,,,, B rcintHisrAmc i g A PACIFIC AS IANORISL li H PINPANIC ta r som"-ri.uSPANte i M mutimAC IA- (I U RESIDENT 0 0. FOREIGN EXCHANGE STUDENT Er I. OUT-Of-COUNT' RESIDENT i --2. OUT-DI-STAIR RESIDENT 3. IN-COUNTY RESIDENT IS) /I 0 il RAI IMPACT TES 040 TES Erk TES I7 ITS ns Erie AID SURREY A. Ell STUDENT B 114 slimier NO C. THE PARENT D. DIE PARENT F TIN PAROLE If YES, RESIDES Oil RESIDES IN IS EMPLOYED IS EMPLOYED IS III THE IS TM( PARENT AIR FORCE FEDERAL LOW RENT ON FEDERAL ON ION UNINSURED ON ACTIVE i ARAM PROPERT E. HOUSING PROPERTY RENT HOUSING SERVI:IS of CUPP 0 COAST LOCATED IN LOCATED IN Ta UNDID i TES 9 GUARD Pal STATES i BEACH COUNTY. PALM REACH COPIRT. NO MARINES 0 NATIONAL GUANO i NAVY IM HAS e 0 THIS CHILD KEN ENEOLLED N ANT PROP OE? C. CHAPTER I 0. PRE-N VISAHILITIES E. PRE-A EARLY INTERVENTION IMAM Paa A EMECILMAIN (H/ ST EACH PROGRAM WITH AN ant* I *I TIE PLOGRAM TOLM CRUD e H. INA3START e £. MILREAN/ PIE-A 0 N NON-StIOSIENLED one CARE ATTENDED. M.50, INDICATE WAS IM THE LONGEST.1 i 0. OT/NR 0-417111SIDIZED CHILD EAU III) IS THE STUDENT A SINGLE PARENT? I EIS NO III) N CURRENT GRADE NE TRANSFEft INFORMATION: eplANIE 01 SCHOOL,LNSFERRIN ERON m i ci dt e yr.)/ 111) CITE Or L ATIO A a7) pa-• i A ND DATE Of T TTENCIANCE 6c (20/ GRAM LEY (21) LAST BUG SCHOO ATTUNED IN COUNTY .4 / eci" a--- / ND D / PWI7 FREE REDUCED PRICE HAND 14)14114 6POIWA nfr (231 NAVE YOU FILLED OUT AN APPLICATION FOR FREE OR REDUCED LUNCH? 0 YES (APPLICATION IS PROVIDED WITH THIS REGISTRATION FORM) (241 MEATH SCREENINGS: I GIVE PERMISSION FOR MT CHILD TO BE GIVEN MALIN SCREENINGS. THESE TESTS MAT BE GIVEN ufflitiOLIALLT OP IN GROUPS. TES I NO 25/ $00101/ FLUORIDE. I LIVE PERMISSION FOR MY CHILD TO PRAM:PATE M THE SODJUM FLUORIDE PROGRAM TO PREVENT DENTAL DECAY. PERMISSION IS VALID THROUGH GRADE SIX. i ns ,Er "---- 63 NEW STUDENTS TO PALM flEACI" COUNTY: HOME LANGUAGE SURVEY (261 WHAT LANGUAGE IS SPOKEN IN THE NOME BY TM PARENT w GUARDIAN C.-J -79/ 4A (27) SPAT LANGUAGE IS SPOKEN IN THE NMI ST THE STUDENT? 02057) UM DATE Of ENTRY INTO THE ISM. PROGRAM UR/ LMIGUAGE SURVEY I. IS A LANGUAGE OTTER NMI ENCUSH USED IN TIE NOME? X. DOES THE STURM 11A0 A FIRST LANGUAGE OTHER TIAN EllaISN? 3. DOES THE STUDENT MOST INIDUENTIY MAX A LAIIGNAGE OTHER THAN IRWIN? I ns Y • us Ins Ern NO e I. 130) DISCLOSURES IN( lira lazy fop Ills SCHOOL DISTRICT RAS THE STUDENT EVEN SEEN EXPELLED FROM SCHOOL? 2. HAD AM ARREST RESULTING IN A CHARGE? • Y•N •••• (HY...". Nitta'. ••••••.«, ,TES 5 OnS Ell n-. rr, EFTA01710110 THE SCHOOL DISTRICT OF PALM REACH COUNTY - NEW/MITURNINO STUDENTS REGISTRATION BACK ISII OCITI4 PARENTS --• ' T LIMES WITH IOICtIt ONO YOTIER U FATHER LiSHARED CUSTODY OTHER OS) TRANSPORTED IV Slaw a be wismsami Haws awe, My Loan II sow ion 'weed ES 31 IS TIIFNC • COURT ITARREICOMIETFPARERT-FROil CCMACTING THE STUDENT WRING THE SCHOOT DAY/ IF YES, PLEASE PROVIDE THE SCHOOL REMOVING R M YES WITH A COPY OF ____I;pr a irte-A4A-1 /22 POI — atzei- KdPATHW Nal w I.NINOVIST / 9 /fi ..,.... se. eW MS IJC 'TICKET LEVEL OF EDUCATION COMPLETED ICITIONALI i A j earn INNia B n ..... SOON C 0 ......M .". :4* I--I RICE IS 9-01 D] am rOtTWINNOW4 E C1M AL HIGHEST LEVEL OF EDUCATION COINISETED (OPTIONAL) aw In amerr Fraot B D sows eatiocaL s . mm C 0 .....ni Wile • 41 D Er l ...ran...X."' E 0 "Dir. • Iiir et rorMONII UM LEGAL GUARDIM1 M AM) DC*1 LEGAL GLIMMAR HAVE CUSTOM? 0 yss Li NO 1St WIT MOM ARNIM Sin "WM i. a 0011sTait Wen Pa'.. EMERGENCY HEALTH AND SAFETY INFORMATION PART if RE)NISI OTHER WAS PARER, AUTHORIZE) TO PESK UP MOEN) RS) 44M arc IEW an= may , Air Is Ern 0 NO REIATIONSMI e nv IIIMMITAN arie 0 ND RELATiowsnr I', ..J. P RELATION trn ! • 0 ND YE: 0 ND NM NASA ADDRESS Pilot RELATIONIMP ---- U ITTI TV 0 Pm F rOTTIRE91:4RTM PART 0 F SCUM. PERSOMSEL ME UNWISE TO CONTACT YOU IN CASE Of ILLNESS OR ACCIDENT. NAY WE 41011 YOUR PERMISSION TO CALL YOUR DOCTOR CO MERGENCY SERVICES (SID FOR TRANSPORT TO THE HOSPITAL/ — 1TOW-FIOIE HUMAN "HI %ist YOUR 04IIITS ALIN SUS, ALLERGIES OR OTHER PHYSICAL LIMITATIONS D., CHILDREN IN (ER PALM REACH COUNTY St'HOOklk ISO I WIWI' TWAT 111 iMontATION GIVEN IS nut AND ACCURATT TO TN MST OF MT IMOWL100 FOR OFFICE USE ONLY: "Tfil ES I IIT 11434. 0 WO. ATTE q SCH AMMON: I ( 011 DATA KM OMMIETI IT Hit i,ARENT/61.61JIOW IANCOMIT MEG iffirrm IVA rerilaisitakip, 1W HAN VSS—KG 0 TES 0 Nil 0 1 2 2 4 0 I j 4 0 0 / I I I STUDENT NO. 10,1101U0 StOENT 110. 10.91011AU STUDENT NO. IDPTIONAO CH. cant (tilt CITES 0 ta GIRTH DATE C/D T612 CALENDAR 1:1 be witilTAT iT i 1ST bon! AMU SAW r DCVO: ;WALWIZA TOME 0 DEL SOCIAL. SECURITY E- 1 DOA,/ NO 4DMIOAALI Li LTA'S ET: TI ONA N3 MO GA Troia Of •wr.4 ow.GORITIS YHYYSICAL ESSAYS EFTA01710111 1.......,t NEW/RETURNING STUDENTS ILI IRE PARENTS OR GUARDIANS: NEIN STUDENTS: Complete all non- shaded areas. TURNING STUDENTS: Please review both sides for l TICPOluter REGISTRATION correctness of typed information belOw =nu shown and on the other side. If the information printed is incorrect. Please correct it by carefully and lightly crossing out the incorrect information and writing the correct information above it .. .... 1.,.....t, tier..... ok3 IC ..83$ 4 <F PAM I0 MI 0 • 0,01 It. (Cot MOM'S SOCIAL OCIIRITT ND AI SEX al PAC( lOPTIJNAU ......... Eig,miu. Ill I 0 t1/4 &VAN PACIFIC iSLAMOIR El--w .....- 4.5,.° MALE DB otACA NON-WSPANIC 0 H HISIMPIIC 'ATE CC BIRTH 10) PLACE Of GIRTH (II) RESIDENT STATUS 0 0. FOREIGN EXCHANGE STUDENT (Ill GRAVE LEVEE a 0 I. OUT-CIF•COUNTY RESIDENT 0 2. OUT•OF•STA1E RESIDENT Ell. IN•COUNTY RESIDENT Cl ItOtRAL IMPACT AID SURVEY III A/P*2[AM) (CHECK THE LETTER CODE FOR ONE CODE ONLY) .- A . 4. 01 0, 4 ”400. M. S....... j B ...... :fel...luso rev... at ffiN. epteearda.deelatur ver . ;A. r ril: T. HO HAS TENS DIU SEEN INTERCO IV ANT PRESCHOOL? Please place a checkout Doi by *act prelims otte•441. Alm, lodlcole .in' as .Heist ( *I its Horse ye.. child NH is NH Hindu I O c. GUAM I 0 M. MIGRANT PRE-A [1 0. PM -S DISABILITIES 0 N. NOR-SVEISIBIZEO CHILD CARE DE. PRE S (MY istrivornar, 0 0. OTHER M. NEMISTRAT al.SUCSIOill0 ORO CARL 1M I Is the sane* a OW* puede YES gao VISMOAINP 10. e, 4..:41WnAk 0 NAM( OF SCNOOL TR ERRING PROM i• _Oa /LEO III CITT OR LOCATION /20 Clai eae4 4.-- AgeteL (IS) GATE OF {AU ATTENIMPla it -1 19 9 5 GRAD( LEVEL / 20 ?AST PUBLIC SCHOOLATTENSE0 IR PALM Mot tOterff aldi/e- 12 OAT( ATTED010 -77 e), f Inv . aStaATIQN: . . .,,,.4... . .... ..,.. L. . ., , . .,.. Nate it, filled eel as aottliceilos IN free or Iltdste1 leech? (eternalise is erttleed wills this Ilniurstle• Tool i TES 1- --1 .-' 10 *ACM SCREENINGS: I gin pecolisloa may he lives Individual', Ill lee ley child to be give@ health scietoioqs. Timm NM et Is genes. RS VA/C 241 SODIUM RUORIDE I Ain onmissio• foe my child to officio,. is He Sotos Fluoride Provos lo aproven ..... I decay. Penults's. is .slid latotigh path Hs ri y • zi-7_„---,, , OlAr L`ANGUAGE :SURVEY ( c by fillcd cut nyw ctudentc. ONLY) Ilikm laarase is anima la the leer ay the punt et giseibia ek, (./. ...S;1-- US/ Mbar Isaias,. is spurn I. at hem by the Miter? /- (27) Ora .1 tr., co Mt Tromso . E .., r_4,-,,,, L..... ... „......, h.... .........„ ..... th... E . E T ti [3 no J. 04.• sn stoo•ni Host *t. env •o..0. • Is...Hos •Ant on. (..v.,..• E ..: E4-2_, vim smosti-w, ..: ,..,.. ..., St000I4440; DO 'sttoOnt Nillin00 . 01) PAdENTICUSRION cAticUACC• a- Nfa:Ctir i l, • I32 CEP 201:ENTIT CODE In/ ;Rt..,-C toy; .00 ENTRE CATE D6) CAUFOIR 13 W SAC C(-1) 13t TItulf; Ni. 121ASSICHHENT cp( A.,841, LI C.-n.1 /EH jannspEEETATION [k r " 1.-1 N° 1121 CEA FICAT1.1.4 iI laiT1( 13; IC-,S I4 41 00:U 4".00.1 :01 (14ECIIJ,1* (C11(0. AK) 0:\ot scion ,i(covE0 0 - - ..........0.1, 0.5 n pa C ', 0 V K A v.0^ 44 • ii, fl., f(<0.0 { ' . 3•150.. 0 11.MA( 0 I 2 a s 5 .../.:. .... Hawn.. 11,, c ..........A., tr.... . .A DATA Pliny CONirttifil BT . -------------- 0..0 I NO T1001 To( IN OAPASHON CVO, li IF 010 ACTURAH TO Tilt OUT Cl MT 'NOM( /01/ / * -c BSD 0636 REV. 4195 FRONT EFTA01710112 LI UtAINEN I I SHARED CUSTODY OMER .• by I. 7 oils. slat tfOESE- ACOUNI ARRING OTHER PAALNI !ROY RE DU l STUDENT DUADtt SOIODI my) Gc / )1)6O OH! jj ..4‘15/201,0/‘- 61172oPA--- harts. MOH P.M IsciikDEET UWE orsiSteatioil Zotakes5 Thasfotrar A 0 gusent's1°." 1 B cir ...xissocit lf amaaraompti Pelt •NOHNtlay E HICHIcas/Ccula Ceeanat H.OP TOOT C 0 VOCCH arsenal, 0 N YES. PLEASE PROVOS THE SCUD*. WITH A copy os t oactla-ki l lE3i HIGHEt1 LEVEL OF EDUCATION CONKETCO lOPTIONM) onetwon eta enon B 0 ter...secet DO Rata. SONII f011empav E onttecttffi 040 .83;rA-3 C. n~I Lome, 141 LEGAL GUARDIAN W ATM DOES TEM GUARDIAN NAVE CUSTODY? OYES OCOAHHION U NO {TAM Ze HOC 1.ca a IIMPLONCHT IA PART swivel.) SFr iltaia Pares. aothertto• N pit% Fp ordeal. :T ISO AbORESS • Pea hinOtact ErEES 0 NO 0 YES 0 NO 0 YES 0 NO 0 YES 0 O ID PART it N staea . soak I. mac' y„ ...,...i a... « misfit say we In 1•01 Pnettll• As toll TON ack• •F amorier nnelltt all) It' Hann,. It Om btlPlttP ns 0 I, al PHONE MAIM On WEAL P it it e b 7L 1 . i ft.44.1, et dolecis t ti • • . .ad 1.4. aware. • . plot• Ini :71 MIAMI OF 011OCREIO •••5- Iii.?x?) — • la MOOS ATTENDING UM STUDENT NO. OPTIONAL) GARDE 1711 ORM OATE 1 )4/14-4cettY 3 11,22/62Zete-M--- ti 61-em tysth 62 ISO PASSWORD EFTA01710113 e ; • NEW/RETURNING STUDENTS ;., •.. ..... • REGISTRATION _. "cove Lou,-- ...aiotii kJ I I MC l'AktitN I .b UH liUAtil.)1ANS: NEW STUOENTS: Complete all non - shaded areas. RETURNING STUDENTS: Please reusevv both sides for correctness of typed information shown below and on the other side. If the lot/Danaher] printed is incorrect. please correct it by carefully and lightly crossing out the incorrect information and writing the correct information ab ove it 10 HALING MOMS (II it ..... R. em4 so DWI ma. ...I ._..{_.) i il f( 5.9y,c? ..,, 3.. fw T.. t.,,,,,,, I STUDENT'S SOCIAL SECURITY O. (7(7) SET IS) R CE 8...ftwac AmERiCue INDIAN 1 A As,„ 9 - 1/11 ,W0741-1415P ANC PACIFIC $9....noto " a t II B ZlitiliSPAitiC D H HISPANIC I OAT( OF BIRTH 10) PLACE OF BIRTH ON NESIOENT STATUS (IL 0 0. FOREIGN EXCHANGE STUDENT 0 I. OUT•OF -COUNT Y RESIDENT 0 2. OUT -OF -STATE RESIDENT En: IN•COUNTY RESIDENT MOE LEVER al FEDERAL IMPACT AID SuAhly (IF APPLIGAIRD ICHECX THE LETTER CODE FOR ONE CODE ONLY/ A e an .n )o. aodmi a. ion Service. K B et :: oa • C WO ICahni •...v er» oi,tin I., or: 0.42 ,. dt....,11:zsi or e.....,..zt to:. rocs.,0 •-,“, MI KAS THIS (KILO eft. TNT t KW IN ANT PRESCHOOL? "(Pima place a DecimanI VI Dy each PM , an Rliamdt RI"). lai cal* wille. a• aslelitt I * ) tic p.00f am von child nu im Ike longest.) DC CHAPTER 1 o IA MIGRANT PRE-( DO. PRE-IK DISABILITIES O N. NON-SUBSIDIZED CHILD CARE DE. PPE-( (ART INTER itH TICS f] 0. OTHER OH. iitaosrAnt DI( SUEZ:lei:It o ui ;o v. n; .151 ll Is lie *Meat a sink punt? YES 9-go "-ICANSgEgitNRORMATION: . . . . .. SI NAME OF SCHOOL TR ERRING FROM 7 . a ,e AM i` In r :sr et I ! (...Too. 7 ' ,../ /- /-OC-' ea-l i a/ -e M- - (:,./C......... a IesT ATTIN- G. 24-1L-1 I . i 7.5 in DRAIN LEVEL 001 tAST NARK 51100E Al UNIX° DAIM MAUI LINNET .7 -•-a--,/fue co aluiz_. Z IT DATE •TTENOtO ri 2 " 96 aggeiMgjjWCE»PATCE':IUNCfig.SN:t>/HMttIItNf.bgi5WAttO .. • Agin s w .• i.:t ::,, ' "`"-:: :21 Hire hoe lined oil ai application Ice lice ot Nedoced leach? (Applicatioa is provided with IhiS RegillialiOe Fels) Ell TES lair; "31 HEISTS SCREENINGS: I give peinisiese lot Wy child ID be gevert he nis weeping,. These tests may be give. Re..Ideally oe in gams. TES s/j4 . 24/ SODIUM FLUORIDE' I give pusissioi lor ay child to panicle.* is obe Sodium Fluoride Pregeam to to prevent 100111 decay. Fermi .. i .. it valid Ilmagh glade til. TES ES — WaNESV-405« `' '.f. a MVO 1.03.F.A.0. 13agi N 1- Y : HO MF.);,..t.f_ain.00ASVEY t > 8. Èt.0 t Si ! What latietag• it spoke* ie Ole bomt by IIN p rat pastime: git .6 ( 7,--(>--/ -. ! " 1251 %Mt Memo is spek.. • Me tome by the 'Meal? CAL4 71i_ 15-/ L 711 Ile, ei. Fiery ism MI I SDI. Peeler.. e is a empRace. oil,•, Ih.. I •01•0-• ..,,a .^ ', I. ', Inn El ITS Efir0 .. T. 13••• 0.• • ..... • ha •• • fn. ••••”••• oth•e i••••• cstai.ro Ores &To 3 ems no Roue.. ems m........ ..... • emus,. eve.. um. e.son) Ei ycs p..... r.,:OR OFFICE USE ONLY: ..n % '0 <, . t.... .14:::..SCilWrii:No. 001 $11,1hr tn,Nl . t311 0f.gtert:CiltR00.0 **SWAG*, it) MI 4M iNTFE CO0f • WIHI'Ai' veS•W, US/ SRS.00 ti g Mt S115.401. I h..o.Lt... e'l :RAT( it VI t .2- DO) CAUNOIR 11' HOC I / 7 0% A€Ass.G2d4E10' c(0( alk•ADM jtrisE ,.,:. C40 tl.‘sipolTeli)ti t_ITIS Li NO (111 1.1iMiCtTIO Bilall CI T/I I.I) NoS Ills I.M 00: NI.I.Et0nt ClECAUS 7 KNECI Ak0 tArt 1.104 atureft0 1],„ •___ _ ."..‘fr‘ 1.1..4 Cr -44 . --• ---------- itsia Ljun:AG i I 2 a 4 S 5 ...Tv .--) ,„„_______ n~ ,- Int. 1 :.?':. . entra ISIR.T OMNI EW _ !Rat _----...- I G, i WI 'T THAT TIlE MORMAT Ins Cl if N is TRIP. ono ACCURATE TO III( OM Of 1/T INOVRIOU _ 2 2/ / *3 ..-- n PBSID 0636 REV. 4195 FRONT EFTA01710114 urallf OA NIL. PITMAN ~ENT TRESIFISCITNOVVetrarN.: Isti4 • TIIS STUDENT OPENING THE SCHOCIN DAN> YES If YES. flan PRGivIOf THE SCHOCH. WITH A COPY Of INE COUNT «Ca IS tr. . 144.4E ClISTOOr) . or No ...o t e_. /2i)A.), L-----• .AN i14041 K.,gL .9 15/20 A ) /L.-.'-. r CO« ‘dtkL 4(11 fa i4 -4 - A ( 9 101 4), A. nu[ f wan uwr ansuearicw, ZOIIPETE6 10 at iciwrAn c. poOCA B vi,„...c..........- mar< ..[ FDPTIONA.LI I =7"....' C 0 .7' ••M1•I ..5.4t 531 HIGHEST lEvEt Of ECOCATIO« COlatETED (OPTIONAL) AO ' an= ' B 0 .... ..o. C ig''''.o.:., I . ED l•Mals11.4444 D ~Gs... E 0 2.== 0 irstoo . I lEGAI. GUARDIAN OF AIM DOES LEGAt GLLARDIAN HAVE CUSTODY) DYES O NO .41 4.44 4.04 ../4.4. 1 u.v 51,t( VI CO« Sat.44 -1...1. ".. '` '..: X. -- xz`1•.>:>., .,°^,R;,'?.r.*M5.r. . ). :.* ., . 1 PART k {MN(I) aiNt An wail arthArIzed LA 'NCI LIP tia.m. (541 ATSWORD: .. - I 50) AO0It Pit • awn= ..... Err es ~ilia I tan 0 No 0 YES Ø NO El Yes Q NO 0 YES El PART IL N schol is «CH I. want sAp s4)4 41 il$4.44 « &Hark may w v...snit Aria w ea nut 4.Aus 44 w.~.)Iscy 44 II. 15111 In unipen k) elm AHAN411 YET 0 NCI III~ 4) PION( ~UR 4851 HOSPITAL PREF4R0I4ICE "....... ,Q ' / Itiele, Ir. 4--7T641- - ii 4., en O. 41 Ill WK. . 7,COUN »am Of afitCHRENTI l6N SnOE NO. (OPTIONAL 171 Nfi 0A /421-Ialtat ' . j9zialug,-- . . li /seem sysia EFTA01710115 : s TR itTrn311- 117.1-- T-CHRIWANKLI11 3ARBAKA IRElS. a te w own. -.‘\ I 1 -.Dit el SCHOOL DISTRICT OF PALM BEACH COUNTY REGISTRATION FORM . NEW/RETURNING STUDENTS (yq3 DATA Win COdLEDIO de " NEW STLADErT larinURNIO SWORE VERIFICATION FOR NEW I RETURNING STUDENTS: (7O•THE PARENTS OR GUARDIANS: NEW ETIX)DITE: Carded el non almboild anat RETI)roING EXUDE WES. Pla miss br amdinnta Irs shaded biOnnaacal Ewan b ih • boxes b re Kea and taloa Ito Inbrmabm dinteal N incorrect ban carrel in be STUDENT INEOPAATION seta Immadabh. hob* Plana wily tin wan added d Si. *daft by %Miura Wove nurCoic 8/22194 - atsfOOL ND 2141 lailla PENN COOS E01 Oat DATE 03/22/94 SAC COOS 063D 01 01 TEACIER ND. 106 Pa COUNT, DOM= 030E 50 SEX F I RACE W %ER. OF lunTHCATE 1. ASE Z ATIYIEW251.251A2 NAPO ALSO *OM .43: FL 63418 PALM BEACH GARDENS FL 33418 STUDENT 40•02. SECIAITY NO 4OPTONAL) HOME ROW SINUS PaRENT N IIIANWORTATION CAT N 3 MCRAE IMPACT AO HEALTH $CPEENTESTAKI N SCO FILCCUIX Y INTR• DATE NSA) MEV:EDI/CEO LIME :, INC. EN POE EN CO6 US STUDENT INFORMATION- (Parents, please write corrections in the appropriate area fisted below) (N. Cr004147-5 (CCU. NAPA( ' 1'.. ' LA .1 ra. NO SE 50•4411.140 A.001425/3 . , I ,11 / r 1.•• ' . „ . - .:.:%..". '//A HEWS NO STREET NAVE APT ND an STATE DAP CCM CITY STATE DP CO 61 StuCENTS SOCIAL SECEOETY IC Cdr•ONAO — — _ _ _ _— — __ _ En HONE /Wad MO. M SID( • FEMALE II MALI IS) FACE • -- aALASKAN kAIDICAN NOO PUCK A AWN NAME N ❑C d a NEN-HISPANIC K Pt ECM WA MITE SLOW ❑H H NG K IN .. 210151119,5241C NI GATE Of 041M I Ic rl-OCE Ct (16(7.1 W. AMDENT VOUS C:3 0. PleNaatIp0OCT 0 1 curmann 02; ENT12e DAM DAN /Cam LAY MAP CITY NO Oat OR Men*/ DEWCO SINE DT moot etc bi iota nt inn - Ill El AO anon coot me out CODE A i am n the Federal B I am a civilian clean Werner CrkT) Military Service. employee in :he Federal Military Service and the cost of my is provided in par, or wholly by Federal subsidy (.4 HINENOU En, Dana my rcd:flock frE3a (Plum plows/by each progw attended. wit e • 616 MOWEm your did was In the longest) ). nt, El E.Miro teranlirtiON 0 14. Sri, n emanation — nine Socp1 P10AT" 9 0 DA AICIPMT Ptah MATE Air. is El . 0 icertro ;Woo Indicate $ SUASOZEO CHI.D CARE C Dant n i o Onto N NOv SLOSODED CAC CARE TRANSFER INFORMATION i 15) 'CAME OF SCHOOL Wen/EN:MO Filed OE OTT OR LOCATCal an oat DE LAST ATTENDANCE I lel ::RAGE LEVEL DIA LAST DUBUC SCHOOL ATTENDED IN PALM ElEAC4 COJfl 126 DOE ATTENDEE) FREE OR REDUCED PRICE LUNCH AND HEALTH INFORMATION (21) Hine you flaw ere an application Tor Free Or Reduced Odes Lunch? (Apollcaon hp provided with des Roniebstion Foto) I= YES 17:3 no (21) HEALTH SCREENING Alt &WEE TES•IND Ia.. pnewn Al nrosa * te anon t*. Those ism N., Os Mn now.* . in TN.. CI strong WO ••••••2 tag iow, massy YES ICI PC inl SOD0LAI a Udt OF I pe penusson Iv no clA0 0 panw in F. Sohn. anon Pngnvt la dna -tang detAY hams. a nisi .....4.. cr..... In/ YES ID .5-1 NEW STUDENTSTO PALM BEACH COUNTY: HOME LANGUAGE SURVEY (To be filled out by new students ONLY) tat) vete lovaSOC ie One. Al Tie HON Erf lid *MDR OR OUNOVN • NN dotal 1/1/0.141A0t13 WOKEN Al IKE Ott WV INF 111.02N77 MI IS 014/5505.2eihr tan frollenral no 2 Ono a dart new . are *quip dor ION* Ow awn acre 1.02•w is 41•221004 taw? CI YES CI 1.3 /an sin.' 0 as 0 PO SW ten &coo? C3 YES Cl NO WI moan LARK4UAGE al) Paaran OR GUASOAN UNMADE Rd COWER, OF S FOR OFFICE USE ONLY Pa) CHM 000c 00 Cram malt '72, SAC OWE 133104210242:52 CODE 0 /as Mem oh mun3FORTADON CITED CI .43 13S1 YIPS/CAPON Of BOMA Fel SEE STUDENT A Si'.'.' , MOO OM GRADE LEVEL 1311 CALMAR Nov: WIER PC. 0 esa Li Milo CATEOCIre 0 1 23115 1 3 4 5 5 . i l lI T 0 WS MI HO DOCUMENTATION CHECK UST: (CHECK AND DATE WHEN RECEIVED) 4'1 OAR MAINVADCOS DATE VileriCAMOI OF MN RECCa3 SOOAL lecorriAn3 OdllONAL) CATE POMPOM Wad •_. I EFTA01710116 ( Pca- 441 I SCHOOL DISTRICT OF PALM BEACH COUNTY rju j STUDENT REGISTRATION FORM - PAGE 2 (42) (43 STUDENT NO PARENTAL INFORMATION: (45) HOME PHONE NUMBER: (46) TRANSPORTED BY: BlUdent vnIl be tranSpOrted10/1”1SCh001 by (named Other that parent)- / i . C I /(41C / ( 1 1 v/ ., ffri ( ( (47) STUDENT LIVES WITH CHECK OhF) / J 007i- PARENTS ,..1 MOTHER u FATHER j SHARED CUSTODY J OTHER (48) IS THERE A COURT ORDER BARRING EITHER PARENT FROM REMOVING OR CONTACTING THE STUDENT DURING THE SCHOOL DAY? J YES _ j NO IF YES PLEASE PROVIDE THE SCHOOL WITH A COPY OF THE COURT ORDER . . . (50) HIGHEST LEVEL OF EDUCATION COMPLETED A j ELEMENTARY SCHOOL 8 j (Grades N-8) above) OCCUPATION BUSINESS PHONE (OPTIONAL) SOME HIGH SCHOOL C j HIGH SCHOOL D j SOME POST-SECONDARY erifICHNICAUCOLLEGE (Grades 9-12) (Graduate) (Technical ! College) (Graduate or (51) LA / (CY /A: ' • (OPTIONAL) J SOME HIGH SCHOOL 0 ;HIGH SCHOOL 0 J (Graces 9-12a (Graduate) COLLEGE or above) (52) HIGHEST LEVEL Of EDUCATION COMPLETED A j ELEMENTARY SCHOOL B (Grades K-8) BUSINESS PHONE SOME POSTSECONDARY E J TECHNICAL (Technical College) (Graduate (53) LEGAL GUARDIAN (IF ANY': LAST NNE FIRST MD. NT. OCCUPATION PLACE OF DMLOYMENT BUSINESS MOPE I %MU I 51PIPIC SCHOU EMERGENCY HEALTH AND SAFETY INFORMATION: (54) PART I: Person(s) other than parent authorized to pick up student. i 61 %WE (57) ADDRESS (54) PHONE (59) RELATIONSHIP (74) " • ' . 'arsons to contact authorized to remove IJ Check here if the inbrmattion n t event o an emergency i parents cannot be reached. student from campus in an emergency situation. is the sane as in Part I. Complete Pad II I' different fbm those authorized ./H/ IA C. -- Those listed are also in Part I. ( ) NAAE (61) ADDRESS (62) PHONE (63) RELATONSHIP 1'91 PART III: If school is unable to contact you in case of illness or accident, may we have your permission to call your doctor or take your child to the hospital j YES j NO (64) =AMILY DO:TCR (65) PHONE NUMBER (66) HOSPITAL PREFERENCE ihYIlloartlefeets;lbef.vie should bp' onlaaa Ist.71 2cr-7--- it C YOUR OTHER CHILDREN IN PALM BEACH COUNTY SCHOOLS: (VI VANE S Of CHILDREN (68) SCHOOL A (69) GRADE 170) BIRTH DATE ..._, 1 f - 7 19 I (71) I VERIFY THAT THIS REGISTRATION INFORMATION IS TRUE AND . 1,4 ACCURATE TO THE BEST OF MY KNOWLEDGE. s rE .flay PBSC 0636 (REV. 7194) GCS06-2 EFTA01710117 \LN,t 51S.-c C1-0\\E-Vc °IK-I SCHOOL * 4 454°(0 ;:,....,9 ; SCHOOL BOARD OF PALM BEACH COUNTY STUDENT REGISTRATION (3) 1 NEW STUDENT TO PALM BEACH (2) COUNTY 1 RETURNING STUDENT (4) 1 DATA ENTRY COMPLETED isi Please complete all non-shaded areas and verify the resident address DIRECTIONS: of the student by your signature below. (6) TO AY'S //f/29 1 DATE (7) STUCENT'S LEGAL NAME (81 ALSO KNOWN AS Mi l l. MID. !Non. (10) STUDENT SOCIAL SECURITY NO. _ - (11) (12) SAC (14) MArhDDRESS„. /)1 e----• (16) CITY STATE ZIP a niew-ae ) raft- n3 ci 3 We 11T) SEX J MALE Zieraa (18) RACE : 1 i AMERICAN NDIAN j B EN0LAN4CKimpoac '--' I ALASKAN WIC 3 A pA NDER Cl HmsPANic alr,"0 NI T. FE IISPANIC (19) IS THE STUDENT A SINGLE PARENT' J yts ,a -t10 (21) VERIFICATION 1 3 4 5 G 7 0 9 T 23) HRS A e z (21) ON CODE: CHECK THE LETTER FOR ONE CODE ONLY. Have continuous?' lived in Fbrida kr the past LID Am n tee Federal Milian, Seneca J G Pad fee this 931COI year in another Florida year or lenge. coLray as ‘erified by CI E Am a Slim enployee in INe Federal Military U B Have purchased a home in Ftnda when is row( e Sena and the cost & my :hols education is occupied as ny residence. provded in part Dr Melly by Federal subsidy. J H Pad fee in Palm Beam County as velsec by Q C Have filed a mailestation cf domicile in lbs wave OF Am a migratory agricultural worker. Montt _.. _ J I Exempt (25) ENTRY CODE: (26) ENTRY DATE: (27) CUT DIST. LIAM CD ESOL Li ESE U MAG (23) TRANSPORTATION: J YES J NO CATEGORY: 0 1 2 3 4 5 6 (29) RESIDENT STATUS: U 0. NON U.B. FtEsiCENT LI I. OUT OF COUNTY U2 as RESIDENT J 3 INCOUNTY FL U.S. RESIDENT (30) GRADE: (31) CALENDAR: (32) TEACHER NO.: TRANSFER INFORMATION: (33) NAME OF SCHDL TRANSFERRING FROM LI 1 1/7 ) 479)/) iC it i h (34) CITY aC i (A) , 7v/2 TION i (35) DAT; OF LASTrIDANCE /is (36) GRADE LEVEL (37) LAST PUBLIC SCHOOL ATTENDED IN PALM BEACH COUNTY: ) (30) DATE ATTENDED. FREE OR REDUCED PRICE LUNCH: (39) lace you :riled 00 an application for a Free ce Reduced Price Lunch? (Appkation is provided with die Registration Form) fitC LI No SCREENING AND ASSESSMENT: SODIUM FLUORIDE PROGRAM: (40) I give Derrnissron for in) child to be given screening and assessment tests when w_essavy. These tests nay be given individually air groJoS :Y irs K No (41) I give permission to my child to par.icipate in the Sodium Fluoride Program to pr 1 dental decay. Pemvession valid througx grade six. ES j NO FOREIGN STUDENT INFORMATION: This irtorrnabon is voluntary and used solely for !he purpose cf obtaining Federal funding. (42) ORIGINAL ENTRY INTO USA SCHOOL MONTH DAY YEAR (43) STUDENT CITIZENSHIP STATUS (Circle One) 1 2 3 5 6 8 IrResident Allen 2:Non-resident Alien 3rExchange Student 5:Relugee 6:Entrant S.:Immigrant (Counselors can provide assistance in determinlig status) NEW STUDENTS TO PALM BEACH COUNTY ONLY: (44) ENTRY DATE (USA) MONTH DAY YEAR (45) U.S. CITIZEN TES U NO (46) IF NO, CITIZEN OF WHAT COUNTRY? (47) .N WHAT COUNTRY WAS THE STUDENT BORN? (4a) WHAT LANGUAGE IS SPOKEN N THE HOME BY THE PARENT OR GUARDIAN? (49) WHAT LANGUAGE IS SPOKEN IN THE HOME BY THE STUDENT? (50) 1. Is a ianbuage other than Enpish used in the home? Q YES Q NO (51) STUDENT (52) PARENT (53) COUNTRY OF 2. Cid the student have a first language other than English? 3. Does the stulent most frpouertly speak a language other than Engish? 1:1 YES Q YES CI NO Dr* LANGUAGE GUARDIAN LANGUAGE NATIONAL ORIGIN DOCUMENTATION CHECKLIST: (54) CHECK AND DATE ONLY WHEN RECEIVED: 1 DATE: IMMUNIZATIONS 1 1 DATE: BIRTH CERTIFICATE PROOF OF DOMICILE 1 DATE. SOCIAL SECURITY NUMBER AND ACCURATE TO THE BEST OF MY KNOWLEDGE. 9 Oft P8SD 0536 (REVISED 493) GC MOB EFTA01710118 SCHOOL BOARD OF PALM BEACH COUNTY 1‘,..d STUDENT REGISTRATION FORM - PAGE 2 IN) STUDENT NO PARENTAL INFORMATION: (60) TRANSpO5TED Br: it ya12:ted ,.... I bit (name if ent) , 1 --- totdCe SX I Q EOTH PARENTS tyri)THER CI FATHER ID SHARED CUSTODY I3 OTHER (62) IS THERE A COURT ORDER BARRING E PARENT FROM REMOVING OR CONTACTING THE STUDENT DURING TIE SCHOOL DAY? j vES (0 IF YES. PLEASE PROVIDE THE SCHOOL WITH A COPY OF TIE COURT ORDER. It OCCUPATION 7 a BUSINESS PHONE (64) HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) A 3 ELEMENTARY SCHOOL B 3 SOME HIGH SCHOOL C 3 HIGH SCHOOL D ...J-SOKIE POST-SECONDARY E 9 TECHNICAL COLLEGE (Grades K-8) (Grades 9-12) (Graduate) iTechnkal / College) !Graduate or above) OS) a -C-S2 niti L 0 111110 P BUSINESS PHONE (66) HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) A J ELEMENTARY SCHOOL B 3 SOME HIGH SCHOOL C -416ISCHOOL 0 j SOME POST-SECONDARY E 3 TECHNICALCOLLEGE (Grades K-8) (Grades 9-12) (Graduate) (Technics College) (Graduate or above) (67) LEGAL GUARDIAN (IF ANY): i LAST NAME FIRST MK/. INIT. OCCUPATION PUCE OF EMPLOYMENT BUSINESS PHONE (54 SCHOOL EMERGENCY HEALTH AND SAFETY INFORMATION: 168) PART I: Person(s) other than parent authorized to pick up student. (73) RELATIONS,. /;41/4fer 74) PART II: Person(s) to contact in the event of an emergency it parents cannot be reached. Those listed are also authorized to remove student from campus In an emergency situation. tick here d the iMormation is the same as in Part I. Ccmplete Part II 4 dlferent from those auttorzed in Pad I. (75) NAME (76) ADDRESS (77) PHOTE (78) RELATtOtISHP 179) PART III: If school is unablo o contact you in case of illness or accidont, may wo havo your pormission to call your doctor or take your child to the hospital j YES j NO (80) FAMILY DOCTOR i81) PHONE NUMBER - (82) HOSPITAL PREFERENCE r C (83) It your child suffers from any illness or has any physical defects that we should be aware of please list. /1 ‘91 1 -1 YOUR OTHER CHILDREN IN PALM BEACH COUNTY (85) SCHOOL ATTENDED (se) I VERIFY THAT THIS REGISTRATION INFORMATION IS TRU ACCURATE TO THE BEST OF MY KNOWLEDGE. PDSD 0636 (RE,. 393) OC64116-2 EFTA01710119 shore: • dummorm...64.4.—rom..646.......emsot SCHOOL BOARD OF PALM BEACH COUNTY STUDENT REGISTRATION (2) SCHOOLS Is) 1 NEW STUDENT TO PALM BEACH COUNTY 1 RETURNING STUDENT (4) 1 DATA ENTRY COMPLETED (5) Please complete all non-shaded areas and verify the resident address DIRECTIONS: of the student by your signature below. I I S l GRACE ('5) CITY 17) SEX J MATE afEMALE • INATt re- ran. /Mt DM RACE n AMERICAN BLACK A ASIAN HiSPAIIC I ALASKAN NATIV ROAEN El NONHISPME O PACIFC ISLANDER H 1 STATE . .21P A .-4. 33c /if (11) HOME (14) MAILING (16) CITY IS: A MONTH DAY YEAR (21) VERIFICATION 1 3 4 5 8 7 8 9 7 (24) TU ON CODE:,CHECK THE LETTER FOR ONE CODE ONLY. A 1-avo oortniuusy Toed n Fonda for the past year or longer. D 9 have puichmed a home in Florida weigh is cccuped as my residence. C Have filed a manifestation el domicka n tins count/ 1221 P1A3E OFBlfr • D Am in the Federal Military Service. • E Am a *tan encegyee in tie Federal Military Seneca and the cos) 01 my .:Oles oducabor is provided in part or who!), by Federal subsidy. K F Am a migratory agricultural worker (6) TODAYTITE/timy YtiO 121-Vr INON-HISPAMC NRE STATE ZIP (19) IS THE STUDENT A SINGLE PARENT^ Sin _I NO (23) HAS (Do Paid lee this school year in another Florida comfy as verified by receipt a H Paid fee in Pan Beach Count/ as verified by MONO # _..I I Exempt (25) ENTRY CODE: (26) ENTRY DATE: (27) WT DIST. j ADM j ESCL J ESE J MAD (28) TRANSPORTATION: J YES J NO CATEGORY: O 1 2 3 4 5 6 (29) RESIDENT STATUS: j 0. NON US. RESIDENT j 1 OUT OF COUNTY j 2 U.S. RESIDENT J 3 INCOUNTY PL L.S. RESIDENT (3O) GRADE (30) CALENDAR, (321 TEACHER NO.: TRANSFER INFORMATION: (33) NAME OF SCHOOL TRANSFERRING FROM (341 CITY OR LOCATION (35) CATE OF LAST (36i GRADE LEVEL ATTENDANCE (37) LAST PUBLIC SCHOOL ATTENDED IN PALM BEACH CCUNTY: (38) DATE ATTENDED: FREE OR REDUCED PRICE LUNCH: (39) Hale you filled oLt an app):cahoh fcr a Free o" Reduced Price Lunch? (ApplicatOn a provided wdtn this Pegistrarion Form) 0 YES SCREENING AND AND ASSESSMENT: SODIUM FLUORIDE PROGRAM: (4O) I gme Permisson for rn) child to given Screening and assessmett tests when necessary. these tests may be given mon/dually 0 If groups. res J NO (41) I give permission for my child to paropate in the &chum Fluonde Program to pr ert dente decay. Permsmcn valid through grade so. YES _IND FOREIGN STUDENT INFORMATION: This information is voltntary and used solely for the purpose of obtaining Federal funding. (42) ORIGINAL ENTRY INTO USA SCHOOL MONTH DAY YEAR (43) STUDENT CITIZENSHIP STATUS (Circe One) 1 2 3 5 6 8 1:Resident Alien 2rNoniresIdent Allen 3:Exchange Student SzRelugee 6:Entranl BrImmIgranl (Counselors can provide assistance In determining status) NEW STUDENTS TO PALM BEACH COUNTY ONLY: (44) ENTRY DATE 'USA) MONTH DAY YEAR (45) U.S. CITIZEN J YES J NO (46) IF tiO, CITIZEN OF WHAT COUNTRY? (47) IN WHAT COUNTRY WAS THE STUDENT BORN? (43) WHAT LANGUAGE IS SPOKEN IN THE HOME BY THE PARENT OR GUARDIAN? (49) WHAT LANGUAGE IS SPOKEN IN THE HOME BY THE STUDENT? (50) 1. Is a language other than EngIsh used in the home' OYES 2* ) 2. Did the student have a first language otter than English? AYES 2010 3. Does the studert most 4recuerrly speak a language other than Englsh? OYES (51) STUDENT LANGUAGE (52) PARENT GUARDIAN LANGUAGE (53) COUNTRY OF NATIONAL ORIGIN DOCUMENTATION CHECKLIST: (54) CHECK AND DATE ONLY NHEN RECEIVED: 1 DATE IMMUNIZATIONS 1 DATE PHYSCAL EXAMINATION 0 DATE: II DATE: BIRTH CERTIFICATE 1 DATE: PROOF OF DOMICILE SOCIAL SECURITY NUMBER Ifs) SI IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. 0 (1 DATE / )< - RELATONSHIP PESO 0636 ,REMSED GC 96506 EFTA01710120 r • . A MCA) Mov..1„, v.. Art • •• lele rXTh ial SCHOOL BOARD 00 PALM BEACH COUNTY STUDENT REGISTRATION FORM - PAGE 2 (58) (57 STUDENT NO J 'WULF. IIMONG PARENTAL INFORMATION: (60) TRANSJORTED BY: Student will be transported to/IroM school by (name /Cya//4//i) ictleiti //tcye (61) STUDENT LIVES WITH (CHECK ONE) j BOTH PARENTS a -MOTHER j ::AT-IER j SHARED CUSTODY 0 OTHER (62) IS THERE A COURT ORDER BARRING EITHER PARENT FROM REMOVING OR CONTACTING THE STUDENT DURPIG THE SCHOOL DAY? Li YES alcr IF TES. PLEASE PRO\IDE THE SCHCOL KITH A CCPY OF THE CCURT ORDER. ' /1 .4- ./ 0/(0 1 \.1 - ( i fi i-019 /1/ (7 ///r or above) PUCE Of EIAPLO1ENT BUSINE S PH ry (64) HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) A j ELEMENTARY SCHOOL 8 J SOME HIGH SCHOOL C Ij HIGH SCHOOL Diad31:51E POST-SECONDARY E j TECHNICALCOLLEGE (Grades K-8) (Grades 942) (Graduate) (Technical . College) (Graduate ssal____ m AS /Aft. LAST NA , PAD. NM &Aid)/ AS) OCCUPATION COLLEGE or above) PLACE 0 BUSINESS PHONE (66) HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) A j ELEMENTARY SCHOOL B j SOME HIGH SCHOOL C letraSCITOOL D 0 SOME POST-SECONDARY E _J TECHNICAL (Grades K-8) (Grades 9-12i (Graduate) (Technical College) (Graduate (67) LEGAL GUARDIAN (IF ANY): LAST MALE FIRST MID. INIT. OCCUPATION PLACE OF EMPLOYMENT BUSINESS PHONE (58) EMERGENCY HEALTH AND SAFETY INFORMATION: (68) PART I: Person(s) other than parent authorized to pick up student. 70) NAME (71) ADDRESS (72) PHONE (73) RELATIONSHIP tee/ 0 7.1 ne/t (74) PART II: Person(s) to contact in the event of an emergency if parents cannot be reached. Those listed are also authorized to remove student from campus In an emergency situation. a -C-Keck here il the i formation is the same as n Part I. Complete Part II I deferent korr those authorized in Part I. (75) NAME (78) ADDRESS 77) PHONE (78) RELATIONSHIP kievek pheue r9) PART III: If school Is unable to contact you In case of Illness or accident, may we have your permission to call your doctor or take your child to the hospital led u Ho (80) FAMILY DOCTOR (31) PHONE NUMBER (82) HOSPITAL PREFERENCE , ia.31 I! ycur child suffers ron any illness or has any physical defects that we should be aware of please Ilst. YOUR OTHER CHILDREN IN PALM BEACH COUNTY SCHOOLS: 84 NAMES OF CHILDREN (85) SCHOOL ATTENDED (86) GRADE (87) BATH DATE / /4) b) . V (8s) I VERIFY THAT THIS REGISTRATION INFORMATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. 193.50 0636 (REV. 3 93) GC6498-2 EFTA01710121 40 01 THE SCHOOL DISTRICT OF PALM BEACH COUNTY 9-12 Academic Improvement Plan (AIP) SY: 04 Ir. „...? Marking Period DOB:J Monitoring Dates: FNRT. FCAT: REAC: AIP: First / Second / / WAP: PRIM: LEP: Third / / Fourth / ALP BEACH SA) n IPA* ABS: 3 R ' MATH: MATH: R-ZZ W-ZZ M-Fl S-ZZ 504: O READING U WRITING ['MATHEMATICS • SCIENCE /Textbook Assessments C DL FCAT Diagnostic I Practice Ten 2 71:akin 0 Beach Writes Portfolb Von -taros Assessments FCAT Diagnostic/Practice Tests D eFextbcoli Assessments 0 Portfolio agerfarnance Assessments aliCAT DiagnosticiPractice Tests 0 0 II • Textbook Assessments Pontoto Performance Assessments FCAT Diagnostic/Practice Tests 0 D'09nntk, Software 0 Other (see attached) 0 • Diagnostic Software Other (see attached) O Diagnostic Software 0 Other (see attached) p Diagnostic Software 0 Other (see attached) a L.) hY 0 Phonernt Awareness 0 Letter Recognition 0 Phonics: Sound / Symbol Correspondence Mg/Encoding Meaning Structure n t__, Visual (Mot) Fluency Types of Writing 0 Word/Sentence writing O ,• /nraph Writing i , / Dcelposition Writing Awareness !Application of FCAT Writing Rubric E Fiscus 0 Sipper% [Number Sense, Concepts and Operations a -Measurement ErGeometry ErAlgebraic Thinking atata Analysis and Probability 0 Reatling in Content Area Speak Concepts 0 0 • 0 0 • 0 The Nature of Matter Erergy Force and Motion Processes that Shame the Earth Earth and Space Proayscs of Life § How living Things Interact with their Enviroorneri 0 High Frequency Words J Organ taboo 0 Conventions M The Nature I:: Science concepts 0 Rate Compositions • Readng in Content Area Meaning 0 erratve Specific Concepts Vocabulary tory • 0 Text Comprehension Persuasive ii it 11" 8 Xe 0- , Tutoring n pfuring School Day D'AflerlBefore School / Saturday Instructional Alternatives Tutoring 0 Instructional • ring Schoct Day Ater/Before School I Saurday Alternatives Temporary Skill Groups Tutoring 0 During School Day [3-After/Before School/ Saturday Instructions:Alternatives Tutoring 0 During School Day 0 AtterGefore School I Saturday Instructional Alternatives 0 Tempora-y Skill Groups 1 PR g3 Is fe 3 k 0 Minpvicily Skill Groups 0 (44krali" Learning Groups 0 Guided ReadingNtiling Groups 0 Technology O Other (see attached) Assignment Alternative r—i 0 Time K Quantity 0 Product Requirements 0 Child Study Referrals 0 hairdo-tonal Reading 0 • 0 • Assignment O [ IT E 0 Cooperative Learning Groups Guided Read ngaritrig Grams Technology , Other (see erected) Alternative Time ammity Product Requiremerts (Mild Study Referrals Instructional Language Ms 0 [cooperative K0 n Assignment • 0 • 0 0 Temporary Skil Groups Learning Groups Technology Other (see attached) Alternative Time Quantity Product Requi ts ChM Study Referrals littictional Mathematics 0 Cooperative Leaning Groups 0 Guided ReadingtWnting Groups 0 Technology 0 Other (see attached) Assignment Alternative 0 Time 0 Quantity 0 Product Requirements 0 Child Study Referrals 0 Instructional Reading Student progress will be monitored throughout the school year. and student progress will be reflected on the report card. 11 D ii 0 Successfully Rernediated Requires New AIP Next Schoen( Year Special 0 _evicts / Placement Other (see attached) O [Ti 0 II Successfully Remediated Requires New AIP Next School Year Special Scivi,es / Placement other (see attached) O Successfully Remediated 0 Requires New AIP Next School Year 3 Special Seivices I Placement 0 Other (see attached) • 0 • 0 0 Suoresslully Remediated ,,_. Requires New AIP Next Schott Year Special Senices 1 Placement Other (see attached) In Deficiencies due to non-attendance refer to Attendance Specialist) Number of Days Absent Parent/Guardian Contact CommItnentIContdbution O,ecl te 'het eppy. El Monitor Attendance I Tarries K Check Homework 0 Read with Child Every Night 0 Reinforce Skills K Attend Parent Conferences 0 Sign Daily/Weekly Notes D Attend Parent Curriculum/ Information Meetings PBSD 1687 (REV. 911312002) SIGNATURE OF PARENT/ GUARDIAN DATE DAZE /().-.12 -43 DATE -Ch; -A/10 41 SIGNAItIRt 0FIEACmER OATS ORIGINAL • Cumulative Folder COPY - Teacher COPY - Parent/Guardian EFTA01710122 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES Nar CUMULATIVE SCHOOL HEALTH RECORD (This form is not intended for physician's use) Address IAJ Pf3 P1 33L1 Date of Birth Place of Birth Race Sex Father's Name Mother's Na Immunization Certification: Yes® No0 Special Immunization Programs A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES School Special Health Problerns • See Warr at ve e.6 let.kc a e I e ben • e ath Reco•ded Yes No0 Screening and Assc0sitient Grades K.3 1 2 3 cs c r8 CS To 'et IT, cc Outcome ci c 'E a' , ti 0 a t. _ e 4-i z., cc g c = 0 EP i rb° t% tv - re a: ix E c c • ' a en c E 7.8 t' 7, .- C3 - . •-3 cc o 0a Vision 5.1) .; `g4- 3-1- 95 Hearing \230ti• 3-- y — T5 Height. Weight Mir 4.), a Graphing (4, 7 chi 4 194 9-845 I - Nutrition Dental Health Mental I teal th Communicable Disease aikk's\5 1 Records Review Physical Assessment % k t s )4711c Other Other Screening and Assessment Grades 4R 4 5 6 7 8 m - ,- 0 a 0, Ts ..: i cc I) 5 ; o ca: c — I') 8 r:6 To ... i- i cc Outcome cs c c ... a cx _ r's k- 1 cc 0 E 8 5 cs cri -C w c — ia2 5 fA Referral g 5.9. = 0 cc' .- e g .e; C ' To ._ icr, z cc I Outcome Vision HAI Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Physical Assessment Scoliosis Other Other HRS-H Form 3041, MAY 80(Replaces previous editions and MCH 304) EFTA01710123 IttACIMIT FLORIDA CERTIFICATE OF IMMUNIZATION (HRS 680 - PART A) kFtiridi S•attees 232 0321 FOR CHILDREN WHO HAVE COMPLETED ALL REQUIRED IMMUNIZATIONS FOR SCHOOL ATTENDANCE DATE 3F BIRTH (BLU S NAME DOCTCR: FART A OF THIS FOAM IS USED ONLY IF TI1E CHILD HAS RECEIVED ALL REQUIRED IMMUNIZATIONS LISTED KM. F. NOT. SEE REVERSE SIDE. DTP - 5 DOSES REQUIRED •1 PA:411,T f R NIARDAN IF THE FOURTH PRIMARY DOSE OF DTP IS ADMINSTERED ON OR AFTER THE FOURTH BIRTHDAY. A FIFTH DOSE IS NOT REQUIRED. DT (PEDIATRIC) VACONE IS ACCEPTABLE IF PERTUSSIS VACCINE IS MEDICALLY CONTRAINDICATED. ICCMPLETE PART C FOR PERTUSSIS ONIRAINDCATION Td (ADULT VACCINE (A SERIES OF 3 DOSES) IS ACCEPTABLE AND RECOMMENDED FOR CHILDREN 7 YEARS OF AGE OR OLDER POLIO ITOPR - 4 DOSES MOORED IF THE THIRD PRIMARY DOSE OF TOPV IS ADMINISTERED ON OR AFTER THE FOURTH BIRTHDAY. A FOURTH DOSE IS NOT REQUIRED. POLIO VACCINE IS OMITTED FROM THE REQUIRED IMMUNIZATIONS OF CHILDREN 18 YEARS OF AGE OR OLDER. MEASLES, MUMPS. AND RUBELLA - I DOSE REQUIRE° PMR COWRIE() - I DOSE AT 12 MONTHS OF AGE OR OLDER AND IN 1968 OR LATER (RECOMMENDED AT 15 MONTHS. -OR- 7 fr124., MEASLES SINGLE - 1 DOSE A7 12 MONTHS OF AGE OR OLDER AND IN 1968 OR LATER (RECOMMENDED AT 15 MONTHS) MO DA YR MUMPS SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER MD DA YE RUBELLA SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER MD DA VP 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 I IAVE REVIEWEC THE RECORDS AVAILABLE AND TO THE BEST OF MY KNOWLEDGE THE ABOVE NAMED CHI 9 HAS BEEN ADEQUATELY IMMUNIZED AGAINST DIPHTHERIA, TETANUS, PER RUBELLA AS REQUIRED BY Fl nnina I Ameono cflannl ATTENDANCE. PHYSICIAN OP CLINIC NAME (PLEASE PRINT) PHYSICIAN OR AUTHORIZE NATURE DATE EFTA01710124 Leac NAME: TITLE: ADDRESS: 7 f' (Please Print) Mr. STATE OF FLORIDA DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES T HEALTH EXAMINATIONS OP- /9 YS Date Phone Ago Race C- Sex r ricci-bs Birthdate Nam. of Parent or Gu3rdan A. HEALTH EXAMINATION Height Weight BI0Cid Pressure • • On Normal-N; Abnormal-A I Appearance N A 2. Skin /Nose 3 Fir.xl /Scalp 4 Eyes 5 Visual Acuity (R & 6 Ears 7. Audilory Acuity (R 8 L) 8 Nose Throat 9 Mouth. 'teeth and Gums 10 Chest / Lungs tI Heart 12. Abdomen 13. Gemtad and Ante 14 Muscula-Skeletal 15. NeurolC9Cal 16. Alertness 17 Emotional / Mental/ Behavior Pr0b.) 18 Handicap. physical/ other (Speedy) 19 Activity Restrctians (Specify) 20 Abuse. substance/ physical / emotional 21 NuPlti0n 22 Owe. I COMMENT: Abnormal Findings, by number B. HEALTH HISTORY (Serious Illnesses Intures. explain) 'attach narrative if addition; space nocdcd) C. LABORATORY (as in0Celei3) Hemoglobir/Hcmctocrt Stool1O8 n Tuberculin teal Sckle Cell type date row d'19. 13 D.• HIS- H Fore 3040, mar 91 (besot *tea previous editions) (Stock Muter 5744 OW -3440-2) EFTA01710125 ir ,/7/2 4.)i C es- err -1/4/ , 06 W/ 7/7/ tA./ / 7 /-1 /;-/ FA: rowf Kr_ c ,,//c r7tfW A7 STATE OF FLORIDA COUNTY OF PALM BEACH "• _ . Ns:: 3 PUBLIC, STATE OF FLORIDA. 311. COMMISSION EXPIRFS: Dee. 13, 1991. BONDED 711RU NOTARY PLISLK UNDERWRITERS. /- 33 yr/ On this the 20th day of August 1993, before me the undersigned Notary Public of the State of Florida, personally appeared and whose name is subscribed to the within instrument, and he acknowledge that he executed it. WITNESS my hand and official seal rOTARY PUBLIC, TATE OF‘PIORIDA Produced identification: Ti nrivera Lirtanctw Did take an oath EFTA01710126 This certifies that a certificati of bieilelsatt Sex: Female on: At: Name of father:- uK Maiden name of mother: Date filed: - :Date issued: New York State Departmeb, Albany, N. Y. 12237 (gunfire, of !frill! tr - 'n uncrfil.:she name of: --;:cliki,%.7;i"*.f,•i' • I - w. " "' • :;:r7ti" • • ,Z.4.7.i:•=;Vt: • ' .11taisiPt oeiStit Shfiltki ?Meek.: -1111i-nefice is voicrif if tonfoinsopOwasswes .gamsiist . 66060060660000660000000_00 "3" EFTA01710127 • NARRATIVE RECORD Notations by educators, nurses and other designated personnel should be dated and signed. Narration section should include information concerning referrals, follow-up and special consideration to be given students in classroom as a result of screening. as well as teachers' observations, parent conferences, home visitations and services rendered. Educatcrs need only record information concerning teacher observation and educational depSi0ns made for students in the classroom as a result of screening and other health Information. DATE 742/91 AL/724,4=4;42-75t.14f4;a424,7217teize-0A-Inenye,07 , HRS-I-I Form 3041, MAY B0 (3) EFTA01710128 TEST RECORD INFORMATION A,^ RAEW 173 MEP Pi.".° CTBS/4 LEVEL 13 FORM A READ MATH T T L NG LANG FLORIDA COMPREHENSIVE ASSESSMENT TEST FLAT) OCTOBER 2004 SUNSHINE STATE STANDARDS STUDENT: GRADE: DISTRIC SID. SCHOOL: 2531 ROYAL PAIN BEACH NIG DOB READING SS: READING DSS: 11 MATH SS: NOT TESTED MATH 03S: PBSO 0280 FRT EFTA01710129 F Florida Comprehensive Assessment Test Spring 2002 Florida Comprehensive Assessment Test (FCAT) Sunshine State Standards - Grade 08 Student Report MN= School Name and Number 1691 - CRESTWOOD MIDDLE District Name and Number SO - PALM BEACH The FCAT is a test developed in Florida to measure student achievement of the Sunshine State Standards (SSS) for reading, mathematics and writing. The test is one measure of how much students have learned and how prepared they are for more challenging work. The standards tested on FCAT were developed by groups of teachers and Identify the knowledge and skills students should achieve as they move from, grade to grade. The A+ Plan for Education established an annual assessment of student learning in grades three through ten as well as regular reports to parents. This report provides parents with independent information about the achievement and learning gains of their students. 2002 Achievement Levels and Scale Scores Grade 08 Achievement Levels Scale Score Ranges Reading Mathematics Level 5: 394-500 371.500 Level 4: 350.393 347470 Level 3: 310.349 310-346 Level 2: 271.309 280-309 Level 1: 100.270 100-279 2002 compared to 2001 Your FCAT score is reported in several ways. The Scale Score is a score between 100 and 500. The Achievement Level score is one of five success levels described on the back of this report. Your test scores show how you performed on the day you took the test. If you had taken this test numerous times, most of your scales scores would likely have fallen betiveen two scores. Your FCAT Reading scores mght have been between 303 and 335. Your FCAT Mathematics scares might have been between 301 and'319. The range reflects the amount of statistical variability in the scale score. Content scores show your performance on more specific areas of the Reading and Mathematics tests The table shows the number of points possible and the number you earned tor each category. Questions on this test were worth from 1 to 4 points. 2002 Content Scores Number of Points Possible Number of Points Earned Reading Words/Phrases 8 Main Idea/Purpose 22 ComparliOns 10 Reference/Research 10 Mathematics Number Sense t2 Measurement 12 Geometry 12 Algebraic Thinking 12 Data Analysis 12 2001 Achievement Levels and Scale Scorer" Grade 07 Achievement Levels Scale Score Ranges This section of the report shows the scale scores and achievement level scores you earned last year. The table on the left shows the scale score ranges for the test you took last year. Reading Mathematics Level 5: Level 4: 389-500 344-386 379-500 344-378 Scale I Achievement Score Level Level 3: 300-346 306-343 Reading Level 2: 267-299 275-305 Level 1: 100-266 100-274 Mathematics 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 good progress. " 2001 scores and learning gains are reported if matching records were found on the computer file. Data ALA Data: 05/11/2002 Oie0152 EFTA01710130 Florida Comprehensive Assessment Test FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2002 NORM-REFERENCED TEST Student Report GRADE 08. This report shows your results from the FCAT National Norm-Referenced Test. Student Name OM= School Name and Number 1691 - CRESTWOOD MIDDLE DlatrIct Name and Number 50 - PALM BEACH The FCAT Norm-Referenced Test measures your achievement on a test that was given to a national sample of students.. Your norm-referenced scores in Reading Comprehension and in Mathematics Problem Solving describe your performance in relation to the performance of students throughout the nation. Your scores are shown below. SUBJECT SCORES Scale Score National Percentile Rank Stanlne Reading Comprehension Mathematics Problem Solving The Scale Score expresses your performance and allows comparisons from year to year. Reading Comprehension Scale Scores range from 510 to 820. Mathematics Problem Solving Scale Scores range from 527 to 836. The National Percentile Rank and Stanlne 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 47 and 71. For Mathematics Problem Solving, your National Percentile Rank should be between 62 and.79. CONTENT SCORES Number of Points Possible Number Number of Points of Questions Earned Attempted Readin• Comprehension - 54 initial Understanding 8 ■ Interpretation . 27 Critical Analysis 7 ■ Strategies 12 Mathematics Problem Solving 52 Measurement 5 ■ Estimation 5 ■ Problem Solving 6 ■ Number Relationships 6 4 . ■ ■ Number Systems Patterns & Functions 3 ■ Algebra 6 ■ Statistics 4 ■ Probability 4 ■ Geometry 9 Each question was worth 1 point. a Data Run Data: osninon 0189636 EFTA01710131 Student Name: ,,,,,• , 4ofr.7Z i... - 4`, . , h ---. —`.: { : FCAT WRITING Student I.D. No.: STUDENT REPORT School: CRESTWOOD MIDDLE t. ...... 4t , ,.. „ 4 ,, , 21 District: PALM BEACH 2002 Grade 8 e; r . P SCORE: Florida Comprehensive Assessment Test WRITING TO CONVINCE 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 (1) the use of transitional devices to relate the supporting ideas to the main idea, theme, or unifying point and (2) the evidence of a connection between sentences. Papers representing the higher end of the point scale use transitions to signal the plan or text structure and end with summary or concluding statements. Support refers to the•quality of the details used to explain, clarify, or define. The quality of the support depends on word choice, specificity, depth, and thoroughness. Papers representing the higher end of the point scale provide examples and illustrations in which the relationship between the supporting ideas and the topic is clear. Conventions refers to punctuation, capitalization, spelling, and variation in sentence structure used in the paper. The conventions are basic writing skills included in Florida's Sunshine State Standards. Papers representing the higher end of the point scale follow, with few exceptions, the conventions of punctuation, capitalization, and spelling and use a variety of sentence structures to present ideas. Dear Student The paper you wrote in February as part of the FCAT has been read independently by two people trained to score this test. Each reader judged the paper against a set of standards and gave it an overall score. Your score is the average of the two readers' scores. This writing score will help you, your parents or guardians, and your teachers understand how well you performed on this statewide writing test. A description of how papers are scored is printed on the left side of this report. A description of each possible score is printed on the back of this report. Remember, you were given 45 minutes to read the assigned topic, plan what to write, and then write your response. The conditions under which you write papers in class or at home may not be the same as those for this test therefore, the writing may not be the ; same. You and your teachers should consider the score on this test along with all of your other writing when planning activities to continue developing your writing skills. DESCRIPTION OF THE TOPIC: You were asked to convince the reader to accept your opinion on teenagers having jobs or chores. RUN DATE: 04/11/02 50-1691 . • EFTA01710132 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2002 READING SUNSHINE STATE STANDARDS PERFORMANCE TASKS Student Report Grade 8 This report provides your results on the FCAT 2002 Reading performance tasks. Each performance task on FCAT requires you to respondwith either a short response or a longer, more detailed response. The short-response tasks are worth up to two points and the extended-response tasks are worth up to four points. One of the short-response tasks Is shown below with a copy of your answer. The number of points you earned for your answer IS shown In the box to the right There were tour performance tasks on this year's test. The highest number of points possible on all lour tasks was 10 points. The total number of points you earned is also shown in the box to the right. • This task required you to read an informational passage about surWval skills that can be used under several adverse conditions. • How are the survival skills needed for extreme heat and extreme cold similar? Use details and information from the article to support your answer. FCAT 2002 READING PERFORMANCE TASKS POINTS EARN ED Student Name ID Number School Number 69 School Name CRESTwOOD MIDDLE District Number so District Name PALM BEACH Points earned for answer shown below: 0 Total number of points you earned: 5 -\\1e tuswoRIN o rot exki-efore lvDtk. rb r cOhl • beComac 6 ‘, ei 4 Vt) eca tonl te. In% VAAter Grove 464- mi-ratie 7\v,cea,sea Itref , opal cian load -6 conwltiena ark ccen a ,14 1WAxis t\ttr% rerak• rViNt ats-vwcA -aSe;ilt,5 exl-rerne colot. At/QUA \)es_oa cm* 'e. butrvigo6 verdket1/2• enern14cs zs co1h Lea Nzo-NI N-Qmt &ozone Mart Ct tot or aree4rett t 06.0cp 1-ard. ‘ruAcakstrIrs•A ,Mtt c.oaticsAct co"fitcac tycva 1- tett, otarnt f-t-GrAiNt• %-auAlty buttliuoik etre rsedeL 8 • Data Run Date: 05/05/2002 0037109 766300080 EFTA01710133 Florida Comprehensive Assessment Test FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 SUNSHINE STATE STANDARDS Student Report Grade 07 This report shows your results from the FCAT Sunshine State Standards Test. 1691 - CRESTWOOD MIDDLE District Name and Number 50 - PALM BEACH The FCAT Sunshine State Standards Test measures your performance on selected benchmarks in reading and mathematics as defined by the Sunshine State Standards. Scores on this test are one indication of your achievement of the challenging content that Florida students are expected to know. Achievement levels for this portion of FCAT have not yet been determined. LEVEL 5: LEVEL 4: LEVEL 3: LEVEL 2: LEVEL 1: Student Achievement Level Descriptions 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. 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. 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. Performance at this level Indicates that the student has limited success with the challenging content of the Sunshine State Standards. Performance at this level indicates that the student has little success with the challenging content of the Sunshine State Standards. Your scores are shown below. SUBJECT SCORES Student Achievement Level Reading Mathematics Scale Score State Comparison: Thirds Lowest Middle Highest Sunshine State Standards Reading and Mathematics Scale Scores range from 100 to 500. If you took the test again, your scores might be slightly higher or lower than the scores on this report. However, your scores would probably fall within a certain range. For reading, your scale score should be between 277 and 301. For mathematics, your scale score should be between 286 and 316. The check marks ( J ) show if you scored in the lowest, middle, or highest third of grade 07 Florida students who took this test. "13D: To Be Determined Run Date: 04/26/2001 CONTENT SCORES Reading Words/Phrases Main Idea/Purpose Comparisons Reference/Research Mathematics Number Sense Measurement Geometry Algebraic Thinking Data Analysis Number of. Points Possible 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 was worth 1 point. 0178486 S EFTA01710134 Florida Comprehensive Assessment Test FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 NORM-REFERENCED TEST Student Report Grade 07 This report shows your results from the FCAT National Norm-Referenced Test. Name and Um er 1681 - CRESTWOOD MIDDLE District Name and Number 50 - PALM BEACH The FCAT Norm-Referenced Test measures your achievement on a test that was given to a national sample of students. Your norm-referenced scores in Reading Comprehension and in Mathematics Problem Solving describe your performance in relation to the performance of students throughout the nation. Your scores are shown below. SUBJECT SCORES Scale Score National Percentile Rank Stanine Reading Comprehension Mathematics Problem Solving The Scale Score expresses your performance and allows comparisons from year to year. Reading Comprehension Stale Scores range from 490 to 619. 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. Stanlnes range from 1 to 9. It you took the test again, your National Percentile Rank might be slightly higher or lower than stated here. However, your National Percentile Rank would probably fall within a certain range. For Reading Comprehension, your National Percentile Rank should be between 54 and 76. For Mathematics Problem Solving, your National Percentile Rank should be between 54 and 75. CONTENT SCORES Number of Points Possible Number Number of Points of Questions Earned Attempted Readin! Comirehension 54 Initial Understanding 10 I Interpretation 24 I Critical Analysis 10 I Strategies 10 I Mathematics Problem Solving 50 I Measurement 5 I Estimation 6 I Problem Solving 5 I Number RelatIonships 6 Number Systems 4 Patterns & Functions 3 Algebra 4 Statistics 5 Probability 3 Geometry 9 Each question was worth 1 point. 0 Run Date: 04/26/2001 0181361 EFTA01710135 I.7 FHA It. FasHA a. "Cony. thane. 45M4 VA, 6. Con. ino. ... . .. .,.. a. FIN Numb*, leiR04043 7. Loan Nurnbto 6. Menage Inautanca Ono Numb°. . • C. NOTE; This form Is furnished to glue you a statement of actual settlement costs. Amounts paid to and by he settlement agent are shown. Items marked (P.O.C.) were paid outside tho closing; they are shown hero for Information purposes and are not included In the totals. ewer IIIIN t Her II MIDLOTHIAN, VA 23112 ""4"""" WIERSDALE. FLORIDA 32195 ;,,,,,,,.., F. Name and Address of Lender GNAC MORTGAGE CORPORATION TAMPA. FLORIDA 33609 „„....n, ,,,^m G. Property Location LOXAHATCHEE. FLORIDA 33470 - H. Settlement Agent HARM TITLE L.C. Place of Settlement Royal Palm Beach. Florida 33411 t. Settlement Date 08/14/00 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: io0. Gross Amount Due From Borrower Ann nr..e sn,...... ra.... v... caole — I ELITE POLICY: I REPLACING POLICY NO: 1ST MORTGAGEE AND ADDRESS GMAC MORTGAGE CORP ITS SUCC &/OR ASSIGN PO BOX 57003 IRVINE CA 92619-7003 NON-ASSESSABLE POLICY PERIOD LOXAHATCHEE FL 33470.0000 ESS INCEPTION 8-14-00 EXPIRATION 8.14-01 NATIONWIDE INSURANCE COMPANY OF FLORIDA DECLARATIONS PAGE 1 OF 1 POLICY PERIOD BEGINS 12:01 AM STANDARD TIME AT THE RESIDENCE PREMISES. BED PROPERTY LOXAHATCHEE FL 33470-0000 ADDITIONAL INSURED NOT APPLICABLE *****TO REPORT CLAIMS. CALL 1-800-421-3535 FOR INQUIRIES. CALL 561-793-5000**k* INFLATION PROTECTION COVERAGE IS APPLICABLE. We will provide the insurance described in this policy in return for the premium and compliance with all applicable policy provisions. See policy for details regarding the SPECIAL LIMITS OF LIABILITY and ADDITIONAL COVERAGE OPTIONS. SECTION I COVERAGES LIMIT SPECIAL LIMITS OF LIABILITY ADOITIONAL COVERAGE OPTIONS A-DWELLING $155.000 OPTION LIMIT B-OTHER STRUCTURES $8.000 SEE POLICY A-JEWELRY-FURS $2.500 C-PERSONAL PROPERTY $77.500 I-EXT. REPL. COST APPLIES D-LOSS OF USE $15.500 J-REPL. COST PLUS APPLIES SECTION II COVERAGES E-PERSONAL LIABILITY $300.000 L-PROTECT. DEVICE 0-ORD OR LAW-25X P-WATER BACKUP APPLIES OF COV-A APPLIES PD/BI-EA OCCURRENCE F-MEDICAL PAYMENTS $1.000 TO OTHERS-EA PERSON OTHER COVERAGES LIMIT -FIRE DEPT. SERV. CHARGES $500 -CREDIT CARO-FORGERY $1.000 AND ELEC. FUNDS TRANS. ern.wew TT rorrniTAMC. The ”acidanra nromiAOA is the only nremises EFTA01710136 NEXT REPORT CARD DATE: CHESTERFIELD COUNTY SCHOOLS STUDENT EVALUATION SCHOOL YEAR: 19991 MARKING PERIOD: P4:4-: STUDENT: GRADE Team ABSENCES 06 YEAR TO DATE: 15.0 COUNSELOR: SCHOOL: SWIFT CREEK MS rei: 4.0 HIV 117 1P CLASS 0105 LIGON MARKING PERIOD: P L GRADES E E E a F EARNED COMMENTS TEACHER RSUBJECT SUBJECT V 1 2 x A s E 3 4 x A E U s I I N CREDITS 0 NUMBER NAME E M M LI M A T D L L • 01 SST206 SOCIAL STUDIES 6 02 MAT306 MATH 6 03 ENG106 ENGLISH 8 05 HPE706 HEALTH/PHYS ED 8 06 5C1406 SCIENCE 6 07 EXP006 EXPLORATORY 6 GPA CUMULATIVE: SEE REVERSE SIDE FOR EXPLANATION OF COMMENTS, GRADE SCALE, LEVEL, GPA & PARENT SIGNATURE. EFTA01710137 N ." , • -• . •1 IDtt Page: 1 of 1 Student Name: Grad Date: Demographic Address: MIDLOTHIAN., VA 23112-4049 Parent/Guardian: Cumulative Data GPA: Diploma Type: Grade: Sex: e Counselor: Soc Sec No: Birth Date: Rank: Specialty Center: Semesters Enrolled: 0 Earned Credits: School: SWIFT CREEK MS School Year: 1999 - 2000 Grade: Class Name ENGLISH 6 EXPLORATORY 6 HEALTH/PHYS ED 6 MATH 6 SCIENCE 6 SOCIAL STUDIES 6 06 AB Si Total Credits: S2 FG redi 0 . 0 Present: 157.0 Absent: Credit Summary Number of counts successfully completed in each area. Standard Diploma Requirements Enge 2000/2001 4 credits Advanced Studies Diploma Requirements 2000/MOI En2tI ntud, 4 credits n2 Ma tics 2 credits M 3 credits English 0000 Laboratory Science 2 credits Laboratory Science 3 credits Math or Science I credit Social Studies 3 credits Math 0.000 Social Studies 3 credits World History/Wodd Geography, 1 credit Laboratory Science 0.000 World History/World Geography, 1 credit United SOW & Vioicil History, t credit [ Social Studies 0.000 United States & Virginia Watery, l credit ( United Sete & Virginia Government 1 credit Foreign Language 0.000 United States & Virginia Government I credit Foreign L 3 credits Health/PE 0.000 Health & Physical Education 2 credits (3 years olo lgi;tileirknguage or 2 years each of 2 Languages) Fme Arts/Practical Am 0.000 Fine Am or Practical Arts 1 credit Health & Physic! EdUCID01. .--... 2 credits Fine Arts or Practical Arts. I credits Electives 6 credits Electives 0.000 Eleaires 4 credits Total = 23 aedia Total: 0.000 T = credits nay be met by an approved o vocational vononal se 21 quence 15.0 Membership: 172.0 GRADES brawn Very Good w AB • Abler Level Level - Acfacneed Prow= Level1- Wel, * pasta/OMGra* level Level Meeling Raxtomontal Grade level Level X • Basic Sob Level C -Ccengreeeeve Wel 0 -No Geouring Signature of Official Certifying Transcript Printed: 06/23/2000 08:43 AM EFTA01710138 STANFORD 1 TEACHER: NO NAME GIVEN SODOM: SWIFT CREEK MIDDLE -02I0270 DIVISION: CHESTERFIELD - 021 TEST TYPE: MULTIPLE CHOICE ACHIEVEMENT rrsr SERIES, NINTH EDITION - ABBREVIATED VIRGINIA' sir ASSESSMENT PROGRAMt - .new CRADE: OS aScarS,EYll4kenifttsr4t. TEST DATE: 09/99 • ;:"bitccvs 1 Ski Y 0:0R4 NIPON^6 WI:" , • f; nng2 :Oa wale tonne! STUDENT'S PERFORMANCE Recently this student took the Stanford Achievement Test. The graph to the right presents the student's test results. These Percentile Rank Scores compare the student's performance with scores of students in the same grade from across the nation. Percentile Ranks range from a low of I to a high of 99. For example, a Percentile Rank of 70 means that this student obtained a score that is equal to or higher than 70 percent of the'students in the comparison group. Please keep in mind that this test is only one indicator used in isiessing a student's achievement. The school has additional information about how the student is performing in class. NOTE: The Partial/Basic Battery is comprised of the reading. mathematics, and language sublests. When Science and Social Science are taken, the Total/Complete Battery is also reported. Reading Your child's score In Reading was in the average range. Encourage your child to read books about topics of interest. Social Science Your child's Social Science score was in the average range. Talk often with your child about people, places, and events. 1995 NORMS: Fall JF dennedisite 2 1; National Mathematics Total Roadine; Total Math Language Sci erne Social Selene Partial Ai tem; Total Batti NATIONAL GRADE PERCENTILE RANKS 10 Below Average Nol ft: • The student had it non-standard adscomn 30 50, 70 Average dation in thl, content are.'. I I 90 99 Above Average . Your child's score in Mathematics was in the average range. Help your :Mkt use math to solve problems in everyday life. tanguage The Language score was .n the average range..-Let your child .. ... • write letteps„stories,,anitlists whenover'possible.' "" Scorn band on normative Jan copyright *1996 by lareoun Brace & Company. All nghu reserved. ._.Science: . .. .. The Science score was in the averageI range. Encourage your child's .,... . curiosity about the world. Coo _y_0 Process No. 19960026-321:059-5392-S6M EFTA01710139 L a; • TEACITERginO,NAME OWEN , SCHOOL' SWIFT CREEK )4 61i dhazio DIVISION: CHESTERFIELD Oil TEST TYPE: MULTIPLE CI IOICE -I. Al VIRGINIA STATE ASSESSME.NT PROGRAM TEST DATE: 09j99 . — . SUBTESTS AA D TOTAIS No. of Items Raw Score Scaled Score National PR -s Total Reading cc Vocabulary 20 ReadngC4MIP., 30 Total Mathematics 50 Problem So's-ing 30 Procechres 20 Language 30 prewriting 8 Composing 8 Editing 14 Science 3C Social Sciencs 3C Partial Battery 130 Feral Rattery 190 NATIONAL GRADE PERCENTILE BANOS 1 10 30 50 70 90 99 Bch. An tats" Attar Ainisge Recently this student took the Stanford Achievement Test. This brief description of the scores presented above tells how the student did on the test, compared to the 1995 performance of students in the same grade from across the country. The Battery score is an overall indication of how well the student performed on the test. The score for this student is in the middle range for the grade. which meant that performance on al =busts combined was well within the average range. In reading, the score ism the average range for the grade. Continued opportunities to read a variety of materials should be helpful. In mathematics. the score is within the avenge range for the grade. Continued experiences in working with mathematics procedures and problem solving could be helpful to future learning in mathematics. Performance on the Language test was in the average range fur the grade. Examination of the Preventing, Composing, and Editing scores for this test can be helpful in guiding the student in the writing process. The Science stablest score is m the middie range for the grade. The Social Science subtest score is somewhat below average It appears that the student may be having difficulty understanding the concepts and skills measured by this subiest It is important to keep in mind that test scores give only one picture of how a student is doing in school and that many things can affect a student's test stores. Therefore, it is important to consider other kinds or informaCon as well. The school has more detailed information about how the student is doing. NOTE: The ParualfBasic Battery is comprised of the reading, mathematics, and language subtests. When Science and Social Science are taken, the TotaliCompkte Battery is also reported. • The student had a non-standard accommodation in this content area; scores belonging to this area are excluded from summary calculations. 1 STANFORD LEVEL/FOR-Vt. Intermediate 2TA Copy 01 1995 NORMS: Fall National Process No. 15961026.3211059-5392-560SA Scores based on tormatne data copynght C 1996 by Harcourt Brace & Company. All nghts reserved. EFTA01710140 Student Teacher THE SCHOOL DISTRICT OF PALM BEACH COUNTY ELEMENTARY REPORT CARD MARKING CODES - ACADEMIC SUBJECTS GRADES 1 and 2 E - Excellent S - Satisfactory V - Very Satisfactory N - Needs Improvement GRADES 3-5 A - Outstanding (94% • 100%) B - Above Average (85% - 93%) C - Average (75% - 84%) D - Below Average (65% - 74%) F - Failing (0% 64%) I - Incomplete ACADEMIC SUBJECTS Marking Period let and 4th Mathematics tInclCate lace! with a check) On or above grade oval ftaIow gracte *vet ------ _ - — .. Reading (Ineciato level with • chock) On or above grade revel Flaw grad* ievat Composition Language Spellirg Handwriting/Penmanship Social Studies Science/Health Grades not given this nine weeks MARKING CODES - FINE ARTS 3- Outstanding effort end paliczpation Z • 541.2feet:icy effort end parttcpaton 7 - Inadequate effort and parucipetion: raiment conference requested FINE ARTS REPORT Art M uS c Physical Education Marking Period !1: PARENT/GUARDIAN/TEACHER CONFERENCE 3rd 4th Marking Period 1st Confer/ma conducted (Indicate date(s)) 7 3rd 4th Grade Year 19 17 -19 ?EC? School Nig/eV Fiem.4 CatlfraU Principal SOCIAL DEVELOPMENT/CLASSROOM STUDY HABITS Please work on the area(s) that have a check (I) Marking Period ist 2nd and 4th Overall effort Works cooperatively Works independently Completes classwork on time Completes homework on time Follows classroom rules and routines Uses time wsely Follows directions Accepts responsibility for own actions Comes to class prepared with materials linititL e V 01' ALTERNATE ASSESSMENTS Irdicate those used with a check (!) Marking Period In :nn see 4eh Skills Checklist(s) Portfolio Audio Cassette Recording Video Recording Computer Program Standardized Test(s) ObservationsANntten Comments Other ATTENDANCE Regular attendance and punctualtty are essential for quality educator. Marking Period "` Days aid 4th Present V l2ndia Days Absent Days Tardy I 0 Information Included Grade PLACEMENT • Special Session • If Special Session program rs indicated, grade placement Mil be determined by the borne school. PHD 0788 (Rev. 7/94) GoidenrodHst Period PInkJind Period Canary/3rd Period Greionflte Period White/Office Copy EFTA01710141 THE SCHOOL DISTRICT OF PALM BEACH COUNTY Elementary Student Transfer To Be Completed for All Transfers (Print or Type) LAST GRADE. ' TEnT RACE CODE kA SE% CATE OFriTwytWAL C..) or') /9S DAYS PRESENT ti O DAY , AP FN1 (% TARDY PAPEFC ESOL Status A0 R K EU ZZA. Psychological on file Yes 0 No p. Physical Exam on file Yes W. No 0 Date 1/ 6? Jci 3 Immunization Dates: Lunch Free 0 Reduced K N/A El Copy of form attached Yes K N/A Health Problems/High Risk Yes JI N/A lY PRNCIPAL SCHOOL NAME ii ; titste.2.44.- - ---e-- 2;&- -/ M / Ltitt.. , SCHOOL ADDRESS &FM V fibi). 11..iftte-A F2 53Y") REGULAR INSTRUCTION PROGRAM INFORMATION Copy of Roped Card Attached Teacher Name(s): CLIREENT GRADE U Instructional Materials (indicated level) GRADE KG 1 2 3 5 5 PAGE Mathematics KG 1 2 3 7 . ( 5 Macmillan J Level Level Level Level - -It LevelAj-bef /4Wfrqr l ' 7:I . i !ii Level ' Reading FOCUS a i fr b* . -1--- e f L ; 4e - , irk, ,S , pe ;r Other / _y at JP tVIii ki Student meeting Pupil Progression S andards Pupil Progression Letter sent Yes No -1 / Student currently repeating grade Yes LI No D i , School Pat of ... Yes Yes 0 0 No No l.a Letter signed Yes U No Di Workbooks sent with student Yes 0 No ILS Disk Yes 0 No W SPECIAL INSTRUCTIONAL PROGRAM INFORMATION Sfudent is in special Program (circle) EH EMH Gifted LAD SEH SLD Speech SOI VE Alt. Ed. Migrant Current I.E.P. Date N/A 51, ESOL 504 Staffing/Testing in Progress Chapter 1 Other (name program) OBLIGATIONS FULFILLED Tex arks rpltrned Yes J No K I ihrary hooks returned Yes No 0 EAr OFF Pbb 1E LLOW/sanamg scnoof office rupwcumulative I older EFTA01710142 I`le-1c1au.cc t ?..2tt1GrAn Interim Progress Report 1 2 3 4 Student Classroom Teacher Mathematics K Satisfactory K Unsatisfactory O Satisfactory K Unsatisfactory Behavior Attendance Art CI Satisfactory O Unsatisfactory O Satisfactory K Unsatisfactory O Satisfactory O Unsatisfactory Social Studies O Satisfactory K Unsatisfactory Music O Satisfactory O Unsatisfactory Spelling K Satisfactory K Unsatisfactory PE O Satisfactory • Unsatisfactory Your child needs to: O attend school regularly. O bring the necessary supplies and materials to class. O listen carefully and follow directions. O complete homework assignments, ILIASS a.n tn Prtn13 C work cooperatively. I request a conference with the parent. I request a conference with the teacher. Parent Sign O Yes 11 Yes El No - E No Date 9AM EFTA01710143 cso -fe,ou,h not& ii34-your Ida /lief bu+ r ao-Fmoraifrovii nam6e • EFTA01710144 Ili —uniting Writing Fluency Kindergarten --. First Grade Dates checked Draw picture and tell about it. Draw picture and write random marks. . Draw picture and write letters. Begin to leave spaces. Write the first letters in words. Write the first and last letters in words. Write some middle letters. Write some whole words. Use a period. ' , ' • • Use capital letters correctly. i .,/ Write sentences. / Yes, I can ... Second Grade Dates checked Use capital letters at beginning. Put periods at end. Use a capital I for myself. Write two sentences that go together. Write three sentences the go together. Spell sight words correctly. Use spelling dictionary to correct words. Can change or add words to make meaning dearer Can write four or more sentences that go together. -280 EFTA01710145 ad I \ t 166 +h c. rmi ( kr-1 A \ \APIELE'h+ EFTA01710146 Teaching questions for tomorrow's answers ACREAGE PINES COMMUNITY ELEMENTARY SCHOOL To The Parent(s) Of: 10-3 - CLi Date Soiens, Your child, , has been absent 6 times in the last weeks. Excessive absences are detrimental to your child's academic progress. Thank you for your cooperation in this matter. Sincerely, ad* g-Sz77 a1/- GUL Ue 4 oitex V4br. assn Y--xx 1/4 14t, J cad" yifaf S/Li sk-4,./LY kx„, EFTA01710147 'SCHOOL BOARD OF PALM BEACH COUNTY ELEMENTARY STUDENT TRANSFE i C.C% To Be Completed for All Transfets tri (Print or Type) Last IN Grade Race Code Student Number Sex Parent/Legal Guardian ESOL Status A R E 22 Lunch: Free Li' Reduced O Psychological or file Yes D No Er Copy of form attached Yes O Physical Exam en file - Yea D No O Date Ticket attached Yes O Immunization Dates: 4th DPT ' MMR Health Problems/High Risk Yes 0 WA O Date of Withdrawal / / Days Present Days Absent Telephone Principal_ School Name School Address Street N/A K N/A O NiA K PX No. City REGULAR INSTRUCTIONAL PROGRAM INFORMATION Current Grade Copy of Report Card Attached Instructional Materials (indicate level) GRADE I 2 3 a 5 PAGE Mathematics I 2 3 4 5 Macmillan O Reading FOCUS O Lcvc: Level Level Level Level Other El Student meeting Pupil Progression Standards Yes O No O Student currently repeating grade Yea D Pupil Progression Letter sent Yes O No El School Patrol Yea D Letter signed Yea O No O Workbooks sent with student Yea O State Zip SPECIAL INSTRUCTIONAL PROGRAM INFORMATION Student is in special program (circle) Eli LAD Speech Alt. Ed. Migrant EMI! SEli 501 ESOL Staffing/Testing in Progress Gifted SLD VE Chapter I Other (name program) OBLIGATIONS FULFILLED Textbooks returned Yes ri No O Library books returned Yes ID/ No D °RIC TN AL'.ra Stand PM 99331Rn. 111/1,11 Teacher Signet, Office Contact Signature Today's Date YEI-LOWThending ..Mott tlk. No K No O No O Current LE.P Date N/A O POIKJe-salegin folder WIN 014404 1111124101; MI/Gil/F.14 EFTA01710148 'SCHOOL BOARD OF PALM BEACH COUNTY ELEMENTARY STUDENT TRANSFE To Be Completed for All Transfers (Print or Type) Last Name (Legal) First Name Middle Initial A /6 Sex Grade (ace Code ESOL Status Psychological on fde Yes 0 Physical Exam on fde y Yc Immunization Dates: • Health Problems/High Risk Ducat Withdrawal / / ie 96/ Dater-/9- Y3 A R E ZZ Lunch: Free IV Reduced 0 N/A 0 Copy of form attached Yes 0 N/A 0 Ticket attached Yes 0 N/A 0 Days Present Street N/A Days Absent Telephonelli PX No. !Se City S State REGULAR INSTRUCTIONAL PROGRAM INFORMATION Current Grade Copy of Report Card Attached Instructional Materials (indicate level) GRADE 1 2 3 4 5 PAGE Mathematics 1 2 3 4 5 Macmillan❑ Level .. Level Level Level Level Reading FOCUS • Other • Student meeting Pupil Progression Standards Yes 0 No 0 Yes K Student currently repeating grade Pupil Progression Letter sent Yes 0 No 0 School Patrol Yes 0 Later signed Yea 0 No 0 Workbooks sent with student Yes 0 3.31A-7/ Zip SPECIAL INSTRUCTIONAL PROGRAM INFORMATION Student is in special program (circle) No 0 No 0 No 0 EH LAD Speech Alt. Ed. Migrant Current 1.E.P Date N/A 0 EMH SEH SOI ESOL Staffing/Testing in Progress Gifted SLD VE Chapter I Other (name program OBLIGATIONS FULFILLED Textbooks returned Yes 21/ No 0 Teacher Si Library books returned Yes e No 0 Office Contact Today's Date ORIGINAL/with ateclert YELLOW/maims othael O11k* 13.113 0938 (Rev. 10/92) WN PINI/JeumulalIve rows 01.9400 IVN292;110/GWF.I.1 EFTA01710149 Student Teacher THE SCHOOL BOARD OF PALM BEACH COUNTY KINDERGARTEN REPORT CARD hool ncipal Year 1961_3-1a9 WeAVrus\--ion MARKING CODES H - Highly Successful P - Progressing Satisfactorily N - Needs Improvement ACADEMIC DEVELOPMENT Marking Period 1st 1 4th Communicates ideas and feelings Speaks in complete sentences Shows interest in stories, books, and poetry o. Understands what is said and read aloud Retells a'story • Recognizes letters introduced Recognizes beginning sounds introduced Demonstrates an understanding of mathematical concepts Classifies objects and pictures M R A check (1) indicates those areas that, if improved, would help your child to make additional progress. Marking Period 1st 2nd 3rd 4th Regular attendance Getting to school on time Additional work at home with adult supervision MARKING CODES - FINE ARTS 3 = Outstanding effort and participation 2 - Satisfactory effort and participation 1 - Inadequate effort and participation; parent conference requested FINE ARTS REPORT Art Marking Period lit 2nd 3ro 4th Music Physical Education PARENT/GUARDIAN1TEACHER CONFERENCE Marking Period fat '2nd 3d Conference conducted (Indicate dede(s)1 SOCIAL DEVELOPMENT Marking Period 1st 2nd 3rd 4th Displays self-confidence Practices self-control Listens attentively/follows directions Follows classroom rules and routines Works independently Works well in a group Completes work in a reasonable amount of time ALTERNATE ASSESSMENTS Indicate those used with a check (•f). Marking Period 1st 2nd 3d 4th Skills Checklist(s) V / t., Portfolio ObservationsANritten Comments Other ATTENDANCE Regular attendance and punctuality are essential for quality education. Marking Period 1st 2nd 3/d as Days Present 4 I 45 Days Absent I 0 Days Tardy I O Information Included Grade PLACEMENT Special Session • If Special Session progrim is indicated, grade placement will be delemined by the home school. Pilot FY 94 Goldenrod/1st Period PInkand Period Canary/3rd Period Creenbith Period, Whito/Offico Copy EFTA01710150 PANE • SUMMARY STDT: 1111111111222222222233 1234567890123456789012345678901 ABS PRS MBR : YEAR: 94 SCHL: 1671 GR: KG ST: I CAL: 01 ASSIGNMENTS SCHL ENTRY WITHDRAWL I JUL 0 0 0 1 1671 E01 082393 WO2 011894 1 AUG 0 7 7 : I SEP 0 20 20 1 ' OCT A. .T. .... 1 18 19 : I NOV 0 18 18 : 1 DEC 0 13 13 1 I, JAN 0 10 10 : ,. FEB 0 0 0 1 1 , MAR 0 0 0 1 4. APR 0 0 0 1 ., MAY 0 0 0 : i. JUN 0 0 0 : i, JUL 0 0 0 1 AUG 0 0 0 : TOTAL: 001 026 087 % = 1 99 PFI=HELP 3=EXIT 7=BKWD 8=FWD 12=ESCAPE RECORD IS DISPLAYED...NEXT? TERML: R571 EFTA01710151 Teaching questions for tomorrow's answers Dear Parent, ACREAGE PINES COMMUNITY ELEMENTARY SCHOOL 14200 Orange Boulevard, Louhatchea, FL 33470 (407)795-4994 March 1, 1994 phi hp Sweet:le-. PfDV Pa' The State of Florida has asked that we obtain the following information on all students in kindergarten: Has your kindergarten c • d had pre-kindergarten experience? Yes No If yes, please answer the following: The program my child attended was pablic School 17Private Pre-school Home-based Day Care Other Please state other. Teacher's Name Please return this form to your child's classroom teacher by Friday, March 4th. Sincerely, S illi ata Processor EFTA01710152 PICTURE CARD Name Schoo I NtslekAi_n*Catv_itt School/Del 4{ et CEN Year ThAs 7 -- Grade--.3 ________ _ ________ LAST IMST MIDDLE School Year Grade School Year 9, "IL Grade School School Year Year Grade Grade EFTA01710153 I verify that I have received and read the initial eligibility requirements of the Florida Bright Futures Sc EFTA01710154 THE SCHOOL DISTRICT OF PALM BEACH COUNTY 9-12 Academic Improvement Plan (AIP) Marking Period Monitoring Dates: First / Second Third / / Fourth / SY: 04 LH. 008: FNRT. FCAT: MAP: PRIM: PALM litACH COM PISS: 3 MATH: REAL: PATH: A . R—ZZ 14—ZZ M—FZ. S- IL LEP: 504: Get lO READING 0 WRMNG ErMATHEMATICS _......_ 0 SCIENCE 0< 0 exttook Assessments • Palm Beach Writes 0 Portfolio aTe Assessments 0 Portfolio • K Textbook Assessments Portfolio . FCAT Diegi lc 1 PractiCe Tests 0 Diagnostic Software 0 Other (see attached) EjP.eformanceAssessments K,."FCAT DiagnoshciPnectice Tests 0 Diagnostic Software 0 Other (see attached) agerformance Assessments OFCAT DI29110StkiPtadiCA Tests 0 Diagnostic Software 0 Other (see et ached) 0 0 • 0 Perftenance Assessments FCAT Diagnoshr/Practice Tests Diagnostic Software Other (see attached) FOCUS OF RELEGATION 0 Phonemic Awareness 0 Letter ReccgnMon 0 Phorics: Sound I Symbol Types 0 of Writing WOd/SentenCe writing r‘grapti Writing Erhumter Sense, Concepts and Operations ameasuremert aGeornetry D The Nature of Matter 0 Energy 0 Force and Motion Ceneupinsiendie ring/Encoding Meaning 0 structure 0 visual (phonk::5) Fluency Awareness FCAT ill 0 Composition Writing /Application Writing Rubric Focus a of SuPPut [Algebraic Inking 0 , 0ata Analysh ard Probability 0 Readng n Content Area Spec Concepts 0 Processes that Shape the Earn 0 Earm and Space e•-i Li Processes of Lite 0 How Living Things Interact win their Environment 0 High Frequency Words Organization Illi Ccaventicns 0 The Nan of Science C0,0303 0 Rate Compositions D Reading in Content Area Meaning 0 arrative Specific • Concepts 0 Vocabulary dory Ej Text Comprehension Persuasive INSTRUCTIONAL DBNERY -Untie/mom INTERVENTION STRATEGIES STRATEGIES Tutoring 0 instructional El • 0 0 • Assignment 0 0 0 0 0 School Day AftenBefore School/ Saturday Alternatives Temporary Skill Grcups Cooperative Learning Groups Guided Reading/Writing Groups Technology Other (see attached) Alternative Time Quantity Prockact Recuirements Child Study Referrals Instructional Reading Tutoring In SS After/Before Instructional 0 0 0 • 0.Other Assignment 0 0 0 • 3 pang School Day School/Saturday Attematives Temporary Skill Groups Cooperative Learning Groups Guded Reading/Writing Grabs Technology (see attached) Alternative Time Quantity Product Requirements Child Study Referrals Instils:IWO Language Ms Tutoring El 0-MeriBefore Instructional 0_,..Temporany 3 . 0 Assignment 0 0 0 0 0 Moro School Day School/Saturday Alternatives Skill Groups - Cooperative Learning Croups Technology Other (see attached) Alternative Time Quantity Product Requirements Child Study Referrals Piste:hone/ Melellatcs Tutoring 0 0 Instructional 0 • El 0 0 Assignment D D • 0 0 During School Day After/Before School/ Saturday Afternatives Temporary Skill Groups Cooperative Learning Groups Guded ReadingAMiting Groups Technology Other (see attached) Alternative Time Quantity Product Requirements Child Study Referrals Instructional Reading Student progress will be monitored throughout the school year, and student progress will be reflected on the report card. r.1 0 Suocessfulty Remedlated 0 Requires New AIP Next Scholl Year 0 Spedal Services I Placement 0 omen (see attached) 0 0 • 0 Suotessfuly Ben:dieted 0 Successfully Rernediated 0 Successkily Remedlated .., ,_. Requites New AIP Neel School 0 Requires New AIP Neil School C Requires New Ala Next Year Yea Year Spedal Services/Placement - I Placement Other (see attached) hod) 0 Deficiencies due to non-attendance (refer to Attendance Specialist Number of Days Absent Parent/Guardian Contact Commitment/Contribution awe es that ropy O Monitor Attendance / Tardies 0 Check Homework O Read with Child Every Night 0 Reinforce Skills O Attend Parent Conferences 0 Sign DaityMteekly Notes O Attend Parent Curriculum/ hduitnetion Meetings LNER PBSD 1887 (REV. 9/13,2002) ORIGINAL • Cumulative Folder COPY • Teacher COPY - Parent/Guardia-1 DATE EFTA01710155 STUDENT RECORD FOLDER 4 COMPOSITION Grades 3-6 PALM BEACH COUNTY PUBLIC SCHOOLS GRADE 3 INTEGRATED COMPOSITION Fall Testing Spring Testing School tie-keAev-cA School N\e-- Na*C A Teacher Teacher f Date S.S.0.44tWO Rank 3 Date )4`y The student needs further work on: Response to Prompt - Audience - Development - Organization/Sequence Details - Vocabulary Sentence Structure - Grammar Mechanics Rank The student needs further work on: Response to Prompt Audience Development - Organization/Sequence Details - Vocabulary Sentence Structure _Grammar Mechanics UNIT ONE — UNIT TWO — UNIT THREE — UNIT FOUR — UNIT FIVE — UNIT SIX — UNIT SEVEN — UNIT EIGHT — Photo Story Journal Entry How-To Report Friendly Letter Story Ending News Story Book Report Descriptive Paragraph UNIT EVALUATIONS Date Rank Date Rank Date Rank Date Rank Date Rank Date Rank Date Rank Date Rank RANK: 4 - Outstanding 3 - Reasonable , 2 - Minimal 1 - Insufficient FY 93 PRINTING lemPRF EFTA01710156 )ky FOVOP iteTk 'og My Fay° Pi7Le Y-1)/i-6 is Pv • Lloch coteM TT Lt 1--)as IDecoine 5?ec; a / O me hecouse Irny rnoro 99otjf for, O7e. 11i is a/So Si oec,a/ , be Cause. ir*, cot s 'di-,ed end vegot-anotAet C&71;-, My ca isrny PaVon EFTA01710157 3 , 0010 r th \NOS Her le) apn p \N hen ' ()Of S he. unpe2 \Al 0 dy) otcAp y t t ±VMQ.1O001., StcLwien \NIG ct A aA \-O 3 r vc. Ir\o r fo rv- e \\-;(2 Coo.por:Ires T r ib Thew EFTA01710158 My F-O‘..\10C1-1-e r \--I,n3 \No“ --777 ACIP-elevi rf y t, 070 PI- fiTITT-- TiA tifPd 077- re-V) :VT - c/o-L.04 :9 o1--) • ; de. a rA A p 1 (N, -tn p kiAA io sett- -1,--)-p-r - T-----OFT-TrrnTral en vve I erir, ki‘7 o v • _N-46 rny rj,\)ur fte—±ti r EFTA01710159 6/6/96 6:46am COURSE PERFORMANCE Page Class(es) : Student('s) Course(s) : Total Course Time MCS 27:54 IR 21:25 FAB 7:28 RW 5:59 PS 0:52 LS 1:05 TRN 1:47 RA Total Corr/Att Exercises GRAND TOTAL RECORDS = 1 Total Percent Correct Enrol l Level IPM Level Current Level Gain 24/95) 1.49 1.83 2.81 0.98 1.00 1.67 2.99 1.32 N/A N/A N/A N/A 2.80 2.83 3.02 0.19 3.11 3.52 3.31 -0.21 3.00 3.80 3.82 0.02 1.00 1.64 1.73 0.09 N/A N/A N/A N/A Copyright (c) 1991-94 by Computer Curriculum Corporation. All Rights Reserved. If the format of this report is altered by the customer. CCC shall not be held liable for any inaccuracies that may occur in the report as a result of such alterations. EFTA01710160 5/27/97 1:33pm COURSE PERFORMANCE 302 200R2I (continued) Total Total Tot Cor/At Per Enr IPM Curr Tot Crs. Time Exer Corr Lvl Lvl Lvl Sess Gain - 10/9/96) RW 10:59 3.00 3.54 4.02 57 0.48 MCS 12:03 2.50 3.53 3.80 54 0.27 LS 0:50 3.00 -- 3.67 5 0.00 EFTA01710161 Si ULU" AorcQ an HOME PHONE Seventh graders will have FOUR academic subjects (Language Arts, Math, Comprehensive Science and Social Studies) and up to 4 ELECTIVE! I 2000-2001 YEAR Choose one of the elective options below: ND Select 1st, 2nd and 3rd choke. 81 Students in reading. TI to take nim 13 fi-Aat set- Lato 13 13 1303000 CHORUS I (Grades 7 - 8) 1303010 CHORUS 11 (Grades 7 - 8) 13021 I0 HANDBF.LLS 1 (Grades 6 - 8) 1302120 *HANDBELLS II (Grades 7 - 8) NOTE: • Requires teacher recommendation. 5 8600110 SHOP 8200220 *COMPUTER APPLICATIOD 0708000 BEG. SPANISH/JAPANESE OR .eption: Students who are reading below grade level will not be exempt frc hr school tutorial program or they will be removed from their year long electi Elective courses are subject to administrative change based on availability. Unless this form is signed and returned, we will select the stude electives. Limited space may be available for Art, taught outside regular school hours. If interested, request an application from your Guidance counse s S nature Student's Signature EFTA01710162 lbw4a (cart-4r sive Attisoniro October 2004 Florida Comprehensive Assessment Test (FCAT) SSS Reading and SSS Mathematics Retake Tests Grade 11 Student Report NAME: ID. SCHOOL: 2331-ROYAL PALM BEACH HIGH DISTRICT: SO-PALM BEACH This report shows your resists from the Grade 10 FCAT Retake lest(s). Passing both the Grade 10 Reading and Mathematics Tests is a requirement 'or a standard Florida high school dipoma. Student's must earn an FCAT Score of 1926 or better in Reacing 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 S'andards. Scores on this test are one indication of your achievement cil the challenging content: that Florida students are expected to know. Your Reading Results You did not pass the Grade 10 FCAT Reading test. Talk to your teacher or guidance counselor to find out about ways to Improve and when you may retake the test. Your Reading Content Content Areas Points Earned Perils Possinie Wads/Phrases Mail Idea/Purpose Comparisons Reference'Research Reading Content Content scores give more specific information about the skills on the FCAT Grade level expectations for studenis include: • Words and Phrases -uses skills to deterrrine word meaning, including word naffs and relationships between words. • Main Idea/Purpose -determines a slated or implied essential message, details. authors purpose, Cr pbt. • Comparisons • knows simile- and different, cause and oiled, and contrast. • ReforencetResaarch •uses infomat ion from a variety o! sources to reach conclusions Your Reading FCAT Score F Szere• Ac'reverr ent Love I Passed 3000 24C0 1800 1200 COO student scot. rasingSas 'This score Mows your achievement on the day you were tested, d you were to take the sane test was. Is Italy cial your 2005 Reading score would turf between 17S4 and 1891 Your Mathematics Results We were unable to find a Mathematics score that matched your student identification number. If you took the test this year, be sure to contact your school about locating your FCAT test scores. Your Mathematics Content Content Areas Points Earned Penis Possible Number Sense Measurement Geometry Algebraic Thinking Data Analysis Mathematics Content - Content scores give more specnic Ho:metier about the skills on the FCAT Grade level expectations for students include: • Number Sense -uses number concepts and computation skills. • Measurement -saes problems involvng measurements, e.g., time, length, area • Geometry - analyzes and combines shapes to solve problems. ▪ Algebraic Thinking -analyzes patterns and uses equations and inoquaktios • Data Analysis and Probablity -uses data analysis tools to display in'ormation. make predichoss and make nferences. Your Mathematics FCAT Score FCAT Store' Achievement Level Passed NT NT 3000 2400 1800 1200 SOO 0 Stickni C< or. Psauril Cc or. NT-Not Tested NR-Not Reported Data Run Date- 11/22/2034 0115252 EFTA01710163 \ CI in e_.., Chapier ) C.kaep-kv-- 2 3. C1-wpi-er 3 Ckcp+er c.C\-)c1/4epie r ;.C .;?-Ver G Ckcpfer ckApitc 1. Ckcke -ler 9 0 Ohap-f-cr 10 I.Ckap -kr I 2,CA-No,picr V10.41-1 3 SSeSSOrientS qiackf-6 RTE / 0/2 thg FirE /// 1 Pe DATE /745-(th pp RTE //If q47 b Pot DATE EFTA01710164 Page: 1 Document Name: untitled PANEL: STDT: A07. ASSIGNMENT HISTORY YEAR: 07 WArinacAm.u. Minn 1t5, 2006 10:30 am SCHL: 2331 GR: 12 ST: I A ENTRY C CD DATE WITHDRAWAL OD CD DATE P R PF SY CL DS SCHL DESC E GR PRS ABS Y DS CO E01 081005 W06 060106 P 06 01 2331 ROYAL PALM HIG 12 172 Y 50 US E01 081104 __ WO1 060105 P 05 01 2331 ROYAL PALM HIG 11 169 6 Y 50 US E01 081303 WO1 060104 P 04 01 2331 ROYAL PALM HIG 10 178 2 Y 50 US E01 081402 __ W01 060403 P 03 01 2331 ROYAL PALM HIG 09 177 3 Y 50 US E01 081401 W02 060302 P 02 01 1691 CRESTWOOD MID 08 172 8 Y 50 US E01 081800 W01 060401 P 01 01 1691 CRESTWOOD MID 07 173 5 Y E01 082097 W03 022598 N 98 01 1441 MELALEUCA ELEM 04 114 Y E01 082196 W01 061197 P 97 01 1441 MELALEUCA ELEM 03 174 6 Y E01 082395 W01 061396 P 96 01 1441 MELALEUCA ELEM 02 172 8 Y E01 082395 W02 082395 N 96 01 2141 ACREAGE PINE E 02 E01 082294 WO1 061595 P 95 01 2141 ACREAGE PINE E 01 170 10 R02 011894 W01 061094 P 94 01 2141 ACREAGE PINE E KG 93 Y E01 _ _ 082393 W02 011894 _ 94 01 1671 WELLINGTON ELE KG 86 _ _ PF1=HELP 3=EXIT 5=REFRESH 7=BKWD 8=FWD 12=ESCAPE NO ADDITIONAL PAGES...NEXT? TERML: DQ35 Date: 8/16/2006 Time: 10:30:12 AM EFTA01710165