EFTA01709902

CH COUNTY OF PAL BEAFLORIDA BOARD COUNTY THE SCHOOL ALM EACH PALM B CARD KINDERGARTEN REPORT KINDERGARTEN CHECKLIST MARKING CODES tr araia. r_ 5- tila MI Stal l. needs a es. argestsriaradlaaWA Pea ematanctlan \ CiVat NN\ r'sliagiaikeig sagisikellaillia h '14a ctureallinililagaelhiaballadirle ----- ta aisinCrialassis sea IS ausetlis WsMa* DA estrisks is;Ma - a aided a. CENTRAL PeOCESSINCI LANCIIJAOS tal Am Mb MIES SOOT WAGE USTINING inns are Ilavieenes I I ▪ tassel $9 • Oa I Sri Omar ANS IS Pans I3 'Mr May 53 MON ROTOR SMARM 21 'aura a NI 77.411. liar haw 21 twa Car Ohms it' NS 101119.70 grri a 23 RPM it 3 The areas listed on the Outsells! as *au as music. 4ega 2 art and physical educat on are inciLded in the PRIMMAINFOR kindergarten curriculum The check! st n comiad tar 25 it I INoplIS Pan 01 SktilS mat are eSSertial for students to Malted Naga Ubila 111 they are to be successful in the primary grades All w▪ artaa ins 2 Ill 'rpm Os Mae activities provided .13 kindergarten lead toward the NATO Ma Mary It d attain-I-rent 01 these Puts The teacher determines the era Thee Nadi IIS appropriate time le Vie study. to tegm Iwnral Cane 3 itgrrl onstruChOn in each slue Beginning with IM record Haas Came a1rWMTN wee ass 32 marking per rod, the C haCk I nt is used to report modern I. Th Dllid= V T Ill 121 Send MRS, by progress SimMatas Otspos Maas Fat kne 122 ke rata s. ✓ut NOTOWEVE NANO NONACADEMIC BEHAVIOR Wv biath 4. GRADES 1.5 kiaddtde. Pura/ 4 Cain Shoe 4 This grade reflects the studs is OvereN conduct IR ENVIRONMENTAL AWARENESS rage r rota lawn tie all School activities CAM tack 45 bin 4 Very Good Cam Oath 46 I3 I seen IatneS 3 . Good images fees 4 Mr Cep asap 122 2- Fair Parent sonteronda requested VISUAL OUICAIMNATION Fran Ora 133 I e Poor Parent conference requested suer crui 3I la Spirt SreWle 91402:1:) Inds Wpm 52 Nag PON IebN Sa 53 Ilsadls istau 5.a IN !al Lin lEa tieseried pr n eras II IlleleerS Mw SS Nonscademir Pnhayin. sti MATHOAAMCS Let • evater= .4.1.• 37 LIEN. NWIBIA/1001 err Ca Palate SI Is Maas One-0e VMS.. MEMORY lbws lank On 141 ATTENDANCE Sates Peer .1/4 0.• Cahn g Ileseee fele See Regular attendance and punctualirr ald WI IU an eaddellal for uafl ieduC Alen IN IN 34 a Sawa Rese at ISOM Oen Pada Ise ass Haan a2 Days Present Days Atwell Days Tardy nnun lees Las Nagl=1101I as Patellae* nagorwi owerag slIXT INFORMATION INCLUDED Is Sore "reeve lasemeatiadad ISM! niEgICEI NS de Ian 11§FIR TEACHER REQUESTS CCHIVEMENCE dalleva *al U 7 31 area I annedered* 122 _s Ueda 2t ECM 03 AUMT0911IlltRORY 'PLACEMENT Soso Pr Main Maces li sr Seat _I.__ Sumas* Stec. 090.99, a Seri giros *sr a2 I 3 SPECS. TOMES ran Oans II 'I* warned edjappi Wows ern is a.c.Caled. rade peewee., 'hags Oat I 4 Sr Yr of On In %rill be delernit9491 by Me home sC1530I 55 Jon, $40•0•10 Sea Giver3.40. Pe nod WhaVOII • Copy K 6347 f NIS Eel ATM Wet' Oelisediell/IN Poo*/ Plakeled Paella Yellow IS Palled EFTA01709902 /4S..L Lv THE SCHOOL DISTRICT OF STUDENT NUMBER: PALM BEACH COUNTY CI FOR NEW.SETURNING STUDENTS: r TO TIE PARENTS OR GUARDIANS. STUDENTS Complete a: non-shaded wen on Doth cttt.t.'-'1' NEW RETURNING STUDENTS lt.,:.‘ NEW S1MPS Of Town REGISTRATION RETURNING ETVGENTS Please r *e?. both ides foe correctness of typed snforrnatton If Use nSorrnaton [tinted is IMOCIOCL PleiS0 core ocl it by catisfulh PISTR: '701 TOOL I NOR'. 504STOT 1002127 I a old IOW UOSSin9 OA toe incorrect .nformsoon and Hi" . 50^ writing Ina owe:, 'thymus's's, above it TTOTTIT• Ral s situ LORI a; Rill PORI Al IM I= )." •••• 01 UP I.1 blahs la MIRK /021/10m am., or e la //mom ROYAL PALM ESAC/1 FL 134'1 .ii MOOT I Wu sl ern ..) 63 114.114 NOM ai 0) Ifs F • 4 I It ...i...,, 1114 'n' t 0 1 .u.sm . 0.'" 0 10 %.<.:celstatig• W ron s,.„„c 0 4.3/4e 106 .." /101/ /M4PC OH ....AK FA wo„,.., PRATE P PR III/ SAIL RIEP WEST PALM BEAM FL UR FLORIDA -. .s. no ma on 11511X1PAPS OD ECU pm ORO 111A 3 0 .0111/16 I /01.0lif 1.110Ile 2 0410I•VATI 11/111NNT 0 0 I PFT-O.001‘11 11/10110 ni.nuen IMMO 0 0 5 III/1101U1 YACT Alt SOO/ ant 00 (100.0 * III StRI011 111.141, PI 01/1101 PIKPIAT/ 0 nsTM Too 1 NI MORO IIsots a LOW um misers : ne FAUWI it memo OR OMR*/ 111 11T1 mune S Paul sum mom 0 0 0/0 Res) S. rt. PAIIIIT II II 00110 PI LC* PAW )0X131114190 II PA01 MACK IPSO 0 41 (21.0 / Pe P.0141 -, is lot ~many sticsitti 01 IR PPTIO MAIO • ym, a TM Kama Ca aura port 0 ,,s 0 10 0 ... ittac, 0 a— 0 a.n.—• 0 wan,. 0 -nr..at ..a. El .. OP KM On 01111 IIIII 15•X41015 III PIISCPOr PURR PIACI • comma ( 5.0111141 AMU. ETIRM MOO PIPPO WM AA AMOR 1 RI 1111 PIPARAI MOO 040 MO IN MI /011101) El , cnna. 0 . i• ,,,,, n 0 0 .fla. 0 IM-I •SAMillip a 0 m 6///44,0 141/4 0 4 OsiMet//0 Out• (Sal 0 15144 too IITIMIRTIC• 0 lt /4/0•1411SIP/II Ckl0 CAM Hy, a la /14/14' A /4/14W4M1/1/ OW 041137 PAW ad os 0 in O N° TRANSFER INFORMATION. I/. %MI 01 .0.0(1. TRIR•114/Init IMP I II CIO II InflIKO HI 1011 C4 IAIT liolat/E1 :3, POP. IOU on its/ Poo/ SC/Ca AIT0100 It P•01 ROO/ MAO [21 API A111101/ FREE OR REDUCED PRICE LUNCH AND HEALTH INFORMATION: 21 KmI MC 031111 OM AP utymal 101 /RAI OR POMO Ingle M IAPPOCAION /S. PICIVANO WON MO RIIMM0011 1(11* 0 n, 0 No 211 OUP 1011111161 ORM PIPPRISIO• IP la 0010 10 11 41171 RUM/ SP/1MM' 1041 1111: MAI 4.1 aiIR iPsynyusui pi 0 owns YES 0 II, 0 .0 IS KOOK 111044* • On 0141attufs PR MY none TO ...../*An p im tops 10.515 •••••••• YES / 114/111 DOOM PEA/ 1014111115IS vA111 MOSS GRAM III 0 I" Nri NEW STUDENTS TO PALM BEACH COUNTY: HOME LANGUAGE SURVEY :1. GMT 1.411010.4 IS VOID III 'M. /KAM On wail 1/44/0.1 IS Man OR 5414 01 taut , t NI - PRAIA,/ IS 04 /Owl II 14 triOlor• 1.10 ns nu ;vac..., I: II I•apat4 SUMO I is • /01p41 oists 1501 11MIN MO • MAW On, 2 (KIS PI S11/314' .1.4 A ORS? 1•11001.4 01•111 11113/ 041/1117 O n, [;11., r 301 141 511•241/ MOO 1.10011010 ..... A 1.41114444 COMM 111/0111Mair 0111 LIF4Y EFTA01709903 I". v°4;',,t+1, ''4(4)/ OF« Pramil sav» tam PH nLLVron ofl« 5•4« •• 14 v••••nar .41M mår« h. 1.4.4 I øde ~4 .4. Tart ter merWIIIII- MICrPIPINTilln« corotn% Moveat mas n« 1003( On, G ,-;75C ):/ / 145 • ni Mint •IntOt '14 $010:41Wit• wo A gOt tOF '1.Sr L OM? agio MP MVA 00I: FAD.« Lyt Ortf.00 C.11 0 ,40 flal INITFOrtelF4).4« VIS YES ~e •••••• .... 110YA e. PALM MLia FL 33411 ROYAL PAL11 1191/01 PL 33411 a rn >"R rna .110111.1-- a aner «non na — som! Ilt ~RF in,. Or [y-L.1 1311 rolakInD /Or^ MI «Ann Iren. OF 50.1CnCr4 COIARI110 MPAANAU An ...........x. A 3 =n — e 0 =.77.7' C Ste —r, L., ......? i-. B 0 =,:r . C 0= 0 g . ---- E 0 "=" ....... D E; =:,;-r E Q.==2„. n« Lr..4 4IJA.Dort « Ant °on lost Gai.oar nr! Cnt00/0 0 r!! C «3 4«. I ../...0. p , ERCENCY HEALTH AND SAFETY NYFOIMATION ta« li Frn un« , >.v. 1....n ørn! FrIfnI.:1! 10 nr ... %%roer s. Eli NtAFIT1/44 • NKS rnefri 0 NO Imoic meiAtosme trirts i n' ,t, 0 4 Øtt xYN1 «,..,..,- 0 ns 0 PC MA Lat “PAISI ~PM MILAPAMAI Ei ns . 0 to 1441 APA ~Mfl ••001 MLATI01.94, o 'Rf El le ~I nen I. • 5.~ rta$00•00. V« 1.~. /Q CIWIACI IV« • CAS QF •11.0.1 Wc 441.000! W, •I runt 101.• IINSISOOF 10 C•Li 1.W Øla 0« 11.E.W.0 StRICIII Irr f CM ~mor lo ni. .,11.,Ro a ris GNO I .41- I ISO r roa 0110 onnis ne« sin ault K AUN't oft la un PnliCIr 111104110•5 r441 X PIOL40 it Fanaf a. nemt Ia/ «NR MUR= IN 01TIER PALM IlEACH COUNTY 3090011k un sona nnicsi i n« non, 50 onwoo do4 o.44 n• pre• one efe6jW0öd NI I «An rin 111 II•ONVATI011 LIIIII n TIM a rtL•alt IV nr1 801 0 Yr 10.110{4 out Gummi {/ 8 'I .ilq 7 FOR OFFICE USE OMS: .11, SZnO11- MG h1.1 elos .t .u./11. MI 1110111 041.14‘1 141 COB Lo 1•111, tör11 4/1 iii1., 41: Bo. 1.: CO« EN E01 06/20/97 421D 1111:41 .0.IFOIAN .41Fr..L:r Db POOI lidi 14« Csue.prIr IVI 1/FOIIN NO 17191 2002327/ EN in OR 01 504 Au «ritninel ..1 nt! +ni trnra0n1,04 1/0 "-KAI o. a li" Jr. idr rsf 01.(n.11•Tilt. ffininIrnmo. an NIF an ittOoli• 01.01011 01.11. On' 0 % sainA0041. a,..,,, ..... li. CM-at el AICAPA 1 z CrAn 06.1101 ao‘tif G i t 3 4 t. .. i 3 1 O4 1 1 1 , 14:an V.C.ø./ .1.0.0.0. C m, ~filt" inFel OD 1114 Ortai CON/1710 Ir FISI« C415 *h !II) ... n EFTA01709904 L. Lj .,.,...., yysig , / fICTUn 3 STUDENTS: I %anew , no. • o OR e S .-- Cores a ro nes or TOCO. NO ylia Dorn 50cox one on SILOWS Nes wort. trate* Iro abblar reorer ran r• 1751 1 08/22/94 P• fael. ba to 171BY 0.• OM Sty., germ:i • te a.. M on.. liz coo ay*Inn µ.M.. ft •.:or A yy re town ponceon. M ruocrer aceitaariON ........ t.,ass•Not Noe.. 421D 02 31 208 50 Pe cuty a madore ladete• a e. abet b, mnitentotw KA $10 10 , 0it a, a arson .u:.co tea ma wows 8/22/94 F V 1 VEST PALM FL 2 IPLEtialknlet Wel trateDel gaga ...Lir . y'rro . ROYAL PALM 3: AC 1, FL 33411 il l......L 33411 mean CrarketOrarr NO al ark .. ro ......r WA( New TANSI0NWCD. to: ritsertrer stall N N 3 • .... et 0 EN EN US STUDENT INFORMATION (Panned. 0000 note taint-Hon In Ito appropiisby AN Wed take) mw '1, Ina"'`,.."'l Am ec, loan al PriallitanferrObi sr 1•44.1•0:94Is re.iiit re3 trimrr rywr ono ram re no rasa .n IC 'm torn le O= an On DUO. ...van°. re.. ,, ry.. ' VW.'" ' a ' . " Qr." W v" " .“ tr —_ —— —— _ _ - • nun El .." O I =•= O a Zr. v.,.,c OA =moan • i' — ` Dv, Pr. a • ..c ob OCT Or NM a Mit ' or rglibixho serol (OS 11 - FreCCT MA, °O . ri a 0 • troilitsOon O • an re cerryoN 0 it Okrr C. not can. Os TVA an 001.1.... CO wont 03000 aniCT AC DSC, ,µ..N Kull.. WIND MO r..!..CO1 V IIO ROM 01.01", ars Pace /iv Sell pognet allenel Alm Ore odes sena' CIS ptarO Wif Chid *mina kdratal {ditty TIS trintot roy. OM O:OCOPAY 0 t mt. Dar reason,/ 3 a same aic.a• I:Ai:inner FtOetS Murry Sena O. Haat., 3 cooraft, iil B i woe orlon envoys, on TV Fecipal Wary arra and Ow cosI aI my ciders souccion es peonsw n pal or rota by ederril save, 0004 Omar*. eau •.....0..... D o ow ri...... n 5 kr* ...tan, 0.* CAM TRANSFER INFORMATON i• *PAW CV ICHX• nweletiveC WA rear.a•Lcomos •ntOt O..A.S1 roo.a r- • TO ,y.b. ,y LA, ,o..„ort my, y ry,,..........r K. FM Cart ronretO FREE OR REDUCED PRICE LUNCH AND HEALTH INFORMATION pHs..Hu Hod St se appaess........ to Maw.. R....J...., i st.s, ..I. • r.........wi .... yr sn F..) C) nd (- 1 so ras rear.b• $farcerarO 150 nyrOicrbinvo a Saul Roast . in. r................... br.............yory r.r............— ..— p yyr rar......ar at eon... aryls roars Fern ..... Tars, b....err. tn... os......, . • y•••• ....a .asses sun a "" ..) a O " a a l ' NEW STUDENTSTO PALM BEACH COUNTY: HONE LANUUAUE SURVEY (To be MIRO out by now Mara ONLY) Tc-i-,,,- --.44 • KT-is T. T.: w••••• ,.. Tn.-, .........,. .........,............................fla....Kw. • a l • •...owns.. Ts, oar.-. T T•n•—• Ti IS in w en turn ato‘ratyrr ore [ryas.. cloCastritr Cris, I N. ...........“*.e....... vs.. r... ovum ore anural on..., o rls „.....,............. V as fl yby... *sr 1.00., 0 „ s 0 se FOR OFFICE USE ONLY ...i.,,. ., .,,,,,,......ti ........aa pa one...run no Tiwomonwo. rt.m.4.0'4v on. .....,,t fl aW. Slet .n..•. 0 0 CI .0 0 0 pat "..., 0 001,INft unCciNia• C. M.00ONO Din 0 we COMO. 0 ds 0 rs' . s , 1. • • • r • • r NY ' UM ENTATION CHECK LIST: (CHECK AND DATE WHEN RECOVED) on sauna OM saleaO 0 Yr , Plicarc} MI SCOMIXOLIOK1iY•roiro onind inn tr-- i - EFTA01709905 ,,,ATA VERIFICATION FORM 5:1 DATA ENTRY COMMIE° BY . ..,--t-* NEW,RVURNING STUDENTS O ?sowio O Rev-wg SfArt Caw _ł_ i _ - tEREIGADON EORNELE. 'U HAAR XCE n t C, - WÓJT. RI SECICENTGO---- . ENTRY CODE i ENTRY DATE TOTER PARENT WERS. AM 1761 E01 OB/23/93 Hem twe. EX Wwalono ew shaded Soontaw Row w ne CALENOA TEACHER It) OUR ORMICTCOSE ban, ta in a iat na ,,,,, , tti, w an n a , anka a 'ront SAC CODE I MADE LEWE Ww phew cetna m Re STLOENT INTORVATION• NEER 9.210 01 01 103 "nM0'aeA' 0°mY Mow LITR W mare lwom G RN 3RENN SEY red SIGGIDAIE EtA- CSINIGICATEFFL/a OF mani MRS ty your wean Debet Kata J/lo/G3 F I4 1 BEST PALM FL Z iiiittGAL RWE ALSONIKIKr1AFi ifini fil RGYAL PALM BEACH FL 33411 ' e M WJENG AODGESS ill iMIERI L 33411 Wat MFW NNWPWATCAGUTODAIRESWITSTSO6 WM CEDE . SCIWPONCASSESSIGNI WWW GLGROE I WWW SOW, Waro ro N N 3 A Y N sO. U.S CITLEEN ' OKASCHOOL ENTRY DAll (USA) CAD .US 0 EN Es US STUDENT WORMY/ON Warwa *ow wrIN corectiens h the epseopdele wew lad Sos) ERST PISO KNORR AS itl% SALING AGGRESS • OM, STATE N• NEV STATE W ERCRIT SEGAL *WPM IC. RWE WIONEND. Na NW ORE Merl san ASAGLIFOADal WEYWAk raw , ACE ta NRF W." °O RMALL O I ALAS(Wsuca O D XOEHISFAwC CA PCK WAGER O M HOPa O TE mhesessuac OYES ONO On EE Ilell RACICY WS( k WENT STAGS 00 MAUI RESEW O i US RISCOIT CNN OR YEW cn rATE 1)" os 44 coustur 0 x ICONTIO 4.U 4 MOM ASTO, CCC< o A. ReseaRywnot Sad r Firet ti D. .......6en man sin. n G. Pl•1611%• eol la anno Fenu...non RWPG ROPI tf EWES MVO Olt nE SaSYAS,0•0160•YerSaar. O B. ,....xpaiła ł 'rw!, Ftąa Sena rd Pe ott d ry REG Rake s CI N. PuNerRakie We Caritas treed G . en, sapa a wf Nona Rowed o W w ROOF Nan anet wasi o n C. saho lied a ...gmt d a F. sw anod» awAnweir a I. Ewa torcie n lm cipay L TRANSFSR INFORMATION. MANE Cf SCROOL TRANS/ERNS FRCW CIYOT LOCATION DATE Cf LAST KIENSINCE GRADE LEVEL LAST xUOUG SPOOL ATTULE0 N PAW MAW GWINTY CATE ATICH0( O FREE OR REDUCED PRICE LUNCH: KlY. YOU f6OCI O/ an 11;0220110ra kent AIOJOKI NCO URM kopiatCs 4 modelem Ma NrOcaxe Fcar) CI IS Ow SCREEN/44 A/CASSIUS/EAT %MV FLUORU PROGRAM i gon pr imp% lor re, OC *tytym, worn irg inarnnt Sp Or I me worralsr bi reloada wsypo o to Sstsal Novls PIOSCIT MglINini reassert Nie NOS maybe wen SCSYCISSOY X 1.1 70S0 ar TES ONO Sili Olaf Porressew vid RW Galen CIES J NO FOREIGN STUDENT INFORMATION: This Illoenudien Is volLertery aru used solely lot th. pumom ol ableinItsd Pewni MI6% diem onln Krowo scum IITUDINIVALLIWRIF SCRLISICIOIOMI I 2 3 4 5 6 $ flaPY GATT LVSIJ stormsiammin Hat 5Allom Iłom IOC" (OzabsommaidelimarolndOming1M61 YJIIM yr NEW STUDENTS TO PALMREAOF CORRY ONLY: US WREN NO. CITIZEN OYW Ib ODWIANI M WHAT °SWIPE NAS MC MOM kale OYES Owo ' LAMUJCIE SPOCEN oCiget M PmixrolGulavan teul UNNA/64 IS SPOIN NINE POR rest smar? • s wsuw ero hr Dat OSIO WW\ MORT LARUM( STUDEMTUNOWOJSRODOUNOMOr . OAS OC ' 1WseaabAMse.aPlNa.MEHANN OYES at *.Ndste San •••*•••• w. 1wywer tOY, tie (VW, LIAS o.o FOR OFFICE USE ONLY: LITW cOo€ mln ads Lc CON MINSPORTMOI WRIMATIOM WIS )0 Cit o... OYFS ONE Cyder/On Woe GM 121456719T A I Z WIX <ADOM TOCHEA %O OISE CATEGORY CIELN O • 2 34 S S DOCUMENTATION CHECKLIST: (Check wee ANN ody aro notheet) I son o skr •sonotore Crf FINSFAAK Otul PFO0FCF 0010:11 E \ EFTA01709906 STUDENT I LAI BEACH COUNTY STRATION 1 NEW STUDENT TO PALM BEACH COUNTY 1 RETURNIN3 STUDENT -1 UMA ENTRY GOMPLETEO U all non-Shaded areas and verity the resident address "eAr S DAT! by your signature below. MAIM I a - ll - if d rA Er :MYl K woo ataiess dlo)/ 0 dint PATE m WY ST ATE 1W • Foyer ,°alm 80) F1 3.341/ .4 Arne. SEE Ma IS 1N STUDENT A L141.1 LIntat JIMENCAM:ACIA1 urea( AMC noon ' ' al AMMO WES n ii emit 11 n ew wan YRSAIL SINGLE PARENT? .4 ygr. j ,,,, WRIFICAISOM PLACE MINIM MRS ill/ Palm Roach Fnu A o z IIIIIIIIIIIIR ONE COOS Ott.T. d A iefe meeswas Nec R ItywN Ef CA oat j 0 An m to Psi Rory Since a 6 MO Wm Si alert Twine Flcr.-. As ce bros. sag as NMI ty Mises mesa a roe* w stem mem o a E Afi" oan i n ier n hi Fall al l mops re he NN el Any *lift team le • RAP00 SIMI amerce mesa 0 we n asde by Semi abide 0 H ea WRNS MS CRAW m imMi .. CI C IWNI NO a adellitan N [bole 0 Ns ye** ste/ ] F An a Thiltccli ARgubtal sake 0 I Enrol E/CRY CODE ENTRY DATE. OUT DER. • RESICMT STATUS JAM M r:: Us Out ace Ursa GRACE: CALENDAA: TEACNER113.: CATEGORY: Q L art CFCCWIT Due I:Imo o I 2 3 4 1 6 at MIIIIIINT Y -- 0 3. MOWN it us IASIVIT TRANSFER INFORMATION: NAME OF SCICOL !RANEE/MG FROM an OR tOCEION DATE OF LAST ATTE1CANCE GRADE LEYL. LAST Mime 5C}OX ATTEN00 IN PALM MACH COUNTY: GATE ATTENTCO FREE OR REDUCED PRICE LUNCH; IWO yto NW al SIT apposor aN a RN a MOAN Fete theme (Apircason N DWAIN MD Dlis Regento: FINN) OM arm SCREENING AND ASSESSMENT: SODIUM FLUORIDE PROGRAM: I re perriSSbn lot ny UNTO lo b pee screemel an/ eseuesowl sets GM permutes b my NMI es pet pa n SN Scan Rade Flown atm :unary Sy what MI NNW; Wesel/TN ray t• Omen INIYMAIN b CreNtt bit ORM MAMMA veld Swoop grade sot an "cum an CI No Uva alle0 FOREIGN STUDENT INFORMATION: ITN inlernmton b eosins, and Mad whIsty lot tat Armee at oblate RAS ItevEres a ENTRY INTO USA SCHOOL STUDENT OR STATUS (ORM Ow) 1 E 3 5 6 7 I ENTRY DATE USA mieeMent Pan hasesteehave kin 341chtnNt Man Sall40.9m tAEntan 1:51.1A0 ertirsigreel say (Condon an =Mb matisnm 0 0•10ninn2 arm) Mel DAT YEAR NEW STUDENTS TO PALM BEACH COUNTY ONLY: F NO CITIZEN Cf MET COWRY? N WHAT COINTRY WAS THE STUDENT BORA? r Jr nS ran4 WHAT LArMailr S SPOKEN IN RE NOME BY RE PARENT CA GAMOW* WHAT LuGUAGE IG SPOKEN N THE KW BY TIE SLID Nil C /LIG /1/ Co 1. pi a Linguica veer Tan Engash undo Sr non*? j ifs WO =our covsun or UNMADE CUMnius NATORt. Ckd no Iltdert Yunnan! beguage Ohm tan ENAAni a YES WO Oft LAND:Hot 3. Does Ye syden mom lreoartly gain language caw NnEnosh: tans &Kb Eu iCs DOCUMENTATION CHECKLIST: Ma AND GATE ONLY WIEN RECENV.0: SCE: mmaKnom 9/ Li man HARMAN CSIATE - SCC1AL IMAM NUMSCR MICA/ MUMMER nein! —111100FIRMOIROLE I VERIFY THAT THIS REGISTRATION INFORMATION S TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE _0(mui tia PESO ms ammo Gm I EFTA01709907 SCHOOL BOARD OF PALM BEACH COUNTY STUDENT REGISTRATION FORN-Pmx2 STJDEnT NO STUCCO WOE -II OM PARENTAL INFORMATION: KW MOE NLUBER. TIMNSPORTATIOM SOKIenl wit TWAIN' Wan schCci Py Itilec• 1 01* Pen Per L'IfiS --)a SMOOT WES NM (CIRCE OM: g BOTH PNIVCS D MOYER a MCI U WSW CUSTODY j OtHEP IS THEN A COURT OMER IPARNG EMIR PARER ROM WRY* OR CONTACTING ME Ma Ca 114E SCHOOL DAY? D YES j100 if YES RENE Komi n4 SMOG WIN A COPY Of DIE WC OMER. FATHER M Rea l (s ide Iree6 -Li MM. MT. OCCIPATOI RACE Of DOLOYMENT BUSINESS ROM MOTHER 1 -e- OC 4 M0. PIT. °carom r f PLACE Of EMPLOYMENT MANESS ROM LEGAL GUARDIAN (F ANY): LAST NAME MST a NT. OCCUPATION PLACE Of EIMLOTIMEN DURESS RCM EMERGENCY HEALTH AND SAFETY INFORMATION: PART I: Pomade) other than parent authorized to pick up student. P CP - Gti,4,5 /0 MS ACCPASS PIIDNE RELATICNIMP Mi gsl , I ___, Ell 6 'Writhe -I be r PART II: Parson(s) to contact In the event of an emergency It portals cannot be reached. Thom listed all also authorized to maws. student from campus In an emergency silualion. jOrieck Weer. 'Oration o Ire Salle acre's! r Canyitle Pan i d Mort( iron Pa. SKr ed n Pay I XAIE TONESS I MOM RELATIONS. _ PART Ill: N school la unable to contact you In can of "nese of accident, may am nave yore pennlasion to call your doctor pr take your child to the hospital 3.111MI 0 MO raw CORM Peoria ihNIER NOSRTAL PRESSMAN rrood &Irian Jon If pouf child Sullen tern any Enna co hal any physical Moth mat as Mould be swan al Mem at YOUR OTHER CHILDREN IN PALM BEACH COUNTY SCHOOLS: YANTIS? Of CIALDITEN 5D0001 ATTENDED I GRADE Mini DATE 4h LO:Pi 171 ..) rid ii hit /0 I VERIFY THAT THIS REGISTRATION INFORMATION IS TRUE AND ?hiIi ACCURATE TO THE BEST DF MY KNOWLEDGE. RAE a vAPfNT a LEGAL POOP PDS (RR. AIN A I 1 S t 1‘t ‘` EFTA01709908 O tl VI 0 • COL DISTRICT OF A 3ECH COUNTY : 11 9.12 Academic DO as RET: 59 MATH: 74 Improvement Plan (AIP) F ET: ratios. READ: 362 MATH: 311 FLAT: W-LZ M-1F S-FL MAP: 5.0 ATP: ft-U PRIM: LLP: 504: O READING O WRRING O MATHEMATIC!) O SCIENCE O somas AissIffents O PathBean Woes Ert<euxoa F4IFOIRCOO GIA‘ca Assessments it O Pollan O Poreein O O FCAT Mart/Rate 0 Perbmance Asuttrnenb Canoe Agnomen' haseSsmeno Ten 0 RAT Da?xstcdPretece Tees 0 RAT Dip ostotback• Tests T OFFICIAorreace Tests ❑ Wrote Sobers 0 Dor/ostic Sateab O Nona& Sarno O Oarostc &erne O Oar tocne• ❑ Omet (see tend) O cow No tenet) O Ceet (see tech* Phonemic Awanniss O miring O 13/Una= ❑ Sinnentnogerdno Phonics Typos cl Writing ❑ WoroSenrenre mug O Paragraph Ming O CarOasbon Wrong Wrenn Sine. Concepts rd =1 0 Geom.? g r ail'', et Mater ord atom O Processes tot Shape ne Fan ❑ SOASSynto Caregnthrou O comonvEicon Rooney Ammons Applicalion of FLAT Writing Ibbric Mt Trinkrg n ant Rotabily O Rada it Carol Area O Eat rd Spa 0 Pitons aLN O IR* thrg TNiNs HadRIM ❑ HO Frequency Wads O row. ikon' Spook Crawls thee Entente I O Rale ❑ Droawaton ❑ Comentrors • Seto moms Vocab.dory fl Striae* Marra Carves/Non CEntert Area O Word IANnix C] art em SON& Cacaos Tat Cornpronension ❑ Evoiti-, ❑ Cuisurng • =mum ❑ s‘••••..2 A-55 L t (re CI •rr.C— i t ,,.t._ s it e tinertdr /blabs Tubing Tutoring 8tonng ❑ Outsc &Radom Own; Saar Day O Deng Scheel Dee ou Do O Rittlek• Revd / Sea/ O Altentareon Genre /Saturday ❑ AfmAioltroSehooI I Sun* Instructionalamity's Insruc6oniI Alternatives MIMIWWISWANS RAZ:re S.md I SaArdo Ireflukes! Alternatim o Terwary Gr•AS ❑ tompfly St/Craw ❑ Tosawy SRO Crows T Sim Groups O Canon Lining Gaps O Caveat* taming Groge O CowenIan° Oman erre Lena Goods O Gad ReueledAbt•EDbm• ❑ Duna RadnoWriing Croups O Tendon O Gilled hoetindenntwc Grout o Tedmolon O Tedookor o dew OnStand) ❑ Technakgr O Ohm (see emceed) O Other On teachod) Atsignianaltionitts O Ore (see Ora) AssignmnsMinify* AnIrmont Alomolivo AssignmettAR•math• ❑ The O 'me tea O Tr. O Gatti O Ourtey O On! O Gal O Orel,* Reairerants O Pada Remanent O Foam RefWalesre O Produd Reaxerrents O OW SudsRotas O ago Stith ROWE O chidSbAy Worn O Chad SW( Relents O Insinanar lAnierrelks O Antabacnal Resdng ❑ martacoiLorogoiNto O tratuctona Nato; Student program, will a monitored throughout tin school rem, wed student peeress eele be Estleoned on the report card. T.R.OJOI Rwoolared ❑ Sixassluly Rernadaled ❑ Sicrossruer Flemedisted O Sucoosduei aro • C 5 ,F O Stamm Nam AO Next Schur" O Regales Non' MPNor SOS O Paquin.' Nik*A Nett Scheel Yea' Year Year Yew O Spcoal Senecas / Placental 0 Snail Sera I Pecirent O Speoa Sereces/Platenwt 0 Sod* Senates f•xtmen O qua (se. altatheS O Otte (see eftscheci) Daher bee Oxen) Doter (see anal) O Deficiencies die to nonattendance OW to Attendance Specialist) Paant/Guardlan COMMItmenUCoritribUtiOn out Ova as That •0•Y O Monitor Attendance I Tank** ❑ Chock Homework arra O Encourage Rimdm3 at Home Reinforce Skills cm/ -W:4— art O Mena Parent Conte/axes C Sign CiallyINO•dy Notes O Mend Parent Curnculurnl Infornatith hieetngs XIAA nu OF rd R our PEISI) '687 (REY. Br 2,2(03) ORIGINAL • Cumutaes Fodor COPY. Teacher COPY - ParankGuardian EFTA01709909 Nart*: Vear: 2002 Wade: 10 School Code: School Copy n•:94Cl2I T Your Vrhal Math Writing Skills Scores 48 50 48 Sores erithil these mams can te cansidered erniar to pul: 90 20 80 20 80 Intens' Merit MIr niallillsa PIM •. 1." ~ " MI Schelarship Corporation 41 52 46 54 44 52 INMSC) Programs Selection Index teen Wener een 59% ar unnervern ve. acne. ro)no, 63% sr renenet eng een. t..e. 59% er manmamt Percentiles 146' detk Mak 5511 Percent'. so —we ...imenť. Mat SAT roll ~Wen Ranges Con SAT IYwW 880 250 SAT atm 200 SAT N: »Ilias Teat MM Be ~Kan re no of Von Expect? -155~~15~1~ -Mala MEM ME rag vena mant ad Aam a 440 540 440 560 450 540 aa MC tas die &karn kfeltnelin 98.991re bi braam eam. hMamalMlltRanaRC wiel dart Ika its ..trAr*, 10:•• 1• 010416 taNnatS Ger mese) eiN elMo ľi ...n re be./n Review 9~11 Madam m4 mies yeg ▪ St ~0 ree. noran11 tO Your ~ia --Z- 04--•--44; I- -..4 --e-ana enter ~K's 2004 veert Zee We, ~In ~oe te Answers ▪• .1 -e -s« ever, dam am ~V en /nar er ema —No slat Ak r _Le_ a_ A C af /842 test box cS .0 4 n,, Cc< bid< so sou - sLia. C B rn Ap trn see th* Coby Reateronionte S- en _.L4 D C m Aa quetttont. ..-11 a st ra c., )dort n ~ti du pratte !! A ing en mor ante« Met _P e .4 re Geo rolt tag Mei ar — K" 0 C E rn Ara- • tertuí— Kt _Jr. a t/ h COO- o bal Mama Iq, Mae M _.18 E C n aa u bon» mt11.1 Me n cdest m tm_ • law 19A6 n Ad__ IVO) m trim Ms b ro etba ram 50' h 116 e heem •93 Art geadjaelbe 4_4 _a_Mth_ 21 n ES cartia AM ~Mc Crietappe tž c J Om balty aa 'ron meren ~na: e fI e :een NO meel and intense ▪ 411~ rn :043.1.4. -use tata .h• narmuses men n zi n e go "Ne 0.1rilyear nurrr.r year)of ▪ 0 C m Om Ata41—an raas a Ineke, 12 ter een • ClI nAla NMSC ontorens • 116hGee 11 6ChAle 11 e ./ naPro Your Educalional Plans $Idkntit0and Ponem« Gade Wenst A ri J • lage Mar Oven " E r/ r. St mennen u .4 frt Nti Greet 33 B Í n Geo Eairentarr streel barlaar • R A h en AM' iriaimaxa Ome a siii~ 3 ar • Artr -en n Ye ermeed certarať l a a a astag Mis Darai sedinan.: are 11 Artn mw art emmer. Manna te _AL A__./ A. 38 ar2 daeddrti ad umn ie pint 1 en me al 3 ai:Tonen:os ✓och chlIdna 1n er~* -96-11-48. 35 anaMaeMtllrlgelra. h Geo ______33j 44 _ • J r• 40 3s_mnftvparostirm tennis ons a taadaĎon In h Ar , ~all art& lubjetta leem a JI_a_41_1 aa al _a. hredevenons van.yw onelhe4S fe/ • OmMem - Lm ***** wend,. hot arde", RUI PIM _o_c_ (As answered cornet/in DI 40 nath lat eend o naanan(O. ei/Miers1,4<ndlyead ,reoloat.oFit. 444 an aflaat...el ▪ OSS amen = _DL gutntat and MMO 22 prots lou aantrad arAtnntý 21 QtelblIA0 Sad ,• een<* Pm reines reien‚ arre N C el m a ta e='/ cirnonrs 'ai s pen(s) ret nennti eA meng • Mamma ge __S_A 6_13. st ri ti mam, rpetorn Ir Ok I carenn a 2 0 . 11 bad gutsten Aeleežaled saut. ermirnty. 1111113 Vl plp raren sennt neneriny, 42.!l/ *camera! 1 queatm(t). 10 tnána• *rem eithuLaVn ■ egel er b en Via easaixedramothi n do sabel Vee ~wed nceenctl, ia mients; al tern doe roman eoned raat ameremended Men Scheel PIMS VIPOIlt kl 4 ro tu). .„, al ~oma" Carnet Er.one 4, InCe494 nenennet 3. oen/ r. ■ ra ren ene • ary I ~les 1, ro obry ~ar 32-4 • - rtakeestlim eeg. reen es 7. ene cone... 1101C4řa{, 11: worg* I Vco erend p meshe(s). tres rre irtie Other Kalers ta Cureer. VA meed nam* n queM04(c) inc Cerneneneen• Pet rik eed ~at." Jun•Or ..,4•OinaitiOrt n nam tree $00 C 00660. Meen *eerde Prverwroov Sheneary Meekon. ed tree amesCaten Improve • Uindiďatandfni mala Haas In n MMg paap. ■ Vang basic concept. and .panclone In erlthritotic ambten. zalving • Beleg praam and da stem te Impreem team re ďeoneteaimence Careers' in* wernentary eatgaten mem Mans Your sr ., Rem the ‚Maa passage Hoe tO Inren Practici sc AN moderns eerrenn teat arerning;,aus and conklirg 'n ‚n teer warmg, <rooie wood!. Cerefulty and ✓ree le team m enetary Redes wen 4(4.44•,414 Wertully end try tO de/MMO dič attnOrg intortneg tremen. eednel., ratio. reent, Skills oyardi ~sus Pracht. Making castmclons herweel tli. main dea and nopartina detail* en2OnentS. square root‚ Ome voute aso andice lome° půot4ems maden) om am CO,VIOrt ‚hem te tell Men?, rig. 500 poenen /, '2, 14. grodadio th.dy ean 1414 a• ..nats 4(5444 oen...noor. wentonal neemt*. er Knee Stro oeren* ra, 20.5d men witgors. crime noemers, mades. -he sKds and • UnderstandIng M. nructure el netslity, and neme Wen. are heel nn ■ DMIngulahIng conflIcting vinnen aantonen sikh abstract Idem How b inOraVe: Veen Maning, pratpao See questions a, IA 14, Mem te hierom Raad ~Paden. te49*0245. your rhernne-,1Ins man !dein and eend tenteen< ■ dans; basic algebrak concept* and *no boen tAat deal vin neyecto such as taal mark transtton rints. „sar, to undleltald potrtio.aconomm. rrstoey, or pinano;ny. Indiblůnal ~trein et aanvielen and indun.rviitloi °panelen@ to all problerns Se* erstrom 7..0, 1/. performance Exped geur taan to Int:.Ja egunentelve Hos to lepton Review almtem ruim. toen on tm tra. wert:n2, thch es poineer tornmentarb, •• .new !reine eigentb. 'anno *oeren. meceophy. aW C/ tiCi3M. and inept:a:tel, and COn0.01•19 ia0014IC beo gr:kom '9, 20, 34. 0.3, 051. ,0", • Pt the ■ Reen/MINI <onmensen betwean suggesticrn to Sec pannerk 4, 0. 0. Ideaa In a martelnat mooi in ■ Making Ponne:dons neon* Mee ie inert*: Lenin how coniecrno ral toch mee (enen as naad., reentl end cAnrytketiOnli) mathematkal teak, estatnsh rop manonding name Omazal pna Hei to lenfrOVIr PfaCt105 PODIO•n$ Pad regen) er a lančantaa combi/eo +kril aCquired :n Otter natn Sele derft," 2, 32 eturse2, SiAln N prObrem2 trp Na Cent> ka- ten a annimele, retter. and decmetfy. Set emmers e, a. It. EFTA01709910 Ila COURSE PERFORMANCE Past 430 FINNIE-P21 (continued). ===== Total Total Total Corr/Att Percent Enroll IPM Current Course Time ExerCises Correct Level Level Level Gain 4305 (Enroll- Date - 9/12/96) MCS 4:12 312/385 81 0.01 3.99 - 4.01 0.02 RW 3:59 570/666 86 3.50. 4.72 4.89 0.17 RA ' 0/0 0 N/A N/A N/A N/A EFTA01709911 6 5 97 7:52am COURSE PERFORMANCE Page 430 FINNIE-P21 (continued) ' Total Total Total Corr/Att Percent Enroll IPM . Current Course Time Exercises Correct Level Level Level Oain 4355' (Enroll Date - 9/12/96) 213/244 87 0.01 3.92 0:00 RW 2:32 362/416 87 3.50 4.72 4.72 0.00 RA 0/0 0 EFTA01709912 6/7/96 6:28am COURSE PERFORMANCE Page End of Year Report Total Total Tot Cor/At Per Enr IPM Curr Tot Crs. Time Exer Corr Lel Lel Idyl Bess Gain 3504 (Enroll Date - 8/22/95) IIIIIIIIIIII . 1470/1773 83 2.80 3.20 3.79 37 0.59 MCS 21:04 1213/1640 74 2.50 2.75 3.55 74 0.80 FAB 8:34 N/A N/A N/A 36 N/A WE . 2:37 25/38 66 -- -- EFTA01709913 6/2/95 12:36pm COURSE PERFORMANCE Page End of Year Report Total Total Tot Cor/At Per Enr 1PM Curr Tot Crs. Time Exer Corr Lvl Lvl Lvl Sess Oain 2352 RM.. (Enroll Date - 8/29/94) . 1043/1170 89 2.00 1.55 2.53 54 0.98 MCS 10:10 818/1087 75 1.99 2.05 2.41 54 0.36 EFTA01709914 REPORT 11 STUUSNT KMFOKT lEMEITE: FOR: SCHOOL: ELEM CRAM: 02. DATE Of TESTING: 4/18/95 TEST: CTBS/4 LEVEL 12 FORM A VIDEO NOMA: o SMUT Am VER m AGsE mama TESTS mammal S. NAM WM TOTAL READING READING COMPREHENSION Si .====m===== READING VOCABULARY TOTAL MATHEMATICS MATH CONCEPTS S APPLICATION 58 .. MATH COMPUTATION UMTSOF OS-/O' M., 2-0 S1-TS PEWMUM PERCEMILE NMEWILE WKWUM MKOMM MEd Dear Parent/Guardian: This spring,.. was given the Compreh Tests of Basic Skills/Fourth Edition (CTB . This report explains test results. When compared with students across the nation, scores were in the high-average range on all tests taken. Additional information about these tests can be Alin the back of this page. If you would like more information about test scores, please contact our school. Sincerely, Principal EFTA01709915 REPORT II CTBS/4 STUDENT REPORT TEACENR: KA: SOKOL: ELEM GRADE: 03 DATE OF TESTISG: 4/17/96 Ian CTBS/4 LEVEL 13 FORM A SIMENT WAITER: SUM MIKES LOWE AVERAGE MOKET IESCEMILE TESTS MOKS LOW MW READING COMPREHENSION 70 ==K=0... MATH CONCEPTS & APPLICATIONS 69 TOTAL LANGUAGE LANGUAGE MECHANICS LANGUAGE EXPRESSION umas or 1-0 Al* 51-75 74.1, PMCOTRE mao MIKEWILE POCOMLE PEACOMLE mmamu Dear Parent/Guardian: This spring,S. was given the Compreh • Tests of Basic Skills/Fourth Edition (CTB This report explains test results. When compared with students across the nation, scores were in the high-average range on all tests taken. Additional information about these tests can be the back of this page. If you would like more information about n test scores, please contact our school. Sincerely, Principal EFTA01709916 nowt. TEA,MR: FM: SOMOL: ELEM CRME2 04 DATE OF TESTING: 4/15/97 TEST: CTBS/4 LEVEL 14 FORM A SMOLT MIA: SOME ROM LOWST AVERAGE MUTT MMIMILE TESTS NAM LM MM TOTAL READING READING COMPREHENSION 77 ....... READING VOCABULARY TOTAL MATHEMATICS MATH CONCEPTS & APPLICATION 45 = .. MATH COMPUTATION SCIENCE SOCIAL STUDIES RIMMIN 1-25 2650 51-75 7.-t, FMCMTILE IMEMMLE PMCVMU IMCMIRE MMEMILE MAIM Dear Parent/Guardian: This spring,11. was given the ComprehmalysTests of Basic Skills/Fourth Edition (CTB This report explains IIIIIII test results. When compared with students acrosii i iation, scored in the highest range on Reading Comprehension. scores were in the low-average range on Math Concepts & Application. Additional information about these tests can be iin the back of this page. If you would like more information about test scores, please contact our school. Sincerely, Principal hskiii6YS4pitz. EFTA01709917 TEAOCER3 Mitt I SCHOOL: ELEM 05 DATE OF SSSSS 4/20/98 TEST: CTBS/4 LEVEL 15 FORM B STUDENT MISER! SCONERA EMU AVERAG MISE MOT MUMETKI TESTS MAIDE UM moi READING COMPREHENSION 79 ...man MATH CONCEPTS & APPLICATIONS 39 et. • TOTAL LANGUAGE LANGUAGE MECHANICS LANGUAGE EXPRESSION MAWSW MACCOUt 1-tr. REHM 51.5 U.9 name= IDOWIU PIAMMU FUUNTUE IUMS Dear Parent/Guardian: This spring, s . was given the Compreh Tests of Basic Skills/Fourth Edition (CTB This report explains test results. When compared with students acrosii i iation, scored in the highest range on Reading Comprehension. scores were in the low- average range on Math Concepts & Applications. Additional information about these tests can be n the back of this page. If you would like more information about test scores, please contact our school. Sincerely, Principal EFTA01709918 J&II4.0.4fla a rya.. HINER: TOO: I SOIOOL: GRADE: 06 DATE of TESTING: 4/13/99 TEST: CTBS/4 LEVEL 16 FORM A SWOP? MIER: SCORE RANGES WORST AVERAGE MI0IEST EMMET TESTS RAMS LN MN TOTAL READING READING COMPREHENSION 69 name READING VOCABULARY TOTAL MATHEMATICS MATH CONCEPTS r. APPLICATION SQ 41..e•• MATH COMPUTATION .... uwms Of 1-m. EE-SC fl-T! TO-If mmeNna mem POURITILE mann, PEICNTILE ME UMMA Dear Parent/Guardian: This spring,A. was given the Compreh rests of Basic Skills/Fourth Edition (CTB . This report explains test results. When compared with students across the nation, were in the high-average to low-average range on all tests a en. Additional information about these tests can be the back of this page. If you would like more information about test scores, please contact our school. Sincerely, Principal ',O"64410 EFTA01709919 SCHOOL BOARD OF PALM BEACH COUNTY Notice of Student with Special Characteristic PLEASE PLACE THIS NOTICE IN THE STUDENTS CUMULATIVE RECORD • "HUAI Please chock Fl In pencil each of the Information Items below which are accurate for this atudenL When changes occur please update by adding or erasing check marks as appropriate. Please sign and date each time the information on this page Is changed. El Psychological evaluation has been completed. al Student is being processed for placement in en exceptional student program. ❑ Student has been staffed for an exceptional student program but has not been officially placed. ❑ Student has been placed in a full-time exceptional student program. List M / Student has been place In a part-time exceptional student program. List: ❑ Student has been referred for attendance problems. El Dispensing of medication during the school day has been authorized. Ei Evidence regarding high risk medical condition is in fettle. ❑ Student has been referred to the Community Mental Health Center. ❑ Student has been referred to community agencies foiservice. ❑ Migrant student ❑ Other This pap* has bean updated IT: DATE DT: GATE (006. 0/91 PISS NH EFTA01709920 THE SCHOOL DISTRICT OF PALM BEACH COUNTY Grade / Course Change Documentation rallIKM1 CENTRAL INFORMATION CHANGE DOCUMENTATION GRADING PERIOD GRADE EXAM CONDUCT From r From From 1-1 To To To From From From To To TO Change course code From To Reason for change: Micrcalculated Grade Average 0 Student Completed Wm* ❑ Other (.AMM Wow) APPROVAL SIGNATURES (two of three required) sort 01112U00 DAM / rumor MWCWA • DESIGNEE sr MTh OPMLAMittintrit4r01 cunt DATA PROCESSOR CONFIRMATION 4- ia,-61 51,44,RAM OF DATA IY P3500797 (REV. smaocii) CRIONAL -Cuaularwe Folder eqpy • Orice EFTA01709921 THE SCHOOL DISTRICT OF PALM BEACH COUNTY Grade I Course Change Documentation GENERAL INFORMATION srteemuste 4‘. Oman. I2cruazeomi Cern, Lrnto3LoJoeS Comae CHANGE DOCUMENTATION GRADING PERIOD GRADE OCAll CONCOCT From From )14 inn From Lith To To To From From From To To To Change course code From To Reason for change: twit- gh-at- 0 Recalculated Grade Avenge ❑ Student Completed Work ❑ Other (noonbekoN 0424.4.4.4... to/ iaab-- APPROVAL SIGNATURES (two of throe required) -3 ...Stri =NounOravverA/L • CESGNIE CATE ScnATting v ArcA 0.0“:4971fArCa CUM DATA PROCESSOR CONFIRMATION SIOWTIRE Of OITA PlbrrcESSOR NYE P08O 0797 (REV. 9/122001) ORIGINAL - Cumuatve Folder Copy -Oda Re EFTA01709922 Spring 2003 Florida Comprehensive Assessment Test (FCAT) . sw"Homter NORM-REFERENCED TEST Sacoi Name anaNuinber. GRADE 10 Student Report rill er SO - PALM BEACH D2MtEtifl.tEll This report shows your results from the FCAT National Norm-Referenced Test. The FCAT Norm-Referenced Test measures your achievement on a test that was given t0 • national sample of students. Your nomnteferenced scores kt Reeding Comprehension end in Mathematics Problem Solving describe your performance in relation to the performance of students throughout the nation. Your scores are shown below. SUBJECT SCORES National Scale Percentile Score Rank Stanine Reading 712 59 5 Comprehension Mathematics 717 74 6 Problem Solving The Scale Score woe's, your sorktroance on the 1 at and aliens or COmparisenS Iron year to year. Reading Comprehenalen Scale Scorn range horn 577 to 817. mathematics Scala Scores ranee bin 568 to 883. TM Ns/Sonia Percentile Rank and Stanine indcate your relative Montana In ecovarivon to the national referent* group. National Pertenble Realm rang. from I to N. Sargon range lion 110 9. RSV:block one test again, your National Percentile Rank night be stgMN Noise or Icwer than staled nere. However. you, National Percentile Rank wood probably tan "reign a tartan range. Foe Regant. Cotner...en...Um. your National Percentile Rank should be between 44 and 74. For itanetnatich your Notional Foramina Rank 'naiad be barmen 64 and 82. CONTENT SCORES Number of Number of Number of Questions Correct Questions on Test Responses Attempted Reading Comprehension 51 40 St Irilia/ UncYxsrandirg a 8 8 interpretation 22 19 22 CrItcal Analysis 9 5 9 Stralealto 12 8 12 Mathematics Problem Solving 48 28 48 Problem SWAM 6 2 6 nifseca 6 5 6 Dashikis 6 .5 6 Probability 5 2 5 Function* 5 3 5 Geornetry-Syntherle 7 2 7 Cecrnetry-Algtbreic 4 3 4 TrigenonCray 3 1 3 Cescate maul 3 2 3 Precaleutur 3 3 3 Data Runtime: 0413/1,2003 0145293 EFTA01709923 5.. )b(k\ THE SCHOOL DISTRICT OF PAW BEACH COUNTY 0 High School 4 Grade and/or Course Change 0 Middle School [ ,........p Documentation 0 Elementary School COWNI.Be. SOUOt MAC9O1 SOI COMM THIN High School ME EV at Z ° MSC Ar" • C-1 oven^ vsks& CHANGE DOCUMENTATION GPADINO POEN WW3E WM CONDUCT yvi oppAE. row j ih. 3 MCI Z From Oft;ollicsys FTo WIS To 0.9 To From Firm From To To To Change course code From To Reason for change CI Recalculated Grade Average WAStu:lent Completed Work CI Other (explain below) APPROVAL SIGNATURES (two of three required) DATA PROCESSOR CONFIRMATION I confirm that the gradokourse change has been implemented. SCALIIVAF Or OATAMOCT AGWAROW Oe /AEA Ad.:NISTA' TOR DATE PESO 0797 (REV. sibtacciq ORIGINAL - Cumulative Fades Copy - Nice rile EFTA01709924 Page: 1 Document Name: untitled PANEL: A13. ACADEMIC HISTORY ✓ YEAR: 05 MIiiiil August 16, 2004 10:19 am STDT: SCHL: Ill, GR: 12 ST: A A CREDIT CREDIT FIN H P --TAKEN--- C SY T COURSE SA CODES ATTP EARN GRD FLGS C S SCHL DS GR 130 99 3 1302000 M/J BAND 1 R 0 1691 SO 06 00 3 1302010 M/J BAND 2 H H 0 1691 50 07 01 3 1302030 M/J BAND 4 . . A H H01691 50 08 02 1 1302300 BAND I PF F .50 .50 A JE R 0 2331 50 09 02 1 1302500 JAll ENS I PF F .50 .50 A HJE H 0 2331 50 09 02 2 1302300 BAND I PF F .50 .50 A JE R 0 2331 50 09 02 2 1302500 JAZZ ENS I PF F .50 .50 A HJE H 0 2331 50 09 03 1 1302310 BAND II PF F .50 .50 B JE R _ 2331 50 10 03 2 1302310 BAND II PF F .50 .50 B JE R 2331 50 10 04 1 1302340 RAND V PF F .50 .50 A HLE H : 2331 50 11 04 1 1302510 JAll ENS II PF F .50 .50 A HJE H 2331 50 11 ATTP: 21.00 EARN: 21.00 POINTS: 52.00 GPA: 2.4762 EXCLUDE RANK: N PF1-HELP 3-EXIT 5-REFRESH 7-BKWD 8-FWD 9-NXIP PAGE 12-ESCAPE ota-st— PAGE FULL...00NTINUE. TERML: DQ32 pc ,,,-0-AřreAtir Date: 8/16/2004 Time: 10:20:16 AM EFTA01709925 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2000 Sr S d r NORM-REFERENCED TEST chool Name and Number Student Report Florida Comprehensive Assessment Test Grade 07 e t MI0=CNumber 50 - PALM BEACH This report shows your results from the FCAT National Norm-Referenced Test. The FCAT Norm-Referenced Test measures your achievement on a test that was given to a national sample of students. Your norm-referenced scores in Reading Comprehension and in Mathematics Problem Solving describe your performance in relation to the performance of students throughout the nation. Your scores are shown below. SUBJECT SCORES CONTENT SCORES National Number Number Number Scale Percentile of Points of Points of Questions Score Rank Stanine Possible Earned Attempted Reading Comprehension 54 47 54 Reading 720 88 7 Initial Understanding 10 10 10 Comprehension Interpretation 24 22 24 Mathematics 704 85 Critical Analysis 10 9 10 7 Problem Solving Strategies 10 6 10 Mathematics Problem Solving 50 . 38 50 The Scale Score expresses your performance and allows comparisons from year to year. Measurement 5 5 5 Reading Comprehension Scale Scores range from 490 to 819. Mathematics Problem Solving Scale Scores range from 513 to 829. Estimation 6 4 6 Problem Solving 5 4 5 The National Percentile Rank and Stanine indicate your relative standing In comparison to the Number Relationships 6 5 6 national reference group. National Percentile Ranks range from 1 to 99. Stanifies range from 1 to 9. Number Systems 4 3 4 Patterns & Functions 3 2 3 If you took the test again, your National Percentile Rank might be slightly higher or lower than stated here. However, your National Percentile Rank would probably tall within a certain range. Algebra 4 4 4 For Reading Comprehension, your National Percentile Rank should be between 77 and 94. For Statistics 5 4 5 Mathematics Problem Solving, your National Percentile Rank should be between 77 and 92. Probability 3 1 3 Geometry 9 6 9 The content tested Is described on the back of this report. Each question was worth 1 point Run Data 08/21/2O00 0141721 EFTA01709926 Grades 5, 6, 7, and 8 Grados 5, 6, 7, y 8 The FCAT NRT Reading Comprehension Test assesses La Prueba de Comprensión de Lectura FCAT NRT evalúa the following objectives: los siguientes objetivos: • Milla/ Understanding - Demonstrate the ability to comprehend explicitly • Entendimiento - Demostrar su habilidad para comprender stated relationships in a variety of reading selections. explícitamente el contenido y la relación entre si dentro de una variedad de • Interpretation - Demonstrate the ability to form an interpretation of a variety selecciones de lectura. of reading selections based on explicit and implicit information in the • Interpretación - Demostrar su capacidad interpretativa dentro de una selections. variedad de selecciones de lectura, basándose en información explícita e • Critica! Analysis - Demonstrate the ability to synthesize and evaluate impilcita en dichas selecciones. explicit and implicit information in a variety of reading selections. • Análisis crítico - Demostrar la habilidad para sintetizar y evaluar • Strategies - Demonstrate the ability to recognize and apply text factors and información explícita e implícita en una variedad de selecciones de lectura. reading strategies in a variety of reading selections. • Estrategias - Demostrar habilidad para reconocer y aplicar el contenido del texto y estrategias utilizadas en una variedad de selecciones de lectura. The aboye objectives are measured within the following contexts: Los objetivos anteriores se evalúan en los contextos siguientes: • Recreational - material typically read for enjoyment. • Textual - material typically found in grade-appropriate textbooks and other • Recreativo - material utilizado para entretenimiento. sources of information. • Textual - material utilizado en libros de texto del grado apropiado y en • Funcional - material typically encountered in everyday life situations. otras medios informativo. • Funcional - material utilizado eh la vida diaria. The FCAT NRT Mathematics Problem Solving Test La Prueba para Resolver Problemas de Matemáticas assesses the following objectives: FCAT NRT evalúa los siguientes objetivos: • Measurement - Demonstrate an understanding of the principies of • Medidas - Demostrar sus conocimientos de los principios de medir. measurement. • Estimación - Deteminar cuán razonables son los resultados y aplicar la • Estimation - Determine the reasonableness of results and apply estimation estimación en la solución de problemas. in problem solving. • Estrategias para resolver problemas - Demostrar comprensión del • Problem Solving Strategies - Demonstrate an understanding of the process proceso de resolver problemas convencionales y fuera de lo común. of solving conventional and non-routine problems. • Números y relaciones entre números - Representar y usar números en • Number and Number Relationships - Represent and use numbers in formas equivalentes en problemas de matemática y de la vida diaria, y equivalent forms in real-world and mathematical problems, and demonstrate demostrar sentido para las fracciones, los decimales y los números enteros, number sense for whole numbers, fractions, decimais, and integers. positivos y negativos. • Number Systems and Number Thectry - Demonstrate an understanding of • Sistemas y teoría de los números - Demostrar conocimiento numérico de relationships among arithmetic operations and apply concepts of number las relaciones entre las operaciones de aritmética y aplicar conceptos de la theory such as primes, factors, and multiples in real-world and mathematical teoria de los números tales como números primos, factores y múltiplos en problems. problemas de matemática y de la vida diaria. • Palferns and Functions - identify numerical and geometric patterns and • Pautas y funciones - identificar funciones y pautas numéricas y usarlas functions and use them to solve problems. para resolver problemas. • Algebra - Demonstrate the ability to evaluate expressions and solve linear • Aletas - Demostrar la capacidad para evaluar expresiones algebraicas y equations. resolver ecuaciones lineales. • Statistics - Demonstrate an understanding of the relationships in data sets. • Estadistica - Demostrar conocimiento en procesamiento de data. • Proliability- Demonstrate an understanding of the laws goveming chance. • Probabilidad - Demostrar conocimiento de las leyes que gobiernan el azar. • Geometry - Demonstrate an understanding of geometric principies. • Geometría - Demostrar conocimiento de los principios de geometria. So urce: Stanford Achlevemenl Test SeM1es, rüeb Echtion, Cerrad= of Metniettatal Objectives Noldr PilnInd wth nottnIAAkto ItuMarero/1 Felotailanal Lia••••••••••• 4000 EFTA01709927 EVALUACION DE SECRITURA DE LA FLORIDA PRIMAVERA DE 1997 REPORTE ESTUDIANTIL INFORMES DE LOS ESTUDIANTES DE 4' GRADO Descripción de las Notas de Redacción Estimados padres o tutores: 6.0: la redacción se concentra en el tema, está lógicamente organizada e incluye un La prueba escrita por su niño(a) en enero como parte del Programa de amplio desarrollo de las ideas o ejemplos fundamentales. Demuestra un dominio maduro del idioma, incluyendo precisión en la elección de términos. Las oraciones varían en su estructura. Evaluación de Redacción de Florida, fue leida independientemente por dos La puntuación, uso de mayúsculas y ortografia son generalmente conectas. personas capacitadas para evaluarla. Cada lector Juzgó la prueba en relación 5.5: La redacción recibió un S por parte de un lector y un 6 por parte del otro lector. a un conjunto de normas y la calificó con una nota general. La nota final de 5.0: La redacción se concentra en el tema y tiene un desarrollo adecuado de las ideas o su niño(a) es el promedio de las notas otorgadas por los dos lectores. ejemplos fundamentales. Tiene una estructura organizada, aunque haya algunos lapsos. La elección de términos es adecuada. Las oraciones varían en su estructura. La puntuación, uso Esta nota de redacción le ayudará a usted, a su niño(a) y a los maestros a de mayúsculas y ortografia son generalmente conectas. comprender cómo se desempeñó su niño(a) en esta prueba de redacción 4.5: La redacción recibió un 4 por parte de un lector y un 5 por parte del otro lector. realizada en todo el estado. Una descripción de cada una de las notas 4.0: La redacción se concentra en el tema, aunque puede contener información ajena al mismo. És evidente una estructura organizada, aunque puede haber algunos lapsos. Algunas posibles aparece en el lado izquierdo del Informe. ideas fundamentales contienen datos específicos y detalles, pero otras no están desarrolladas. La elección de términos es adecuada. Las oraciones varían algo en su estructura, aunque la Los estudiantes dispusieron de 45 minutos para leer el tema asignado, mayoría son simples. La puntuación, uso de mayúsculas y ortografia son generalmente conectas. planificar lo que iban a escribir y escribir sus respuestas. Las condiciones 3.5: La redacción recibió un 3 por parte de un lector y un 4 por parte del otro lector. bajo las cuales los estudiantes redactan otras pruebas en clase o en el hogar 3.0: La redacción se concentra generalmente en el tema, aunque condene información pueden ser diferentes a las empleadas en esta prueba; por lo tanto, la ajena al mismo. Se intentó una estructura organizada, aunque puede haber algunos lapsos. redacción puede ser diferente. Ustedes y los maestros deben considerar la Algunas de las ideas o ejemplos fundamentales pueden no estar desarrollados. La elección de términos es adecuada. Las oraciones varían algo en su estructura, aunque la mayoría son nota de esta prueba junto con todas las otras redacciones del estudiante, al simples. La puntuación y la ortografía son a veces incorrectas pero las palabras más planear actividades para continuar desarrollando las habilidades de comunmente usadas están escritas correctamente. redacción del estudiante. 2.5: La redacción recibió un 2 por parte de un lector y un 3 por parte del otro lector. 2.0: La redacción está apenas relacionada con el tema u ofrece poca información relevante, así como pocas ideas o ejemplos fundamentales. Hay poca evidencia de una estructura organizada. La elección de términos puede ser limitada o inmadura. Las oraciones se limitan a construcciones simples. Pueden encontrarse errores frecuentes de puntuación, uso de mayúsculas y ortografia. 1.5: la redacción recibió un 1 por parte de un lector y un 1 por parte del otro lector. 1.0: la redacción considera mínimamente el tema porque no hay o hay muy poco desarrollo de las ideas o ejemplos fundamentales. No hay evidencia de una estructura organizada. Las ideas aparecen enumeradas en listas y la elección de términos es limitada o inmadura. Puede aparecer información no relacionada con el tema. Los errores frecuentes de puntuación, uso de mayúsculas y ortografia pueden Impedir una comunicación efectiva. U: La redacción no tiene relación con el tema asignado, no puede leerse o no obtuvo respuesta. . EFTA01709928 Student Name: r 1997 Florida Writing Assessment Student I.D. No.: STUDENT REPORT School: District: PALM BEACH COUNTY Grade 4 TYPE OF WRITING TESTED: WRITING TO TELL A STORY SCORE: 3.5 Description of Writing Scores Your Student's Score 6.0: The writing focuses on the topic, is logically organized, and includes ample development of Dear Parents or Guardians: 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. The paper your student wrote in January as part of the Florida Writing Assessment Program has been read independently by two people trained 5.5: The writing was given a 5 by one reader and a 6 by the other reader. to score this test. Each reader judged the paper against a set of 5.0: The writing focuses on the topic with adequate development of supporting ideas or examples. It standards and gave it an overall score. Your student's final score is the has an organizational pattern, though lapses may occur. Word choice is adequate. Sentences average of the two readers' scores. vary in structure. Punctuation, capitalization, and spelling are generally correct. 4.5: The writing was given a 4 by one reader and a 5 by the other reader. This writing score will help you, your student, and the teacher understand how well your student performed on this statewide writing 4.0: The writing focuses on the topic, though it may contain extraneous information. An test. A description of each possible score is printed on the left side of 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 this report. somewhat in structure, though many are simple. Punctuation, capitalization, and spelling are usually correct. Students were given 45 minutes to read the assigned topic, plan what to 3.5: The writing was given a 3 by one reader and a 4 by the other reader. 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 3.0: The writing generally focuses on the topic, though it may contain extraneous information. An for this test; therefore, the writing may not be the same. You and the organizational pattern has been attempted, but lapses may occur. Some of the supporting ideas teacher should consider the score on this test along with all of your 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 student's other writing when planning activities to continue developing most commonly used words are spelled correctly. your student's writing skills. 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 DESCRIPTION OF THE TOPIC: 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. Students were asked to write a story about what happened 1.0: The writing may only minimally address the topic because there is little or no development of when they traveled on a wagon pulled by horses. 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. RUN DATE 04/19/97 SO-1781-00O3074M U: The writing is unrelated to the assigned topic or cannot be read, or there is no response. EFTA01709929 Mathematics Content Tested Área de contenido del examen de Matemáticas PCAT Mathematics Is an assessment of the Sunshine Sude El examen de Matemáticas PCAT es el examen que evalúa las normas Standards In mathematics. PCAT Mathematics assesses content educativas de Matemáticas del estado de la Florida (Sunshine &ate from the following aseas: Standards). Este examen evalúa las habilidades siguientes: Number Sense, Concepts and Operations Compresión numérica, conceptos y operaciones • identifying operations (+, x, +) and effects of operations • Identificación de operaciones (+, a, x, +) y efectos de operaciones • determinIng estimates • estimación de resultados • knowing how numbers are represented and used • uso y representación de números Measurement Medidas • recognizing measurements and units of measurement • reconocimiento de medidas y de unidades de medidas • comparing, contrasting, and converting measurements • comparación y conversión de medidas Geometry and Spatlal Sense Geometria y noción espacial • describlng, drawing, identlfying, and analyzing two- and three- • descripción, dibujo, identificación y análisis de figuras de dos y tres dimensional shapes dimensiones • visualizing and IllustratIng changes in shapes • visualización e ilustración de cambios en figuras • using coordinate geometry • uso de geometría coordinada Algebralc Thinking Razonamiento algebraico • describing, analyzing, and generalizing patterns, relatIonshIps, • descripción, análisis y generalización de patrones, relaciones y funciones and functlons • uso de expresiones, ecuaciones, desigualdades, gráficas y fórmulas • using expressions, equations, inequalities, graphs, and formulas Análisis de datos y probabilidad Data Anaiyzing and Probabillty • análisis, organización e Interpretación de datos • analyzing, organizing, and interprefing data • identificación de patrones y elaboración de predicciones, inferencias y • identifying patterns and making predictions, Inferences, and conclusiones válidas vaild concluslons • uso de probabilidad y estadística • using probability and statistics Mensaje a los padres de familia: La Prueba de Evaluación Comprensiva de la Florida: Florida Comprehensivo Assessment Test (I7CM) es un examen nuevo diseñado para los estudiantes del estado de la Florida. El examen PCAT mide las normas educativas (Sunshine Suite Standards) de matemáticas y de lectura. Dichas normas, que fueron adoptadas en 1996, tienen expectativas altas CAT de los estudiantes del estado y se aplican a todos los estudiantes ya sea que vayan a trabajar o que sigan con estudios universitarios después de la escuela secundarla. Las normas educativas representan lo que los estudiantes omprebensive deben saber y pueden hacer en su avance académico. Las normas educativas establecen la base para un sistema Assessment que define una mayor responsabilidad para las escuelas de la Florida. Test El examen PCAT fue administrado por primera vez en enero de 1998 en las escuelas del estado de la Florida. Los resultados del examen de 1998 determinarán la base para el futuro logro de las normas educativas del estado de la Florida en las áreas de lectura y matemáticas. Los resultados del PCAT' son un reflejo general de estas nuevas normas educativas y sus altas expectativas. Los resultados del PCAT no se usarán en 1998 para decidir en qué grado se colocará el estudiante pero sí será uno de los factores que se considerarán en el futuro. CTB McGraw-Hill EFTA01709930 •• . • • 2 •. • en. a% •••• el .A• e7/44••••• • it%Pe'ree . • FCAT Total Score The Total Score indicates the student's level of achievement on FCAT Mathematics. The Total Score that a student could achieve ranges from 100 to 500. 1998 Individual. Profile Total Report — Score The Total Mathematics Score of 290 Indicates that scored in the • middle third of grade 5 students who took FCAT Mathematics in 1998. ID Number The Subscores indicate the student's level of achievement on separate content areas Subscores of FCAT Mathematics. Each Subscore represents the percentage of content in that Grade 5 area that the student responded to successfully. 0 25 50 75 10D CAT Mathematics CommeOensive Number Sense 51% Assessment Measurement 28% Test Geometry 51% Algebraic Thinking 39% Data Analysis 54% The Sunshine State Standards content tested by FCAT Mathematics is described on the back of this report. Message to Parents: The Florida Comprehensive Assessment Test (FCAT) is a new achievement test for Florida students. FCAT • measures the Sunshine State Standards for reading and mathematics. Adopted In 1996, the Sunshine State Standards are challenging expectations for Florida students. They apply to all students whether they plan to enter the world of work or go on to further education after high school. The Standards signify what students should know and be able to do as they progress through school. The Sunshine State Standards are the foundation for a strong accountability system for Florida's schools. 31 um or: PALM EIVACti FCAT was administered for the first time in Florida schools in January 1998. The 1998 test scores will set the baseline for future achievement of the Sunshine State Standards in reading and mathematics. FCAT scores are an overall indicator of achievement of these challenging new standards. FCAT results will not be used in making Run bate: 4/30/90 decisions concerning the promotion of students in 1998 but will be one consideration in promoting students in future years. r it' CM • I PM' S.•••:31S• . 13.3 i McGraw-Hill : EFTA01709931 Student Name FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 FEAT lorido Comprehensive Assessment Test NORM-REFERENCED TEST Student Report Grade 08 *co Mime ame and Number an um r 50 - PALM BEACH This report shows your results from the FCAT National Norm-Referenced Test. The FCAT Norm-Referenced Test measures your achievement on a test that was given to a national sample of students. Your norm-referenced scores in Reading Comprehension and in Mathematics Problem Solving describe your performance in relation to the performance of students throughout the nation. Your scores are shown below. SUBJECT SCORES CONTENT SCORES National Number Number Number Scale Percentile of Points of Points of Questions Score Rank Stanine Possible Earned Attempted Reading Comprehension 54 51 54 Reading 759 97 9 Initial Understanding 8 8 8 Comprehension Interpretation 27 26 27 Critical Analysis 7 7 7 Mathematics 667 46 5 Problem Solving Strategies 12 10 12 Mathematics Problem Solving 52 25 42 The Scale Score expresses your performance and allows comparisons from year to year. Measurement 5 3 5 Reading Comprehension Scale Scores range from 510 to 820. Mathematics Problem Solving Scale Scores range from 527 to 836. Estimation 5 1 1 Problem Sdving 6 0 0 The National Percentile Rank and Stanine indicate your relative standing in comparison to the Number Relationships 6 4 6 national reference group. National Percentile Ranks range from 1 to 99. Stanines range from 1 to 9. Number Systems 4 4 4 Patterns & Functions 3 1 3 If you took the test again, your National Percentile Rank might be slightly higher or lower than stated here. However, your National Percentile Rank would probably fall within a certain range Algebra 6 3 6 For Reading Comprehension, your National Percentile Rank should be between 91 and 99. For Statistics 4 3 4 Mathematics Problem Solving, your National Percentile Rank should be between 38 and 57. Probability 4 2 4 Geometry 9 4 9 Each question was worth 1 point. Run Date: 04/26/2001 0181621 EFTA01709932 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 FEAT Student Number SUNSHINE STATE STANDARDS Number Student Report Grade 08 .itlame nd Number lorido Comprehensive Assessment Test 60 - PALM BEACH This report shows your results from the FCAT Sunshine State Standards Test. 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. On the FCAT, you can attain one of five possible achievement levels. The table below shows the scale score ranges for each Student Achievement Level. Student Achievement Level Descriptions FCAT Student LEVEL 5: Performance at this level Indicates that the student has success with the most challenging content of the Sunshine State Standards. A Level 5 Achievement Levels student answers most of the test questions correctty, including the most challenging questions. Scale Score Ranges LEVEL 4: Performance at this level Indicates that the student has success with the challenging content of the Sunshine State Standards. A Level 4 student Reading Mathematics answers most of the questions correctly but may have only some success with questions that reflect the most challenging content Level 5: 394-500 371-500 LEVEL 3: Performance at this level Indicates that the student has partial success with the challenging content of the Sunshine State Standards, but Level 4: 350-393 347-370 performance Is Inconsistent A Level 3 student answers many of the questions correctly but Is generally less successful with questions that are Level 3: 310-349 310-346 most challenging. Level 2: 271-309 280-309 LEVEL 2: Performance at this level indicates that the student has limited success with the challenging content of the Sunshine State Standards. Level 1: 100-270 100-279 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 CONTENT SCORES State Number of Number of State Comparison: Points Points Comparison: Student Thirds Achievement Scale Possible Earned Thirds Level Score Lowest Middle Highest Reading Lowest Middle Highest Reading 4 383 I Words/Phrases 5 5 1 Mathematics 1 279 1 I Main Idea/Purpose 19 17 Comparlsons 9 9 1 If you took the test again, your scores might be slightly higher or lower than the scores on Reference/Research 8 6 I this report. However, your scores would probably fall within a certain range. For reading, your scale score should be between 354 and 412. For mathematics, your scale score should Mathematics be between 266 and 292. Number Sense 10 4 1 Measurement 10 4 1 The check marks (1 ) show If you scored In the lowest, middle, or highest third of grade 08 Geometry 6 2 ./ Fiends students who took this test. Algebraic Thinking 10 4 1 Data Analysis 8 1 1 The Content chart shows the number of points possible and the number of points earned for each category. Each question on this portion of the test was worth one point. The results on your performance items will be reported separately. Run Date: 04126/2001 0178747 EFTA01709933 Studcnt Name: FCAT WRITING Student I.D. No.: STUDENT REPORT School: District: PALM BEACH 2001 Grade 8 SCORE: 4.° WRITING TO EXPLAIN How Papers Are Scored Dear Student: The student responses arc scored by trained readers using the holistic method to evaluate The paper you wrote in February as part of the FCAT has been read a piece of writing for its overall quality. The readers consider four elements: focus, independently by two people trained to score this test. Each reader organization, support, 'and conventions. In this type of scoring, readers make a judgment judged the paper against a set of standards and gave it an overall about the entire response and do not focus on any one aspect of the writing. score. Your score is the average of the two readers' scores. Focus refers to how clearly the paper presents and maintains a clear main idea, This writing score will help you, your parents or guardians, and your theme, or unifying point. Papers representing the higher end of the point scale teachers understand how well you performed on this statewide writing demonstrate a consistent awareness of the topic and do not contain extraneous test. A description of how papers are scored is printed on the left information. side of this report. A description of each possible score is printed on the back of this report. Organization refers to the structure or plan of development (beginning, middle, and end) and whether the points are logically related to one another. Organization Remember, you were given 45 minutes to read the assigned topic, also refers to (I) the use of transitional devices to relate the supporting ideas to the plan what to write, and then write your response. The conditions main idea, theme, or unifying point and (2) the evidence of a connection between under which you write papers in class or at home may not be the sentences. Papers representing the higher end of the point scale use transitions to same as those for this test; therefore, the writing may not be the signal the plan or text structure and end with summary or concluding statements. same. You and your teachers should consider the score on this test along with all of your other writing when planning activities to Support refers to the quality of the details used to explain, clarify, or define. The continue developing your writing skills. quality of the support depends on word choice, specificity, depth, and thoroughness. Papers representing the higher end of the point scale provide examples and illustrations in which the relationship between the supporting ideas and the topic is clear. Conventions refers to punctuation, capitalization, spelling, and variation in sentence structure used in the paper. The conventions are basic writing skills DESCRIPTION OF THE TOPIC: included in Florida's Sunshine State Standards. Papers representing the higher end of the point scale follow, with few exceptions, the conventions of punctuation, You were asked to explain why capitalization, and spelling and use a variety of sentence structures to present one thing is special to you. ideas. RUN DATE 04/18/01 50-1691 EFTA01709934 Description of Grade 4 Writing Scores Description of Grade 8 Writing Scores Description of Grade 10 Writing Scores 6.0: The writing focuses on the topic, is logically organized, and 6.0: The writing focuses on the topic, is logically organized, and 6.0: The writing focuses on the topic, Is logically organized, and includes ample development of supporting ideas or examples. includes substantial development of supporting ideas or includes substantial development of supporting ideas or It demonstrates a mature command of language, including examples. It demonstrates a mature command of language, examples. It demonstrates a mature command of language with precision in word choice. Sentences vary in structure. including precision in word choice. Sentences vary in freshness of expression. Sentences vary in structure. There are Punctuation, capitalization, and spelling arg generally correct. structure. Punctuation, capitalization, and spelling are few, if any, usage, punctuation, or spelling errors. generally correct. 5.5: The writing was given a 5 by one reader and a 6 by the other 5.5: The writing was given a 5 by one reader and a 6 by the other reader. 5.5: The writing was given a 5 by one reader and a 6 by the other reader. reader. 5.0: The writing focuses on the topic with adequate development of 5.0: The writing focuses on the topic, is logically organized, and supporting ideas or examples. It has an organizational pattern, 5.0: The writing focuses on the topic with ample development of includes ample development of supporting ideas or examples. though lapses may occur. Word choice is adequate. Sentences supporting ideas or examples. It has an organizational pattern, It demonstrates a mature command of language. Sentences vary in structure. Punctuation, capitalization, and spelling are though lapses may occur. Word choice is adequate. Sentences vary in structure. Usage, punctuation, and spelling are generally correct. vary in structure. Punctuation, capitalization, and spelling are generally correct. generally correct. 4.5: The writing was given a 4 by one reader and a 5 by the other 4.5: The writing was given a 4 by one reader and a 5 by the other reader. 4.5: The writing was given a 4 by one reader and a 5 by the other reader. reader. 4.0: The writing focuses on the topic, though it may contain 4.0: The writing focuses on the topic, though it may contain loosely extraneous information. An organizational pattern is evident, 4.0:The writing focuses on the topic, though it may contain related information. An organizational pattern is apparent. but lapses may occur. Some supporting ideas contain specifics extraneous information. An organizational pattern is evident, . Some of the supporting ideas contain specifics and details, but and details, but others are not developed. Word choice is but lapses may occur. Some supporting ideas contain specifics others do not. Word choice is adequate. Sentences vary in adequate. Sentences vary somewhat in structure, though many and details, but others are not developed. Word choice is structure. Usage, punctuation, and spelling are generally are simple. Punctuation, capitalization, and spelling are usually adequate. Sentences vary somewhat in structure, though many correct. correct. are simple. Punctuation, capitalization, and spelling are usually correct. 35: The writing was given a 3 by one reader and a 4 by the other 35: The writing was given a 3 by one reader and a 4 by the other reader. reader. 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 3.0: The writing generally focuses on the topic, though it may contain loosely related information. An organizational pattern contain extraneous information. An organizational pattern has 3.0:The writing generally focuses on the topic, though it may is demonstrated. Development of the supporting ideas may be been attempted, but lapses may occur. Some of the supporting contain extraneous information. An organizational pattern has uneven. Word choice is adequate. There is some variation in ideas or examples may not be developed. Word choice is been attempted, but lapses may occur. Some of the supporting sentence structure. Usage, punctuation, and spelling arc adequate. Sentences vary somewhat in structure, though many ideas or examples may not be developed. -Word choice is generally correct. are simple. Punctuation and capitalization are sometimes adequate. Sentences vary somewhat in structure, though many incorrect, but most commonly used words are spelled correctly. are simple. Punctuation and capitalization are sometimes 2.5: The writing was given a 2 by one reader and a 3 by the other incorrect, but most commonly used words are spelled correctly. reader. 2.5: The writing was given a 2 by one reader and a 3 by the other reader. 2.5: The writing was given a 2 by one reader and a 3 by the other 2.0: The writing addresses the topic, though it may lose focus by reader. including extraneous infonnation. An organizational pattern is 2.0: The writing may be slightly related to the topic or offer little demonstrated. Development of the supporting ideas may be relevant information and few supporting ideas or examples. 2.0: The writing may be slightly related to the topic or offer little nonspecific. Word choice may be limited. Frequent errors may There is little evidence of an organizational pattern. Word choice relevant information and few supporting ideas or examples. occur in sentence construction, usage, punctuation, and spelling. may be limited or immature. Sentences may be limited to simple There is little evidence of an organizational pattern. Word constructions. Frequent errors may occur in punctuation, choice may be limited or immature. Sentences may be limited 1.5: The writing was given a I by one reader and a 2 by the other capitalization, and spelling. to simple constructions. Frequent errors may occur in reader. punctuation, capitalization, and spelling. 1.5: The writing was given a I by one reader and a 2 by the other 1.0: The writing addresses the topic, though it may lose focus by reader. 1.5: The writing was given a I by one reader and a 2 by the other including extraneous and loosely related ideas. The organizational reader. pattern is weak. Ideas arc presented through lists and limited or 1.0: The writing may only minimally address the topic because there is inappropriate word choice. Frequent errors may occur in sentence little or no development of supporting ideas or examples. No 1.0: The writing may only minimally address the topic because there is construction, usage, punctuation, and spelling. organizational pattern is evident. Ideas are provided through lists, little or no development of supporting ideas or examples. No and word choice is limited or immature. Unrelated information organizational pattem is evident. Ideas are provided through lists, U: The writing is unrelated to the assigned topic or cannot be read. may be included. Frequent errors in punctuation, capitalization, and word choice is limited or immature. Unrelated information and spelling may impede communication. may be included. Frequent errors in punctuation, capitalization, and spelling may impede communication. U: The writing is unrelated to the assigned topic or cannot be read. U: The writing is unrelated to the assigned topic or cannot be read. EFTA01709935 lilt bUIltJUL. IJI5 I ttIL• I UP 5 I UUCP.' I NUIVIISCFE: 41$ ' 163N PALM BEACH COUNTY 1 . 4) )4 VERIFICATION FOR NEW/RETURNING STUDENTS: TO THE PARENTS OR GUARDIANS: %sto,,I9NEW/RETURNING STUDENTS At,',,„ NEW STUDENTS: Complete all non-shaded areas on both sides of form . • REGISTRATION RETURNING STUDENTS: Please review both sides for correctness of typed information. If the information printed is incorrect please correct it by carefully • and lightly crossing out the Incorrect information and • .. CAft writing the correct Information above it. tti NPs A NAM CO ALSO XNOWN AS 12/ LOCAL AWNLESS (4) MAILING ADDRESS €a m e . ithit, h Nit am. 14 ill I.Ja I Pairil ' exteh TL IIAI( 3sL Kona I itIV 11411 1V St (6) ST firs SOCIAL SECURITY NO. (6) HOME PHONE NO. (71 SEX (1) RACE . (OPTIONAL aitalt 0 cofttARLICAVANDIZITC 0 A :ete:t7i:RISLANC CR , NON•HISAMOC were I MALE 0 B ittit-HISPANIC 0 H HIPANIC 0 M MULTIRACIAL DATE OF BIRTH 1101 PIKCE RICH MOM tx)eziPalm eeoeh T1- (TAU maim Be'etell (I l) RESIDENT STATUS (12) ENTRY DATE INTO USA 0. FOREIGN EXCHANGE STUDENT 2. OUT-OF-STATE RESIDENT I I. OUT-OF-COUNTY RESIDENT 3. IN-COUNTY RESIDENT I Hsi FEDERAL IMPACT AID SURVEY . .. - Ii us.. .10 Ualio A. THE STUDENT RESIDES ON FEDERAL PROPERTT. .. DYES • . B. THE STUDENT RESIDES IN LOW RENT HOUSING. ... I Its 04o C. THE PARENT IS EMPLOYED ON FEDERAL PROPEATT LOCATED IN PALM BEACH COUNTY. I i340 0. THE PARENT IS EMPLOYED ON LOW RENT 'MUSING LOCATED III PALM BEACH COUNTY. TES um B40 E. THE PARENT IS IN THE UNIFORMED SERVICES Of THE UNITED STATES. IF TES, IS THE PARENT ON ACTIVE NUTT? D ID 0 NO I AIR f ONCE 0 am! 0 COAST GUARD g MARINES 0 NATIONAL GUARD I NAVY ' 141 HAS THIS CHILD BEER ENROLLED IN ANY PRESCHOOL? . (PLEASE PLACE A CHICKMARK 1 yoM DY EACH PROGRAM ATTENDED. ALSO. INDICATE WITH AN ASTERISK 1 * ) TM PROGRAM TOUR CHILD WAS IN THE LONGER II? C. CHAPTER a I H. HEADSTART 0 0. OTHER I 0. PRE4 DISABILITIES I M. MIGRANT PRE-X g S. SUBSIDIZED CHILD CARE I E. PRE•R EARLY INTERVENTION 0 H. NON-SUBSIDIZED CHILD CARE LW 19 THE SMUT A SINGLE PARENT? 116) CURRENT ,1-A. GRADE LEVEE 0 TES gm .. CITY OR LOCATION OM DATE Of LAST ATTENDANCE M Reiff ) Pa Im 8eae_h leIV' UM NATE ATTENDED (DO) GRADE LEVEL 121) LAST PUBLIC SCHOOL ATTENNE0 IN PALM BEACH COUNTY 4 1\ - • A. ION %, (231 RAVE IOU FILLED GUT AN APPLICATION TOR FREE OR REDUCED LUNCH? I TES 01110 (APPLICATION IS PROVIDED WIEN THIS REGISTRATION FORM) 1241 SUM SCRIUMISS: I GIVE PERMISSION FOR MT CHILD TO BE GIVEN HEALTH SCREENINGS. THESE TESTS' MAT BE GIVEN INDIVIDUALLY OR IN GROUPS. WEER I NO (261 SODIUM MUORIOt: • ur run vn PWNW An IN THE SODIUM FLUORIDE PROGRAM WM NO EFTA01709936 BACK TRICE or PALM BEACH COUNTY - NEW/RETURNING STUDENTS REGISTRATION DOI STUD 4(1 WEE WITH ICKES& I 0 MOTHER 9 TAHITI. 0 SHARED CUSTODY . ;7 OTHER • [If OOHS PARENTS Wild lillleee SSW by RWIR a *Wu thta yawl (32 THERE A COURT ORDER SARUM EITHER PARENT WILE MOVUNC 0R WI TRANSPORTED IV, Stviint 1.41 be I aaaaa m• CONTACTING THE STUDENT 'DURING THE SCHOOL DAY? YES g NO M YES, PLEASE PROVIDE THE SCHOOL IRA A COPY OF THE COURT ORDER. MI FATHER/GUAROLAN DOES FATHER RAW CUSTODY? • YES oho ISO MOTHER/GUAROLTA: DOES Tina RAVE CUSTODY? . YES . NO -.... ...pat s... -- WIT r. (. 7. e-- Ili 1%/ /12 -3--L 3.19;1.14 .. . ...l T COTOM eRoj(Y I Piiii rk -FE_ 33q PI P lil liii. RAM OI SIQUIriNper IIIi.c. OPRIM ••••... igillina ll sega , eil MI HIGHEST LEVEE OF EDUCATION CORAL 1 P TONAL I36) HIGHEST LEVEL OF EDUCATION COMPlETIO IOPTMNNAII A0 sownr;SP.00i D Clac, FIR r' RroG ::(N A TO AO angTilt."`""x E n som moo mom C 0= = IMIWn L--I Kamm. Pou D 0 ' MK POST•STISISTAT DX r kwincr„A" E VII0IIIWICRIallt E 0 Tri7 4.`,":00 137) LEGAL GUARDIAN OF AM DOES LEGAL GUARDIAN HAVE CUSTODY/ 0 yEs ❑ NO TO WI ROW SUSS my sy • • NS, t. (.1:.•V, II J r 3 0tila 4a ' .. 4 1301Witic0PW09 'fr et :1reti.: e';';:2 .C. ".• • 4 ... va EurvoNtse POI ISO PART h PERSONIS1 OTHER THAN PARENT AUTHORIZED TO PICK UP STUDENT. IMPOIROT TM PASSWORD: INKRP I ADDRESS PHONE RELATIONSHIP tallES. ( ADDRESS Qh PROVE ( RELATIONSHIP al . 0 NO ce YES NS) ADDRESS ef P.6 =tr17r1C1203 ProhE RELATIONSHIP U YES MI NAVE ADDRESS P6LO PHONE 3i5-4¢r 0 RELATIONSHIP O ' NO • YES . 0 NO 1441 NAME ADDRESS PHONE RELATIONSHIP PI i—, YES 0 No No) PART II:IF SCHOOL PERSONNEL ARE UNABLE TO CONTACT YOU IN CASE OF ILLNESS OR NEciDENT, mix E EWE YOUR PERMISSION TO CALL YOUR . El .0 .No DOCTOR OR EMERGENCY SERVICES (II U FOR TRANSPORT 10 THE HOSPITAL/ YES RLIIIII.N.Ita 1551 PHONE NUMSER MN HOSPITAL THRTERRRIA `{Palms Ides4- • ISO/ IF YOUR CHID FERS FROM ANY ILLNESS. *LEWES OR HAS AMY PHYSICAL LIMITATIONS THAT WE SHOULD BE AWARE OF. PLEASE LIST: . • - 411511310 NVILL 1131110 33YRSTIV1 V 11.34S ATINIADIVI Icon mons in $log " 0 SjA 0 ON a atn !HMSO NVN1 N3N10 310119411 Anti Y ION DMUS IRA 1300 '1 13WOR 341 NI OISII inEWN3 WEI V3B10 391MSNY1 N• El 1 on "A O /Mug nvnewn ot, • EIVII50114 1053 HIL 01111 tINSONIS NU AO EKON 3111 NI 1Y1011rro ,o Ulna VII 19 AUNT 10 31V0 In/ mimes SI 39flISNVI LYNN fa. ,11;1• Eqi NI N31041 SI loYONOT ORM (Ea AgiVEMS sovneNvtAINCSAINnoo H0VD8 INTid:Oral.N3GOSA EFTA01709937 SEX: RACIAL/ETHNIC GROUP: 0 Hispanic STUDENT NUMBER: RACE: W SE O White Not Hispanic 0 Arnettan I ncliaiThative Aaskan BIRTHDATE: 0 Black Not Hispanic 0 AslanPadlia Islander Multi Racial ADDRESS: (use pencil in this space uniii final ) PHONE NUMBER: (optional) BIRTHDATE: VagBed by Binh Ceniticate: 0 Yes 0 No II No. What Type Verification? BIRTHPLACE: NAME OF EARENT(S) OR LEGAL QUARDIAN OR OTHER RESPONSIBLE ADULT AT HOME: CURR Name Street City Date First Entered This District &hoot Grade: Schott Grade: Schad: Grade Schaal: Grade: Schcot Grad. Schad Year: IS • Shoat Year 19 • School Year: 19 • School Year. I9 • SchoolYeer. 19 • Days Present Days Meant Days Present Days Absent Days Present Days Absent: Days Present Days Ateent: Days Present Days Absent COPY OF COPY OF COPY OF COPY OF COPY OF REPORT CARD REPORT CARD REPORT CARD REPORT CARD REPORT CARD INCLUDED INCLUDED INCLUDED : INCLUDED INCLUDED INDICATE INDICATE INDICATE INDICATE INDICATE Administrative Mmiristrailve MrenIstratiee AerninhaeW• AcksinisteiNe Placement (ADMP) Piecemeal (ADMP) Placement (ADMP) Placement (ADMP) Placement (ADM') Promote (P) Promote (P) Promote (P1 Promote (P) Promote (P) Resin (R) Raisin (R) Main (R) Retain (R) Retain (R) Special Session (S$) Special Session (55j Special Session (SS) Special Session (SS) Special Session (55) School: Grade: 50100t Grade: Scholl: Omer SCOW: Glade: Shoot Grans' School Year 19 • Deeds Year 19 - School Year. 19 School Year:19 • School Year IS ' Days Present Days Absent Days Present. Days ATAent Days Prewar: Days Absent Deis Resent Days Absent Days Present Days Absent: COPY OF COPY OF COPY OF COPY OF COPY OF REPORT CARD REPORT CARD REPORT CARD REPORT CARD REPORT CARD INCLUDED INCLUDED INCLUDED INCLUDED INCLUDED INDICATE INDICATE INDICATE INDICATE INDICATE AcIminiabetive Admirisvellvo Actrnineeative AdmInettelNe AcrnntsvatIm PlaCemenl (ADMP) Placement (ADMP) Placement (ADMP) Placement (ADMP) Placement (AIWA') Pron/cte (P) Promote (P) Promote (P) Promote (P) Promo:9(P) Rat" (R) Ratan (R) Retain (R) Rash (R) Retain (R) Special Session (SS) Special Session (SS) Special Session (SS) Special Session (SS) Special Session (SS) PESO 0919 (REV. 312(1,97) EFTA01709938 For Secondary Cumulative Grades: SEE STUDENT RECORD SCREENS GENERAL QUERIES ATTENDANCE A01 Student Name (District) A15 Daily Summary A02 Student Name (School) A16 Period Summary BASIC RECORD A17 Absence Detail A03 Demographics Al8 Absences (Class Hours) A04 General Assignments A19 Letter Preview (PRD ATD) A05 Contact Information TESTING A06 Health Information A20 Test Score Query A07 Assignment History A21 Test Score A08 Local Data Elements A2A Test Score Errors COURSES A22 Standard Mastery A09 Course Requests MISCELLANEOUS A10 Current Schedule A23 Special Programs Al 1 Interactive Scheduler A24 Discipline Al2 Current Grades A25 Fees and Fines A13 Academic History A26 RecognitiorVAchievement A14 Graduation Status A27 Letter History SPECIAL CHARACTERISTIC CARD STUDENT Place a red dot or red check in any area to denote that this student has additional information available ESE ESOL 504 DOP HEALTH MIGRANT OTHER 0 See ESE See 504 Confidential Fotdor See ESOL Folder Confidential Folder See DOP Folder See Health Flakier See Migrant A23 A23. A03 A23 A23 A06 A23 EFTA01709939 THE SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) (1) SIUUENT NUMUtH (2) SAC CODE. New and Returning Student Registration 1068 NEW STUDENTS: Complete all non-shaded areas on both sides of the form. RETURNING STUDENTS: Review both sides. If the pre-printed information is incorrect, correct the information by carefully and lightly crossing out the incorrect Information and writing the correct Information above it. DISTRIBUTION: STDT RUN DATE: 08/07/01 (3) STUDENTS LEGAL NAME oast frst Inkldle) (4) ALSO KNOWN AS (5) LOCAL ADDRESS NounRad (reel 0•444) OA 4O (nib) moo aro rose) ROYAL PALM BEACH FL 33411 (6) MAIM ADDRESS (ken no. a /toot name) (RP( no) (020 (aMS) (zip coda) (7) SCC1AL SECURITY NO. NON)Q0 (8) HOME TELEPI4ONE NO. Q)) SEX (10) RACE/ETHNIC ORIGIN W • O1-American Indian/Alaskan Native O B:BlicK Non-Hispanic O H-Hispanic F O A-Asian/Pacific Islander O W-White, Non-Hispanic O M-Multiracial on DATE OF ERRTH (12) PLACE OF WITH (aty. 5104 comity) (13) RESIDENT STATUS (14) LISA ENTRY DATE 3 (MLIaflnYYY) (IAMtCONYTY) O 0. Foreign Exchange Student WEST PALM BEACH FL US FLORIDA O 1. Out-ol-county Resident O 2. Out-of-state Resident (I5) FEDERAL IMPACT SURVEY O a In-county Resident YES NO (16) PRESCHOOL ENROLLMENT INFORMATION O O A. The student resides on federal property. Place en X by each program attended. Also, indicate with O O B. The student resides in low rent housing. an asterisk (*) the program your chid was in the longest. O O C. The parent is employed on federal property located In P.B. County. D N. Non-subsidized Child Care O M. Migrant Pre-K O O D. The parent is employed on low rent housing located In P.B. County. O D. Pre-K Disabilities O H. Headstart O O E. The parent Is in the uniformed services of the United States. O I. Pre-K Early Intervention O C. Chapter I ❑O S. Subsidized Child Care O O. Other O O If E. is YES, is the parent on active duty? Check service below: 07) IS THE STUDENT A NE) CURRENT GRADE LEVEL SEIGLE PARENT? No 0 Air Force O Army O Coast Guard O Marines 0 National Guard O Navy 09 O YES O NO LTSVOSINFORMAlla, (IS) NAME OF SCHOOL TRANSFERRING FROM V (20) CITY OR LOCATION (21) LAST ArrEiroANCE DATE (22) LAST GRADE LEVEL (23) LAST PUSUC SCHOOL ATTENDED IN PALM BEACHCOUNTY (24) DATE ATTENDED IN PBC MW4PAggN14041a0AVAlticiN , FREE OR REDUCED (25) Students will receive non-invasive heath screenings pursuant to Florida Statute 381.0056(7)(d). Non-invasive PRICE LUNCH • screenings may include vision, hearing, scoliosis, height, and weight. These tests may be gNen indwidualhi or (27) Have you filed out an in groups. Parents or guardians, however, have the right to request an exemption in writing. If you DO NOT application for free and want your chid to receive the screenings, mite the words 'Do not screen" here: (This exempthon MY cover all types of screenings) reduced lunch? • „..,_- O YES O NO (261 I give permission for my child to participate in the sodium fkoride prograin to prevent tooth decay. O YES . 10 (Application Is provided' (permission is mid through 6th grade) YES ii, with this form): tomilsovpa• (26) HOME LANGUAGE SURVEY A4MilaEoScii:PQVAn. .ear. ataraRattv.c , YES NO • O 1. Is a language other than EngIsh used in the home? ' If YES, what language? O O 2. Does the student have a first language other than English? If YES, what language? O O 3. Dces the student most frequently speak a language other than English? If YES, what lanoyepat.: '— Qin 4. What language is spoken in the home by the parent or guardian? (30) 5. What language is the student's first language? (32) STUDENT UVES WITH. (check one) (31) What Is the date of entry into an ESOL program? El Mother O Father O Both Parents (33) EINCL018I taEs FOR ENTRY INTO PEG SCHOOL DISTRICT YES NO O Other 00CUSTOOY STATUS OF STUDENT Knecic Aly , O O 1. Has the student ever been expelled from school? O O 2. Has the student ever had an arrest resulting in a charge? O Mother O Father O Shared Custody • O 3. Has the student ever had any juvenile Justice actions? O Other (35) Is there a court order barring either parent from removing or contacting the student during the school day? O YE$ O NO If YES, provide the school with a copy of the court order. PBSD 0636 (REV. 5/29/2001) page 1 of 2 EFTA01709940 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION (Y) FATHER OR LEGAL GUARDIAN (rest Madre mad MI0 (37) MOTHER OR LEGAL GUARDIAN dad made Med. 1630 a l PU: Y PU: 'V ADDRESS (sINwrimienber, steel twee *mimednumber) ADDRESS (strool number, stoat name, Warned Medea CITY STATE ZIP CODE CITY STATE ZIP CODE ROYAL PALM BEACH ' FL 33411 ROYAL PALM BEACH FL 33411 OCCUPATION OCCUPATION PLACE OF ELIOLDHAENT PLACE OF EMPLOYMENT HOME TELEPHONE BUSNESS TELEPHONE CELUPAGER NUMBER HOME TELEPHONE BUSINESSTELEPHONE CELUPAGER NUMBER EMAIL ADDRESS 0:9544190 EMAIL ADDRESS NON* INIKSENOWArfitg4 0 100Es C9SIQN Person(s) other than parent authorized to pick up student (38) PASSWORD (llra 10 characters) (39) NAME Hest melee MAW ma) (41) NAME (FEN middle SW 44 ADDRESS (street number. abed name, Apedmonf number) ADDRESS 01rot: number. seed mime, amtamed nungaa CITY STATE ZIP CODE CITY STATE ZIP CODE TELEPHONE RELATIONSHIP (40) AUTHORIZED FOR 1ELEPHONE RELAZONSHP (4Z AUTHORIZED FOR EMERGENCY PICKUP EMERGENCY PCICUP OTHER O YES O NO •If OTHER O YES O NO V (44) MEDCAL INFORMATION gist audenTs Menne hamar, haat (43) If school personnel are unable to contact you In case of illness or accident. ruin . emcees, medications. or oMeephysbel emEdkam) may we have your permission to call your doctor or emergency services (911 for transport to the hospital? O YES • O NO (45) PANAY PHYSICIAN (48)PHYSCIAN PHONE (48) Does your child currently have health insurance? O YES O NO If YES, indicate: (47) HOSPITAL PREFERENCE O Medicaid O Private O Healthy Kldsfiad Care O Interested In receiving information worsompospwnwcoamosotrama-g4stgoostitsomot5k 4-1 STUDENT NO. (opt,o1.; ) WIN/WEOF CIAD (rest mW4. WO SCHOOL ATTENDING I GRADE DATE 0? 9IRTH 11 (SO) NAME OF 0 11.0 (Mg middle, MN) SC Pl i STUDENT NC). (cptcoa3 GRADE DATE OF hikl H (SI) NAME OF CHILD ((kg made M10 SCHOOL ATTENDING STUDENT NO. (4040043 GRADE DATE OF BIRTH (52) NAME OF CHILD deg made, !am) SCHOOL ATTENDING STUDENT NO. (aprons,) GRADE DATE OF GIRTH PARENT/GUARDIAN SIGNATURE 4E0. .$tiEt.I0aftCOTNM: .., i Niro. (54)S csej on IN (59K.A. I verify that the information given 55)U wb S 59 WTRY E01 ". " 0687 2701 09 01 is true and accurate to the best of my knowledge. (60) TEACHER MO. ‘61)REISSIGN COVE (62 TRANSPORTATION (63( BM VEIN. (61) INS O PSC els s O Palm Tian 1 2 3 4 5 A O Parent/Student Trars. O Walk O Bike 6 7 8 9 7 BZ (65) DOOMENTA110:1 CHECKLIST (thetk and tble 41/4 4 rtteNS) O Immunizahons (date) O BIrth Records Veil. (de e) • Soc. Sec. No. (date) O Physical Exams (date) IPIIIIIIIHIS g L b (65) DATA ENTRY COMPLETED BY DATE S A TURE OF PARENT/GUAR/YAM DATE PBSD 0636 (REV. 4'6/20015/2912001) page 2 of 2 EFTA01709941 ilm•••'Mr INN tacl.Score Report Plus r. 'Preliminary SAT/National Merit Scholarship Qualifying Twit . Get the Most Out of Your Score Report! INSIDE: the results of the PSAT/NMSCIT. you took in October • Your Scores is Review Your Answers • Use this report together with your test book to review your answers. ■ Improve Your Skills The areas for improvement listed in each section are unique to you; they are based on your performance on the test. OUTSIDE: more information about • Test Scores • ritiSC Scholarship Programs in Planning for College and Careers EFTA01709942 ... • no • • %no • Ate r ineats smewn quAsun r T - Pecrir Amu Kt I MINIMS STUDENT REGISTRATION (36) FATHER OR LEGAL GUARDIAN 0144 MUMMY( MO (37) MOTHER OR LEGAL GUARDIAN OR mMdlo *WM bsQ PU: Y PU: Y ADDRESS (Oval numb:4 MootImmo, opmintoM ewes**) ADDRESS M.Yeei number a boot name. end/non( numbs) CRY STATE DP CODE CITY STATE ZIP CODE ROYAL PALM BEACH FL 33411 ROYAL PALM BEACH FL 33411 OCCUPATION OCCUPATION PLACE OF EMPLOYMENT PLACE OF EMPLOYMENT DOME TELEPHONE BUSR4ES3 TELEPHONE CELUPAGER NUMBER . HOME TELEPHONE BUSINESS TELEPHONE CELLaPAGER ((LIMBER EMAIL ADDRESS (opticaaQ EMAIL AGGRESS 006oniN AMERG,ENDY<HEALTHAND SAFETY,INFORMATION,, Person(s) other than parent authorized to pick up student (38) PASSWORD (Unit 10 characters) pm NAME fest middle In KM les0 MN NAME (MA mickNoinfiaf IasQ ADDRESS (sin*MS, steelimam apalmene nombef) ADDRESS Nisei number. nee( name. Anil:nerdnomtv0 CITY STATE VP CODE CITY STATE ZP CODE TELEPHONE RELATIONSHIP (40) AUTHOECCED FOR TB.EF140hE RELATIONSHIP (42) AUTHORIZED FOR EMERGENCY PICKUP OTHER 0 YES 0 NO Y OTHER 0 YES 0 NO V (44) AIECOCAL INFORMATION OAS sluctenrs Nnesses, MANNA bees, (43) If school personnel we unable to contact you in case of limes cc accident, Magic% Am1"cations. o-oilsphySkANANAWAAM may we have your permission to cal your doctor ct emergency services (91 ) for transport to the hospital? 0 YES 0 NO (45) FAMA.Y PHYSICIAN (46) PHYSICIAN PHONE (48) Does your child currently have health insurance? MI YES 0 NO If YES, indicate: (47) HOSPITAL PREFERENCE 0 0 Medicaid Private 0 Healthy Kids/kQd Care 0 Interested In receiving information ASWALOA491.4:04iiit lit (49) NAME CF CHILD(Mg mild*, t330 filierAlaffiblikr0S-1-101)1; . SCHOOL ATTENDING STUDENT NO. (*100.0 GRADE DATE OF BIRTH .. tc * :iitc2t/144 1:a..6 ,0 &cell 44 igh U. MN ere) NAME CF CHILDKis( middle. MO G STJOB4T NO. (*100.0 GRADE DATE CF BIRTH (SI) NAME OF CHAA)(Cnt middle. Imo SCHOOL AlTENDWG MOST NO. OptionaQ GRADE DATE OF 8RTH (52) NAME CF CHILD pest middle, lasts SCHOOL ATTENDING STUDENT NO. (opeons0 GRADE DATE OF BIRTH PARENT/GUARDIAN SIGNATURE FOR OFEIGMAE"ONLY.' kJ. BB SIICENT NO. 6) ENTRY CD t 57) WRY DATE 03) GR IV PK CAL I verify that the information given us EO1 O8/14/O1 O9 01 is true and accurate to the best of my knowledge. (60FTEACNER NO. (61)REASSIGMCCCE (67)TRANSPORTATION (aBEM VERF. 0SI) ISS 0 PSC Bust 0 Palm Tian 1 2 3 4 61 A 0 Parent/Sludent Trans. 0 Walk III Elks 6 7 8 9 T BZ PSI DOCIALEITATION CHECKLIST(P.4 YdPo ALP Ncei.e8 0 Immunizations (date) 0 Birth Records Verif. (date) '0 Soc. Sec. No. (date) 0 Physical Exams (date) PP DATA EMMY COMPLETED BY DATE it eillSk( 771RE OF PARENT•GUAROMN DATE page 2 of 2 P88O O636 (REV. 4/6/2OO16(29/2OO1) EFTA01709943 IIIt bcl-IVUL LAU I KIL: I tar PALM btAL:11 QUUN I Y (SUF'UC) i(_,stam1)) New and Returning Student Registration 1088 NEW STUDENTS: Complete all non-shaded areas on both sides of the form. ' RETURNING STUDENTS: Review both sides. If the pre-printed information is incorrect, correct the Information by carefully and lightly S.air 001 crossing out the Incorrect Information and writing the correct Information above it. DISTRIBUTION: STDT RUN DATE: 08/07/01 (3) STUDENTS LEGAL NAME (lest trig middb) (4 ALSO KNOWHAS I (5) LOCAL ADDRESS (house no. St nee name) (apt no) 0 11)0 (stale) (zip code) ROYAL PALM BEACH FL 33411 (6) MAILING ADDRESS (house no it steel name) OW no) 91110 (stab) ' PIP code) (r) SOCIAL $EGURITY HD WOO* (8) NOME TELEPHONE NO. (0) SEX (10) RACE/B- 04NC ORIGIN W • O I -American Indian/Alaskan Native O Warrick, Nor.-Hispanic O H-Hispanic ll r O A-AsiarUPacific Islander O W-White, Non-Hispanic O M-Multiacial (1)DATE Cf 011114 (12) PLACE CC MTN rag so* county) (13) RESIDENT STARS (14) USA ENTRY DATE itAINDONYYY) 3 (01/DantYYY) CI O. Foreign Exchange Student WEST PALM BEACH FL US FLORIDA O 1. Out-of-county Resident O 2. Out-of-state Resident (15) FEDERAL IMPACT SURVEY O 3. In-county Resident YES NO (1131 PRESCHOOL ENROLLMENT INFORMATION O O A. The student resides on federal property. Place an X by each prcgram attended. Also, Indicate yeah • O B. The student resides in low rent housing. an asterisk (') the program your chid was in the longest. • 0 C. The parent is employed on federal property located in P.B. County. O N. Non-subsidized Child Care O M. Migrant Pre-K O O D. The parent is employed on low rent housing located In P.B. County. O D. Pre-K Disabilities O H. Headstart O O E. The parent is in the uniformed services of the United Slates. O I. Pre-K Early Intervention O C. Chapter 1 O S. Subsidized Child Care O 0. Other O O If E. is YES, is the parent on active duty? Check service below: 07) (SYNE STUDENT A 08) CURRENT GRADE LEVEL 0 Air Force O Army II Coast Guard MI Marines O National Guard O New SIN3LE PARENT? No 09 O YES O NO asIVII:O.KatiartgrifektOfriarCal4 , rdWill , ' A ' ,,.-7., , ,,, tact;:vi: (19) NAME OF SCHOOL TRANSFERRING FROM (20) CITY OR LOCATON (2I ) LAST ATTENDANCE DATE (22) LAST GRADE LEVEL (23) LAST PUBLIC SCHOOL ATTENDED IN PALM BEACH COUNTY (24) DATE ATTENDED IN PBC VcgtificcBgENRWNEPRAMICAtin ?I'I mi /es.* qEE OR REDUCED (25) Students will receive non-invasive health screenings pursuant to Florida Statute 381.0056(7)(d). Non-invasive DICE. LUNCH screenings may include vision, hearing, scoliosis, height, and weight. These tests may be given individually or in groups. Parents or guardians, however, have the right to request an exemption in writing. If you DO NOT (2?) Have you filed cut :::-. application for free and want your child to receive the screenings, write the words to not screen' herhere: (This exemption MI cover 0 types of screenings) reduced lunch? O YES O NO. (26) I give permission for my child to participate in the sod= fluoride prograin to prevent tooth dimy. O YES L 'NO (Application is provided • (pemttssion is valid through 6th grade) YES Al with this form EACH coliNtie . .... ,,. :. Yr '1.: > _ 1 -, (93) HOME LANGUAGE SURVEY YES NO O 0 1. Is a language other than English used in the home? If YES, what language? • O 2. Does the student have a first language other than English? If YES, what language? O O 3. Does the student most frequently speak a language other than English? If YES, what langtitig1;; (2c) 4. What language is spoken in the home by the parent or guardian? poi 5. What language is the student's first language? (32) STUDENT LIVES %1111. &Saone) (31) What is the date of entry Into an ESOL program? O Mother O Father O Both Parents (33) DISCLOSURES FOR ENTRY INTO PBC SCHOOL DISTRICT YES NO O Other O • 1. Has the student ever been expelled from school? (94) CUSTODY SIMS OF STUCENT (check oi6):. O O 2. Has the student ever had an arrest resulting in a charge? • Mother D Father • Shared Custody O O 3. Has the student ever had any jwentle justice actions? O Other (35) Is I here a court order barring either parent from removing or contacting the student during the school day? O YES O NO II YES, provide the school with a copy of the court order. PBSD 0636 (REV. 5/29/2001) page1012 EFTA01709944 Spring 2003 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Grade 10 Student Report 50-PALM BEACH The Florida Department of that student has the ability to learn and succeed. The purposeof the FCAT Is to ensurethat Florida's public schools arem providing the best uca on possible, and preparing students to succeed in the competitive 21st Century job market. Working with teachers, the State has developed a measurement system that allows you to track a student's academic achievement from year to year and determine if a year's worth of learning has occurred In a year's time. This system also allows you to compare a student's score to a score that represents 'grade lever achievement. If a students score is above the 'grade level' score, then they are performing at a level above thrOr current grade. If a is below, they are In need of improvement. Using the 'Content Scores,' you are able to Identify any specific academic skills needing improvement. Below you will find your 2003 FCAT Reading and Mathematics scores as well as your scores from previous years. The chart on the right side of the page shows your score compared to the score that represents "grade level achievement. Congratulations! You have passed the Reading test and your score Reading is above grade level. You have answered most of the questions C11 FCAT correctly. 2003 Reading Content Scores Content Areas Points Points Possible Earned FCAT Score 2000 Words/Phrases 9 7 Main Idea/Purpose 14 11 tS00 Comparisons 13 12 ReferencelResearch 16 13 Year 2001 2002 2003 Grade Tested 8 9 10 Achievement Level 4 2 4 Grade 3 Grads 4 Credo 6 Grade 6 Grads 7 Grade 8 Grade 9 Gracie t0 11+ FCAT Score' 2233 1961 2262 • Your Score CI On Grade Level Congratulations! You have passed the Mathematics test; however, your achievement needs improving. Talk to your teacher or guidance Mathematics counsebr about classes you should take to better prepare you for college or a career. 3000 2003 Mathematics Content Scores Points Points 23 Content Areas Earned Number Sense 11 6 2000 FCAT Score Measurement 10 • 2 Geometry 14 5 Algebraic Thinking 14 6 Data Analysis 10 11 7 Year 2001 2002 2003 Grade Tested 8 9 10 Achievement Level 1 3 2 Oracle One. 4 • Oracle 5 • Grade I Oruro 7 • Grade FCAT Score • 1732 1998 1934 • Your Score O On Grade Level These scores show your achievement on the day you were tested. If you had taken this test numerous times, it Is likely that all of your scores would have been within a certain range. Your 2003 FCAT Reading scores probably would have been between 2170 and 2354. Your 2003 FCAT Mathematics scores probably would have been between 1893 and 1976. NT= Not Tested NR =Not Reported NA= Data Not Available Data Run Date: 05/09/2003 0164772 EFTA01709945 FCAT Reports Informes FCAT (Spanlsh) Rapò FCAT (Haitian Creole) Separate reports are produced for the Sunshine State Se preparan informes separados para los exåmenes del FCAT Yo prepare rapò apa pou egzamen lekti ak matematik, syans Standards tests in FCAT Reading and Mathematics, de lectura y matemäticas, ciencias y redacción según las ak redaksyon FCAT bay swivan prensip Sunshine State Science, and Writing. A separate report is also printed normas estatales Sunshine State Standards. También se Standards yo. Yo ekri yon rapb apa tou pou lekti ak matematik for the norm-referenced tests in Reading and imprime otro informe por separado para los exåmenes de lectura pou "modet egzamen ofisyél FCAT itilize pou fé evalyasyon" Mathematics. y matemåticas de acuerdo a las normas de aplicación nacional. an. Informe sobre el FCAT cefildo a normas de aplicación FCAT Norm-Referenced Test (NRT) Report The FCAT naclonel (NRT) El informe del FCAT NRT presenta los Rapò egzamen ofisyél FCAT itilize pou fé evalyasyon NRT report shows reading and mathematits scores on resultados de lectura y matemäticas en una versión del estado (NRT) Rapb FCAT NRT a montre nbt lekti ak matematik nan a Florida version of the SAT9 (published by Harcourt de Florida del SAT9 (publicada por Harcourt Educational vésyon Florida genyen pou SAT9 la (Se Harcourt Educational Educational Measurement). Student scores are Measurement). Los resultados obtenidos por los estudiantes se Measurement ki pibiliye h.) Yo konpare nöt elev la ak yon compared to a national "norm" group, where a percentile comparan con el grupo modelo o "norma-, en el que la gwoup nöt yo konsidere kbm "modél pou egzamen ofisyél" la, rank store of 50 is average. cladficación es de un 50% del promedio. kota swivan klasman pa pousantaj la, nbt mwayén nan se 50. Sunshine State Standards (SSS) Reports The FCAT Informes segån las normas estatales Sunshine State Rapò Sunshine State Standards (SSS) Rap() FCAT SSS SSS Reading, Mathematics, and Science reports show Standards (SSS) Los Informes según las normas estatales pou kid, matematik ak syans lan montre nöt elev yo fò nan test scores from Florida's tests of academic standards. SSS del FCAT presentan las calificaciones de los exåmenes de egzamen Florida bay sou prensip akademik yo. Rap() sa yo These reports contain subject scores and content lectura, matemåticas y ciencias de las normas académicas de gen nbt pou matyé ak nöt pou kontni ladan yo. Nbt pou matyé scores. Subject scores describe the overall Florida. Estos inlormes contienen calificaciones por materias y yo dekri tout sa elev la reyalize anjeneral epi nöt pou kontni yo calificaciones por contenido. Las calificaciones por materia bay kantite pwen elev la fé nan yon matyé byen detémine. Ou achievement, and content scores give the number of proporcionan un resumen general del rendimiento y las points earned in specific skilt areas. Success on the calificaciones por contenido que proveen el numero de puntos ka konprann kisa elev la reyalize nan egzamen lekti ak Reading and Mathematics tests can be best understood obtenidos en åreas de habilidades especificas. El éxito de los matematik la pi byen si w itilize yon nivo siksé kote 3 oswa plis by using the achievement levels where a 3 or higher is exåmenes de lectura y matemåticas puede entenderse mejor se yon nöt ki nan nivo klas la oswa yon nöt ki pi wo pase nivo on or above grade level. utilizando los nlveles de rendimiento en los que una calificación klas la. Achievement Levels Five categories of achievement de 3 o superior estå al nivel del grado o por encima. Nivo siksé elév yo Gen senk kategori siksé ki dekri nivo describe the success students have with the content Niveles de rendimiento El éxito que un estudiante ha logrado siksé elev yo pote nan kontni yo teste nan egzamen lekti ak tested on the FCAT Reading and Mathematics. Level 5 en el contenido examinado en el FCAT de lectura y matemåticas matematik FCAT la. Pi gwo nivo a se nivo 5 epi pi piti nivo a is the highest and Level 1 is the lowest. Since science se describe por medio de tinto categorfas. El nivel 5 es el mås se nivo 1. Piske yo poko detéminen nivo siksé nan egzamenn achievement levels have not been determined, science alto y el nivel 1 es el mås bajo. Como los niveles de rendimiento syans lan, yo klase nöt pou syans lan swivan si Ii tonbe pi ba, en ciencias no se han determinado, las callficaclones de scores are ranked as to whether they fall in the lowest, ciencias se clasifican con respecto a si entran dentro del tertio nan mitan oswa pi wo yon tyé péfömans elév toupatou nan eta middle, or highest third of statewide student inferior, medio o superior del rendimiento estudiantil a nivel a. performance. estatal. 5 Elév sa a gen siksé nan matyé kl te gen pi plis difikilte ladan yo nan egzamen Sunshine State Standards la. Yon elév ki 5 This student has success with the most challenging content 5 Este estudiante tiene éxito con el contenido mås difícil de las nan syém Nivo reponn pifö kesyon egzamen yo of the Sunshine State Standards. A student scoring in Level normas Sunshine State Standards. Un estudiante del Nivel 5 kbrékteman, elev la menm reponn kesyon kl gen pi plis 5 answers most of the test questions correctly, including the responde a la mayorfa de las preguntas del examen difikilte ladan yo. most challenging questions. correctamente, incluyendo las preguntas mås dificiles. 4 Elév sa a gen siksé nan matyé ki te gen difikilte ladan yo 4 This student has success with the challenging content of the 4 Este estudiante tiene éxito con el contenido difícil de las nan egzamen Sunshine State Standards la. Yon elev ki nan Sunshine State Standards. A student scoring in Level 4 normas Sunshine State Standards. Un estudiante del Nivel 4 responde a la mayorfa de las preguntas correctamente, pero 4yern Nivo reponn pifb kesyon egzamen yo köréldeman, answers most of the test questions correctly, but may have men Ii ka gen kök siksé sélman nan kesyon ki sanble yo gen only sonve success with questions that reflect the most es.posible que solo tenga cierto éxito con las preguntan que reflejan el contenido mås diffcil. pi plis difikilte ladan yo. challenging content. 3 Este estudiante tiene un éxito parcial con el contenido diffcil 3 Elev sa a gen enpe siksé nan matyé ki gen difikilte ladan yo 3 This student has partial success with the challenging de las formas Sunshine State Standards, pero su rendimlento nan egzamen Sunshine State Standards la, men péfémans content of the Sunshine State Standards, but performance es inconsistente. Un estudiante del Nivel 3 responde muchas Ian pa rete estab. Yon elév ki nan 3545m Nivo reponn anpil is inconsistent. A student scoring in Level 3 answers meny de las preguntas del examen correctamente, pero por lo nan kesyon egzamen yo körékteman, men anjeneral li gen of the test questions correctly, but is generally less general tiene menos éxito con las preguntas que son mås mwens siksé ak kesyon ki sanble yo gen pi plis difikilte ladan successful with questions that are the most challenging. dificiles. yo. 2 This student has limited success with the challenging 2 Este estudiante tiene éxito limitado con el contenido difícil de 2 Elév sa a gen siksé limite nan matyé ki gen difikilte ladan yo content of the Sunshine State Standards. las normas Sunshine State Standards. nan egzamen Sunshine State Standards la. 1 This student has little success with the challenging content 1 Este estudiante tiene poco éxito con el contenido dificil de las 1 Elév sa a gen yon ti siksé tou piti nan matyé ki gen difikilte of the Sunshine State Standards. normas Sunshine State Standards. ladan yo nan egzamen Sunshine State Standards la. FCAT Certificates Students who earn Level 5 scores or Certificados del FCAT Los estudiantes que se claslflquen en el Nivel 5 o cuyos resultados de ciencias sean superiores a 400, Sétifika FCAT Elév ki fé nöt syöm Nivo oswa elev ki fé gwo whose science scale scores are greater than 400 receive reciben Certificados de rendimiento. En redacción, los nöt ki pi plis pase 400 nan syans ap resevwa Sétifika pou Certificates of Achievement. For writing, certificates are given certificados se otorgan a lodos los estudlantes que han obtenido Siksé. Yo bay tout elev ki fé nöt 5.5 oswa 6 ak elév klas to all students with scores of 5.5 or 6 and to fourth graders with calificaciones de 5.5 y 6, y a los estudiantes de cuarto grado que katriyém ki fé nöt 5, 5.5, ak 6 yon sétifika pou redaksyon. Yo scores of 5, 5.5, and 6. Certificates are not awarded based on han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados pa bay sétifika swivan nät elev fé nan egzamen ki baze sou the FCAT Norm-Referenced Test scores. en los resultados del FCAT ceilido a normas de aplicación "modél egzamen ofisyél FCAT itilize pou fé evalyasyon" (NRT) nacional. an. EFTA01709946 Sludent Spring 2003 Florida Comprehensive Assessment Test (FCAT) U/11 et Sunshine State Standards School Name and Number Grade 10 Student Report sr am 50-PALM BEACH The Florida Department of Education believes that every student has the ability to learn and succeed. The purpose of the FCAT is to ensure that Florida's public schools are providing the best education possible, and preparing students to succeed in the competitive 21st Century job market. Working with teachers, the State has developed a measurement system that Includes reading, writing, mathematics, and science. This report allows you to compare a student's score to other students in the state. Using the 'Content Scores; you are able to Identify any specific academic skills needing improvement Below you will find your 2003 FCAT Science scores. The chart on the right side of the page shows your score compared to the average score this year. Science Score 500 State Comparison 460 Score. lowest Middle Highest 400 278 i 360 300 The Score is a number between 10.1 and 500. 250 203 150 100 Student's Score Slate Average Science Content Scores Content Areas Points Points State Comparison Possible Earned Lowest µiddle Highest Physical and Chemical 12 3 i Earth and Space 13 5 i We and Environmental 13 7 ,/ Scientific Thinking 13 7 i • These scores show your achievement on the day you were tested. if you had taken this test numerous times, It Is likely that all of your scores would nave been within a certain range. Your 2003 FCAT SSS Science scores probably would have been between 261 and 295. Data Run Date: 05/09/2003 0060359 EFTA01709947 FCAT Reports Informes FCAT (SpanIsh) Rapó FCAT (Haitian Creole) 3eparate reports are produced for the Sunshine State Se preparan informes separados para los exámenes del FCAT Yo prepare rapo apa pou egzamen lekti ak matematik, syans Standards tests in FCAT Reading and Mathematics, de lectura y matemáticas, ciencias y redacción según las ak redaksyon FCAT bay swivan prensip Sunshine State Science, and Writing. A separate report is also printed normas estatales Sunshine State Standards. También se Standards yo. Yo ekri yon rapé apa tou pou lekti ak matematik or the norm-referenced tests in Reading and imprime otro informe por separado para los exámenes de lectura pou "modöl egzamen ofisyél FCAT itilize pou fé evalyasyon" dathematics. y matemáticas de acuerdo a las normas de aplicación nacional. an. Informe sobre el FCAT ceñido a normas de aplicación Rapó egzamen ofisyél FCAT itilize pou fé evalyasyon :CAT Norm-Referenced Test (NRT) Report The FCAT nacional (NRT) El informe del FCAT NRT presenta los klIRT report shows reading and mathematics scores on resultados de lectura y matemáticas en una versión del estado (NRT) Rapé FCAT NRT a montre nät lekti ak matematik nan Florida version of the SAT9 (published by Harcourt de Florida del SAT9 (publicada por Harcourt Educational vésyon Florida genyen pou SAT9 la (Se Harcourt Educational Educational Measurement). Student scores are Measurement). Los resultados obtenidos por los estudiantes se Measurement ki pibiGye II.) Yo konpare nät elév la ak yon :ompared to a national "norm" group, where a percentile comparan con el grupo modelo o "norma", en el que la gwoup nät yo konsidere köm "modöl pou egzamen ofisyél" la, ank score of 50 is average. clasificación es de un 50% del promedio. kote swivan klasman pa pousantaj la, nät mwayén nan se 50. 3unshine State Standards (SSS) Reports The FCAT Informes según las normas estatales Sunshine State Rapó Sunshine State Standards (SSS) Rapé FCAT SSS 3SS Reading, Mathematics, and Science reports show Standards (SSS) Los informes según las normas estatales pou lekti, matematik ak syans lan montre nät elév yo få nan est scores from Florida's tests of academic standards. SSS del FCAT presentan las calificaciones de los exámenes de egzamen Florida bay sou prensip akademik yo. Rapi, sa yo (hese reports contain subject scores and content lectura, matemáticas y ciencias de las normas académicas de gen nät pou matyé ak nät pou kontni ladan yo. Nät pou matyé ;cores. Subject scores describe the overall Florida. Estos informes contienen calificaciones por materias y yo dekri tout sa elév la reyalize anjeneral epi nät pou kontni yo calificaciones por contenido. Las calificaciones por materia ichievement, and content scores give the number of proporcionan un resumen general del rendimiento y las bay kantite pwen elév la fé nan yon matyé byen detémine. Ou mints earned in specific skill areas. Success on the calificaciones por contenido que proveen el número de puntos ka konprann kisa elév la reyalize nan egzamen lekti ak Reading and Mathematics tests can be best understood obtenidos en áreas de habilidades específicas. El éxito de los matematik la pi byen si w itilize yon nivo siksé kote 3 oswa plis using the achievement levels where a 3 or higher is exámenes de lectura y matemáticas puede entenderse mejor se yon nät ki nan nivo klas la oswa yon nät ki pi wo pase nivo in or aboye grade level. utilizando los niveles de rendimiento en los que una calificación klas la. achievement Levels Five categories of achievement de 3 o superior está al nivel del grado o por encima. Nivo siksé elév yo Gen senk kategori siksé ki dekri nivo iescribe the success students have with the content Niveles de rendimiento El éxito que un estudiante ha logrado siksé elév yo pote nan kontni yo teste nan egzamen lekti ak ested on the FCAT Reading and Mathematics. Level 5 en el contenido examinado en el FCAT de lectura y matemáticas matematik FCAT la. Pi gwo nivo a se nivo 5 epi pi piti nivo a s the highest and Level 1 is the lowest. Since science se describe por medio de cinco categorías. El nivel 5 es el más se nivo 1. Piska yo poko detéminen nivo siksé nan egzamenn whievement levels have not been determined, science alto y el nivel 1 es el más bajo. Como los niveles de rendimiento syans lan, yo klase nät pou syans lan swivan si li tonbe pi ba, :cores are ranked as to whether they fall in the lowest, ciencias en ciencias no se han determinado, las calificaciones de nan milan oswa pi wo yon tyé péförnans elév toupatou nan eta se clasifican con respecto a si entran dentro del tercio niddle, or highest third of statewide student inferior, medio o superior del rendimiento estudiantil a nivel a. ierformance. estatal. 5 Elév sa a gen siksé nan matyé ki te gen pi plis difikilte ladan yo nan egzamen Sunshine State Standards la. Yon elév ki i This student has success with the most challenging content 5 Este estudiante tiene éxito con el contenido más difícil de las nan 5yém Nivo reponn pito kesyon egzamen yo of the Sunshine State Standards. A student scoring in Level normas Sunshine State Standards. Un estudiante del Nivel 5 körékteman, elév la menm reponn kesyon ki gen pi plis 5 answers most of the test questions correctly, including the responde a la mayoría de las preguntas del examen difikilte ladan yo. most challenging questions. correctamente, incluyendo las preguntas más difíciles. 4 Elév sa a gen siksé nan matyé ki te gen difikilte ladan yo This student has success with the challenging content of the 4 Este estudiante tiene éxito con el contenido difícil de las nan egzamen Sunshine State Standards la. Yon elév ki nan Sunshine State Standards. A student scoring in Level 4 normas Sunshine State Standards. Un estudiante del Nivel 4 responde a la mayoría de las preguntas correctamente, pero 4yém Nivo reponn pito kesyon egzamen yo körékteman, answers most of the test questions correctly, but may have men II ka gen kök siksé sélman nan kesyon kl sanble yo gen only some success with questions that reflect the most es posible que sólo tenga cierto éxito con las preguntan que reflejan el contenido más difícil. pi plis difikilte ladan yo. challenging content. 3 Este estudiante tiene un éxito parcial con el contenido difícil 3 Elév sa a gen enpe siksé nan matyé ki gen difikilte ladan yo 1 This student has partial success with the challenging de las normas Sunshine State Standards, pero su rendimiento nan egzamen Sunshine State Standards la, men påfomans content of the Sunshine State Standards, but performance es inconsistente. Un estudiante del Nivel 3 responde muchas lan pa rete estab. Yon elév Id nan 3yém Nivo reponn anpil is inconsistent. A student scoring In Level 3 answers many de las preguntas del examen correctamente, pero por lo nan kesyon egzamen yo kärékteman, men anjeneral li gen of the test questions correctly, but is generally less general tiene menos éxito con las preguntas que son más mwens siksé ak kesyon kl sanble yo gen pi plis difikilte ladan successful with questions that are the most challenging. difíciles. yo. ! This student has limited success with the challenging 2 Este estudiante tiene éxito limitado con el contenido difícil de 2 Elév sa a gen siksé limite nan matyé ki gen difikilte ladan yo content of the Sunshine State Standards. las normas Sunshine State Standards. nan egzamen Sunshine State Standards la. This student has little success with the challenging content 1 Este estudiante tiene poco éxito con el contenido difícil de las 1 Elév sa a gen yon ti siksé tou piti nan matyé ki gen difikilte of the Sunshine State Standards. normas Sunshine State Standards. ladan yo nan egzamen Sunshine State Standards la. :CAT Certificates Students who earn Level 5 scores or Certificados del FCAT Los estudiantes que se clasifiquen en SétIfIka FCAT Elév ki fé nät 5yém Nivo oswa elév ki fé gwo el Nivel 5 o cuyos resultados de ciencias sean superiores a 400, vhose science scale scores are greater than 400 receive reciben Certificados de rendimiento. En redacción, los nät ki pi plis pase 400 nan syans ap resevwa Såtifika pou Artificates of Achievement. For writing, certificates are given certificados se otorgan a todos los estudiantes que han obtenido Siksé. Yo bay tout elév ki fé nät 5.5 oswa 6 ak elév klas o all students with scores of 5.5 or 6 and to fourth graders with calificaciones de 5.5 y 6, y a los estudiantes de cuarto grado que katriyém ki fé nät 5, 5.5, ak 6 yon sétifika pou redaksyon. Yo :cores of 5, 5.5, and 6. Certificates are not awarded based on han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados pa bay sétifika swivan nät elév fé nan egzamen ki baze sou he FCAT Norm-Referenced Test scores. en los resultados del FCAT ceñido a normas de aplicación "modöl egzamen ofisyél FCAT itilize pou fé evalyasyon" (NRT) nacional. an. EFTA01709948 Spring 2003 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) READING SUNSHINE STATE STANDARDS PERFORMANCE TASKS Student Report flails Comprehensive Assessment Test Grade 10 This report provides your results on the FCAT 2003 Reading FCAT 2003 performancetasks. Each performance task on FCAT requires you READING PERFORMANCE TASKS to respond with either a short response or a longer, more detailed response. Short-response tasks are scored on a 2-point rubric and extended-response tasks are scored on a 4-point rubric. Student Name One of the short-response tasks Is shown below with a copy of Student Number your answer. The number 01 points you earned for your answer Is School Name shown in the box to the right. School Number 2331 District Name PALM BEACH This task required you to read a passage about an American District Number so zoologist's attempts to rehabilitate two young gorillas In Africa. PerAll Reading Describe how Coco and Pucker change as a result of their This Performance formance Task Task Response Responses experience with Dian Fossey. Use details and Information from the story to explain your answer. Points Possible 2 12 Points Earned 2 10 ulnae ttwiara d by 9".,, en dPSG V0-tit giVariti epti Mer3 west 1franito ci.dfletd cuti:ri no itct...+.2" and ea,. rtett!ii.t 0255 Mr 5* Mt, •Tiderivat.‘ ChIstial ltrtz Vt•eds ok95, fnatiCLieje ep eTum %yenta twis• • eAractedee tea en be VC" carni.ha Trot. Gond. stk.° :coot trio fry...wog e‘Asti to be. se•recochored With fatid-e• tart teln9 V41t tote t*" OKA IACITYLC.9 C‘MittACk an.* eaten, Ctra uric (ter} til 6.1eAJC5 00- tiaserieed.• Data Run Date: 05/07/2003 0063533 85320[379 EFTA01709949 Spring 2003 FCAT FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) MATHEMATICS SUNSHINE STATE STANDARDS PERFORMANCE TASKS Student Report floti61Compescasiverlisosoini Tel Grade 10 This report provides your results on the FCAT 2003 Mathematics FCAT 2003 performancetasks. Each performance task on FCAT requires you MATHEMATICS PERFORMANCE TASKS to respond with either a short response or a longer, more detailed response. Short-response tasks are scored on a 2-point rubric and extendec-response tasks are scored on a 4-point rubric. Student Name Onc of the short-response tasks Is shown below with a copy of Student Number your answer. The number of points you earned for your answer is School Name shown in the box to the right. $chool Number District Name PALM BEACH District Number 50 This Perfo*rnance All Mathematics Performance Task I ask Response Responses Points Possible 2 16 Points Earned 0 6 The students in the senior class at Paradise Island High School have decided to raise money by selling graphing calculators and geometry tool kits. They have set aside $3,000 to purchase the items they need to sell They will spend $75 for each calculator, and 520 for each tool kit. From past experience, they know that twice as many students will buy the calculators as will buy the tool kits. The inequality and equation below can be wed to determine the number of each item the senior class should have available to sell, where c is the number of calculators and t is the number of tool kits. 75c + 20t 5 3,000 c — Zt How many tool kits should the senior class purchase? Show your work —Mt 42 t 7r e.' ....-------- g. .....------.. . zottsS Number of tool kits t003 Data Run Date: 05/07/2003 0083534 854200805 EFTA01709950 vt)JfV LCVEL Itit SUMUUI WS I HIV I OF PALM BEACH COUNTY (SDPBC) VWC •9 a I.J,,ks)\ New and Returning Student Registration NEW STUDENTS: Complete a areas on both sides of the fomi except areas specified. 068K 12 c!titbet•Late,/ RETURNING STUDENTS: Review both sides. If the pre-printed Information is incorrect, correct the information by carefully and lightly crossing out the incorrect Information and wiling the correct information above it. Complete any areas that are blank. DIST: CHR:PRIETO NBR:1SS STDT CRS:1503350 SEC:00 BLDG:02 RM:GYM 08 11 4 (4)mown.Lam NM,IE pay. int Indire) (5) ALSO KNOWN AS Kg LOCAL ADDRESS MOON no. & Tkm'Ramo) Ill (apt no) robe Ohne/ Cry code) WEST PALM BEACH FL 33412 (7) MAUIO CORMS (house no &semi =me) (apt. no) WY) Woke OP code) (0) SOCIAL SECURITY NO.PAPLOneg (I) HOME TELEPHONE NO. (10) S1 (I1) RACErETNNIC ORIGIN W . 0 I-American Indian/Alaskan Native 0 B-Black, Non-Hispanic 0 H-Hispanic F 0 A-Asian/Pacific Islander • W-VVhite, Non-HiSpanic 0 NI-Multiracial (12) DATE OF BIRTH (13t PLACE OF BIRTH (c4 stab. couphy) (It) RESIDENT STATUS (15) USA ENTRY DATE TMARDCWYYM 0 0. Foreign Exchange3Student RALVDDATTY) WEST PALM BEACH FL US FLORIDA 0 1. Out-of-county Resident ('0) FEDERAL IMPACT SURVEY 0 2. Out-of-state Resident YES NO 0 3.ln-county Resident 0 0 A. The student resides on federal property. (17) PRESCHOOL ENROLLMENT INFORMATION Place an X by each program attended. Also. Indxate with an 0 0 B. The student resides in low rent housing. asterisk (*) the program your chid was In are longest. D 0 C. The parent Is employed on federal property located in PB County. 0 C. Tale I Prekindergarten 0 M. Migrant Prekindergarten 0 0 D. The parent is employed on low rent housing located In PB County. III D. Pre-K Disabilities 0 N. None 0 0 E. The parent Is in the uniformed services of the United States. • F. Fee for Services 0 P. Private Prekindergarten II H. Head Start 0 T. Teenage Parent Program 0 0 If E. Is YES, Is the parent on active duty? Check service below: 9 L. Readiness Program 0 Z. Not Applicable l: Air Force 0 Army 0 Coast Guard 0 Marines 0 National Guard 0 Navy (IS) Is the student a single parent? N • YES 0 NO TRANSFER STUDENT Only students transferring from another school complete this section (19) NAME OF SCHOOL TRANSFERRING FROM (20) cm /STATE I COUNTY COUNTRY (21) LAST ATTENDANCE DATE (22) LAST GRADE LEVEL (23) Have you ever been enrolled in a Palm Beach County School? 0 YES • NO (24) DATE ATTENDED NPBC If yes, what school? All now and returning students compete the remaining form including page 2 Qs) Students will receive non-invasive health screenings pursuant to Florida Statute § 381.0056(7)(d). Non-Invasive screenings may include vision, hearing, scohosis, height, and weight. These tests may be given individually or in groups. Parents or guardians, however, have the right to request an exemption In writing. If you DO NOT want your child to receive the screenings, write the words "Do not screen" here: (This exemption wit cover ail types of screenings) CAD I give permission for my child to participate In the sodium fluoride program to prevent tooth decay. El YES 0 NO (Pemassion Is va,d through grade 6) YES pn Does your child currently have health insurance? I2 'Y ES 0 NO, If YES, indicate: 0 Medicaid 0 Healthy KidsnOd Care 216rivate 0 Interested in receiving information (a) HOME LANGUAGE SURVEY (chccA WI *Nappy) O A language other than English is used in the home. What language? O The student has a first language other than English. What language? O The student most frequently speaks a language other than English. What language? am DISCLOSURES FOR ENTRY INTO PBC SCHOOL DISMICT (check at Met WOW 0 The student has been expelled from school. 0 The student has had juvenile Justice actions taken against him/her. DI The student has wrested resulting in a charge. (30) STUDENT LIVES WITH: (chock ro (31) CUSTODY STATUS OF S7111:Off (check one) D Mother 0 Father oth Parents 0 Foster 0 Group Home 0 Mother ❑ Father 0 Shared Custody 0 Other ' 0 Other IMPORTANT INFORMATION - MUST BE COMPLETED tra Is there a court order barring either parent from removing or contacting the student during the school day? 0 Yes f3 No If YES, provide the school with a copy of the court order. PBSD 0638 (Rev. 03/17/2004) page 1 of 2 EFTA01709951 YANCEY /Lela/AL Ut)4411UUMNI IIVFVKNIMI lull (33) FADER OR LEGAL GUARDIAN (Du mivele /Mist hul) (34) DATE OF BIRTH (44) MOTHER OR LEGAL GUARDIAN (rat middle iniial. hug (45) DATE OF BIRTH (35) ADDRESS (40,444 number. sent 0Famrdid number) (413)A0ORE8S (steelnumber, street epereneni number) (36) CITY STATE ZIP CCCE (47) CITY STATE VP COOE WEST PALM BEACH FL 33412 WEST PALM BEACH FL 33412 (37) OCCUPATION (38) HIGHEST (48) OCCUPATION (49) HIGHEST ED. LEVEL ED. LEVEL h .._l eatlele (39) PLACE OF EMPLOYMENT (SO) PLACE OF EI/PLOY/ ENT (40) HOME TELEPHONE (41) BUS:NESS TELEPHONE (42) CELL/PAGER NUMBER (61) HOME TELEPHONE ) BUSINESS TELEPHONE (53) CELL/PAGER NUMBER (43) EMAIL ADDRESS (op:email (ie) EY 3IL ADDRESS (405440 EMERGENCY HEALTH AND SAFETY INFORMATION Provide name(s) of person(s), other than parent, allowed to pick up student. ms) PASSWORD (limit 10 chamfers) (56) NAME MS middle MU( MN) (82) NAME (8-34 middle int* leap (57) ADDRESS (skeet mimeo,. Meek Apar:PION homer) (63) ADDRESS (OwlreenieN One( neelmeel eumee) STATE ZIP CCYTE (84) CITY STATE ZIP COLE RoNet Pe• %re% Calse.c.)^% FL 3-3(4%1 2c..Ni n( c) -m %Cr% Cbenc." HL 33412 (59) RELATIONSHIP (801TELEPHONE (51) CELUPAGER NUMEER (65) RELATKiNSRP (66) TELEPHONE (67)CELL/PAGER NUMBER OTHER OTHER (68) STUDENTS ALLERGIES (cheek a the/ apple end Weary) ID None 0 Animals 0 Birds 0 Reptiles 0 Amphibians 0 Plants 0 Food -0Other Specify St/AC ( %) Be , I 4-01-0"94-- (89) LIST STUDENT'S ILLNESS. BEHAVIOR ISSUES. MECCC,ATIONS CR PHYSCAL UllTATIONS (70) FAMLY PHYSICIAN (71) PHYSICIAN PHONE NAMES OF PARENT'S/LEGAL GUARDIAN'S OTHER CHILDREN (7Z NAME OF CHILD MU meddle Ina( 4440 (73) SCHOOL ATTENDING (74) STUDENT NO. Optiyme (75) GRACE (76) DATE OF GRIN (77) NAME OF CHILD Firs( middle M$ IMO (78) SCHOOL ATIEM:ING (79) STUDENT NO. fopfiene0 (80) GRADE (81) DATE OF MTH (I3D NAME OF 041.0 MA middle IS MM (63) 80.100L AT-FENCING (84) STUDENT NO. (opeonel) (85) GRADE (88) DATE OF EOM INFORMATION VERIFICATION PARENT/GUARDIAN CONSENT I verify that the information given is true I understand and agree that all educational records of my child may be shared with the District's and accurate to the best of my health care partners and other governmental and social agencies jointly seeing the child or having knovAedge. a legitimate interest in the records, as needed to provide and evaluate health services and government/social services to students. I also understand and agree that my chide medcal records or other medical Information that I provide to the school, and treatment records or other medical records created by health care personnel at the school wit be shared with school officials who have a legitimate educational purpose for accessing such medical records and information. fl Z e) TURE OF PARENT/LEGAL GUARDIAN DATE TURE OF PARENT/ LEGAL GUARDIAN DATE FOR OFFICE USE ONLY Documentati hecldist Transportation COS US CAL Teacher Na. 0 Immunizations O PBC Buse SI. Bin/ Code E01 Reassign. Code 0 Birth Records Verification 0 Patn Iran Si. ENry Dale 08/11/04 Firth F Verification 1 ESOL Entry Date DC 0 Social Scarily Number 0 ParonVStudent Transportation 0 Physical Exams o Walk 0 Bice CI Address Verification PBSD 0636 (REV. 03/17/2004) page 2 of 2 EFTA01709952 RECO TEST!WAIT RD INFORMATIO N •••..•••••••••••••• Tral: KEAL) TUTL -PTATIV.PIAIM — tan READ. COMP YOGA MATH L84 COMP r.cORE TVE GRAD: 0- TE-Tr DATE 4/11/9 58 14E 8- 8 RICLUO met-PR mErnmortvAncm E ai CITIMW aoPE ti...••••••• CTES/4 LEVEL 12 FORM A ...!•••••••i RrAu MAIM Ta LAMP LANEE SECAETYPE COMP C&A LA m CANA*PR NG ECH-EX MADE 'II I IIIM 4)!IIII 'OE 9- 8 PUPA NO • /0. 69 413 Q3 CTBS/4 LEVEL 13 FORM A ••• em••• gob. • Salta „ertolP V0€A MATH ii" UIMP ENCE STUD NAME CODE 4/ 77 ARE 18 NPLAO 0— Q4 I ti nn em/I N LEVEL 14 FORM A TON SCONE TOTE READ READ:TOTE AIN ATH SCI-. KtAU MATH LAMB LAMO -Com 'EWE "" 05 nifunmmu.,04 79 39 11- 8 "mem/mona, Q4 Q2 CTBS/4 LEVEL 15 FORM B .• aa,••• one 'OIL (hp Ote TOIL MATH NATH] " " neEAD..'0 P • A'MATH C&A COMP DE WI. 4/ Si m rum,0 'TR 50 [ L12- 8 Q2 INFORWJICH W ir Q3 69 TBS/4 LEVEL 16 FORM A SCORE FLORIDA COMPREHENSIVE ASSESSMENT TEST ( FCAT SPRING 2003 SUNSHINE STATE STANDARDS STUDENT: GRADE: 10 DISTRICT: SID: Mr SCH001 I= DOB: READING: 362 PASSED MATH: 311 PASSED PBSD0280 01-9330 counc °run Au C11l VJC nuncons. ntomusg LullS 4,0 (a.,...44 1.1IngodrVii. Atekon 4. &Anus IV ;Ann E etintralim SCSMVTL tins tit Car Vac mincien. 'MAIM tin An to NLVJt avotEsinn. ...nu... ....L. IV 3A0n3S 1S0dX1 01 Olen 3A0M38 *IAISNOTV 3soax3 01 saw MOEN .3AIS3HOU ISOdx3 OL e3HI1 3A01130 isirstios3soax3 01 spin 3A0V133 '3AISIHOV 3SO4X3 01 43N11 3A01438 43ATS3ROV MOVE LIVER TO EXPOSE ADHESIVE. REMOVE LINER TO EXPOSE ADHESIVE. REMOVE LINER TO EXPOSE ADHESIVE, REMOVE LINER TO EXPOSE ADHESIVE. REMOVE LINER (0 EXPOSE ADHESIVE. REROVE OOP 10 3A0D3B .3AISIKat 350.03 01 001 MOWN, I TAIS3HOV 330.03 01 VINII 3A0113ti '3AIS3H01/ INDIT3 01 emu 3A0M38 "AMMO( 3SOdx3 01 031111 3A0m38 '3AISINGV 1S0.03 01 031111 3A0r138 IIMS3IED; EFTA01709953 ear :17 THE SCHOOL DISTRICT OF PALM BEACH COUNTY Grade Jr ELEMENTARY REPORT CARD Year 1997-19 qg School Principal SOCIAL DEVELOPMENT/CLASSROOM STUDY HABITS . MARKING CODES - ACADEMIC SUBJECTS Please work on the area(s) that have a cited( (4. GRADES 1 and 2 E - ExceIent S - Satisfactory Madams Period V - Very Satisfactory N • Needs Improvement to 2n4 ad Oar Overal effort GRADES 3-5 Works cooperatively A • Outstanding (94% • 103%) B - Above Avenge (65% - 93%) Works independentty C • Away° (75% • 64%) Completes classwork on time • Below Avenge (65% - 74%) Completes homework on time F raiTeg (0% - 64%) I • Incomplete Follows classroom rules and routines Uses time wisely ACADEMIC SUBJECTS l marking Peeled Follows directions tat ZS NI 46 Accepts responsbitity for own _ actions • Iri, prof L Comes to class prepared with • Vt+AA , 4.1‘ materials .. . .. m.prft,,N1 om Nft.i.Ns...13Ziits nips., rat M ssi.d.tm ALTERNATE ASSESSMENTS Indicate those used with a check (I). Markin Ported let as as se Composition INCLEMX9 Skills Chec/Rat(s) Lan.ua.e IrsIVIMEI Pertfolie it I/ Spew tiandwriting/Peoman '• mtaralit MIAMIll Audio Cassette Recording Wee Recording Compute Program Social Studies • PitlItElln Standardized Test(s) Science/Health IIIMEILI ObservationsWitten Comments Other • Grades not given this nine weeks ATTENDANCE Marking Period Regular attendance and punduenty 2. 2. i 3. 4a are essential fasually educator. Days Present . Vol sit 44,44 FINE ARTS REPORT guide° Period Days Agent .2. 0 -V O IA avi 341 46 Days Tardy 0 0 v/ /2- An .'3' .5 .1 a information Included V ti / Music :3 i., 3 .3 Physical Education 3 v...?a PLACEMENT • PARENTIGUARDIANNEACHER Marking Period Grade (0 Special Session CONFERENCE Id as 2sd 4* • g speed session program a retard. grade Placernald Ltonamonce =inductee Ockale 0003 gfrela /b In be determined by ea home sollow. I PIM 07611(lee. 7114) Gekbantalet Pirkat Plnki2nd Ported etneryl3rd Period Onionleth Potted www/Ontoe Cery EFTA01709954 THE SCHOOL DISTRICT OF PALM BEACH COUNTY 1997-1998 END-O - D INSERT for GRADES 1-5 Grace Dear Parent(s)/Guardian(s), In a continuing effort to keep you Informed, this report card insert Is being provided to notify you of your child's progress toward meeting the school district's desired levels of performance in reading, writing, and mathematics. Your child's end-of-year performance level In reading, writing, and mathematics is Identified below. READING VVRITING (COMPOSITION) MATHEMATICS 2 7AI or above grade level & At or above grade level la ...At or above grade level - ❑ Below grade level* ID Below grade lever ❑ Below grade level* 'If Below grade level has been indicated for reading, writing, and/or mathematics, you will bi asked to participate in the development of a plan to improve your child's academic performance. This plan will be . developed at the beginning of the 1998-1999 school year. • Sincerely, PBSO 1674 (NEW 5/15/98) White/Cumulalive. Folder Yellow/Report Card' EFTA01709955 STUDENT NA UPI F. I SEX A LALJETHNIC GROUP O8 Whita, Not Hiiperik . Not Hispanic O Hispania O Anietken lerSon/Netivti Alaskan O Asian/Peptic Wilder ADDRESS:Tine pencil In this space. until final.) PHONE NUMBER: (cptionet) SIRIHDATt Votified by Binh CeniTicate: Yee IS Not, what Type Venlicati r il iMilliMill— NAME OF PARENT'S) OR LEGAL GUARDIAN OR QTHER RESPONSIBLE /ADULT AT HOME p G OA ii"‹. — GU — Nom Snet CRY , P. ezi Data Pat Enured Ibb Mulct Withdrawal Date . Mithdraval Doe Withdiewal Data 3laspa-, 0.4( on. siimaziGnet Gros G. , • 191_3 -191_t 19 SI9 V? 5 1'4T ..,......‘,..: Seidel Yen: 19- 4-19 Schaal Year; ESN Yam .19—ac. Schell Yew: 19 .19 IlehmiYesr 1$ Days Print" DaVe '3 on,nns VersArisatt Dans net t, Eerie Days Present Nye Amen: i / go 0 i Twits Sublaci isatita Mast Seekci learnt Mast k Iloblait home Mak 1 Ern 'I of IA tAMILIAM in)) u I T. Lt. HAND lltlO iiniameineic; HAAJosvainkry yffoWpTI HANDSING A SOOAL T dadtAL ADAMS SOCIAL STUOite MIMATOWS COM, AlinlIFIZ SCIENCE and a/At 11.1 SCIEME and "Ar TW tr,,Nrc.f rd v "'laic"4 I'A FSAW: •^' 6 9O1AvICHI CODE IL cti4AviOn <001 IIIIMMACA CON MANOR CODE Q., MIHAVOR CODE at RAGE -1- AVrAMW MARAnE 'T AKAAGE 1 AIMANIF 'MAW*: Ir4t3W Hcricait Mame: ,i) Prow* In Promote?) p Promote Pt =API " '- P FLORIDA _PERMANENT RECORD CARD flown ail Roldin CIO RatanIR) Sown4t St/WU= s,...-.,.., scniiil X551 Samna.. School IS Summar 'VT**, Swann Schott 1 ii..... I GISH 5 Stnoot I Goat &nett I G/scl• Shoot l in": Sd.cct I ChS* Sans? Veen 19.33-49S— Eden)Men 19 _.19 — Selma Ye?: 19—.11— Scheel fl an 19_.19_ lame Then 19 —49— Days Pisani: Dm Abend aim Present DeveMeent DmPresent Dm Advent DanPresent Days Atom: Deis Peasant Dove Absent: J.73 7 CATEGORY A - Education Records Sobliet Teacher Mark 9(.140 Twine *Awl. Maths, Men Sag(. 'NOON Mart &Men Tatar Ma MATIOMAMS AAANIZANCS MA/MFMATICS 2.4ATIOMATeM MATHFMAMA RtADONO sv AIA0049 A 010,143 MADIA* ANCUAGe ,. r.fraismte • • um:smut t ANOVA% LANGUAGit WALING WU et() SP/WM) APPI INA %ration ttANDWRHPIG /ANON/TORO HANOWRINNO HANDY441TING )(ANDY/2=s 6OCtet STUDIES AERMA SRAM SOCIAL SWORS //COAL DTIN/ti 5OOA GRADES K-6 SOCNCt one A SCIENCE at d SCIEACC and SCIENCE and SOUK( and NIACIN IKALTH WALT). MM.TH HEN-111 ODWAO*COOE .? eciavion cep( litHeveTWIGODC 1304AVIOACOM BEHAVOR COOt AVFRAGE `-' _AVTRAGE AIMS AVERAGE AVEPAGE IMIkete: e ind,rate: YYNNIN hdalt Ndlealt: . Fonda (PI Proroio (P/ PromosPI Promo* lel Proem l% amenPi) Retain IR: /Man pia . Ameia IL Ratan ITU SiAnnin acme ISEI SATiymi Svice1WI Surname StheolISS) Swami STAppiONS) Sunkmee strewn, PliDot32 01-9340 EFTA01709956 Verification of Receipt (NOTE: This is not the application for the scholarship.) I verify that I have received and read the initial eligibility requirements of the Florida Bright Futures Scholarship Program for the year 2004. Please return to your high school guidance counselor EFTA01709957 lirEALIFIT ENT HEALTH EXAMINATIONS Dn a Sante PLR Name rufivt Race Sea Andra.. &dna Name ol Parent or Quatelon SchOci A. HEALTH EXAMINATION SW?, 5 5 3/ CV Weiiihl -)* ebod Presuxe (I) NeemaleN: AlmortnaleA N A COMMENT: Abnormal Findirps. by number I. Appearance 2 Sloh/Noso 1Hoxl/Scogo &Eon S. Veal Actin ilit s. LI 0. Can 7. Polledy Addy ft EU B. Maas / Ibmal 9.MOOR Teem bald Guns 10. Chu( / LUMS 1I.Ideorl 12.AbOnso 13. Gefiab and Anus i e n.. 14.Masculo-Slablal IS.Meterd0{kal 16;Meelmes 17. Emallanal /Weep's' Bentryke Prob ) IS. Hendee° lanyticeli OMR (Speedy) . IR Acihity Resbiotione (Reedy) 20. Abet CealananCeet physical/ backed 2 lislotraion ‘I f 22.0ther B. HEALTH HISTORY tursanIsms loam apMH0 (Mach nun** i adOEceol abig teddibDRF-NS CLINIC C. LABORATOR Noe Hemp:Rein/limb dole 'read MOM NAME: TITLE: ADDRESS: (Please Pant) tuiUsonse &psaltery, - 4Date On 304 (Me (RPOI:48 Haan Fern 1040 .%cn an be anal Senn Hunter. £7440Od1bO11 EFTA01709958 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Mahoney: FLORIDA STATUTES man, a. 10D-3.088, F.A.C. and s. TOM-12,PSC. LAST NAME . . FIRST MI DOB • M0MANIt • Child's SDI (optional) STATE IMMUNIZATION IDle Directions: •-. Enter all appropriate doses and dates below.' • Sign midden appropriate certificate (A-1 A-2;B, or C) on reverse side of form. • If the child is presenting for the lth grade requateeni6PALWinlItyarneviously filed a Certificate of Immunization (680A or 6.80A-1) with their current Florida sch i?fillilial'eteas liellifastrioni Tete Pan A-2 on the reverse side of this form. .c.r . . Vi s. t...61- !We: ,4j ^Nr. ....,.--s 0- dr/ •,. • For additional information: See -millA o atibtang•Cltilif et Facilities for information and Instructions on form cotnpktio94 ”d hi . Iliettact.f:011id..„, d annually and are available k from the local county health EP ifi ." 3.: ' :rm..... 'Dr ' 3. VACCINE -•• DTaP/DTP' is DT' Polio' RIB° MMR (Combined)' • (Separate)a Hepatitis B9 rl•-• I The state immunization MN is an identifier supplieby.the li stVatelmmunnation `registry (optional). 2 DTP 5 doses required. If the fourth primary dos-c taalinistemdofirar the fourth birthday a fifth dose is not required. DTaP is an acceptable alternative for one or more doses of DTP. • .s .DT (pediatric) is aacqxable if Patustis vaccine is medically contraindicated. (Complete Part C for Paten's • contraindication.) „.• 2 Td (Adult) Vaccine is recommr.nded for children 7 years of age or older. a S Polio 4 doses required. 'If the third close is administered on or after the fourth birthday, a fourth dose is not 4.. required. WV is an acceptable alteMative for one or more doses'of OW. Polio vaccine is not required for children 18 Ia. years of age or older. -` . . . • • . 4 Nib is required for child are and preschool entry arid attendance only. . ' • 4- 7 1st dose valid if given on or after.' st birthday. Second dose (measles) validIf given at least 1mouth:Ulm 1st dose. A second dose ofmeasles (preferably MMR) is required fot students inrades IC-4 in the 1997-98School year, and • 7th grade entry and attendance affective whist& 1997/08 school year. In each subsequent year thereafter, the next highest grades are included s Includes single measles vaccine (0), single mumps vaccine (H) or single rubella vaccine (I). • 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. EFTA01709959 LAST NAME FIRST MI DOB (4O/DAPin) Certificate of Immunization for K-12 Excluding 7th Grade Requirements • PART A-1 (Immunizations ale complete for school entry and attendance grades kinderganen through 12 with the exception of the 7th grade requirement) DOE Code I I have reviewed !ht .:words available, and to the best of my knowledge, the above named child has teen adequately immuni;e'd ogatut diphtheria, moms, pristine:, Polio. %Virg. r. hepatitis B kindergarten fo school attendance as doewhaVellefIhr ; Physlitan.or Clinic Name: Physician or Pintor:tamp) Authodzied Signature: ' Add Date: 5-- Certificate of Immunization Supplement for 7tli Grade Reqairement PART A-2 (Immunizations am complete for students who enter or attend the lih grade after the beginning of the 1991/98 r.• school year. Each subsequent year thereafter, the next highest grade will be included in the requirement.) DOE Code I have reviewed the records available, and so the best of my knowledge, the above named child Ms received the following immuninarions requiredfor entryand anerdance in 7th grade electric. wish the ;PPM schoolyear: tetania-diphtheria booster, hepatitis B vaccine sent, and second dose (sneaks vaccine a,donmentedon the reverse ride ofthisfont (bared areas). Physician or Clink Name: • Physician or Print or cramp) Authorized Signature: Address: Date: Temporary Medical Exemption PART B (Foe preschool children, children in day care and school childitn who are incomplete for immunizations in Pan A=l' of A-2.) Invalid without expiration date. DOE Code 2 1C0116* that the above named childhar received the immunisations documented en she men* side ofthisform and has commenced a schedule to complete the required intmunizanionn Additional immunisations are not enedical6, tndkated at this time. .: , rfsgv Physician or awe Name: • OLEPinitiOnOt • • • 1.47 (Print or swap) torn b` ..,a Physician or Address: Authorized Signature: Date Pennanent Medical Exemption :it PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for examptioo: DoE Ccdp 3 I her*, that thepluaiced condition of this child Is such that immurazation(s) as indicatedin Pan C &bowie medically contraindicated. Pieta or Clinic Name: "tint or stamp) • Physician Signature: Address: Dare: VIM II 54. 0.4,1/4“.1:te °Lied (Swat Oat: 31000)0004) EFTA01709960 STATE OF FLORIDA ERS DEPARTMENT OFHEALTH 8 REHASIUTATIVE SERVICES DENT HEALTH EXAMINATIONS Dale Sloctent's Full Name Race Address Name cl Fares a Guaratan A. HEALTH EXAMINATION %tight BloodPremise WI NormaInn; Abnormal-.A N A COMMENT: Abnormal Findings, by number I.Appearance 2. SI:In/Noso 3. toead/Sasso V 4. Ems S. Vaal Acuity (A 8 LI el EMS 7. Augpxy Acuity (R a LI 8. Noe / Throw 0.14Mh. Tee and Gonna 10. Own / Lungs 11. /Marl 12. AtdCanen 13. Gmbh V.:1Mu le. Muscb-3keletal /NCI Lr-sethanninhs-yi 1 PI(/ 1814eusoloakal in. Mennen ... 17. Ern:Paul / Mental/ Behataa Web I I 8 . Hanc:010.Physical/ .....-taiEsMec other (Specayl ,,,. 19. Acihdy Resaricikm (S—y) 20. Abuse. subsaance/ "Peal / emit:Drug 21. Nuoinan 22. Ona B. • HEALTH HISTORY (Scrips 1:1655CAD INuesey ~lain) (attach narrallna M addincoal space netted/ C. LABORATORY las Inclecated) Hemcglabin/Namt Mod JO SPI Lean NAME, TITLE: ADDRESS: (Please Pant) FOWL ---4110ato MRS- /I ion 3040, Mar 9 *Ostlers) (Stock Weber: 5744.000.3040-2) EFTA01709961 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 23L037., a. 20D4.088, F.A.C. and s. 10M-12, P.A.C. LAST NAME FIRST MI DOB MOIDNYR PARENT OR GUARDIAN Child's SS* (optional) STATE BOILINIZATION IN Directions: • Enter an 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 the7th grade requireaftWOBrarriFFlina rnmiously filed a Certificate of Immunization (680A or 680A-1) with their current Florida schp61,Fdtreiliaid aias lizoaa tete Part A-2 on the reverse side of this form. 41.4. 5:.,..."rt"'" • For additional information: See s jinratunritso. 1.40 §. 7n5") Facilities for information and ion ructions on form co:aplenty ad im Ermaligif ‘annu ally and are available from the local county healthelioa a. • VACCINE DTaP/DTP' DT' Td' Polies' MMR (Combined)' (Separate)' Hepatitis 219 t The state irrummization IDN is an identifier su .die statrommunizatiolficgistry (optional). 2 DTP 5 doses required. If the fourth primary doseTtahlinisteredear the fourth birthday a Mb dose is not required. DTaP is an acceptable a0ernative for one or more doses of DTP. 3 DT (pediatric) is acceptable if Perrussis vaccine is medically contraindicated. (Complete Part C for Pcnussis contraindication.) • Td (Adult) Vaccine is recommended for children 7 years of age or older. s Polo 4 doses required if the third dose Is administered on or after the fourth birthday, a fourth dose is not required. BV is an acceptable altemative'for one or mare doses of OPV. Polio vaccine is not required for children IS years of age or older. • Hib is required for child care and preschool catty and attendance only. 7 1st dose valid if given on or after 1st birthday. Second dose (measles) valid if given at least 1 morthafter Ice dose A second dose of measles (preferably MMR) ii required for students in grades. E-4 in the 1997-98 school year, and 7th grade entry and attendance effective with the 1997/98 same; year. In each subsequent year thereafter, the next highest grades are included. s Includes single measles vaccine (0), single mumps vaccine (H) or single rubella vaccine (I). 9 Hepatitis B vaccine writs 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 schcol year. In each subsequent year 'hereafter, the next highest grades are included. EFTA01709962 LAST NAME FIRST MI DOB (idoAwn) Certificate of Immunization for K-12 Excluding 7th Grade Requirements PART A-1 (immunizations are complete for school entry and attendance grades kindergarten through 12 with the exception of the 7th grade requirement) DOE Code I haw mined the records mailable, and to the ben of my knowledge. the above named child has been adequately immunised ageing diphtheria. karat MMUS'S. poll. 4 hepatitis B brae lindergartin elective with the 99: I ear or school attendance and Physician or Clinic Na • Physiciso or (Print or stamp) Authorised Stgaitutt:. Certificate of Immunization Supplement for 7th Grade Requirement PART A-2 (Immunizations arc complete for snide= 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 needs available, and to the best of my knowledge. the above named child has received the following Mottwasatiom requiredfor may and attmdeutee in 7th grade effienve with the 1997/941 school year: tetansu-chpbtheria boaster. htpantls B vaccine snits and second dove of measles marinas documented on the mane side tithesform (bored arrae). Physklan or Clinic Name: Physidan or (Print or stamp) Authorized Signature: Address: Date Temporary Medical Exemption PART B (For preschool children, children in day care and school children who are incomplete for immunizations in Part A-I or A-2.) Invalid without expiration date. DOE Code 2 I (trek that the *bowers:ma child has methsd the immunisations dontatented co the mane side of this form and has commenced a satiate to complete the required immunizations. Additional inrmanbsolions an not medically indicated at this tine. Physicist's or Clinic MOM: ' Exisiritakita tr t arT1 (Print or stamp) COS dap nitia rrili Physician or Address: Authorised Shalom: Date: Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and stare valid clinical reasoning or evidence for exemption: DOE Code 3 I cestift that the physical condition of this child Lt nth that immenitatiomNat indicated in Pan C above is medically caltraindicated. Physician or Clinic Name: (flint or stamp) Physician Signature: • Address: Date: D44 610, 1196. dada= la (4Omo (SIM Maher 574.11O:MX1106) EFTA01709963 ..cute Po '.Jof lenyb coCded ea twenty. U. Cren ea 'dn..= em mule ea Pe *dada! canFearet wi6 es Metals by be lelieemlet tuectu ceety reletitelleteeba Walla. is Cds Pee. Lretelep Ikeideliceaud rue %rem tetement Yull coetene extp•ence abet mike-oat Heide :wets peeteeiey le ueurigy *posit had revue. le • rya' *puttee% ce eye Indleid.ereorthberalip. rake:mud petered otell leg Wily,. Ois estate= to *Soria emplarce. Thinbemi.m pee.su owe any ccalleCeg ',miens., in gape. 475 ued ti ten exemé et V. >lake Stuatee Noeek/uteetres Oa ester. soya/Abu me* yeas ot deaexe et• Trantes >eke a Ite aphelia a A. eon •14 retehosatievey oats tio‘e• perrlokt• contsbera eXa Lcese letoetentruy. Fiedta eL0 te••1lual eeem(7)1ayseeistn ace:m.4 «reel rell et prriceeteLvere Weed ?tile le verean elead..x•eytha probe weicbeetionfael is/laded:4 addreat wiwa•So kited en be node& Fame tep:ne each° r deb,mitre toter& of 0. tees oteulestre et 83.40(7)(•). Fetid» esztas. Peettean reed tees eel tor seen ResideS den ceptho were •he Wee S. Dybiplaljeurystrœpese II Indeed ineable le Mint portiere et de Yuceata m Lit of in coneesereetset teno. beaus ue oçosit,sent, PC•leasks.m fa unr diet team balked 'La nabolliel• fet Wee is .1•Ilelr pewee. quid Oak.tkot Ps tax meat temedee aka le bleed end Ceecllet.luedwpcelenUe• Ittelket. Tke knells:ice 4••• el A< la eta na be •••••••••1. U tented or. ea. ter wiener dean. p•neke RnIS•at et hue«. feu • puled N A4ry po)4.), ekr At fee illy (lee Weeks. abet liseted et Leilint ray atrial Si. kw by Keen • wimet noCrte to el. Mee. yel ..5 nenke F•i0 6t Rakka eel be Weldsd le fell EFTA01709964 7 A9- AnRI•MtIT • ADDRESt: Litid8 DATE RSOINNotb. MONTILLY P.BtYf PIORATWO MET ADVAXCE 71119 SECURITY TBR FEB MEP Of dun nee DRI6:itT (tun (00. 00 3: 3 (000.00 s 510.0(~l FIPSWINTKAMEO'R NAMIS OP OT1011 "Illt bokt« Pam bona/ pool PatIttp)milly klm nood taibod faUn speontot Po:6nPcabolPm. 1 b tb Pitt p pubs benen P.r.:M.1<i) ▪ Leallad•ad pybo solifla colt Inobbig. Ibbom b Mo lbo op Readni..2 PabliotputfobOtbd ornotto 6tble fes Log Fopbotten blond:P. U1014 EXECUSION OF Te LEAS.. SOU AOCNOWLEIXIITIIAT YOU IIAS9 WAD AND AOLIS TO ALLOFIr. ITOVISIORC. It pa pot:cd ly Out PoOnct(s) on, dus Waad os P Pot lep Des'. S ItSSIDINT SIONATURII: DY IECECtIllh011US LEASE ACREERGYIT. ISSIDENTA0Qt0WIED016 RECTIPT OP TM ECII.Oblt.St (I) N.euvudwpf ot hbo Astonnen, ud (2) dep byt tod ruil beo Idy. bM dan Pabot ottnieu. I. frofflabfrout: lbedkol 1.444 P4114.al du Itpboo bt om ktOpEnt. ittoPore Poon kali lo ban *pik lo truicts 8 W bteal calibwo pownske atno tb tot ot in. lam Tam pl O 6t ontboodco of roupbent lobtrytt e poot POP pront. Ilo bou P Wodan ~b b ntob Puby bt nib imams •• LAndoti tuy taiga Roildtal ba nbjen all robnins ot bi Up otudt ut.plaSk tod tosticont PI e oost,' b cpb kun. 2. 'Plm: lordlet 'Pct ta Eindig • batelybdianct m ortolonOwEdb O.).by afb. cumil. beo Istrord i,J4 ce614 bs kb loc b do Poot ot teut (lb%) pro bb d plu butaboutot. Ray tr• ka da. banoadtt obell b• o4.4~ ). sare.mir lba tretur. ua1Inboaplobbly by /PUP pl Rodattonbutabfab fiauly tot toidnal ?pop MI. tput bet 0.• lu».1 rumlus 010 k otoniod by ro non Pa bob lobbf kpatetd Pm. To Timp boy en k *P Ix Pp,. ~al : n bunoprt pep«.. Al el Oit didos et Rou:dat (<aeg' tooi mynnuit) tic Po dut 6.dou o!uy u.J al oictousto of to Plal"401. Pailrul hal/. poot, employee». eitr4 botweg ttd Whi L1) V.OLVIOS ot bc Pm d Pb lab ot byernotonn Sobiudo.bloloresiatin et P no. a *blaast Acboopolor eultotialtey Loadbudiebotouealubobou ot bin LP* AggKaait kadi bo 6666 by Rodibot. 4. to...mitsr. Atlant, attO •,) • I / 044:ent ..1.•1 &Cm« te 4.341.w4tb• Swaigy D•roel uil.4~5 cut leliegoi Sen ?MI ka tab.peetaka IS* halm baan elatitydpanad bratIpoo tas Pl b kl[ ae lotion4 bnp: I 1 Op:Pol:a • bouw 1 1 kiept beu bus l l op:pp bobby popi Plut Ooit un• tot •:4«e). 8ltead4a loaxet lobby op.:. bb PTI ~In 25% py Ida" tb d s'• 6 2" &P's!, " duandsb 3% Pit Its. 1 1 Oxim'a 4.9. wi Pct kolt. PI brOl rer.44 Pilt, blb Oa oxn deuk of Ito man. Tot WI nalln Instm to ptt aball P tote 015% pu b) Toot tobtin dtobeimuy trAbe nrsa by,cq u bist le rol Ines debba yon lailftl po dorps« of bob omkip b LP Poe pl boon:~ optut son plot: domp b to pabbn prol by bb ot bot lat:P* ▪ Tbc fidooks b Sint 1.2.49(7)Pla tul be beplad to yorrid• b rob PX6) Opa te opeof dubt rebus P ~bobo n be hm.0 ladonbhall bun (444n (I b dan io nam odd hecenty &pa breve rd" Mum. U obabbi uunhel, tob voldutt b tint Ue Tyedbut ordla wikt by ~GIER pil n bb &Piano iropop &P dun cp. u Oe linideain lui bon ~Etui oOttu. !be roep ~I pull • anno« l itabluebuly 0< Inkod. lotto: 'Tb b • onk* ot my Poolm b pm' • In &Pp b be ~pl cl :pen ps «baby depodb tbc b .... 0 La ent b yoa u.gdtdlT. 53.4fily. flodt• Siatuub lbo nebben bond !int you ma /Won toni:20PP dedotecolranyou ~win br:44.PP Illitto(lbbp bt not you teak* bb ptict. ot 1 MI to ottodanl b PIP ny dab, bon po buebby &buit Ton obEcion Put be mol b Plkeet tOttat.Y. bat b gbi M nodin Quibb u 15-6y ptrbd. to falla bb enba b loopst:41n po tu• at, ambt (b) Lbh.aAe &btw ebbe., bu inpalm ot ibt Lablyn't Pm.« On, Pooit Paar:~ Nina (Lbatunbtostabi of be lyeand• nota. d iwnimp Inpust • dils.bo Indom! ruy Ode &don tv pap n tb PP un tmlN. bijna ob& Sneb b Itt Ibidon Mbb (92)dito •ttit Mani. ot WRatT b bnp. • dan fa duopa. p .:..w .tt• fraliPite*. artla. ;A uwnd ~p.e.: Mak<c• ta‘''"" EFTA01709965 a. OFFICE of VITAL STATISTICS CERTIFICATION OF BIRTH NAMES DATE OP BIRTHS SEX: FEMALE PLACE di EBRTHe PALM BEACH COUNTY, FLORIDA CERTIPICA44 NUHBER: DATE PILEDt DATE ISSUED: HOTHER'E.HAIDEN NAME: FATHER'S. NAMES This is to cattily that this is a true abstract of the official record tiled with this office OUVEa H. 000404. MPH. Sim* FlepliVar WARNING: .4527r,c EFTA01709966 ••••• NIS FLORIDA CERTIFICATE OF IMMUNIZATION (HRS 680 - PART A) (FREW Stalutry 232032) 0 HAVE COMPLETED ALL REQUIRED IMMUNIZATIONS FOR SCHOOL ATTENDANCE PARENT OR GUARIYA/I MOOR POT A CF MIL 10B1IS USED QV IF TEE C .MOMS ABEND ALL PEP WO fintIZAIONS LISTE3 IFUR If MT. SEE LEITISF OFF - $ MILS 1E1ORIO F TIE MIRTH PRIMARY DOSE OF OW IS ADIANISTE,ROH cia.i itttmekomni eLY; DT (PEDATRIC) VACCINE IS AOCEPTABIS F PERTUSSIS VAgyfilnEciefil Tga TO (ADULT) YACCTIE (A SEFPES OF 3005E5) IS 146EVADLE:AND:RECOWIEgliDAFIc ' 7 YEARSOF nto OWl) 1 DOSES IIEPODO F TIE 1HRD FRWARY DOSE CF TOP! IS POLO VAW'CE IS WITTED FROM TIE GENSLES. ans. MO 1001114 - I DON REICUELI /AMR COSIGNED - 1 DOSE AT 12 MONLIS MEASLES SD/GLE - 103.5E AT 12 MOITHS 610 DA YR MUM'S SNGLE - 1005E AT 12 MONTHS OF AGE OR MO DA YR RUBELLA SINGLE - 1DOSE AT 12 MONTHS CG AGE OR OLDER MD DA YR ALL APPFMEIMINE)ggeSARIMUS 01CLUDING I3WITHDATE MUSTBE ENTERER MD THE cartecoxesoci) BELOW BY A PHYSICIAN CR AUTHORIZED DEAMBAWAL1W-KONCIMPlifiaTtg.,c4JP TO ATTEND SCHOOL H. JOHN RICHMOND, M.D. I HAVE REVIEWEENTLTEHVONDS AVAILABLE. MID TO THE BEST OF MY KNOWLE EQUATELY IMMUNIZED AGAINST OPHTHE • POLIO, MEASLES, MUMPS, AND RUBELLA ASR D. BLVD. UWE (PLEASE MIT) DATE EFTA01709967 RTH __ _ PAP OR GARMAN CHLUS NAME DA YR APPROPRIATE, AND SIGN AND DATE. DOCTOR IF THE CHILD HAS NOT RECEIVED DIE REQUIRED DOSES USTED IN PART A, PLEASE COMPLETE PART B OR PART C, AS TEMPORARY MEDICAL EXEMPTION (HAS 680 - PART B) • ' FOR PRESCHOOL CHILDREN AND FOR SCHOOL CHILDREN WITHOUT All. IMMUNIZATIONS REQUIRED IN PART A I CERTIFY THAT THE ABOVE NM/ED CHILD HAS RECEIVED THE IMMUNIZATK)NS LISTED BELOV/ AND HAS COMMENCED A SCHEDULE TO COMPLETE THE REQUIRED IMMUNIZATIONS. ADDITIONAL IMMUNIZATIONS ARE NOT MEDICALLY INDICATED AT TIC TIME. TYPE VICORE (tb /DAM) DTP DT 14 PDW MUMPS PAYS/INI OR AUDIONZED SIGNATURE CATS PERMANENT MEDICAL EXEMPTION (FIRS 680 - PART C) I CERTIFY THAT THE PHYSICAL CONDITION, OF THIS CHLD IS SUCH THAT IMMUNIZATION(S) IS MEDICALLY CONTRAINDICATED. UST VACCINE(S) AND STATE VAUD CUNICAL REASONING OR EVIDENCE FOR EXEMPTION FOR EACH VACCINE. PHYSOMS SIGNATURE --- on- Has Nem 55O.. epror agtesseseirM s $dI Hba r,< • ' I "- - ...`:? • r".• t • : -'' „.r - -: I.- -'T r ' - I ^. In: ,"'"'"'"" :- .."..' 97: '''''.:_;.*-"Y r- •Itt elisrilaai r " ••'-'" -C-7--- 1.!, • EFTA01709968 STATE OF FLORIDA DEFAFRWIENT OF HEALTH & REHABILIIATIVE SERVICES NT HEALTH EXAMINATIONS Dale 0-9-q/ Slutlenre Fun Name r Sol Meese Skladate Nairn of Parent or GosePen A. HEALTH EXAMINATION asahl h /, " WW2 BloodPilaw* 5 tnNomlihrt Abnormal-A N A COMMENT: AbnonnalFinings, by number I. MINIMS ti 2. Skil/Nese v i 3.Reed/See 4.1 41Eyes 21la V 7. aA r e Rd Li &Noce/ L., 9.14cuat Teeth and Cans ,../ 10. Chesil / Leo ...../ 11.14esel ‘../ 12. Placlamea cei i3.Garilati ore/ Prue si le.literstib-SbIlelal i../ IS. treatiblazil L./ It Aiertaese ../ 1T.Ernalicoal WSW ElahaVOC Pf00 I it HOIIMCa9. "IOU alba (Soedly) a ci it.. MPAt/ Restricts** (SPOON) 20. Musa subsume/ Physical I famtonid 9 21. Walla 22. Olher B. HEALTH HISTORY (Se locumusses murex muum C. LABORATORY les intrine Herrocktirdlaarialocit Lea CL:HIC Tile NAME: TITE. ADORE (Please Fora 3040, mumFS aPAb1824S1edI II 8n1) (Stock Iliater: 5744-CatkatMa31)2.9.617 EFTA01709969 PICTURE CARD First 7 Riddle School Sch.* School' Tear Tear / 993 - Tear (611W5- Grad* Crude Sc ho Year EFTA01709970 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES Spsciai Health CUMULATIVE SCHOOL HEALTH RECORD Prcetems - See Narrative_ (This tone Is not Intended for physician's use) Name Race VI Sex F . Schoo Address Fathers Name I .? '<Moe: Name Date of Birth Place of Sim WPaN FT-) Birth Recorded: Ye* No 0 Immunization Certification: YesX NO D Special Immunization Programs A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES K 1 2 3 Screening and Assessment E. — • cco w g w 1 Grades 5 -a 11 g 1 1 8 g IO i 5-' K-3 P.O -.: 0 1 ea ..1.; .2 . 1 i A Z m - ,x ,3 Vision "7 1 -41 lafilte Hearing &ar.p&ing Height. Weight 04 tis. ,,,.., d7 3- V' -4V l‘ 45rt . /f' VO" idea it,, 1.0.-55%., „a -r" 414" SD as -If lies- 4114 t i 2 Nutrition Dental Health Mental Health Communicable Disease — Records Review Physical Assessment Other Other 4 5 6 7 8 Screening and Screening I. . T. Screening Outcome F Outcome Assessment P. 2 i a ROI.(MI 7 9 t E E e 8 92 0 $ Grades gi0 c r• 0 0 7. 8 0 A0 - Date Date 4-8 0 P. 0 cc 8 cc 8 8 (8 Vision Hearing Ans/flz ..,. i d / 0 qv P Height, t orr Weight CO7 91,1140thri410 41‘ 8 Graphing um. 47 Novato Dental Health Mental Health Commerical:lie Disease Records Review Physical Assessment Scetloels Other Other HRS-H Form 3041, MAY 80 (Replaces previous editions and MCH 304) EFTA01709971 LEVEL & COURSE PERFORMANCE School End of Year Report Total Total Total Corr/Att Percent Enroll 1PM Current Time Exercises Correct Level Level Level Gain Course 1231 pp III., (Enroll Date - 9/24/97) Class 120 GENCO-607 1493/1837 81 4.50 5.61 6.15 0.54 7:32 557/851 65 4.49 4.51 4.77 0.26 MCS RA 0/0 0 N/A N/A N/A N/A 0:00 -- -- WRT EFTA01709972