EFTA Document EFTA01710316

-Mlami.Flolids . Office of Exceptional Student Education btliVA I PUN CM I uutra f BEHAVIORS Pet Student's Name School>, In 1-10, il-SOY, _31-50% Over 50 . VII. EARLY SEIZURE IDENTIFICATION Never Seldom Sometimes Often Excessive It . Periods of -day dreaming', dazed behavior or blank stann.. Picking of clothes, mumbling. chewing of random movements what) acting dazed. I [repeated 6 times] Head nodding. sr. .....- jy s. Memory gaps. •-•;71.7/ Sudden fear. onset or • • nic. Muscle jerks or sudden falls. , ;,, Inability to communicate for a short time. •V COMMENTS: A Additional Information: 0%. 1.10% 11-30% 31-50% Over 5o% I VIII. SELF-CONCEPT Never Seldom Sometimes Often Excessive! Appears to lack sett-confidence. I I I Exhbits feelings inferiority. of Exhbits leek • s of superiority. .i....1-, Appears to lack motivation. Needs praise and encouragement. - Demands attention from teacher. I ,„ Demands attention from peers. Demonstrates • °evasive e — °elation of failure. rdcY '2. Prefers tasks considerably below instnictional level. Selects overly difficult classroom tasks. COMMENTS: Addl.:anal inlormation in. P55 rake/ 4,...,1.4u° M.1692 Pay. (01.941 EFTA01710316 - Miami, Florida Office of Exceptional Student Education BEHAVIORS Student's Name School: IX. SPEAKER OF LAN GUAGE(S) OTHER 0% 1.10% THAN ENGLISH Never Seldom 1 I -30% Sometimes 31.50% Over S0% Often Excessively A. SOCIAL LANGUAGE y.: Points to classroom items upon command. 1 Follows classroom directions. :.,i Exchanges cannon greetings. e.e. 1 Initiates and maintains a social conversation. e.;(1 Gives classroom commands to peers. a Orally participates in group activities. Appears self-conscious about his/her speaking skits. "?.1 .1 U363 VOICO intonation. 3110331614 • 86303 . :,•C • • rWO COMMENTS: 0% 1-10% 11-30% 31.50% Over S0% B. ACADEMIC LANGUAGE Never Seldom Sometimes Often Excessively •:, Follows specific directions for academic tasks. •Y: Understands vocabulary for academic tasks. ‘;'. Understands teacher's tiscussion. relatedto topics. -:::::. Asks/answers specific questions about the topic t'..' being discussed. :'f Asks for clarification. 2 Volunteerstoanswerquestionsrefatedto thesubject. '1 Follows along during oral reading activities.. activities. '...i Understands reading as a process; is able to A integrate words into meaningful sentences. :. `;.:;.::,: Experiments with writing by drawing, copying a and inventing own spelling. i t...4 Is able to convey information through written v.;:::"; expression, using the correct mechanisms of writing. COMMENTS: X. ACADEMIC PERFORMANCE Grade Level* Instrument Reading: Decoding Comprehension Arithmetic: Computation Application Language Ability: Verbal Written Teacher's Signature ate. If 3 — `I • Teachers, please provide the best estimate of academic achievement in the student's native language, and in English. FOR ALL LEP STUDENTS. Date rotIlS1S neaarasAiuo Based upon your experiences with this pupil, do you believes significant discrepancy exists between this pupil's ability and his achievement? ' -I Recent Home/Environmental Change•• FM-1692 ACV lot -9it EFTA01710317 EXCEPTIONAL STUDENT EDUCATION giving our students the world Speech-Language-Hearing Report/M-Team Referral Name. School. Evaluation Date Develop./Perform. Score D.O.B.. Age Grade/ESE 3 Student's Native Language/Dialect Examiner Verbal IO Evaluation Conducted in (language) P MEMO TO: FROM: DATE: SUBJECT: A , Student Services PFed N EN ( S7- U A, 49.,. /way (5 7- ' keta_e_fif sic, tn.° I I 1440 vtli I [repeated 3 times] f 0 I Ai l 310 1 ji 40 1 MI I I ic i I 1 II -.G I .10 411 •11 11,111.1 4i.our , Recommendations: O Refer for eligibility stalling: (circle) Articulation Fluency Voice Language O Additional testing needed: (circle) Bilingual ESC/ Psychometric O No further testing needed Comments: wa While — Speech File 878-1397 FM-1544 Rev. 110-891 Yellow — Referral Pink — Cum Folder EFTA01710318 Nam School Evaluation Date2-5:.... giving our students the world Speech-Lan wage-Hearing D.0.BIEME Agee- 1 .aw1.9? Develop./Perform. Scorein Fro tress EXCEPTIONAL STUDENT EDUCATION Report/M-Team Referral Grade/ESE. Student's Native Language/Dialectiat t Examiner Verbal 1016 proles Evaluation Conducted in (Sin. (language) Audiometric Screening ato1.5..dB. Threshold Testing Results: R L Referred: PASS El FAIL (Agency or Private) Articulation/Phonology (Severity Rating): Test c-pgr.tik ra She. Test Intelligibility (Connected Speech): WNL MILD .....MODERATE SEVERE Resultsnosnila.ctr...i.fr.v4-• ts...t.ritre:t • Results L7 WNL GOOD FAIR Fluency (Severity Rating): WNL MILD Test -attChl..F...O..os.91-C Supportive Data: YES to Voice (Severity Rating) Medical Clearance Supportive Data: Language (Severity Rating): Receptive WNL Expressive WNL Pragmatics WNL WM_ YES YES WNL ......MILD MILD MILD MODERAT Results le.)05:4:.1(.11:Cl.10.al. POOR SEVERE G eat r "17 a l " MILD MODERATE SB/EFE tO PENANG fa Diagnosis: . ...... ...MODERATE SEVERE MODERATE SEVERE MODERATE SEVERE I [Hilt 111111 S aeeneereorteeei ee • -40 1 lel31•I III lei - Sp RA •I 430 Recommendations: 0 Refer for eligibility staffing: (circle) Articulation Fluenc Language r eAdditional testing needed: (circle) Bilingual Esa Psychometric 0 No further testing needed Comments: 7c/ iOWA44-zelteititi-ihi-cp LAx-.)f Azw. eta Afi t( g. .e. i.1244,fe,Afgatieti217,4,tg White - Speech File v eilnvi/- Referral Pink rn Folder 878-1397 FM.1544 Rev. 110-891 EFTA01710319 - Miami, Florida Unice of txcep ont Education OBSERVATION OF STUDENT BEHAVIORS G irthdate: rade: Date of Completion' 0% 1.109. 11-30% 31-50% Ovor 50% I. ATTENDING BEHAVIORS Never 1 Seldom Sometimes Often I Evereelvelo Seems to have difficulty staying in seat. Does not complete tasks. Has short attention span. Is easily distracted. Appears to daydream. Exhbits impulsive behavior (blurts out. etc.). Appears hyperactive/overacave. COMMENTS: II. INTERPERSONAL BEHAVIORS Tries to dominate others. Is easily led, influenced by others. Prefers soitary activity. Avoids competitive activities. Avoids verbal communication. Does not participate in class activities. Is ridiculed by peers. Is ignored by peers. Sexually aggressive toward miter students. Physically aggressive. hits/kicks/bites/etc. Threatens teachers/students with body harm. Prefers activities with opposite sex. COMMENTS- 0% Never 1.10% 11-30% 31-50% Overt0% Seldom I Sometimes I Often_ I Excessively III DISRUPTIVE/INAPPROPRIATE BEHAVIORS Fi Exhbrts perseverating/repetitive behaviors (rocking, tapping, etc.). Has temper tantrums. Exhbits sell-injurious behavior (specify below). ,,..., ..i. Uses profane language. t ••;tl Lacks self-control (specify below). .7 r :?: .I- %Lc coos inappropnatety. .. 0::,-.- -,1;71; Demonstrates moods. .. ;-S g 'A Takes things belonging to others. :•-- ‘••;421 Makes untrue statements. Pc• 'T : -.Z:-: ',:7 Imitates opposite sex. : •:1"„:4,...-aii Is destructive (speedy below) 0% 1.10% 1130% 31-50% Over 50% Never I Seldom I Sometimes I Often I Excessively COMMENTS: rm•Ise2 Rev 10$ 94) EFTA01710320 O ttiVA I kJ uu BEHAVIORS - Miami, Florida (Alice of Exceptional Student Education Pg. 2 Students Name' School. 0% 1-10% t 1.30% 31.50% Over SO% IV. INDICATORS OF ANXIETY Never Seldom Sometime. Often 11222=a Appears nervous. jumpy. Seems to worry. Seems unhappy. Appears to stutter. Reluctant to speak in group situations. SOOTS tense, unable 40 relax- Seems easily frustrated and confused. • .. .. ,,s.:, Manifests fear al school (specify below): '' - . Bites fingernails, sucks thurrbilingers. Er Compulsive talker. COMMENTS: 0% 1.10% 11-30% 31-50% OM 50% V. COGNITIVE SKILLS/PERCEPTUAL MOTOR Never Seldom Sometimes "Often Excessively 1- --cc.3. Has df1c • from chalkboard. yr- , .14 Has difficulty reproducing drawin'gs.letters. nun-bets o' written words. ,.4- Exhbits poor gross motor skills (specify below). 4' Seems to have difficulty with visual backing: skips Ines words Word andel.- , etc. std3 below. „.. -,- Exhbits poor perception of spatial relationships (letter/number reversals, spacing). ..": ‘.:- Has cfrfficulty remembering (specify below). COMMENTS: 0% 1-10% 14-307. ' 31rSO% Over 50% VI PSYCHO-PHYSIOLOGICAL Never Seldom Sometime. Often Excessively 4.-", Has need to use bathroom excessive . . Speaks unsteady in native language. k~x stomach aches. etc.). Exaggerates physical complaints (headadhes. Rubs eyes. eyelids/eyes inflamed. Holds material close to fate. Turns head to ono side listening/working. Web clothes. Exhibits muscle spasms (IsslcheSAiCkSI trX:," aY'.0 Becomes ill when upset or frustrated. COMMENTS: 1'OLP" cnietvoisxmo FM•i692 Are (01441 EFTA01710321 - Miami, Florida OBSERVATION OF bit UULNi BEHAVIORS Office of Exceptional Student Education Student's Name- Sc VII. 07. 1-10% 1_1 -3_424 3_12_5T% OteLS0% EARLY SEIZURE IDENTIFICATION Never I Seldom I Sometimes I Often I Excessively Rapid blinking or rolling of eyes. Periods of 'day dreaming*. dazed behavior or blank staring. Picking of clothes. mumbling. clewing or random movements whits acting dazed. Head nodding. Memory gaps. Sudden fear, anger or panic. Muscle jerks or sudden fats. Inability to communicate for a short time. Repeated movements that look unnatural. COMMENTS: Additional Information: 0%. 1-10% 11-30% 31-50% Over 50% VIII. SELF-CONCEPT Never Seldom Sometimes Often Excessive! .. Appears to lack self-confidence. Exhibits feelings of inferiority. Exhibits feelings of superiority. Appears to lack motivation. Needs praise and encouragement. Demands attention from teacher. 352 Demands attention from peers. . Demonstrates • -Nasty° a.... ation of faucet. Prefers tasks considerably below instructional level. Selects Selects overly ditficuk classroom tasks. COMMENTS • -I A.Idnoonal information: A * vensis c....rose•4•140 FM•1692 Rov. 10194) EFTA01710322 uppipipplimpr- Miami. Florida Office of Exceptional Student Education P 4 BEHAVIORS Student's Name: School: . SPEAKER OF LANGUAGE(S) OTHER THAN ENGLISH o% Novae 1.10% Seldom 11-30% Sometimes 31-50% Over 50% Often Excessively A. SOCIAL LANGUAGE :.:1 Points to classroom items upon command. ..4 Follows classroom directions. : 4 Exchanges common greetings. Initiates and maintains a social conversation. ‘.`;:4 Gives classroom commands to peers. l: .3 Orally panicipates in group activities. r :;:c Appears self-conscious about his/her speaking soils. ... Uses voice Intonation, stress and pauses appropriately. COMMENTS: 0% 1-10% 11.30% 31:50% Over SO% 8. ACADEMIC LANGUAGE . a . • L. irnes Often Excessive 1'9 ' X .' Follows specific directions for academic tasks. 1:4 Understands vocabulary for academic tasks. i Understands teachersdscussion.retatedto topics. 4 Askdanswers specrlic questions aboul the topic -.1 being discussed. '4 Asks for clarification. I 1 4 Volunteerstoanswerguestions related to thesubject. 1 Follows along during oral reading activities. :-.i Understands reading as a process: is able to 4 integrate words into meaningful sentences. .. Experiments with writing by drawing. copying ..;..i and inventing own spelling. v.4 is able to convey information through wntten :-..: expression. using the correct mechanisms of writing. COMMENTS: X. ACADEMIC PERFORMANCE Reading: Decoding Comprehension Arithmetic: Computation Application Language t Verbal Written Grade Lever fi r Instrument Date 1.res.4. Teacher's Signature Date. • Teacher.. Pleas timate of a• emit achievement e student's native language, and in English, ron ALL LEP STUDENTS. rot t o acw4.--ttUu0 r Based upon your experiences with this pupil, do you believe a significant discrepancy exists between this pupil's abikty and his achievement? Circle One: Yes No II yes. please explain: event tiomerEnviionmentat Chanties FM -1697 Rev 101 -$31 EFTA01710323 TO: FROM: DATE: Keut,-ov Student Services /- 7 -99 EFTA01710324 DEPARTMENT OF EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD Student's Narmz chool Directions: Date/Time Teacher's Si This form is to be utilized by the teacher in consult psychologist. During a three week period, certain maladaptive behaviors will be targeted and recorded below. Antecedent Behavior Consequence Iriclude duration of behavior, if applicable. 11-cl -gig ft-ID-Ta .\-11.-418 1-12-T8 il-tS-(11? ►1-1b-cO3 Form # 878-15 State what happened before behavior, including setting and/or posiible cause. State observed behaviors State what happened following the behavior, such as the immediate response of teacher, student, others. EFTA01710325 DEPARTMENT OF EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD Teacher's Student's NamallilliMa School Signature Directions: Date/Time Include duration of behavior, if applicable. This form is to be utilized by the teacher psychologist. During a three week period, will be targeted and recorded below. Antecedent Behavior in consultation with a school certain maladaptive behaviors Consequence : 1- 2i) --qg 11 —7X-St Form if 878-1 State what happened before behavior, including setting and/or posiible cause. State observed behaviors State what happened following the behavior, such as the immediate response of teacher, student, others. EFTA01710326 ce-44.-ee, -1. 22 Request Assistance Form - Child Study Team Please submit this to Mr. ES after two parent conferences and some classroom strategies have been documented. Student Name Date 0 — l q ID dob Teacher q. to—t-c13 Parent Conferences: 1. Date q-2--q8 Outcome 2. Date q-}s—qg Outcome 3. r>t4-e 4-10-48 cthc Classroom Strategies: Strate ssis an EFTA01710327 MEMO MEM TO: Assistant Principal, Counselor, CST Chairperson FROM: RE ID , Bilingual Assessor Bilingual/ESOL ESE Program Division of Exceptional Student Education DATE: 3 /3 /II Enclosed is the report for the above named student. Should you have any questions, please call meat - Thank you. EFTA01710328 DIVISION OF EXCEPTIONAL STUDENT EDUCATION BILINGUAL/ESOL ESE PROGRAM LANGUAGE PROFICIENCY/DOMINANCE ASSESSMENT REPORT STUDENT !DM SCHOOL STUDENT: CHRONOLOGICAL AGE GRADE: 3rd DATE OF ASSESSMENT: 2-9-99 LANGUAGE PROFICIENCY/DOMINANCE ASSESSMENT INSTRUMENTS ADMINISTERED: °Oral Language Proficiency Scale-Elementary Level (OLPS) °Narrative Development Assessment OBrigance Diagnostic Assessment of Basic Skills-Spanish Edition oKaufrnan Test of Educational Achievement-Comprehensive Form REASON FOR REFERRAL: BACKGROUND INFORMATION: BEHAVIORAL OBSERVATIONS: EFTA01710329 TESTS RESULTS: Analysis oes performance profile reflected the following findings: INSTRUCTIONAL/LANGUAGE DOMINANCE ASSESSMENT INTERPRETATION: Social Language EFTA01710330 EFTA01710331 SUMMARY/CONCLUSION: RECOMMENDATIONS: essor Division of Exceptional Student Education EFTA01710332 EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD 11 11 , Student' Name School Firs+cickVo 1.1 Directions: Date/Time Teacher's Signature This form is to be utilized by the teacher in consultation with a school psychologist. During a three week period, certain maladaptive behaviors will be targeted and recorded below. Antecedent Behavior Consequence Include duration of behavior, if applicable. --t 4-qc‘ I — State what happened before behavior, including setting and/or possible cause. State observed behaviors State what happened following the behavior, such as the immediate response of teacher, student, others. MIS-22480 (01-81) Form 0 878-1559 EFTA01710333 EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD Student's Name Directions: Date/Time School Teacher's Signature This form is to be utilized by the teacher in consultation with a school psychologist. During a three week period, certain maladaptive behaviors will be targeted and recorded below. Antecedent Behavior Consequence Iriclude duration of behavior, if applicable. State what happened before behavior, including setting and/or posiible cause. State observed behaviors State what happened following the behavior, such as the immediate response of teacher, student, others. MIS-22480 (01-81) Form # 878-1559 EFTA01710334 DADE COUNTY PUBLIC SCHOOLS EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD Student's Name Directions: Date/Time Schoo Teacher's Signature This form is to be utilized by the teacher in consultation with a school psychologist. During a three week period, certain maladaptive behaviors will be targeted and recorded below. Antecedent Behavior Consequence Idclude duration of behavior, if applicable. State what happened before behavior, including setting and/or posSible cause. State observed behaviors State what happened following the behavior, such as the immediate response of teacher, student, others. form # 878-1559 MIS-22480 (01-81) EFTA01710335 EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD Student's Name Directions: Date/Time School Teacher's Signature This form is to be utilized by the teacher in consultation with a school psychologist. During a three week period, certain maladaptive behaviors will be targeted and recorded below. Antecedent Behavior Consequence Include duration of behavior, if applicable. State what happened before behavior, including setting and/or posSible cause. State observed behaviors State what happened following the behavior, such as the immediate response of teacher, student, others. Form # 878-1559 MIS-22480 (01-81) EFTA01710336 EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD Student's Name Directions: Date/Time School Teacher's Signature This form is to be utilized by the teacher in consultation with a school psychologist. During a three week period, certain maladaptive behaviors will be targeted and recorded below. Antecedent Behavior Consequence hiclude duration of behavior, if applicable. State what happened before behavior, including setting and/or possible cause. State observed behaviors State what happeneA following the behavior, such as the immediate response of teacher, student, others. Form # 878-1559 MIS-22480 (01-81) EFTA01710337 ZMLVNUAKT blUUtNI WIIHUKAWAL FIJKM School Year 03/04 This is NOT an official transcript. Please send WEST PALM BEACH FL 33411 request to school center for an official transcript. Race HISPANIC Grade Sex Birthdate withdrawal Date Code Reason 08 FEMALE /.£/y EACH TEACHER: Mark grades to present date. Record number of unexcused absences in upper left half of absence box; record total absences in lower right half of absence box. Collect book(s) and note return. Do all work in ink. Prds Course sec 1st Abs 2nd Abs Ex 3rd Abs 4th Abs Book Bldg-rm Title Gr Ex/un Gr Ex/un Gr Gr Ex/un Gr Ex/U Rt'd 01 1205070 01 m/3 MATH 3 IC 02-P-13 c_-3 / Signature of 02 2002100 02 M/!IIII1SCI 3 IB 01-147 va N/A_ Signature of 03 2100010 01 M/J us HISTORY IA .02-P-8 Signature of 04 1303020 01 M/J CHORUS 3 IC 01-155 YIN Signature of 42-C 05 1501040 11 M/J STRIKING OBJE Is 02-201 Signature of 06 1001070 06 M/3 LANG ARTS 3 I 01-168 Signature of 07 1204000 01 M/J INTENS MATH ( 02-P-1 Signature of Title of books not returned Book# condition Price Other Outstanding Obligations Assistant Principal: Occupational Spc: Counselor/Stdt Serv: Data Processor/Dat -Lag, l'2:3 Parent Form# PBSD 0756 (Rev. Media specialist: EFTA01710338 BELL' SOUTH ccot e... er Page 2 of 9 Your Current Charges total is $90.73 Late Charge Reminder: A $1.95 Late Payme.it Charge and a.0% !Merest charge may apply to an utp•id balance as of Ocl 11. Regulate° charges are the minimum you must pay in order to maintain your local telephone seethe. II you do not pay this amount: *your local service may be disconnected, and •you may need to pay a charge or deposh to have your service reconnected. The amount °I Regulated Charges may be attained by calling 1 888 7576500. If you do not pay the rest of your bill, whica includes unregulated charges:- all of vAtich are Identrted by " on your di: •yout local phone service will not be disconnected, and •you ate sell responsible for paying these charges. BellSouth A _ neworeSM ELO 6 0 0 0 0 0 00 0 0 BO 00140 BOO 00 b06L-TT4E£ 09VZOI I CAMS BLZ'O AV I 5096£OX 11"11"1111 1' 1'1 """ II"I' I l'"Ill"11"11"I"II"'l S pasopu3 ninthly Aei(micia:ineoseavvai Rialto 'fed Z9ZT—TOZ8Z m ut . AadricovamosPlIwd% clad • -ssappe astrapuodsenoo 'or uodnao to aaS • 401°S1108 q spun) rn tit apeAed Maul Maid • £f06S :c Jaqopco )(a an° 4unoto H111OS77313 nieuded nob tom wood Still UAW pue ayes) WImord I- EFTA01710339 WtlitiggegNiSit A :R:CH STONE Apartment Lease Agreement Replacement Lease Re ident Address: H FL 33411 Resident Name (s): occ. only) (occ. only) Resident ame : OR Lease Term 12 Refundable Deposit 0.00 Lease Begin Date 03/01/2003 Applicable Fees 200.00 Lease End Date 02/29/2004 Pro-rated Rent 0.00 4:P3 Electricity Gas VaidigigrigsrA RESIDENT N/A algUttf4i*':, ./ Mkit(PY: t- ' ' Water/Sewer RESIDENT Trash RESIDENT Agreement and Acceptance This is a Lease besweer. the above named Resident(s) and the Below-named Management for the a artment dwelling described above. It (and any contemporaneously executed additional agreements) is the entire agreement between Resident(s) and Management and be modified only in writing. As used in this lease, "you" means the resident (tenant) or residents whose names appear above. If there is more than one resident, you are jointly and severally liable for any payments due to us. "We," "our," or "us" means the apartment community. UPON EXECUTION OF THIS LEASE, YOU AC OWLEDGE THAT YOU HAVE READ AND AGREE TO ALL OF ITS PROVISIONS. It was executed by the Resident(s) and Management on the above. Date." In consideration of the mutS eements and covenants contained herein, Reside and Management agree as follows: Page IA EFTA01710340 YEAR Cciej Pei/VI 13CI1/F1 ROM Pln CAISIS WORK MONTI Wilt traders will have FOUR aradsslaic subjeds (Lamgane Arta, Math, Comprebenutve Seleace, ad Social Steam) and rip to • ELEC'ITVES. Cher one of the following dective options: WEIKEL ((9wases will randy each 9 weeks.) 10000704 READING 8200210 8600110 COMPUTER APPLICATIONS PITIRCAL EDUCATION 5001' OR Students may select one of the folberbag full year electives. Exception: Students who at twt below grade level wilt not be cam from reading. They wi l be given the option cd taking man( In the after snood tutorial /awns a they we be resound front the year lank elective to take nine wedot cf raking, ALL OF Tr:a FOLLOWING RIE;QUIKE TENCEIERJADMINTSTRATIVR APPROVAL 1302000 SAND I (Grades 6 - 8) _07083408 SPAM:MICR& CREDIT) - A's & Ws be L.A.) 1302010 LAND DI (Grades 6 - 8) 1302030 BAND IV (Grades 7 - 8) _1400000 OFFICE AIDE (Reecendstkia required) 1303010 CHORUS 11 (Grades 7 - 1363030 CHORUS IR (Grades 7 - 8) 82090218 COMPUTERS R.S. omen) 1302110 HANDBELLS I (Grades 6 - 1302120 1ANEDBELLS 11 (Grades 7 - 8) VI:ks, Ave tatmid% r e subject to administrative douse based ea &thy. Unit. -:! lyni Rif`,-' ' u feint retur:ed, e will select the student's electives . • -"it :Zie,...Var: Student' glut= EFTA01710341 FY2004 Mt GRADE THIS SIDE FOR SCHOOL USE ONLY LANGUAGE ARTS 1001070 Regular 1001080 Advanced 7810010L Gifted 78100101 EH 7810010E MB 7863010T Unique Skills _7810010K SLD/FT 7810010Q SED _7810010G ALP/Lime _78100100 ALP/Acad. 7866030F Speech Therapy SOC/PERS 78630001 VE mui 7815010E Adaptive PE MAMILMATICS 1M5070 Math 8 12003108 ALgl R 12003208 Algl H 12063208 Gem. H 7812010.1 EH 78630100 Unique Skill's _7812010K SLD/F0 78175310Q SW 7812010E EMH UNIQUE SKILLS 786310H HI SCIENCE 21)02100 CompSci 8 7820010L Gifted 78200101 Ell 7163010T Unique Skills 7820010K SLD/FT 7820010Q SED 7820010E EMIL READING 7810320K YE 7810020E EMH OCCUPATIONAL 'HERAPY 7866070 SOCIAL STUMM _2100010 Regular 78210101. Gifted 78210101 EH _78630101' Unique Skills 7821010K SLD/FT 7812010Q SED 7821010t3 E2.03 PHYSICAL, THERAPY 7866070 _ Reading EFTA01710342 SECONDARY STUDENT WITHDRAWAL FORM School Year 03/04 WEST PALM BEACH. FL 33411 Grade sex Birthdate 08 FEMALE This is NOT an official transcript. Please send request to school center for an official transcript. Race HISPANIC withdrawal Date code Reason AL/JCALS/ EACH TEACHER: mark grades to present date. Record number of unexcused absences in upper left half of absence box; record total absences'in lower right half of absence box. Collect book(s) and note return. Do all work in ink. Prds course Sec Bldg-rm Title 01 1205070 01 m/) MATH 3 02-P-13 Signature of 02 2002100 02 MO COMP SCI 3 01-147 signature of 03 2100010 01 t4/TITTISTORY 02-P-8 Signature of 'I'll 04 1303020 01 MO CHORUS 3 01-155 signature of OS 1501040 11 M/) STRIKING OB)E 02-201 Signature of 06 1001070 06 M/) LANG ARTS 3 01-168 Signature of 07 1204000 01 MO INTENS MATH 02-P-1 Signature of 1st Abs Gr Ex/Un IC I/ 2 -i/ B A C 2nd Abs Ex 3rd Abs 4th Abs Book Gr Ex/un Gr Gr Ex/Un Gr Ex/U Rt'd A/ 1 I 7/ 1 • 3Y/ C-3 ye -2 la N/A 3 4'4?-dt CZ tid it74 , 7) Ye i Title of books not returned Book# Condition Price Other Outstanding Obligations Media Specialist: Occupational Spc: Data Processor/pat Form. PBSD 0756 (Rev. 9/90) sistant Principal: unselor/Stdt Serv: - /___/___ Parent: EFTA01710343 f Irrldo Cenerrhiniirr airtime:It Tea blaring nub NAME: Florida Comprehensive Assessment Test (FCAT) ID: SSS Reading Student and Parent Report SCHOOL: Grade 09 DISTRICT: Your 2005 Reading Results Your Reading score is on grade level. You answered many of the questions on FCAT correctly. Tu calificacidn de Lectura este al rivet. Rospondiste a muchas de las pregunlas del FCAT correctamente. Not Lekti Ou nan nivo klas la. Ou reponn anpil nan kesyon FCAT yo kothkteman. 5 4 2 Your 2005 Reading Content Scorn Content Areas Won/Phrases Main IdeaPurpose Comparisons Reference/Research I Points Earned Points Possible Compared to other students OMNI= IN L=Low, /4=Middle, !PH Igh rch Low Your Reading FCAT Score History Year Grade Tested Achievement Level I 2001 2002 2003 2004 2005 Xi00 25C0- 2X0 1500- LL 1 CCO - 5C3 0 These scores show your achievement on the day you were tested. II you were to take this same test again, it is likely that your 2005 FCAT Reading score would be between 1949 and 2091. 10 Grade Tested II Your Score O On Grade Level (Achievement levels 3 and above are considered on or above grade level.) La table do 4 &realm mcestra los &vein do rendim brit° del FCAT y los ranges de <ratification del FCAT para sada nivel. El nVol de mndimlento 3 roprosonta el nab* -al nWo7. Antes de 2032 a los estudiantes se les otorgaba una callicacion qio segula una escala do fres clIghos. Table ki adwat :a montro Nivo Rannman nan FCAT a ak Neat el Net FCAT a you chak Nivo. Nivo lannman 3 reprozante travay "nan nlvo klas` la. Anvan 2002, yo to rant° yon nochel not Id gen twa chit laden pou elev yo. Chart of FCAT Achievement Levels and FCAT Scores Reading Grade Levert Level 2 iC,:ii. .p. Level 4 Leval 5 .3 86-1045 104134197 <::1189I748ei 1489-1885 1868-2514 4 295-1314 1315-1455 ;:.4.,Aailac 1890-1984 1965-2638 6 474.1341 1342-1509 maxim 1782.2058 2059-2713 6 539-1449 1450-1621 MW0ite 1860-2125 2126-2758 7 671-1541 1542.1714 ..ntaiitki. 19454180 2181-2787 8 888-1695 1696-1881 Liggin 2073-2281 2282-2790 9 772-1771 1772-1971 atitalW 2148.2297 2298-2943 10 814-1851 1852-2007 3108M.31::: 22194310 2311.1008 On grade-level Reading Content --Content scores give more specific information about the skills on the FCAT. Grade town expectations for students Include: CalilleaCIOneS de contenido de lecture Las calificacbnos do contenklo proporcionan informacion mss ospecnica sobre as habildades en el FCAT. Las expectatins al ravel del grado pare cos NOt Kontni pou Lela' Net ono kontniyo bay entemasyon kl pl egzak sou konpelans eAv la nan FCAT a Mon sa yo atann de elk la dapre nivo klas a: • Words/Phrases — uses skills to determine word ostudianles Induyon: meaning. including word pans and relationships . MolFraz — alliZ0 apeld pou dettiminen slyifkasyon between words. • Palabras/Frasos —OSA la habliidad pare diatom bar mo ye. sa Nadi chak pati nan no yo opt rektsyon Id • Main Woo/Purpose -- determines a stated or el signiloado do una palabra, incluyendo las partes genyen ant mo yo. Implied essential message, details, authors de palabras y las relations entre palabras. • Ido Pronslpal/Objekttf —deteminott yon mosaj purpose. or plot. • Idea principal/Proprasko --determine un mesa's esansyel ki doklare oswa syere, bay delay sou • Comparisons — knows similar and ddi 'rent, cause esencial manes, o implicit°, detallos del propOsito 01:401(1110SW3 plan eta a. and oiled, and contrast del autor o el argument°. • Konparozon — Kennon monm ak 'Moran. kez ak ofe, • Roloronce/Research -- uses information from a • Co mparaclones -- conoco 51111461 y diligent& cause °pi kontras. variety of sources to reach conclusions. y efecto y contrast°. • Roforans/Rechech — Mize enfomasyon kl soli nan • Referertelannvostlgacion -- usa ta inlormackm do plizye sous pou dcthvikonklityon. una varledad de fuentes pare Ilegar a COMIJS-10110S. 0130807 NT=Not Tested. NR•Not Reported. NF=Not Found EFTA01710344 Spring 2005 Florida Comprehensive Assessment Test (FCAT) SSS Mathematics Student and Parent Report Grade 09 Your 2005 Mathematics Results Your Mathematics score is above grade level. You answered most of the questions on FCAT corredly. Tu calificacién de Mateméticas està per enclin del n val Respondiste correctamente a la mayoria de las preguntas del FCAT. Net Matematik ou depase nivo klas la. Ou reponn pile nan kesyon FCAT yo korektemen. 5 'er n : .Itir 3 2 1 Your 2005 Mathematics Content Scores Content Areas Number Sense Measurement Geometry Algebraic Thinking Data Analysis Points Earned Points Possible Compared to other students fl M22MMIIIM L•Low.1.1.1dIddlo. H-HIgh High Low 3000 2500 0, 2000 É 1500 se. 1000 500 0 NAME: ID: SCHOOL: DISTRICT: Your Mathematics FCAT Score History Year Grade Tested Achievement Level I 2001 2002 2003 2004 2005 *These scores show your achievement on the day you were tested. II you were to take tits same test again, it is likely that your 2005 FCAT Mathematics score would be between 2022 and 2090. Grade Tested ■ Your Score O On Grade Level (Achievement levels 3 and above am considered on or above grade level.) La tabla do la doredm muestra lei revers do roadimionto del FCAT y los ranges do calificaclon dol FCAT para coda rvel. El nival de rendmiento 3 represonta el trabajo 'al niver. Antes de 2001, a lee estudlantes se les otorgaba una caldicacién quo ;enure una oecala do CMS «OilOS. Table ici adwat la montre Nivo Rannman nan FCAT a ais Weenie Not FCAT a pou chais Nivo. Nero mailman 3 reprezanio travay 'nan Moo Mae la. Moan 2002, yo to raptdo yon nacho' not le gen twa cell laden pou aide yo. Chart of FCAT Achievement Levels and FCAT Scores Mathematics Gus Level 1 Level 2 ;,.-.1LeVel-3....j? Level 4 Level 6 3 375-1078 1079-1268 E:(2994S095:": 1509-1749 1750-2225 4 581.1276 1277-1443 :"(4.44.15.67:d: .. 1658-1892 1863-2330 6 569-1451 1452-1631 ::191r ›.17.90 !d.. 1768-1956 19572456 9 770-1553 1554.1691 .:IG.:92.-as.e. 1860.2018 2019.2492 7 958-1660 1661.1785 :t.-71s.-163.8.: 1939.2079 2080-2572 8 1025-1732 1733-1850 ...11.51.-1917- 1998.2091 2092-2605 9 1238-1781 1782-1900 :1901:2022' 2023-2141 2142.2596 10 1068-1831 1812-1946 '1,947.20491 2050.2192 21934709 On grado-kw I Mathematics Content -Content scores Oro more specific information about the skins on the FCAT. Grade level expectations for students include: Calitleaciones de centered° de maternetteas Las califcaciones de contondo propercionan Informachn mas ospocilica sobre las habdidados on el FCAT. Las expedauvas al Sol dol grade para los Not Kontni pou Matematik Net pou konini yo bay enlômasyon XI pl egzak sou konpotans Ay le nan FCAT a Mon sa yo atann de elèv a dapro Nye Mas la: • Number sense - uses number concepts and estudlantos iricluy en: computation skills. I chit/Sans - Ulm konsepsyon chit ak abilite pou tb • Measuremom-- solves probtent involving .ttilmerofSemido - usa conceplos numérises y tall measurements, e.g., time, weight, length, area. habilidados de compute. a Meal — rezoud pwoblem ki gen meal laden, pa • Geometry — analyzes and combines shapes to solve . Mediae -- resuelve problemas quo Incluyen egzanp, tan, awe lone!, alias problems. modidas, par ehn-ple. Memo°, peso, ongitud. area. • Jewometrl — analize epl konbinen figl jewomatik • Algebraic Thinking —analyzes patterns and uses . Geo movie — analiza y combina tonnes para pou rezoud pwoblem. equations and inctuaides. resolver probtamas. oRezonman allobrik — analize model epl Nee • Data Analysis and Probability —uses data analysts • Ponsamlonto algebraic.— analiza pationes yusa ckwasyon ak inegatle. tools to display information, make predictions and ecuachnes y dosigualdados. • Maltz Done ak Pwobabliito —Mite zoutl pou lb make Inferences. • Amide's do dates y probabilidad --usa anallz done pou pezante enlemasyon, le horramlentas de 01 analisis do dates para masher modesyon ak deeksyon. leformaci6n, haver prodicclones o inforanclas 0130808 NT.Not Tested, NR•Not Reported, NF•Not Found EFTA01710345 t. FLAT SSS READING/55S MATHEMATICS • SPRING 2006 EFTA01710346 Na CUMULATIVE SCHOOL HEALTH RECORD (This form Is not Intended for physician's use) Race Address Fathers Nam J 3 321-70 Date of Birth 40 / 7 l fb Place of rth Immunization Certification: Yes LSd Special Immunization Programs A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES Mother's Name ex School Special Health Problems - See Narrative_ Birth Recorded: Yes 0 No El Screening and Assessment Grades K-3 K 1 2 3 Screening Date To' t te as cc Outcome c co 'E ?. tie 01 0 o) -15 5 B 0 cc Outcome Screening Date Ws t0 0 cc Outcome co c 'E 0 B 'E E 0 o co [ Referral Outcome Vision Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Physical Assessment Other .1 Other Screening and Grades 4-8 4 5 6 7 8 Screening Date Referral Outcome • c co E 0 co 75 c o cs 75 0 CC oo E 8 s • c Assessment S 0 e c . ti ga m TS. — m rr Outcome Screening Dale r a. ho 0 cc Outcome c • 'E 1p co ro 2! 0 B 0 cc Outcome Vision Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Physical Assessment Scoliosis . Other - Other --, ti 3H 3041, 9/98 (Replaces HRS-H Form 3041 which may 80 ono° EFTA01710347 STUDENT NAME: Legal SEX: RACIAL/ETHNIC GROUP: 0 White Not Hispanic 0 Black Not Hispanic. gitiC LI American Indian/Native Alaskan K Asiar/Pacilic islander 0 Mull Racial STUDENT NtRiABER: BIRTHDATE: Vetlfied by Birth Certificate: 0 Yes 0 No If No, What Type Verification? CURR Name Street City ADDRESS: use once in thiss ace until final ? NAME OF PARENT(S) OR LEGAL GUABDIAN OR OTHEI2 RESPONSIBLE ADULT At HOME: P G OA Date First Entered This District 'T Ca L.J School: I Grade: School: Grady School: O-to: School: Grade: School Grade: School Year: Days Present: Days Absent School Year. Days Present Schad Year. School Year. School Year. Days Absent Days Present Days Meant Days Present Days Precast. Days Absent: Teacher Name: [repeated 3 times] Teacher Norm: Teacher Name: COPY OF FINAL REPORT CARD MUST BE INCLUDED COPY OF FINAL REPORT CARD MUST BE INCLUDED COPY OF FINAL REPORT CARD MUST BE INCLUDED COPY OF FINAL REPORT CARD MUST BE INCLUDED COPY OF FINAL REPORT CARD MUST BE INCLUDED DE:CATE P • Purcao R • FWati PAW • Pwrole MAP SS •Sanwer Y-Scol EST • &Andel Sol Vat. ESE N0ICATE P- Prwrola R • ROM PAIP• Proncle WAIF SS - Sumter &Mot EST Ederded SDI War ESE INDICATE Prwrow R• Ranh PAW • Piccolo WAIF SS •StrrewSdowl ESY Undo:ISA NAME INDICATE P• Prance - Rd& PAP Pica& WAP SS •SanweScIdol EST Warded Sae Year ESE MCKIE P -Parra* R•Re.sh PAP • Praia WAIP SS •Suranix Sdirad EV-Eno:IS Set Year ESE School: Grade: Schwa I Grade: Schott &oda School: Grade: Smoot Grads School Vaal School Year. School Year. School Year School Yew: Days Presoni: Days Abut* Days Newt on Absent Days Present Days Absent Days Present Days Absent Days Present: Days AbSer2.: Tumor Name: Teacher Name: loather NaTIK Teacher Nam Teacher Na,,: COPY OF FINAL REPORT CARD MUST BE INCLUDED COPY OF FINAL REPORT CARD MUST BE INCLUDED COPY OF FINAL REPORT CARD MUST BE INCLUDED COPY OF FINAL REPORT CARD MUST BE INCLUDED COPY OF FINAL REPORT CARD MUST BE INCLUDED INDICATE P. Roacce R • Nasal PAW • Ptorrole WAP SS • Sires Sch:d N0ICATE A-Pail PAP •PioantesiNP SS- SorrterSctool INDICATE P.Prom:6o R • Patin PNP •P000sto WAR ss • Saone Sava: INDICATE P Pond° R • Roth PAW •Noirolo v•WO INCICATE P • Pronnor R Raub PAP: PioneirerA? EFTA01710348 W/RETURNING STUDENTS REGISTRATION BACK r 13 ( r snow twes WITH Iota( ono 0 BOTH PARENTS El MOTHER j —11 FATHER 0 SHARED CUSTODY OTHER t. ON TRANSPORTED BY: SWUM Ir wi be msperNd Wins school by (morn eI M Da ar n patent) (33) IS INLRE A COURT ORDER BARRING EITHER PARENT FROM REMOVNG CONTACTING THE STUDENT DURING THE SCHOOL DAY? O YES a'.4O IF YES, PLEASE PROVIDE THE SCHOOL WITH A_ČOPY OF (34) FATHER/GUARDWE DOES FATHER HAVE CUSTODY? DYES NO 35) MOTHER/GUARDIAN: DOES MOTHER HAVE CUSTODY? S Omo POST NAM( I at IAtT ICI2OLL LAST L Kiska ( dye f7-939ik MSC ADOSISS CITY WW .IIIIII I IIII STFIt St COOS / /LS ryie C r Man bT . nA.G OP tA410.0•Lam7 Platt 0' Illt0VMSO latME mom metiats Piet LOW' roCILS MINUS WPC (3d) .t,,, RICHEST LEVEL OF EDUCATION COMPLETED . 11011INTART SCLIC.CK WA= B sc'-`7.'"`Usr. * (OPTIONAL) c O. SCICOOL O 0.;is 0-IIII LIMADUATO N TIONitLawalcri 1371 HIGHEST LEVEL OF EDUCATION COMPLETED AO it"*-7:1';,"' B SONS POST•SIMONOMY E (OPTIONAL) O (10....: sw.:4..recL C Al ."" ,,, W4" »,;t3 umw.atotuct • D O E ONACOATI et ASOVO D El t:oLLOVATS LA ..STD 3P) LEGAL GUARDIAN IIF AHNI DOES LEGAL GUARDIAN HAVE CUSTODY? O YES El NO Ilµi N41{ Pat LAST " G" Acaa s A v TbM stnanc.c met iWgPP‘JPX;;,1E4.I".t.:e. r'0.1,70fPn.'2 3 i • na PAK, I: PERSONIS) OTHER THAN PARENT AUTHORIZED TO NCR UP STUDENT . MI PASSWORD (LIMIT 10 CHARACTERS) IAN M1,01/1210 roc tianClAty ct.„ .... ( PHONE RELATIONSHIP Fevo A7444e..,- - YES O NO ( LATIONSHIP n U YES D NO 143) NAME ADDRESS PHONE RELATIONSHIP li D YES NO 144) NAME ADDRESS PHONE RELATIONSHIP r u YES D NO (45) NAME ADDRESS PHOTE. RELATIONSHIP n U YES D NO (48) PART IE M SCHOOL PERSONNEL ARE UNABLE TO CONTACT YOU 94 CASE OF ILLNESS OR ACCIDENT, MAY WE HAVE YOUR PERMISSION TO CALL YOUR DOCTOR OR EMERGENCY SERVICES 4911) FOR TRANSPORT TO THE HOSPITAL? D YES O NO (47) FAMAY DOCTOR (45) PHONE NUMBER (49) HOSPITAL PREFERENCE MC LIST YOUR CHILD'S ILLINESSES, BEHAVIORAL HEALTH ISSUES, ALLERGIES. MEDICATIONS TAKEN, OR OTHER PHYSICAL MUTATIONS: (Si) DOES YOUR CHILD CURRENRY HAVE HEALTH INSURANCE? C YES .t NO Moan IndIcam--..— II yes, 1:7 ModirAd 1=I Heahhy Kids/KM Cu. 'I=1 Privo• ai Imetwed In ?stela., H emotion teNo.r .saN?:9Š 444 44s YOUR CHILDREN IN OTHER PALM BEACH),, šp.:„.4041 : . . -444, '4' .4 352, NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) CRAZE BIRTH DATE (53) NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) GRADE BIRTH DATE (54) NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) GRACE BIRTH DATE (ES) NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) GRACE BIRTH DATE (563 NAME OF CHILD SCHOOL ATTENDING . STUDENT NO. normatau GRACE BIRTH DATE (57) I VERIFY THAT THE INFORMATION GIVEN IS TRUE AND ACCURATE TO THE BEST OF IA? KNOWLEDGE. 0 Q. as .OO DATE FOR OFFICE USE ONLY: i ,,'• I • EN Ca 4 ENTRY LOA E01 •iS INTEL LIS a OS/15/00 33: I• SSS :CSE 058C ai l i EN US I3t) CT AN (foil 05 (34: :SLINIA•3 i 01 T343PL; NS. 514 ,A. i /3 333 ON.PIP:1 DE0E 37t, 13 ,% FidCW1l ri-it, MN •L ' /CS/ I1 fi II •::: • ES 373I OCCOMILL- AT IS:. 3/ E., U. 7 i113C• SIN ' )I • Or R‘q,P,En, Eric DE-ESCL O ..-P17, , 9 i Z /3 i D AT, ''' ,. / ::: 4' 4 w;'; 043 O:.TA ID TNT COW/WILL 3, 3 J;.1t PDSLI U635 (NU. 43133/1 EFTA01710349 STUDENT NUMBER: NEW/RETURNING STUDENTS REGISTRATION )ISTR: 2141 TCHR TNBR: 514STOT il l 08/12/0 6 HMRM: 514 KM DAM VERIFICATION FOR NEW/RETURNING STUDENTS: TO THE PARENTS OR GUARDIANS: NEW STUDENTS: Complete all non- shaded areas on both sides of form RETURNING STUDENTS: Please review both sides for correctness of typed information. If the information printed is into rect. please correct it by carefully and lightly crossing out the incorrect information and writing the correct information above it. II) STUDENT'S LEGAL NAME Sante> (2) ALSO KNOWN AS /All •A I (3) LOCAL ADDRESS (4) MAILING ADDRESS (AML NA MAW mood LOXAHATCHEE FL 33470 is: MAIL . API. MO. Los4p,heiChea_ et 3 5 4-7 e.. .. SIAM 2rctO PIY STAY& zo COM MI STUDENT'S SOCIAL SECURITY NO. (OPTIONAL) 161 HOME PHONE NO. 7) SEX F rrrXXXIII FEMALE MALE (B) I I RACE H AdrEAL ATr ANINOIAAN 14 TAM B NON HISPANIC I rA A PASICAACISLAADER H HISPANIC I I W NON-HISPANIC M MULTIRACIAL IS) DATE Of BIRTH maim riAY VIM 00/ PLACE OF BIRTH DADE COUNTY FL US OW sr/Ai FLORIDA ODUiRtY (I11 RESIDENT STATUS 3 . . ll D. FOREIGN EXCHANGE STUDENT El I. OUT-OF-COUNTY RESIDENT 2. OUT-Of-STATE RESIDENT I 3. IN-COUNTY RESIDENT (12) ENTRY DATE INTO USA (13) FEDERAL DYES I [repeated 4 times] YES [repeated 4 times] IMPACT AID SURVEY NO A. THE STUDENT RI NO B. THE STUDENT 0 NO C. THE PARENT Ei NO D. THE PARENT Ei NO E. THE PARENT IF YES, RESIDES ON RESIDES IN IS EMPLOYED IS MAKI:in° IS IN TIE IS TIE PARENT I AIR FORCE FEDERAL PROPERTY. LOW RENT HOUSING. ON FEDERAL ON LOW RENT UNIFORMED SERVICES ON ACTIVE DUTY? I ARMY PROPERTY HOUSING OF I COAST . LOCATED IN LOCATED IN THE UNITED I YES I GUARD PALM BEACH COUNTY. PALIA BEACH COUNTY. STATES. NO I MARINES I NATIONAL GUARD I NAVY (Ill (AS THIS CHILD BEEN ENROLLED IN ANY PRESCHOOL? 0 C. CHAPTER I I D. PO-ii DISABILITIES I I. PRE-K EARLY INTERVENTION I H. NEAOSTART I M. 0 N. NON (PLEASE PLACE A CHECKNIMIX I sdir BY EACH PROGRAM WITH AN ASTERISK i *). ME PROGRAM YOUR Cilit0 MIGRANT PRE-K -SUBSIDIZED CHILD CARE ATTENDED. WAS I I ALSO, INDICATE IN THE LONGEST.( O. OTHER S. SUBSIDIZED CHILD CARE (151 IS THE STUDENT A SINGLE PARENT? NO I YES I NO (IS) CURRENT GRADE LEVEL OS .,.d TROOF.ECKIR1140,4100. II? OM DATE OF LAST ATTENDANCE 3-t4,0/2- tto1 00 (20) GRADE LEVEL 444A (2 I) LAST PUBLIC SCHOOL ATTENDED IN PALM BEACH COUNTY (22) DATE ATTENDED NfflggicTIARRPPPEP:getilP..,44:Mco. .. ..:NPktiMititi(tliNFORW09,0127,4, - i ,-. 123) NAVE YOU FILLED OUT AN APPLICATION FOR FREE ON REDUCED LUNCH? Er YES I (APPLICATION IS PROVIDED WITH THIS REGISTRATION FORM) NO (24) HEALTH SCREENINGS: I GISE PERMISSION FOR MY CHILD TO BE GIVEN NON-INVASITE HEALTH SCREENINGS. THESE TESTS MAY BE GIVEN INDIVIDUALLY OR III GROUPS. YES gi FON EXAMPLE: VISION, HEARING, SCOLIOSIS, HEIGHT & WEIGHT YES I NO (25) SODIUM FLUORIDE: I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE IN THE SODIUM FLUORIDE PROGRAM YES Igi YES TO PREVENT DENTAL DECAY. PERMISSION IS VALID MAOISM( GRADE SIX. • I No ,.014,44 -WiaaViseta .14 3 /4 .Pa.04 4teOg COSPOiO.Itt!telf00.0*§i400.0,41 1*E4ra ciAft41aSIMI MIN NOME LANGUAGE SURVEY Ws 26-23) I. IS A LANGUAGE OTHER THAN ENGLISH USED IN THE NOME? ri YES I ND II yµ Mile loaguagel pan ts S h 2. DOES ME STUDENT HAVE A FIRST LANGUAGE OTHER THAN ENGLISH? I YES I I. NO I YE; wbM beguile? 3. DOES THE STUDENT MOST FREQUENTLY SPEAK A LANGUAGE OTHER THAN ENGLISH? El YES 0 NO II yes. whet leaguer? (271 WHAT LANGUAGE IS SPOKEN IN THE HOME BY THE PARENT or GUARDIAN? gni (I a / 5°Pa") 44 MST WHAT LANGUAGE IS 7HE STUDENT'S FIRST flu) LANGUAGE? CeCiat L-S tt (29) BATE OF ENTRY INTO AN ESOL PROGRAM 130) DISCLOSURES FOR ENTRY late thle School District HAS THE STUDENT EVER: I. Been expelled Item school? 2. Ned as mai resulting IR a charge/ 3. Ned soy Oriel,. Janice edifies? I ,YES I TES gii. NO Yrs tem P850 0636 (Rev 4/00) EFTA01710350 Student Name Iasi School Name Student's Previous Pr THE SCHOOL DISTRICT OF 678 Academic Improvemen an ) / Student ID # FNRT FCAT — READ: HSCT — COMM: HAP: PRIMARY EXCP: AIP: Diagnostic Assessments Chock (V) all that apply. R 1 A0 i N 0 W R I T I N 0 i II 5 u A T I C Classniom/Schoolwido Assessments " • Gass Performance I Student Portfolio Teacher Assessments Tod PlacemonViests Systemwide Assessments Norm Referenced Test (NRT) 7, 5 State Assessment(s) Other Standardized Assessments Diagnostic Software Other (Soo attached.) MI A H: MATH: MATH: R-ZZ 14-ZZ M-F LEP: After completing diagnostic assessments, check (14 all that apply. READING - Focus for remediatlon: Reading Clues: 0 Graphophonlcs 0 Structure E Context Reading Strategies O Sampling/Searching 0 Predicting O Cross-Checking 0 Confirming Reading Behaviors O Rate 0 Self-correcting 0 Self-monitoring Comprehensive Strategies 0 Fiction 0 Nonfiction Specific Sidls Reading Skills O Vocabulary K Word Recognition 0 Word Patterns Specific Skirls Specific Skills Specific Skills WRITING - Focus for remedlation: 0 Sentence Writing 0 Paragraph Writing 0 Composition Writing Types of Writing: 0 Expository 0 Persuasive Awareness/Application of Florida Writes Rubric O Focus 0 Organization 0 Support O Conventions of Writing (Grammar/Mechanics) Other: MATHEMATICS - Focus for remedlatIon: P -Cmber Sense, Concepts, and Operations Specific Concept(s) 0.-demosuroment Specific Concept(s) O Geometry and Spatial Sense ir S,tufelfic Concept(s) Algebraic Thinking Specific Concept(s) O Data Analysis and Probabfilly Specific Concepts) evel School Year previous AIP (AIP): Instructional Intervention Strategies . Check (V) all that apply. R 1 0 A i N 0 W R I T i N 0 N A T II ! M A T i e s _ Tutoring During School Day . AfterschooVSaturday Program Enrollment in Intensive Course Classroom Organization Small Group instruction Cooperative Learning Groups Guided Reading/ Writing Groups Alternative Reading Program Technology/Computer-Assisted Instruction Other. Instructional Alternatives Suspension of Curriculum I Variety of Teaching Tochnlques i \.," Varied Pacing I L., Assignment Alternatives -Adaptations In: Time Quantity Product Requirements l.--- ESE Referral Other (See attached.) Parent/Guardian Contact - Commitment/Contribution Date Data • Student Performs co Review Date(s) ‘ //oZ R f A 0 N 0 W A I T I N 0 14 A T II t IA A T I C 3 Outcome (indicate Yes or No as appropriate) Successfully Remodiatod Requires New AIP next school year Retention Special Serv.ces/Placement Other (See attached.) CI FWD 1686 FY 00 (REV.810) ORIGINAL • Curnelaftes Feder COPY- School COPY• Parent/Guardian EFTA01710351