Text extracted via OCR from the original document. May contain errors from the scanning process.
EFTA01710166
EFTA01710167
too:
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.
.---. NEW/RETURNING STUDENTS
REGISTRATION
ISTR:2511 TCHR:PUTIGNA, E
TNER:163STOT: 13642421 a.. 03/30/00
0 - 08:3 408
Sc
BEAR? 4:14>
ANA-424 ' 1
STUDENT NUMBER:
NEW STUDENTS: Complete all non-shaded areas on both sides of form
RETURNING STUDENTS: Please review both sides for correctness 01 typed information. If the intormaton
printod is incOrrOCt, please correct it by carefully and lightly crossing out the incorrect information and
writing the correct information above it
C2,6
I-On
(2) ALSO 'MORN AS i...ST
13) LOCAL ADDRESS
(4, GUn IVG ADDRESS
.C./.1 he mar MAW(
a,
,
',We
41;ar orES
Vrilt, 4• Ml s., 4.
cn, sr *Tr t, car rrAW isi metiers SOCIAL SECURITY NO.
(OPTIONAL)
161 HOME >HONE N0.
il)
I
remAte
3
SEX
F
MALE
(8)
. e
I
RACE
AMERICAN INNAN
OP ALASKAN NATIvE.
B
'
NON-HISPANIC
D
A
ttl iCti:IC ISLANDER
I
H
HISPANIC
1
W yy:::,...,,,,..,<,
0 M v..,..0...
(9) DATE OF BIRTH
000ro
,
n''
(IEN PLACE Of BIRTH
Art
FL
U$,,,,
FL0RID4,,,„,
(II/ RES:DENT STATUS
3
0. FOREIGN EXCHANGE STUDENT
I
2. OUT-Of -STATE RESIDENT
0
3. IN-COUNTY RESICENT
112E ENTRY DATE INTO USA
113) FEDERAL
9
YES
0
TES
YES
O HS
YES iNVIACT A 0 SURVEY
0
NO
A. THE
I
NU
B. THE
0
NO
C. THE PARENT
0
NO
D. THE PARENT
0
NO
E. THE PARENT
IF IFS.
IS EMALMID
IS MAIMED
IS IN THE
IS THE PARENT
AIR FORCE
UNIFORMED
ON
0
DN LEDERAL
ON .OW RENT
SERVICES
ACTIVE MITT?
ARMY
HOUSING LOCATED
OF TIE UNITED
0
YES
0
COAST GUARD
IN
IN
0
STATES.
MO
N
MARINES
0
NATIONAL GUARD
ll
NAVY
1 41 HAS THIS OHIO REIN ENROLLED IN AN
PRY srannt,
C. CHAPTER I
I
9
1. PRE-K EARLY INTERVENTION
CEASE PLACE A DICKMAN( I jar SY EACH PROGRAM ATTENDED.
WITH AN ASTERISK I *) NE PROGRAM TIM CHILD SAS
0
It NIAUSTANI
0
I
li MIGRANT PAT-K
0
9 N. NON-SUBSIDIZED CHILD CARE
ALSO, INDICATE
0 OTHER
S SIRSIPIIFIL El•Illl CAM
OM IS NE STUDENT A SINGLE PARENT?
9
NO
us
0
MO
116) CuRRINY GRADE lE4
08
(II) NAME OF SCHOO. TRANSFERRING FROM
(I8/ CITY OR IODATION
(19) DATE Of LAST ATTENDANCE
120E GRADE LEVEL
(211 LAST PUBLIC SCHOOL ATTENDED IN PALM BEACH COUNTY
(22) DATE ATTENDED
(23) NAVE YOU FILLED OUT AN APPLICATION FOR FREE OR REDUCED
(APPLICATION IS PROVIDED WITH THIS REGISIP.ATION IOW/
LUNCH?
II
YES
Ill
NO
(24) HEALTH SCREENINGS:
SCREENINGS.
0
YES
NO
0
NO
(251 $00iuM FLUORIDE:
PERMISSION IS VALID THROUG1
0
YES
GRADE SIR
NO
0
no
UM WHAT LANGUAGE IS SPOLEN IN THE HON!
BY THE PARENT or GUARDIAN.
kri WHAT LANGUAGE IS SPOLEN
IN THE ROME BY THE STUDENT?
28) DATE Of NM
129) LANGUAGE SURVEY
HE HOME?
2
OMIS THE ST,IDENT HAVE A IIRST LANGUAGE OTHER THAN ENGLISH?
3. DOES nit STUDENT MOST FREQUENTLY SPEAR A LANGUAGE OTHER THAN ENGLISH?
OTIS ,YES
OILS
0
NO
El NO
Ill NU
(30) DISCLOSURES Ia lirst say MID
Ellis SCHOOL DISTRICT
I. BEEN EXPELLED FROM SCHOOL?
2. HAD AN ARREST RESULTING IN A CHARGE?
3. HAD AM JAVENILE JUSTICE ACTIONS?
0 YC
0
t>
ll
EL
0
YO
0
NU
■
0
NO
EFTA01710168
THE SCHOOL DISTRICT Of PALM BEACH COUNTY - NEW/RETURNING STUDENTS REGISTRATION
BACK
(31) STUDENT LIVES WITH (CHECK ONE)
0 BOTH PARENTS s MOTHER
El
FATHER
❑SHARED
CUSTODY
E OTHER
(32) TRANSPORTED BY Swart em tie %raspy/IAA le/Lem EON', oy has
,I *Ow Than IMF OM/
T33) IS THERE A COURT ORDER BARRING EITHER PANEW INDIA REMOVING OR
0
YES
0 NO
THE COURT ORDER
(34) FATKER/GUAREHAN
OYES
Elmo
YES
(351 MOTHER. GUAR MAN
DDES MOTHER HAVE CUSTOM!)
D YES
0
NO
YES
ll
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0
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(311 NIGH.ST 'Eva
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PATE
PART I
091 PASSWCRD
OMIT 10 CHARACTERS) In
NPLLe
(II)
NAME
ADDRESS
PHONE
RELA'IONSHIP
u
C- 1 YES
0
NO
OW NAME
ADDRESS
PHONE
RELATIONSHIP
n
U
YES
0
NO
(431 NAME
ADDRESS
PHONE
RELATIONS/4M
U
rl
YES
0
NO
(441 NAME
ADDRESS
PHONE
EFL ATTONSHIP u
I- 1 YES
0
NO
(45) NAME
POORESS
PRONE
PELAIK)ESHIP u
rn
YES
0
NO
ICE) PART II F SCHOOL PERSONNEL ARE UNABLE TO CONTACT YOU IN CASE OF ILLNESS OR ACCIDENT. MAY WE HAVE YOUR PERMISSION TO CALL YOUR
POR TRANSPORT TO THE HOSPITAL'
•
YES
C3 N3
(41) EMILY DOCTOR
148) PHONE NuWEIER
(49) HOSPITAL PREFERENCE
ISO) LIST YOUR CHAD'S ILLNESSES, ALLERGIES OR CHER PHYSICAL ,IMITATIONS
IS 11 NAME Of CH4 0
STOOP(' NO ICPTIONAI)
GRADE
BIRTH CATE
1021 NAME OF CHAO
GRADE
BIRTH DATE
1531 RAW OF CHILD
GRADE
BIRTH DATE
154) NAVE OF CHILD
GRADE
BIRTH DATE
(551 NAME OF Cm()
GRADE
BIRTH DATE
156) 1 VERIFY THAT TIN INFORMATION GIVEN IS TRUE
MY INOVILEME
SIGMATIRE 3) PARENT OR IF GAL GUARDIAN
O..0
DO/ SCHOEN ND
2511
(STD QOM;
EMINTREA
(St
SITIOINT t A Main GE
EN
ED [CR
VII ENTRY (001
E01
U2( ENTRY CATS
08/16/98
4B3L SAC tEVE
420A
184, PARENT, GLARCIAN LANGUAGE
EN
us
'lib/ GRADE LENT.
08
(561 CALM OR
01
Nil) TEACHES NE.
438) REASSIGNMENT CODE
0A, AOM
074SE
0B 7ESOL
010.M0G
1611 TRANSPORTATION
0
YES
0
N?,4
0
I
I
3
4
s
6
70) tE 6
(CATION OF O.RTH
1
T
3
4
6
6
7
6
9
T
011 EMS
z
AEI ,GATE
72) DOE MINTATION CDECAUST misuNiZATiONS
HECA ANN DATE WHEN gifttriel
VISIMICATION Of
BIRTH RECORDS
El 'ATE
BI
CloATE
SOCIAL SECURITY
n
NO OP ORAL la 'ATE
PMCGICAL EXAMS
OM DATA FERRI COMPIFT(0 St
DATE:
PBSO 0636
(REV. OM)
EFTA01710169
STUDENT NUMBER oat oks, \
1
4e., K.. L
..",:";NEW/RETURNING
.;7) /
r
STUDENTS
NEW STUDENTS Complete all non- shaded areas on both sides of
RETLRNI form
NG STUDENTS: Please review both sides for correctness of typed nforrration. If the information
printed is incorrect, please correct it by CarefUlly and lightly croSsEng out tho incorroct information and
writing the correct information above it.
REGISTRATION
... ea
Cl) STUDENT'S LEGAL NAME
21 ALSO PINONN AS
(3) LOCAL ADDRESS
)•7
L.
.i
1.3 4' )Pn—•
C
7 2 iligraffini r
<T.
/.. I
. <foe
IS) STIM(NT'S SOCIAL SECLIRIT, N)
.
PTI NA.
0( S
FEMALE
0 mA.,
MI RACE
0
I
frOM
R CAL
P I AC sA ill AINtOi
NATIVE
9
MAC .:
0
.:
NON-HISPANIC
I A PArIFNI: 1
ISLANDER
I W w„.".1(Hip,..,
El H
INSANE. C
El M
MULL RACIAL
MOO.
DAY ■
rA
MD/ PLACE OF BIRTH en. La‘Pi t 411 CA.
F io t do,
..---, (15,
III) RESIDENT
I
STATUS,
DV
0 Fano IICIWIV STUOINT
I. OUT -OF •CORNTT RESIDENT
I
Et
1 OM-Of-STATE RESIDENT
3. IN-:OURTV RESIN!
ENTRY CATE IN70 USA
1131 FEDERAL
0
115
I
I
ll
O
fFS
IMPACT AID Suarfir
0
NO
A. TOE STUDENT
TES 9 NO
B. TOE STUDENT in ii NO
C
THE PARENT
YES
0
NO
0
THE PARENT
D
NO
F
TN( PARENT
IF YES.
RESIDES ON
RESIDES IN
IS EMPLOYED
IS EMPLOYED
IS IN THE
IS TIC PARENT
AIR FORCE
IECERAL
LOW RENT
ON FEDERAL
ON LOW
UNIFORMED
ON ACED(
I
ARM)
PROPERTY,
VOWING
RENT
SERVICES
GATT?
OF THE UNITED
1:l TES
I
I
COAST GEAR(
STATES.
NO
9
MARINES
0
NATIONAL GUARD
I
NAVY
04: HAS
ll
THIS CHILD BEEN ENROLLED IN ANY PRESCHOOL?
C. CHAPTER I
LPL; AM PLACE A CHECOAA4K Ike ST EACH PNONKAM ATTENDED.
ALSO, ALIKAlt
WITH AN AMMO I * I THE PROGRAM TOUR CHEM WAS IN THE LONGEST I
I
H
HEAESTART
9
0
OTHER
I
El
S. su6ScIZED CHILD CARE
I
N. NON-SUBSIDIZED CHILD CARE libi IS THE STUDENT A SINGLE PARENT?
I
Iris
NO
IMO `[ARE IT GRAPE LEVEL
-01
(Ill NAME OF
SCR( 01 TRANSFERRING FROM
(20) GRADE I WI
20 I AST POOL IC SCHOOL ATTEND) S IN PAi Ns RA AIN COUNT(
(22 DATE ATTENDED
123) HAiE IOU I DU 0 CUT AN APPLICATION FOR FREE OR REDUCED
(APPLICATION IS
MOO
I
IFS
134) HEALTH SCREENINGS:
I GIVE PERMISSION FOR Mr CRIED TO BE GIVEN HEALTH
SCREENINGS.
YES
II
NO
1151 SODIUM ILUORIOE:
I RIVE PERMISSION ION MC ONItO TO PARTICIPATE IN
INF SURMA *IMAM( PROAAM
YES
:RARE SIX.
I
NO
'25) WHAT .ANALIAISE Is. SPOKEN IN THE HOME
BE THE PARENT re GUARINO& an WHAT IANCJAGE IS SPOKEN
IN THE NOME BY TIE STUDENT"
URI DATE Of ENTRY
INTO TN ESOl PROGRAM
135) LANGUAGE SURVEY
I
IS A LANGUAGE OTHER THAN ENGLISH IMO IN THE HOME?
3. DOES THE STUDENT HAS( A FIRST LANGUAGE OTHEF THAN INDIAN,
3 DOES THE STLIIHNT MOST IRFOUENTI Y SPEAK A LANGUAGE OTHER THAN ENGLISH?
IES
II
f(
STUDENT DISCLOSURES FOR 1F
,
,.
THE SCHOOL ()STRICT OF Pf
<5
o
A
COUNTY
,
n
iv
4
;46
S
I
BEEN ExPILLE0 HUM SCHOOlt
'f'
••
2
4.
3. HAD AND JUVEIIIII JUSTICE
PBSO 0636 IRA7 $/97/
EFTA01710170
BACK
IS)) STUD
GOTH PARENTS
0
MOTHER
0
FATHER
i
SNARID CUSTODY
Q
OTHER
1
4
1311 TRANSPORTED OY $14.4*.a ..a 4.6 ucitspmned tylinr +w. kw C.. m•
4.4/ I646 p....1)
CA CC:q-
(B3) IS THERE A COURT ORDER BARROIC EITHER PARENT FRoirtEMONNen
CONTACTING THE STUDENT DURING THE SCHOOL DAY'n YES
OR
THE COURT MUM
74e F.
IFER/Gu
Al
YES
0 NO
13.5) MOTHER/GUARDIAN
DOES ROPIER HAVE CJSTOOY'
CipeES 0 NO
C
7O
VI
ISLVD C
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(3)) PASSWORD fLIMT 10 CHARACTERS) a'
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7"""ZW
PO.
0•1001100
PICK/
PHONE
RELATIONSHIP
/YES
Fa
ea. 0
NO
1:11tTIONa Bp irec rn.
0
NO
ADDRESS
REEATIONMiro
u
I- 1 YES
0
NO
IAN ma
ADDRESS
PHONE
RELATIONSHIP u
rl
YES
0
ND
145) NAME
ADDRESS
PHONE
RLLAIION Sm. r-1
u
YES
0 No
KM PART II f sa4001. PERSONNEL ARE UNABLE TO CONTACT YOU N CASE OF Ill NE SS OR ACCIDENT, ILAY WE HAVE YOUR PERMISSION TO CALL YOUR
DOCTOR OR EMERGENCY SERVICES 19111 FOR TRANSPORT TO THE HOSPITAL,
'as
0
w
o
( 71 F
DOCTOR
.9 d) ,... a-t C
CS? e‘ S•ct (
40) PHONE HUREER
1447 ROSiUAL PREFERENCE
(50) LIST YOUR CHAD S BONUSES. ALLERGIES OR OTHER PHYSICAL LPArATONS
I)
47 A.L.
STUCE 4 NO (OPTIONAL)
GRAN
:.
.
C•40Ct
We
ATTENDRIG
( I Intkon etmorl4cA
4n
•
.
SCHOCt, ATTERVERG
LOP4kovcido tAkrttle_
GRADE
14-‘n
SCHOOL ATTE
Gr
Loy.cmakevee etta
Vet ery
GRA tCHOCI. ATTENDING
STUDENT NO 1011
AO
GRADE
5010“ ATTENDING
STUDENT NO 'OPTIONAL)
ORAOE
IIRTI1 DATE
1661 I VERIFY THAT THE INFGRNATION GIVEN IS TRUE
5's_ OO
OA TI
-
5671 SCHOOL NO. (It 4TUDEN7 WImaiIi
1541 s3U011it
AN AlAtf
FIN (C0.
2611
TOOL
7 I TR( OS if
463) SAC CODE
64)
414(11T 611.1401AN 14.111,3461
1461 GRA 7k 14.11
IFS) CALENDAR
%II TEACHER NO.
HI REA SSIGNME 7 CODE
CIF.M
1571 TRANSPORTATION
9 us
0
NO
701 SERIF IC A TIEN Cf BUM'
II) IRS
I 72) DEICUNIDITATION tMCNLIST (ClllCS AND DATE WN18
IDEATE
HAmuNIZAT:066
0 CATE titY401
WMFICAT.044 0,
44148 RECORDS
M.PAAG
0
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11110 Sy
°ATE
EFTA01710171
)
71ploot.:p;.\
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t:
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Saga ler-> // t e e,t C/ E/1-1
'ail
Principal:
-
Lt-) iS
The areas listed on the checklist as well as music, art and physical education are included
kindergarten curriculum. The checklist is corn of skills that are essential for students to ma
they are to be successful in the primary grad( activities provided in kindergarten lead towar
attainment of these skills. The teacher determin€ appropriate time for the student to begin k
instruction in each skill. An explanation of program is attached at the end of the first mai
period. Beginning with the second marking pe.
the checklist is used to report student progress.
MARKING CODES
E - Excellent
S - Satisfactory
VS - Very Satisfactory
N - Needs Improvement
Miklos Pried
Demonstrates self-control
Respects the rights of others
Respects the property of others
Demonstrates good listening habits
Follows directions
Demonstrates consistent effort
Completes assignments
Works well independently
Participates well In group activities
Takes care of and uses materials properly
ATTENDANCE
Regular attendance and punctuality are essential for quality education.
Days Present
Days Absent
Days Tardy
I
2nd
4th
*PLACENli tIT
Grade
Summer School Program
'If summer school program Is Indicated, grade placement will be determined by the home school.
MARKING CODES
El formal instruction has not yet begun
R
' student receiving formal Instruction to meet specific needs and ex-
periencIng difficulty with skill
El student receiving formal instruction and making satisfactory progress
IN student consistently performs skill accurately end efficiently
The asterisks (*) indicate critical skills required prior to the
student being considorod for promotion.
BODY IMAGE
Imitates Body Movements
Identifies Body Parts
Assembles Body Parts
GROSS MOTOR
Craps
Runs
Strings Beads
Assembles Funk
Copes Shapes klatthes/Pactres Shapec
Cuts Circle
Colas Objects
Sequences Fingers
Sons by Coor
Sorts by Shape
Sort by Size
Matches Pictures
*Identities Likeness&Ditterenon of Numbers
'Identifies Objects by
Pelatonships
Identifies Likenesses/Dalai ences of Letters tad 3rd 4th
1.
t.
2
LANGUAGE
LISTENING
Recalls IV ormation
Predicts Outcome
' Betels Story
SPEAKING
' Stales Full Name
9
[repeated 3 times]
'ascribes Common Objects 1
:es Complete Sentences with
Proper Speech Patterns '
1EREADING wets Pictures ognizes Labels
4nties Own Name
Vales Story owes Letters
tt
11
11
II
11
WRITING
Mimics Mastery of e Motor Skulls
12
-Reproduces First Name
12
or
.1•4 ore
Observes Accurately
Makes Comparisons
Predicts Outcomes
Phrases Siginticant
Questions
13 1
13.2
13.3
13 4
2nd 3rd am
Identifies Sire Pelabonmips
VISUAL MEMORY
*Recalls Colors
Seqsences Shapes
'Sequences Numbers
'Sequences letters
AUDITORY
DISCRIMINATION
Names Sounds
Identifies Likenesses/Dittoraces of Words
Identifies Hymn° Words
Identities Licenesses/Ditletaces of Sounds
AUDITORY MEMORY
Repeats Sound Pattern
Repeats Sentence
'Secuences Numerals
'Fathers Oirecticns
'Searences Letters
MATHEMATICS
NUMERATION
'remits One-to-One
' games Numerals 0-10
' Matches Sets and
Numerals to 10 identifies Ordinal Position
FRACTIONS
Identities One Half
GEOMETRY
Identifies Shapes
MEASUREMENT
Compares Objects
'Orders Objets nientilies Use of
Measuement Tools
Measures Objects
SPECIAL TOPICS
Identifies Coins
States Values of Coins
.oinsrSeparates Sets
14.1
14.2
11.3
14 4
'5 1
161
/ l
'i
73
1/.4
18.1
82
83
2nd 3rif 4th
I FIISO 0767
(FY 90 aevlslerfl
Goldenrod/tat Period PInk/2nd Period yellow/3rd Period
GreenbIth Period White/Moe Copy
CC 364t4
EFTA01710172
Date irthdate
h
10}k
Grade Level
1-O)(C_AVCAC.k..e.
17"-zlernesAc-6
Previous School Attended
Student Number (if known)
C te_sf
U3 o OO1 vYYjcile. sc.koc-)
Palm Beach County Middle School you were scheduled to attend
ESE PROGRAMS:
EP
IEP
504 Plan
LEP Plan
EFTA01710173
/0,/,0,,,,
Middle School of the Arts
>,-
EFTA01710174
Please return
to your high school guidance counselor.
right Future
I verify that I have received and read the initial eligibility requirements of
the Florida Bright Futures Scholarship Program for the year 2001.
Verification of Receipt
[This is not the Student Authorization FormJ
NAME [please I fin
SIGNATUR
DATE II/ 13/O0
EFTA01710175
I verify that I have received and read the initial eligibility requirements of the
Florida Bright Futures Scholarship Program for the year 2003.
Please return to your high school guidance counselor
EFTA01710176
Student Name
I hereby give perm' card will be sent h
Parent Signature
7
Teacher at school. I understand that the fingerprint
EFTA01710177
6-91
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. Educators need orly record information concerning teacher
observation and educational decisions made for students in the classroom as a result of screening and other health informaticn.
VA IL
9.a_
be_
4fr iatc--zil-A1 --4--- rod
--64a-ttat. -"at
Oppi t a.A.
17C.
.1.1v orm 3041, MAY 80
(31
EFTA01710178
9/
Date
C •
Prone
Birthclate pi parent or Guardian
(I) Normal-N; Abnormal-A N antlingnrA rmal irnirgriFi
r
1. Amen:ice
2. Skin/Nose tC1/
3. Head /SC*
L.)
4. Eyes
42
5 Visual Acuity (R a Ll
8. Ears t../
7. Auditory Aciity (R a L)
8. Nose / Throat
9. Mouth, Teeth and Gums
10. Chest / Lungs
11. Head
12. AtOornen c.-"/
13 Genitals and Anus ,../
14. Musculo-Skeletal
..-/
IS. Neurological
16. Alertness
...2 y ,
17. Emotional / Mental/
IN:they:or Prob.)
AV-
18. Handicap. Physical/ other (SPecity)
%
19. Activity Restrictions
(SPecily)
20. Abuse. substance/
PhYSical / enbtional
21. Nutrition
.-/, c
22. Other
C "
7
B.
HEALTH HISTORY (swim* messes urturiet expiai
Sexes bum —
(attach narratke il additional space needed)
C.
LABORATORY (as indicated)
Hemogbbin/Hemalocrit
)
Steel (0 6 P)
T
(-Mu
Sickle Cell
i
Tuberculin test
TITLE:
ADDRESS:
(Pleas* Print)
LAKE WORTH, FLORIDA 334
NRS—I4 form 3040, Apr 87 (Replaces Aug ee edition
Islock Humber. 6744.000.3040.2) n may be aim
Mauna
(Over)
EFTA01710179
1
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MUNIZATION (HAS 680 - PART A)
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TEMPORARY MEDICAL EXEMPTION (HAS 680 - (PART 8)
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EFTA01710180
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DEPARTMENT OF
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Health & Rehabilitative Services
DISTRICT NINE
OF THE LOCAL Pr2r:.:23TRAR'S MitC000
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TYPE
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PUBLIC HEALTH
9O1 LWR40.14. ST.
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CERTIFICATnEo OF UVE RTH
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Bethesda Memorial Hospital, Inc.
lowlife Wt IM 1111W olor
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CERXXER—MME Al III
so
Mildred Correll Record Tech.
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—STATE
COIAITT e, 10,01 in Florida eb Palm Beach
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Florida soot'. ECN11Y swistft twin malty)
EFTA01710181
N
Stude
Address
irthdal0
LTH EXAMINATI
S
hone
Name of Parent or Guardian
Heigh
• -t
sex_
(I)NormeleN; AbnOrrnal=A N
A
COMMENT: Abnormal Findings, by number
1. Appearance
C
<
r.
2. Skin/Nose
../
3. Head/Scalp
/
4. Eyes
5. Visual Acuity IR & Ll .
/
6. Ears
/
7. Auditory Acuity (R & L)
/
8. Nose / Throat
/
9. Mouth. Teeth and Gums
10. Chest / Lungs
/
11. Heart
/
12. Abdomen
/
4".
13. Genitals and Anus
/
14. Muscio-Skeletal
16. Neurological
V "
16. Alertness
/
17. Emotional / Mental/
Behavior Prob.)
4.
18. Handicap, physical/ other (Specify)
/
19. Activity Restrictions
(Specify)
20. Abuse, substance/ phytical / emotional
/
21. Nutrition
/
22. Other
B.
HEALTH HISTORY (Serious Illnesses Injuries: explain)
(attach narrative if additional
C. LABORATORY
Hemogbin/liemac
Lead
T r PEDIATIM CENTER, P.A.
(Please Print)
Stool (O a P)
Sickle Cell
Tuberculin test:
re
OH 3040, 10/96 (Riotous HRS.), Form 3040 which may Do used)
(Stook tiumbor. 5744-0004040-2) gnature
Date
EFTA01710182
SS_
_NM
Certificate of Immunization for K-12 Excluding 7th Grade Requirements
PART A-1 (Immunizations are complete for school entry and attendance grades kindergarten through 12 with the exception of
the 7th grade requirement.) DOE Code 1
I have reviewed the records available, and to the best of my knowledge, the above named child has been adequately immunized against
diphtheria, tetanus, pertussis, polio, measles, mumps, rubella and hepatitis 8 (for kindergarten effective with the 1998/99 school year) for
school attendance as documented on the reverie side of this fain.
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 are complete for students who enter or attend the 7th grade after the beginning of the 1997/98
school year. Each subsequent year thereafter, the next highest grade will be included in the requirement.) DOE Code 8
I have reviewed the records available, and to the best of my knowledge, the above named child has received the following immunizations
required for entry and attendance in 7th grade effective with the 1997/98 school year: tetanus-diphtheria boaster, hepatitis B vaccine series,
and second dose of mearles vaccine as documented on the reverse side of this fonn (bared
Physician or Clinic Name:
(Print or stamp)
Address:
WELLINGTON, FLORIDA 33414
Physidan or
Signature:
Date:
a Ss
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
1 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:
xpirAtion ate
osaasiltroexibmigilitkitiir
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
I cent& that the physical condition of this child is such that immunization(s) as indicated in Part C above is medically contraindicated.
Physician or Clinic Name:
(Print or stamp)
Physician Signature:
Address:
LH M. 1196, obsolete earlier editions (Stock Number: 5740.0))4680-6)
Date:
EFTA01710183
A
TATUTES 232.032, s. 10D-3.088, F.A.C. and s. 10M-12, F.A.C.
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 requirerneikhthiihailaipreviously filed a Certificate of Immunization (680.
or 680A-1) with their current Florida schsnKfilifiboted areas bel0W•aililannplete Part A-2 on the reverse side of this
form.
•
For additional information: See.lciniurilZatiencOOMCIiiteSifor4bliObraittEChijdtire Facilities for information and
instructions on form completiorcand iibmpliiiatioiLreqUireinents.:Gnidelineirtie updated annually and are available
from the local county health dinartnient.:.:7:-..
•
<4;14—
•
VACCINE
&Gel?
. ;'
'`.,Dose
Dose 5
/DAIYR- '
O/DA/YR
MO/DA/YR
DTaP/DTP2
DT'
s.
Polies
4Iya
HIB6
MMR (Combined)'
P:\
(Separate):
G,
FIRST
MI
DOB
MO/DA/YR
Child's SS# (optional)
STATE IMMUNIZATION ID#
Hepatitis B9
i
The state immunization ID# is an identifiersupplied by the siateimmunizationiegistry (optional).
2
DI? 5 doses required. If the fourth primary dose is admihisteretorforifter the fourth birthday a fifth dose
is not required. DTaP is an acceptable alternative for one or more doses of DTP.
3
DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis
contraindication.)
4
Td (Adult) Vaccine is recommended for children 7 years of age or older.
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.
i
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 (G), single mumps vaccine (H) or single rubella vaccine (I).
9
Hepatitis B vaccine series is required for seventh grade entry and attendance effective with the 1997.98 school year and
kindergarten entry and attendance effective with the 1998-99 school year. In each subsequent year thereafter, the next
highest grades are included.
EFTA01710184
(This form is not intended for physician's use)
Address
Date of Birth
Immunization Certification:
Special Immunization Programs fcg • At
Special Health
Problems • See
Narrative
IA) Sex'
School 44P>I
CWee
•Cser-4-4:kr ather's Name
Mother's Name of Birth Bni in-ion Bch.
NoO
Birth Recorded:
NoO
Screening and
Assessment
Grades
K-3
K
1
Screening
Date
Referral
Outcome ce c m 8
ou
I'
, ,
a)
cc
?
o 0
D
0
au
ccc.
Outcome
Screening
Date
15
0,
"
cc6
[ Outcome
Vision
Hearing
Height, Weight
& Graphing
Nutrition
Dental Health
Mental Health
Communicable Disease
Records Review
Physical Assessment
Other
Other
Screening and
Assessment
Grades
4.8
4
5
6
7
8
Screening
Date
Tr
•-0
er
CC
Outcome
Screening
Date ro -
rn
4.
CC
a)
Outcome
Screening
Date
Referral
Outcome
•
Screening
Date
7.
16
•iii
CC
Outcome
Screening
Date
7_
0
..
0
CC
I
Outcome
Vision
N
4,
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 an
EFTA01710185
Florida
Writing
Assessment
Program
Florida Writing Assessment
Grade 4
Spring 1996
STUDENT REPORT
Student Name:
Student I.D. No.:
School:
District:
•
•
Description of Writing Scores
6.0: The writing focuses on the topic, is logically organized, and includes ample development of
supporting ideas or examples. It demonstrates a mature command of language, including
precision in word choice. Sentences vary in structure. Punctuation, capitalization, and spelling
are generally correct.
5.5: The writing was given a 5 by one reader and a 6 by the other reader.
5.0: The writinnocuses 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 arc generally correct.
4.5: The writing was given a 4 by one reader and a 5 by the other reader.
4.0: The writing focuses on the topic, though it may contain extraneous information. An
organizational pattern is evident, but lapses may occur. Some supporting ideas contain
specifics and details, but others are not developed. Word choice is adequate. Sentences vary
somewhat in structure, though many are simple. Punctuation, capitalization, and spelling are
usually correct.
3.5: The writing was given a 3 by one reader and a 4 by the.other reader.
3.0: The writing generally focuses on the topic, though it may contain extraneous information. An
organizational pattern has been attempted, but lapses may occur. Some of the supporting ideas
or examples may not be developed. Word choice is adequate. Sentences vary somewhat in
structure, though many are simple. Punctuation and capitalization are sometimes incorrect, but
most commonly used words are spelled correctly.
2.5: The writing was given a 2 by one reader and a 3 by the other reader.
2.0: The writing may be slightly related to the topic or offer little relevant information and few
supporting ideas or examples. There is little evidence of an organizational pattern. Word choice
may be limited or immature. Sentences may be limited to simple constructions. Frequent errors
may occur In punctuation, capitalization, and spelling.
1.5: The writing was given a 1 by one reader and a 2 by the other reader.
1.0: The writing may only minimally address the topic because there is little or no development of
supporting ideas or examples. No organizational pattern is evident. Ideas are 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.
The writing is unrelated to the assigned topic orcannot be read, or there is no response.
Your Student's Score
Dear Parents or Guardians:
The paper your student wrote in January as part of the Florida Writing
Assessment Program has been read independently by two people trained
to score this test. Each reader judged the paper against a set of
standards and gave it an overall score. Your student's final score is the
average of the two readers' scores.
This writing score will help you, your student, and the teacher
understand how well your student performed on this statewide writing
test. A description of each possible score is printed on the left side of
this report.
Students were given 45 minutes to read the assigned topic, plan what to
write, and then write their responses. The conditions under which your
student writes papers in class or at home may not be the same as those
for this test; therefore, the writing may not be the same. You and the
teacher should consider the score on this test along with all of your
student's other writing when planning activities to continue developing
your student's writing skills.
Students were asked to write a story about what happens after they walk through an open door.
50-19014300000403
EFTA01710186
GRAM .
SIM
AGE
8- 7 NMW
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LEVEL 12 FORMA
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AGE
9- 6
MMEMOMATM
CTBS/4 LEVEL 13 FORM A
KANE
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6
OTHER INECMATIM
CTBS/4 LEVEL 14 FORM A
NAME
GRAM
AGE
11
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6
MERVIN:M=OE
C765/4 LEVEL 15 FORM B
NAME
MADE
AGE
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CTBS/4 LEVEL 16 FORM A
NAME
AGE
13-
6
PUPIL NO
O11MR nfOWATON
CTBS/4 LEVEL 17 FORM A
TRIATO4
GRADE
SAT Program
The College Board
PBSD0280 stallETYFt
SCORE Mil wmpit
1119
NW SCORE
READ' EMT TOTL lir MATH
TAD,'CONP
OCA MATH CEA
COMP
COMP CEA
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NG!MECH EXPR
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TEIsSi TAD4T(34 irrE
12
SAT Program
The College Board
WI 01-9330
EFTA01710187
Florian Comprehensive Assessment Test
FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001
Student Report
Grade 09
This report shows your results from the FCAT Sunshine State Standards Test.
Student Number and Number
2331 - ROYAL PALM BEACH HIGH
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..
Student Achievement Level Descriptions
LEVEL 5: Performance at this level indicates that the student has success with the most challenging content of the Sunshine State Standards. A Level
student answers most of the test questions correctly, Including the most challenging questions.
LEVEL 4: Performance at this level Indicates that the student has success with the challenging content of the Suninine State Standards. A Level 4 student
answers most of the questions correctly but may have only some success with questions thatrellect the most challenging content.
LEVEL 3: Performance at this level Indicates that the student has partial success with the challenging content of the Sunshine State Standards, but
performance is Inconsistent. A Level 3 student answers many otthe questions correctly but Is generally less successful with questions that are
most challenging.
LEVEL 2: Performance at this level indicates that the student has limited success with the challenging content of the sunshine state Standards.
LEVEL 1: Performance at this level Indicates that the student has little success with the challenging content of the Sunshine State Standards.
Your scores are shown below.
SUBJECT SCORES
Student
Achievement
Level
State
Comparison:
Thirds
Highest
Reading
Mathematics
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 323 and 357. For mathematics, your scale score should
be between 286 and 310.
The check marks (1 ) show If you scored in the lowest, middle, or highest third of grade 09
Rorlda students who took this test.
"TEID: To Be Determined
Run Date: 04/28/2001
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.
0334681
..
•
EFTA01710188
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MATHS
GRADE clAa AMAlegC6 cA3 • ASIgred
<pa te• student *beganeHATItl.
-
e Student tetoptiteit•HkritrZ
TEST
- ate
"'ROOM/nal — —
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HAP. -2
3
AP;
EFTA01710189
PARI 6101 COUNTY
TESTED ibLICCTIVES feat WOE 1 MANDIATICS
CIMPTIII 1
1.2
Identify Se antral, 0-10, that represents the timber of given objects.
1.5
Ideatlfy *Sett that are to specific cedinal positions, first throe. Seventh.
1.7 identify the gnat« or lesser of too sobers throat 1CO.
OPPTII2
2.2 A0d basic facts, urn to 12, ghee In horizontal end vertical wetter,.
2.5
Identify the addition sentence for a slaty prallen.
2.6 Solve rebus problems In.olving addition.
DINTS 1
3.2
Subtract belle facet. minuends to 12. given in horizontal as vertical notation.
3.5
Identify the subtraction sentence for a story problem.
3.6 Solve rebut and word problems involving subtraction and/er addition.
aura 4
2.2 ads basic facts, suns to [2, glees in horizontal and vertical notation.
3.2
Subtract basic feats, *linel. to 12. Oren is horizontal and vertical notation.
12.1 Reed end interpret tittles to solve problems.
11.3 Identify punter sentences for story problems.
SAM* S
2.2
Add baste facts. sons to l2, given In horizontal and vertical station.
3.2
Subtract bopc faets, aliments to 12, given In horizontal and vertical notation.
1.4
?Webpairsof related addition ved sebtrection matinees.
OUPTEA 6
LI
Cowl orally. read, wile, mad rear carats to 100.
1.7
Identify the greeter er letter of two nanbtr$ throtiitb 100.
IS
Count by ores, twos, floes, and tent to 100.
1.10 Count picturedobjectsWien groused Insets of tens and ses (objects to 1001.
ClIAPTS
8.1
Tell tine oa the hour and half.howr.
9.2 identify the wales of a col leak. of colas.
5-6
CmiPmb velvet of groups of otnniel. nlctets. and dines.
OUTER 8
2.2
Add basic ruts, tal to 11, given In horizontal end vertical notation.
2.2 subtract basic facts, sivuends to 12. given la horizontal end vertical notation.
3.4
Match of related addition end srbtraction tintieres.
3.6
Solve rebus and word problems Involving interaction a4/or addition.
13.3 Identify nurober sentences for sap Problems.
0(1110 9
IS
identify silting numerals or objects In repeating pattern televnet.
6.1 Identify pictures Set show equal parts.
6.2
Identify halves. thirds, end fourths a reglenO.
10.2 Identify plane ~stele floats (circle, square, triangle. rectangle/.
10.4 Ketch «ninon% figtres.
OSPIER to
2.4
Add I- and 2-digit ~news to 2-digit meters, without regrouping.
3.3 Subtract 1-digit toters and 2-digit arbors free 2-digit ~es,
without rt7m0PI^9•
3.6
Solve robas and heed problems Involving subtraction ved/er nddition.
9.5 add end subtract say to 99t.
Oldfa 11
8.4
Mavere length In ~le milts nth., iactet, centimeters, and non.itanderd units.
8.5
~are liquid measures wiling elms. Pints. quirt, , mid littra-
DINTS a lbere Is ea Plastery lest for Cheater 12 at this level.
EFTA01710190
In - In progress
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ern
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EFTA01710191
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EFTA01710192
Name Rd kris
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eivfiCscheol year.
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EFTA01710193
CHAPTER II PEIVEL.1
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EFTA01710194
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GRADE 1
to student began READING 117,_ / ate student ccapieted READING rjr../n/ij
TEST
DATE
RETEST DATE(S)
LEVEL
LEVEL 5
/ /
!Ara 6
LEVEL / /
LEVEL 8
LEVEL 9
LEVEL 10
/ v
/
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EFTA01710195
Me NMI COUNTY
TESTED OILXITIVIS (OM GU« I COMMAICA1101, 54131.5
MINIM! tint 4
4. I. I V Reed [welt voftbrisay words.
4. 2. 1 Y ynderstand em use [nix vocabulary wires.
LEVEL S
4. I. I w 4144 Mtn( wee4Sulavy toads.
4. 2. I v uodeettand MO ace ball( some:platy wards.
Len I
4. 1. I Y Rea basic vocaPriory owes.
4. 2. I Y Lindwilland ead ese basic exatelary «net.
S. I. I C Identity the ash, idea 0! the pictere(1).
5. 2. 1 C [Kali 014111 lee. Met. ~re. Near ireith. ho.).
5. 3. I C
Salute(' *feet 41, 64 itictufei
8. I. IC ~steel
. tttttt tic wiedioe.
10. I. I S 144emate the lettera a the alphabet.
MIN(' LIVE 7
4. I. 1 V Rod basic vocebulary morel.
4. 2. IV ileitrileid fed ate basic ,Ktlulri wards.
4. 2. I V
Uodevstied ån4 .14 01.041 44.4% 444", is t 4"
S. I. 1 C UMW, the mein 1414 of the oictuvelt).
S. 2. 1 C Miceli det4lis tone. neat. Mere. MM. Skid.. M.2.
O. I. I C ~sire a reelittic selection.
14. 1. 1 t tech a decIsr4the sentence .lth 4 capital letter and eon with 4
Mri00.
MIMI Lein 0
4. 1. I V Readbasic aau1Np words.
4. 2. 1 Y U•OrritiA4 M4 ute basic .:‹4b.lary opt".
4. 2. 2 Y Identify &tiniest of netkrowa words hs using ptetest clues.
5. 3. 2 C SeQueste and ndeesln4 tee use of Nest/let and before/
.flex.
6. I. 1 C Identify a pareffiwas4W MITI 1604.
5. 1. 2C Uoderatend . fantaay selection.
Id. 3. 2 L Sepia an Interrogative teotent4 with a capital letter 4nS of with a
eiestio• red,.
FIRS: 4[10(R LULL 9
4. I. I V Rea Wife{ veCa>,Icry ~4%.
4. 2. 1 Y Under$146.4 ind Ne 44%1C Neatelary words.
4. 2.
5. I. 2C 144•011 the te.lf.te Mat erOwistes the mal• ides of a pwasree.
S. 3. 2 C Sequence and Ndrrttand the use of firti/latl ant, tefore/after.
6. I. 2 C
8. 1. 1 C Viderst.nd 4 realistic %Neste».
10. I. 3 5 (into', Wes by categories.
10. 2. 15 Interret a weiti .5th airier, sypols.
11. I. 15 Ceesiete å fore .pusling mew and ope.
14. 2. I L Ioentif2 ads that net people. pleelir ard
FIRST 4110(1 Still 10
4. I. IV lead basic vocabulary an.
4. 2. 1 a Ilpertln0 4,4flete4sit 'Nebular, weds.
4. 2. 5 e U60avtlihnd ad ese contraction.
6. 2. 1 C OI6tyalsh Pets«. rtidity ael fantasi.
6. 3. 1 C (Maw a C06<lø$4,1 fro. Reim facts.
6. 3. 2 C Predict the tetra of . si ttttt oft.
8. I. 3( ippett444 . !tethai selection.
ID. 1. ?S Alohabelife Net to the first, setae. ✓d third letters
14. I. 2 L identify a[tiO, words.
Id. 2. I L I4.11fy•PP,4 ,14te ditcrIbing wards.
EFTA01710196
Student
OBJECTIVES - GRADE 2 READING
Teacher
These :anguage arts Unified Curriculum skills are to he taught in grade 2
Fill in the
date when, in your judgement. the student has consistently demonstrated the skill. The
skill may be demonstrated through observaton. informal assessments, or formal
assessments
2' READS
DATE
I ilq / 9Y
4. 1. 1
Read basic vocabulary words
/ f
/_
4. 1. 2
Spell basic vocabulary words
I
I
4. 2. 1
Understand and use basic vocabulary words.
/
4. 2. 3
Understand and use plural nouns ending in s or es.
I
I
4. 2. 9
Determine the meaning of sentences that contain negative words.
/
/
5. 2. 1
Recall details (who, what, whore, when, which, how).
I
/
5. 3. 1
Sequence events using pctures.
I
/
5. 3. 3
Sequence sentences that describe the events in a picture story.
/
/
6. 2. 2
Distinguish between real and unreal actions or events.
I
I
6. 3. 1
Draw a conclusion from given facts.
/
/
8. 3. 3
Identify clues leading to a conclusion.
I
/
8. 1. 1
Understand a realistic selection
/
/
B. 1. 2
Understand a fantasy selection.
/
/
10. 1. 2
Alphabetize words to the first second, and third letters.
/
10. 1. 3
Classify items by categories.
•
/
10. 3. 1 follow one-, two-, and three-step directions
I
I
14. 1. 1
Match sentence parts :o form complete sentences
/
/
14. 1. 3
Write a declarative sentence about a picture.
/
/_
14. 3. 3
Use a period or a question mark to punctuate a declarative or an interrogative sentence
/
/
14. 3. 4
Capitalize the first lette' of the first word of a
sentence, the pronoun I. and the first letter in the name of a person.
EFTA01710197
2. READER
DATE
4.
[repeated 5 times]
1. 1
1. 2
2. 1
2. 6
2. 7
Read basic vocabulary words.
Spell basic vocabulary words
Understand and use basic vocabulary words
Understand the use of inflectional endings s. es, ed.
and ing
Identify words that describe people. animals, and things.
/
4 2.10
Recognize that words can have more than one meaning.
1
1
4 2.11
Identify antonyms for given words.
1
1
4. 2.12
Identify synonyms for given words.
1
1
5. 1. 2
Identify the sentence that expresses the main idea of a paragraph
/
5. 2. 2
Identify details supporting the main idea
1
1
5. 3. 4
Identify the sequence of events when signal words are stated
/
f 1
5. 4. 1
Identify the cause of a given event when signal words
(because. so) are slated
/
1
5. 4. 2
Identify the cause of a given event.
1
/
6. 5. 1
Complete simple analogies
/
6. 6. 1
Identify paraphrases for given sentences.
8. 1. 3
Understand a folk tale
/
8. 3. 1
Understand a play.
/
1
10. 2. 1
Interpret a map with picture symbols
/
/
10. 2. 2
Read and interpret pictographs
1
14. 1. 4
Write an interrogative sentence about a picture
/
I
14. 2 4
Determine whether a sentence needs a singular or plural noun
1 1
1
14. 2. 5
Use the verb form that agrees with the subject noun in a sentence
/
I
14. 2. 6
Use the correct verb form in the present and past tense.
14. 2. 7
Use appropriate describing words to complete
sentences
Il /
I
15. 1. 0
Write legibly using manuscript letter and numeral forms
STUDENT TRANSFER in order to assist the student's new teacher with planning for the student's continuing language
arts instruction. nase provide a brief description of the language arts materials the student has
been using in your classroom If possible. include the name of books or basal levels that the
student has completed
EFTA01710198
FLAT hler;aa Calutpraminnhre å $$$$$ mat hail
FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2000
Student Report
Grade 08
This report shows your results from the FCAT Sunshine State Standards Test.
2611 . ',DOLE Sa1004. OF 4435
(Tara Wawa owli hwy.
60 - PALM Wes
The FCAT Sunshine State Standards Test measutes your performance pi sekstal benerniens
n reading asd matremeties as defned by the Sundial?. Stete
Standards Scores en this test are cne rick -4~ of yner achievement of the challenging content hat "lada
students ate expected to know. On the FCAT, you can attain one of fve possible achievement levels. The table beau shows the scale score ranges lor each Studer' Achievement Level.
Student Achievement Level Descriptions
LEVELS. Per /orate
I«r.s semi indicates fra: the mudent Men sceceriS with tre most ~Ion^
COnfalnl of tie &Mahn, SOO 5tanaa,as. A Level 5 infant answers rant or Ire test Ocentims correctly, rnouchne Me most enfilionferNifoninlime-
LtVtL•:
Performance al sn] reeer mouton last .lie Waler4 ren sm......ms we, tre isnierne
canard st tine Surname State Startle/Os
A Level a alueent an:Mars most Of Vie QJOhtons correctly NA may have coy some %Wen with dueStiOns that felted the Most chmensing Coolest.
LEVEL 3:
FCAT Student
Achievement Levels
Scale Score Ranges kewlino
Vedta naus
Level 5.
394-5W
3/1490
Lapel ♦.
MO.»)
341-S70
Lama 3:
310-349
316344
Level 2.
2)1.309
280-3a
Lama 4 lems70
Your scores are shown below
GleflOWNInCe at Ins Meer indicates 'Nat the Student has parbal suaassaMr ila racearene content of ion Surdun State Standen?) tel
~again° a muse. stem
A Laval 3 .1~ answers neny of tie Wheaton, op/redly WA e 9✓remerY Man nmominci wahl1WWWW, mal v.
moat chafenpreL
LEVEL 2: PertternanCe at ins level indicates Mat !NI student has line« fume's with the cha tenorng roman( et the Sttaa.a. SUM Staneerør
LEVEL 1: 'aberrance at ths leper indicates Mat the student run nNa success with lee cframentm, cotton of the Sum-Tyne State SlalOarn
SUBJECT SCORES
CONTENT SCORES
Reading
Mathematics
Sement
Achienenlif nt
Lerel
Sc:.
SCO'C wwml
Middle
Nyry;.
State
Ccmponson hirOS yout001 tre test /wan. art saxes mynt oe shontw rirqner ot icrwor Mir , the %OW, ua
Ne moon Hemmer, your 300/el would ot Wadi fall within ace am range. For re40, 0-
yak« mete scoie siesild be ~moan 351 are 389 For mathematics. you scab score sr.:,
w WWWOW $19 0.J 315.
Tee mitti maths ( J ) area it yve Meted in the KWCII. !riddle. of highest niro or Wade Off
Apnea 'Manta Who Ica Vas Iast firm Pale 00/21r2O00
Nu ober of
Points
Possible
Number of
Points
Earned
Stato
Comparison:
Thirds
Reading
Lowest
Middle intimation
Literature
Malnematics
Narnbel sense
~cement
~nary
Aesranin ~wine
Data Anaryfra
'Ihe Content Omit stows tr. Mane« Of >NM% polimee and Me nurnbei Or pCk nth earned
tic eat, c.iewiy. emir question was worth from 14 prams. The cargnat teste) is
deSetilMO or, The Creek of I es report
0271551
EFTA01710199
RØ
Contusa Fintad / °rodea
FCAT Readrn osen ~me« of the &ostia* Sta Standards in madtg The
Literata cohen oree condes campes su& as hacina, etmas. poems and loor teles
The trildmatices contare ame ~teme Destapes such as mapaane and nevespaper
arbcles abad anos hittory oc orner topes FCAT Reading amemos Me tened
~as
•
•
•
•
merenar the menor d In ban on flød eres arens% ~
vi
dd
l
est ~wing conclurione nip tern amt had stadium dum and rerg orponinbonal perlens
or ~bed mim don crt sund menage, det s:a libi
~a
purre« aixtror pon t d VeN
Cht03fig ben) , and eracy of ~ten trom research tincluhno eng
Dal end OginOnli. NM% week arguments. and the influens of an a.Åhore
pasfoil tast
On lod)
MCOnarb the Isa d CainniOn end ntrast venten
=F
itlimPler *møres d tand neludng padl nynne, agning, chetaere,
oxids.
and leanen urdeatantend Isave character and red a..kaamd.
pant d va t ard tone ate used in 'sut selectrtint recopniongi n«
and siTad comparro arear centrado duesolen, sertince and wonis as ptesented
vens teds naniana and interpretinp valen seannon for a vestg d purposes
senge venety Orreleresida notende bang index« enen.
nemmes, and pas's.
to Wild rrtcnnation for a vanety of aromen sYntheerand and sederalind collected information ato utal ~doners.
LØ
a
yanety d lechnemes
Mathematkil COnbitnt 'Usted !Grade 8
FCAT Mathematics m an amanere al die Sabe*
Sta Standards in nathemses
FCAT badenes manee Øer frorn the INIcuand ateas
Rumsar Son& Concepts. and Operations
Comprensión numérica. conceptos y operaciones
•
denthring Operan (•• -. x •t ard tne enecis ot nenas
•
dentereoón de °perennes e. •, Y, 4) y Ittie rectos de has mismas
•
determinar tarmle
•
cremación de resultados
•
irno.nrio has enes are represerted end sed
•
cama« oorro estén representada los Manero* y su tao
Irteasurement
«Mitin
•
reapnunne measurements ard unes ol memoren«
•
recabarme° de medidas y de unidades de ~idas
•
cromparing °cerastro and convertir« measuremerts
•
comparación y conminaron che medidas
Geometry end Surel Senas
~menta y conminen, espaciales
•
abarrn9. traen° en la
or
nentltYlrg. ard analyn no n.o and three-ciimensional shas"
•
ir,: ont nr GapnenthomtAn y anáñsm 0:orae
Oe non y be. ~monee
•
'inmolar° and ibis:rateo changos in al pes
•
ch.yylkra, Cc: e : cabe': em de CambiOS
n
•
using ccordnee peomeny
•
k , be. Je {leer-44,a yyyedmedd
Alpebak nilnkIng
Razonamiento algebraico
•
desalo% analltrg. une Odnetallang partem,* velaron*. ano fundan
•
oct.: lop tinh anclen y itenenizacetin de patrona relaciones y funciones
•
vait nor aro usng exotismo/1s. «mahón irle:tunee grapra. and lamidas
•
ese. t t:..d y ugy de e Y ;Y mactia. •DLISC•dnalå &apandados grifas y Mandas
Data Analysis and PM:Bah"
Analista d
date y probabilidades nat Orpenumg. ard «optan° data
•
aneo" o icsnasc
gr
nuaceón • interpneleteCn 0,3 Clata turorme and rnalong presidas. inlerences. ard valed cceolustans
de patrones de COnduCte y haciendo preoic~.
ntederenCise Y
•
se to ard *tatas omakeelones ~
•
vende prObablediklei y eetadlebraa
La Prueba be EaliluaCitel Continnana del Emde
La FlenCla (Yen') mide el rendimiento de: ebt u0 ante segur atienes especifico. en ~de
lectura y maternales.. be cuales están eepecrécados en las NO!~ 8~
Echada del Estado de la Monda (Sumieres Staros Standards) Debe normas establecen N ~Ida
conocenierrta ore los estudiantes del estado de La fl orida daten tener y aber arar
El estudiad puede alcanzar uro de los cinco rumbas de lendenent0 POS4Yen. en balara° caleciecOn total El ~arde
pues» alcanzar una caltlasción entre
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Contenido de le Prueba de Letnus
Orado 8
La pruebe de Lectura FCAT es la pruebe cale edens las Norms alocas Encentar" ce
Lectura del estado de la Florida (Sunshme Stat. Slanderds) La mecen de Literatura
incenie leeos de ltee n poemas y
d
euertai kddoncos La sección de trylormacein indino artista ide rentase
y lodos seta ~Cele nstona u otros temas
La prueba de Lectura de FLAT edshis lo mosto
•
andar les sordeacks de un testo viendo Menean <Len
•
analizar pareas y ',dos. Indpar a conclunn ose ~menos Naves del tea/ y
de la ~urs de palabras y reconoce patrona ',paz aceras
•
SOMOS be idea pandeaba. raudas o en etla.
o et mensaje mee importanle de im ledo
•
dentecar el «Denlo yro el punto de mita del aria
•
remar dpuuse la vvedamarrete de revnbpacrones ima vine y nasa
00 Out relee
Ls Kb ladón de heces y opinan y Winnentos amnantee Y secundara, Y
la mastererse que las «monee personal«, de un aula Lene en un redel
reconocer el iza de la comporscadi y el cortroste en un len
•
reamar las elementos complots di un ledo lo dar incluye la trama el lamine
lb», donde ocurre is atoren, el desarma° de los pelsormes su coniliet0 Y el
°Menee,
•
comprender lea Mata manen en que se usen el desarrollo de los personales
y de la trena, el punto de sota y el tono en latentes Untos
•
reconocer el uso de causa y efecto
•
comprender las semetarusts y ~ronces este los ~nafta
N lugar donde
Mire b len y be aCantearraentOe Ud como se presentan en Oferente. Mitos
•
ubicar. apencar y ansiar intormsciOn menta pera referentes uso*
•
murar nfonnecdri de ~ tuertas de ~e teles cono han, renda* y
perstdicos. para diferentes usos
•
sentar y dedicar en in orden dedeo d ~macen reunida ~ando eso de
~entes tecnecio
Contenido de la Prueba de Matentiticas / Orado
La pnrebe de MaternbtiCaS FCAT los la pruebe orla eallia las Nana BIS=
Educatmss de Naternation del estigio de La Manda (San. hne Stat. Stardards) Esta
Nudo ~era be bandea rapante,
EFTA01710200
FIAT
I kal. (ser rItergra Als!~
Tul
FLORIDA COMPREHENSIVE ASSESSMENT TEST (FLAT) 2000
Student Report
Grade 08
This report shows your results from the FCAT Nationa: Norm-Relerenced Test.
Eir e— Naam rea Maat
WI • MOOIE SCHOOL Of MITS pad r.. al Nats tp-MAIy KAM
The FCAT Norm-Relerenced Test rreasures your achievoment on a test thai was pioen to a national sample OT students Your norrn.reierenced scores in
Reading Comprehension ana In Mathematica Pokten, Solving describe your perlormance in relation lo tro performance of etudonls throughoul th° namn.
Voor scores are showt" below
SUBJECT SCORES
Scale
Score
Reading
Comprehension
Mathematics
Problem Solving
Nat onal
Percentile
Rank
Stanine
The USO Score altpreneS your partema ce and aLows contfarelOnt hart yxar Ic year.
amiong COnaerenSign Scala Scores rang* non 51010 624. lidatnernatics Protsten sovina
sta mam fonts horn Sfs m aY
Ine Nataal Percerrile Hand, and Mantra> alfa° ytor relativa »anor g Ii fonts« aa to Om
Nataal rearen provo. gaan., Percenbe Ranks range trom 110 stanines langs Wem 110
If
100k tre lest again, your gatend, Portable Rare mirt be tlattly NOV Or bar Man
statte nare. Nalever. yOur Nataal Rareellite Kan WIM prowoly al witten a gaten tango-
Fel/ amant) rarorrtnenson, your Nataal Percentite Rank anould be between OS and ta Fa
itathermucs Pim*" Sotung. vox Nekpa Pettere Rank leid te ~men 30 anoSti
Run Cate owainoco
CONTENT SCORES
N intbor of Po rits
Possiblo
Ni, rnber ot Points
Earned
'Jambe, of Questeons
Attempted
Reading Comprehension
Nubal Unctersianong trimpretabon
Ontval Altai«,,.
btraregitio
Mathematica Problem Solving
Menuremert
EStrnabon
PrOCettM gelang
NtItaber RalatiOnnarn
Nomina Sytakens pan•Wns & Randen
Naba
Statistici
Protettity
Geonatry
The contant halm Is descieee on the bark of tras report E•sh gaston was worm I »FA
OCMW
EFTA01710201
Grades 5, 6, 7, and 8
The FCAT NRT Reading Comprehension Test assesses the following objectives:
•
Insta! Understanceng • Demonstrate tho ability lo cornprehend explicitly
statal folabonships in a vanety of reading ~bono
•
Interpretaran • Domonstrato thc ability to kim an interpretation of a varrety
of reading selectons basad on explot and imitad information m tho
seloetions
•
Cnacal Anetyso • Demonstrate the ability to synthesao and evaluato
explica and implica informaban in a vanoty of reading soleaban%
•
Strabgas • Demonstrato Vio ability b ~izo and apply toa lactas and
reading strategies n a vanety of reading ~tono
Tilo aboyo °bocines are measured within the following contad:
•
Rotterdam*/ • material typicaily read loe enioyment
•
Textual- material baca), hond in grade-appropriate textbooks and other
10IMC05 ditlf0101.12,011
•
Funcbonal - material typically oncountored in ovoryday Ido 'guasona
The FCAT NRT Mathematics Problem Solving Test assesses the following objectives:
•
Measurement - Demonstrate an undentanding of thé principios of
measureinent
•
Estmanon • Determine rho reasonablenoss of rascas and apply estimaban
in probbm solving
•
Problem Solving SU:negara - Domonstrate an undorstanding of ITIO bocas,
of sobrina convenbonal and non-routine agobian,
•
Number and Number ROICI7P7ShIp3 Represen, and use numbers in
equivalent forrns in real•world and mat.mabcal problema, and 0.mi:ostral°
number sonsa kg wad* numbers, tractors. decimal,. and int fiers
•
Number Syslems arad Number Theory Demonstrate an undrymancling of
relationships arrima arlarnetc aportan' and apply concopts of numbor
tneory
ca
panes. teclees. and mulbples in real-world and rnathemahcal problema
•
P•MOrrIS and Funchons • 'denles), numerad and geometric parten,' and
hinebons and use bonito sobe probetas.
•
Algebra • Demonstrate me ability lo ~ate exiXOSsiOns and sobe linear
aquations
•
Statstics • Delfilatlabal0 an understancing data relabonshipc in data sets
•
Probigiáty • ~pm:Arate en ~andina bine taren gamma chanco
•
GaIne • Oamonstraloanundagalinthng off Oaxnetric enmieles
Grados 5, 6, 7, y 8
La Prueba de Comprensión de Lectura FCAT NRT evalúa los siguientes objetivos:
•
E Mamantona> - Demostrar su habilidad para comprender eyplicatamente ol contando y la relación entro si dentro do una variedad de
selecciones de lectura
•
Interpretación - Dementar su capacidad interpretativa dentro do una
variedad de selecciones de lectura. basándose en infamación oxplkrta o
imanada en dichas selecciones
•
Andaos critico - Demostrar la habilidad para sintetizar y evaluar
información emplkita o mal iota en una variedad de selecciones d• Natura.
•
Estrategias • Demostrar habilidad para reconocer y aplicar el contenido dial
texto y estrategias utilizadas en una variedad de selecciones de lectura.
Los obetivos anteriores so ovaban on loa contextos siguientes
•
Recreativo - material utilizado para entretenimiento
•
Textual • matenal utilizado en hace de leido del grado apropiado y en
otras ~dios informativo
•
Funcione/ - material ublirado en te vida diana
La Prueba para Resolver Problemas de Matemáticas
FCAT NRT evalúa los siguientes objetivos:
•
Medran • Demostrar sus conocimientos de los principios de medir
•
Estimación • Detemenar cuan razonados son los resultados y aplicar la
estimación en la solución de problemas
•
E3171k3Qi03 pare resonar problemas - Demostrar comprensión de/
proceso de resolver problemas convencionales y fuera de lo canon.
•
Números y relaciones entre rameras - Representar y usar llamaos en
formas equivalentes en problemas do matemática y de la vida duna. y
demostrar senado para las fracciones, los decimales y los numero, enteros,
posan,» y negativos
•
Sistemas y borla de bs numeros
Demostrar conocimiento numérico de las relaciones entre las operaciones de aritmética y aplicar conceptos do la
tea la de Nº numeres tales como mineros primos, factores y multiplos en
problemas de matemilbca y de la vida diana
•
Reina y 'tocones • klentifkar bribones y pautas numéricas y usarlos
para resolver problemas
•
Algebra - Demostrar la capacidad para evaluar expresiones algebraica, y
resolver ecuaciones lineales
•
Estadistica • Demostrar ~comento en procesamiento de date
•
Probalatrcled - Demostrar conocimiento de las leyes que gobeman el azar.
•
~molde • Demostrar conocimiento de los ~cipos de geometrb
&a SdAdIss• TM Sea ama talaCsaYiallmobad
EFTA01710202
FRS TO- FLORIDA CERTIFICATE OF IMMUNIZATION (HAS 680 - PART A) (11
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I HAVE REVIEWED THE REMOMISAMALABLE ANC TO THE BEST OF MY KNOWLEDGE THE ABOVE NAMED CHILDH0413EEN ADEQUATELY P.IMUNIZED AGAINST
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EFTA01710203
DATE OF RRTH
DELOS NAME iHNOEU
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EFTA01710204
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ESS00032
EFTA01710207
STUDENT NAME:
CURRENT SCH00L: (use pencil In this space. until rival)
Nano.
Siteet
City
Scheot
Clads
School
—49—
Coms PME011t
Otlyll Meant
Schicel
Timber
Wet
THATTENtolia
IWAMOTO
LANGUAGE_
SEX
0 White. Not Hispanic
0 Black. Not Hispanic
SubNci
TolChor
114A
SPFI (RIO
ANCMTVOTING
SHCTEL.StUDIES
SOltitt and
OttA1114
BEHAVIOR
COOE *WAAGE
IN:C.It•.
Prom ale (P)
Amain (P)
Soorner SchoolMST
O HiSpOCOC
0 American InSan/Nalma Abstall
0 Asian/Pacific Islander
Sines
Gras:
SCI.01 Ye. 19 --I
—
Ores botany.
Ocos MIMIC
SWJect
TeliChtd
Mart
MATHEMATICS
PEAOHG
LANGUAGE
STUDENT NUMBER
OIRTHOATE
Swint,
Toochor
Mark
SPILLING
HAiioweiliNG social ttutelS
SCIENCE and
HEALTH
BEHAVIOR root AVERAGE endows
PHT•o101h)
R0414 IR)
Summer School ISS)
EFTA01710208
Pl.P.tmall..PE„aInt.oprrcArk)
2.032 5.61D-3.011 -.LC and s. 65C-22.086, F.A.C.
Child's S.Stt (optional)
STATEDDIUNIZATION 104P
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 oily and has previously filed a Certificate of Immunization (680A or
680A-1) with their current Florida school, fill in boxed areas below and complete Part A-2 on the reverse side of this
form.
For additional information: Sec Immunization Guidelines for School and Child Care Facilities for information and
Instructions on form completion and immunization requirements. Guidelines are updated annually and arc available
from the local county health department.
VACCINE
CODE.
DraPIDTP1
DOE .
Dos I
2
Do
3
. Dosed
tom 5
A
DV
B
Td'
C
Polio'
a
i
s
a
l
•
i
i
D
IMP
E
KKR (Combined)1
F
(SeparatO
G.H.I
Measles (dose
Afeada(icve 2)
Rabat,
Hepatitis B'
The state immunization WO is an identifier supplied by the stain 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 dnc.c of DM
DT (pediatric) is acceptable if ?Metals vaccine is medically contraindicated. (Complete Pan C for Pertussis
contraindication.)
s
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 net
requited. WV 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.
tat dose valid if given on or after 1st birthday. Second dose (measles) valid if given at least 1 month after 1stdose.
A second dose of measles (preferably WAR) 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.
Includes single measles vaccine (O), single mumps vaccine (H) or single rubella vaccine (I).
Hepatitis B vaccine mries 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 grasics
are included.
EFTA01710209
LAST NAME
FIRST
MI
DOB tmonamYtt)
Certificate of Immunization for K-12 Excluding7th Grade Requirements
PART A-I (Immunizations are complete for school entry and attendance grades kindergarten through 12 with the exception of the 7th
grade requirement.) DOE Code 1
Ihave reviewed the records available. and to the best of my knowledge. the above named child has been adequately inutuonsed against
diphtheria. tetanus, penussis, polio, measles, mumps, rubella and kepands II (for kindergarten effective with she 1998199 school year) for
school attendance as documented on the revere side of this fomt
Physician or Clinic Name:
(Print or stamp)
Address:
Physician or
Authorized Signature.
Date.
Certificate of Immunization Supplement for 7th Grade Requirement
Part A-2 (tmmuni rations are complete for students mho 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 requitement.) DOE Code 8
1 have reviewed the records available, and a the bnt of my knotsieclge, the above named child hat received the following immunizations
mauled for entry and attendance in 7th grade effective with the 199708 school year: tear.uPdiplithetio booster hepatitis It vaccine penes.
and second dose of wades vaccine as docrimented on the reverse side of this form (boxed areas).
Physician or Clinic Name:
Physician or
(Print or stamp) thorized Signatu
Date. Nan
Temporary Medical Exemption
PART B (For preschool children, children in day care and school children who are incomplete for immunizations in Part A-1
or A.2.) Invalid without expiration date. DOE Code 2
I ern* that the above named child has received the immunisations donimented an the averse side of thitinnt and has commenced a schedule so
complete :he required immunisations. deldmonal barn:natation ore net medically indicated at this nine.
Physician or Clinic Name:
Expiration Date:
(Print or Stamp)
(I 5 days after next Inuounixation appointment)
Physician or
Address:
Authorized Sig attire
-
Date.
Permanent Medical Exemption
PART C For medically contraindicated immunizations, list each vaccine and stale valid clinical masoning or evidence for
exemption: DOE. Cede 3
I cent that he physical condition of this child is such that inwunizationWas indicated In Pan Cable is medically eantraindiened.
Physician or Clinic Name:
(Print or stamp)
Address:
DK 6$0, TM, opine euklicr calf. &ea Sta. en: 57.04:40-44144)
Physician Signature:
Date.
EFTA01710210
Mairdge SAT
YOUR SCORES
REPORT DATE: 4/08/04
( HIGH SCHOOL COPY - 101493 )
Test Date:
MARCH 2004
• PAAseMng rry velay
Math:. Prillf=1
I
No single 'tome/Nat score can end% rePresecd yaw reasoning skills. If you had taken ctlferer4 *Sons of the test
within a that period of time. your partormance would probably
vary somewhat on the 200 to TOO thole.
HOW DO YOU COMPARE WITH COLLEOE.BOUND SENIORS?
PercenOks ingrate what or tentage of lest taken earned a scan lower than Wars. The natlanal Percentile for you verbal
seas a 400 Is 38 . indinding Tel did Leer than 38 'A of the national gimp or collegrehounl seniors. The nadong
percentile for your math score of 4t0 N 16. indIcallno you did
boner than *6% of U.. national pro,* of e011efle0 OUnel SOMOrS•
DID YOU DO BETTER NI VERBAL OR MATH?
Your scores Inc:scale that you performed hetes on the verbal
test than on trio main test
HOW DID YOU DO ON EACH TYPE OF QUESTION?
AnWetie AM ,RWW41.94teeionet9
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LOXAHARTCHEE
FL, 33470
WHAT'S THE AVERAGE VERBAL OR MATH SCORE?
For codepeesound scram In the CUISS 012003, the aserfge verbal :are was 507 and the average
Math score WaS 519.
IF YOU TAKE THE TEST AGAIN?
If you lase the test again. especially it you study between non and then. your stores IneY 00 UP.
Among Medea with verbal stars of 480, 56% soma higher on a seccnd warn, 13% score OW, and 9% receive the
same score. On average, a person with a verbal score of 480 gains 13 pangs) on a second taring.
Among StunallIS with math scored 01 410, 65% ecore hither on a second testing, 27% score lower. and 7%
racche the sense wee. On aver090, a versos keth a math
SONO of 410 gab! At pangs) one second bang.
Tow responses to seen c types of Winans se presented as numb+, right. metro* wrong, art/ menet omitted. Raw scores aro
based on the specific eth lOn a the tad that you 100k.
You cannot compare raw math en dIderent editions of the test cr
across different types o4 questions. For each type a Question, you
Can Compare you peelernletICO lo conope.bound seniors whO to* this test. Iris percentile la an estknato of the per.
centege Of CO•egmbemd seniors who earned a raw score lower than yours on each type of question.
ID INFORMATION
To We saddle:id tests you Can rerthitste by Malt Or by phone
and use visa. MasterCard. Arntrk n EXPreSS. DOCOyer. or JCS.
You will need M registration number below and the test due
(see above). To send more score repents you se; I nets 100 bsslitutiews 4.Cgtt Cara. See the back of this report for
IMMIX/Jona On IOW to request three settees.
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No information about colleges or scholarship programs is provided here because you did not ask
binciatheel
tr
C•1101•3
P0/110 us to report your scores. Many students have not yet decided to which colleges they will apply. If
you need help making that decision, try some of
Coed the following:
is gii4aertitfrt ilai UMW : IlnOeclaaa
• talk with a guidance counselor at your high school gets*..
tarp °Its
In state
• talk with your parents or other adults whose opinions you value
i
00/mIly el
Ft re•lilent
0111Innift
Cltlien
-R. 'Chili lathe
• talk with your teachers
g
00
a
'wales plans
• talk with your friends, especially older ones that
Vila
Iliselnet• Newt may be further along in the process or have even
.,
.
and odds been through it before glad: ..,int • -' g
Awr•s•
•
• look at college guidebooks (we publish our own, the College Handbook) found in your library or
1.1
Jilin School
04eiriet
10
guidance office in ' tallish
.
'
• Cnillni
• ask whether your school has computer software ,g:
g
11.0.
00.4igning.
.
2 Facelift lift,.
3 Seth that will identify colleges that meet the criteria ilsivratklinal 3 ltetutel $01.
you select u. -.Sochi Salute 4 Satlal Silence
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'Cowles.
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1.00iein4i140,
1.iimmthi..14).1
Ho o Is IntormoUon you provided:
Ulm tursuago. a glish only
Telephone: 561.753-5472
Raiigico:
want Seastli SUNOS: YES
EFTA01710212
TEST:
IOTA MIDDLE
CTBS/4 LEVEL 16 FORM A oust:
06
STOUT SUMER:
4/20/98
TESTS
MOMMUF
RAMS
OMN
SCORIUMAS
AVERAGI
LW
MGM
MOUT
TOTAL READING
NMASOF
1-25
PROMMI
MOCOUU
MOM
MMS
PUOMMI thN
NOMMUF
MHO
MOSUL!
Dear Parent/Guardian:
This spring, Nicole was given the Comprehensive Tests of Basic Skills/Fourth
Edition (CTBS/4). This report explains Nicole's test results.
When compared with students across the nation, Nicole scored in the highest
range on Reading Comprehension. Nicole's scores were in the high-average
range on Math Concepts 6 Application.
Additional information about these tests can be found on the back of this
page. If you would like more information about Nicole's test scores, please
contact our school.
Sincerely,
Principal
ScMOOD:AGOF.
EFTA01710213
SCHOOL:
MT:
SOTA MIDDLE
CTBS/4 LEVEL 17 FORM A mwm, 07
WTEOFTESIDG:
4/13/99
STANT
TESTS
MAIMO,LE mats
UMW
KOMOWALS
ATCRAGE
Um
mm
ANIMIT
TOTAL LANGUAGE
SCIENCE
SOCIAL STUDIES
MMISOF
MKomil
Rams
1-25 rmamac
34-50
KRUKTME
514s
KKOrTat
74-m
MMInnE
Dear Parent/Guardian:
This spring, Nicole was given the Comprehensive Tests of Basic Skills/Fourth
Edition (CTBS/4). This report explains Nicole's test results.
When compared with students across the nation, Nicole scored in the highest
range on Reading Comprehension. Nicole's scores were in the high-average
range on Math Concepts & Applications.
Additional information about these tests can be found on the back of this
page. If you would like more information about Nicole's test scores, please
contact our school.
Sincerely,
Principal lisi4ptg44
EFTA01710214
tai
Dale 4/3o/ 97
Addeo
Race
S
ales
Binhfare tur
Ftfl
Phone
Name or Pore or Corcoran
Roo.
&cod Pressure
(/) Hormalceb AbnonnelcA
1. A0PearMIO
N
A
cc'
2. Skit/aka.
a mead/Scab
4. Eyes
V .7
0. Visual Assay
U
B. Ems
7. AmIllery Artily (12 a 1)
8. Nom Twat
9. Mae. Toth and Gams .7
10. Ovate / Lunge
11. Heart
12 Abdomen ra EOM. and Ann
14.tiuscaloaeletal
16.Naurraoskrel
10. Marinoss
17.Emolional / Wenral/
%Iwo( Rob)
18. Hencraux plokal/ other ISoreelly)
19. whey Rostectiona
ISoebly)
20 Mane. *Amnon claysoml/ errobteral
21. MA/Mon
01-
Nit iv*
22. Other
:
• norm. I Findings, by number
B.
HEALTH HISTORY Iwo= WICSOM
Wadi narrathe a acklabnal scow needed]
NAME:
1111E:
ADDRE
(Please Prim)
ShMI(0 am
7uberculb lett
SON CO ed Si,nalure
/
/
Dare irdS•X Form 3040, Mar 91 (Crateletes previous editions)
(Stock ember: 5744-0))-3040.2)
EFTA01710215
Loxahatchee broves
20 Oldc0100cenol.
analChee. FL 33470
7954061
(407279:4318
School: 1 me:ha4c_hee
to the parent or guardian of
This report is co advise you chat your child Ls making unsatisfactory
progress in:
Elementary interim Report of
:45aris(accory Progress
M.Y2ie Jo Young. .S tan! Principal
Judy HeSSe40n. ASSslanl Pro10024
Grade: 5
( ) Mathematics
( ) Reading
C ) Leagues
C ) Spellin
( ) Handwriting■
( ) Social Studies
( ) Science/Health
III) Behavior
In order to improve, your child needs to:
( ) ascend school regularly
( ) bring the necessary supplies and materials co class
( ) listen carefully and follow directions
( ) complete classroom assignments
( ) complete homework assignments
( ) work independently
( ) develop better study habits
( )
Improve class behavior
( ) other:
We need co work together. Please discuss this report with your child.
Please sign and return the portion below the dotted line.
Student's Signature
Dace
- Parent's Signature
Parent's Phone Number(s)
EFTA01710216
Records Request Form
OO
3,Ao I stir
OCT 2 9 nen
Siudad
t
Date of Illrat
High Scfioo f
?'total.
Weadi C01111111117ity
Wontegkpmlmall
Dab!
Itequod:
Second Itudiest
M
.. Ad/ A_
Proviona School Alleaded
School Address ilds above named modem has availed in ow school. Please tend the following to
Records et your earliest CANIVUliCAICC.
Treitscaint of ray& grades liate of enrollitteca and withdrawal
__Taal eunmidive atom= for year to dale
Grades to dale of withdrawal
_
Garai !emends (linmunizations)
____Intratreedion of yam marking system
_Achievement Test Scram
_
Copy of Strada MCI'
Graduation recirammerds, if senior
jitydratogical Itepart ((fart hem i ['kinglet Ildilation %dont)
Pracra Signature
Staid IlAticalion.
PATNII SitItAllliC
MINI/CUM
Think you for your (^titration in this miner. Federal law 99.21 Slabs: "No pans& eignalwo is requirrat
for oduratiOnal records rail In trantlict allati(111111 agency?
106011 Okralinfort Onsifroan‘ Royal Pa fin Meade, grotitia 334.1.7
Tionste: (5611 7S:3-4000 Ya.c.f061)7S.4-4015
EFTA01710217
ame
Sesta
TH EXAMINAT1 osectiOD
RA N
Arkhael---
t2o3
Raeie--
Sex
Name of Penal or Ouardbn
Scheer
Heinle
°bed Pr.r
1:614ermal4N; AboormaleA
&Omens
COMMENT: Mumma! Findings. be number
1.
7
/
r/ -
2. Skin/New elead/Sorto
4. Ewe
5. MRS Amity IS &I.)
S. Ears
7. AuStery Molly iR a L)
&Now / *Rook
9. Mouth. Teeth and Gums
10. Chest I Lungs
12. Oixboon
13. derails and Anus
14.1ArsodoCkeklal
/7/
IS. Nourdoeical
0. MarInest
17. Emodocul / Mental/
Belovere Prob
Nenoexp: rthyse.k/
0"&"11Seeem
10 Act,nty Pastnctceas
(Specify)
-anal ovnical/ emc4o
21 moisen
22. Ober
B.
HEALTH HISTORY (Wks Mama Nutlet euvraln)
Colleen narratke a ad6Omal sox. Deeded)
C.
LABORATORY
H)croglobin/Hemslocri
Lea]
NAME:
TITLE:
ADORES
(Please Print)
A horized Signature
0141040. 16/94 laneKnr 145141.1 inn 3040sen, nor M non
ISInk Mann 514400P11.4.21
SloolIO &
Stlk Col
II
Tutercut4 test.
L
EFTA01710218