EFTA01710036

C CollegeBoard SAT STUDENT SCORE REPORT REPORT DATE: 12/16/05 ( HIGH SCHOOL COPY - 101493 ) ROYAL PALM BEACH FL 33411 WHAT DOES YOUR SCORE RANGE MEAN? WHAT ARE THE AVERAGE SCORES? Your performance is best represented by the score ranges above. For college-bound seniors in the class of 2005, the average To consider one score better than another, there must be a critical reading score was 508 and the average math score difference of 60 points between your critical reading and math was 520. • scores, 80 points between your critical reading and writing scores, and 80 points between your math and writing scores. WILL YOUR SCORES CHANGE IF YOU TAKE THE TEST AGAIN? HOW DO YOU COMPARE WITH COLLEGE-BOUND SENIORS? Among students with critical reading scores of 530, 55% score The national percentile for your critical reading score of 530 is 56 , higher on a second testing, 35% score lower, and 9% receive indicating that you did better than 56% of the national group of the same score. On average, a person with a critical reading college-bound seniors. The national percentile for your math score score of 530 gains 11 beings) on a second testing. of 550 Is 59, Indicating you did better than 59% of the national group of college-bound seniors. ' Among students with math scores of 550, 57% score higher on a second testing, 34% score lower, and 9% Percentile, average score, and score change information for the receive the same score. On average, a person with a math writing section are not available. The test must be given to students score of 550 gains 13 facings) on a second testing. • for a full year before this information can bo provided. See reverse side for additional score details. ADDITIONAL SCORE INFORMATION ADDITIONAL SCORE REPORT INFORMATION eg Visit vernmcollogeboardoom for detailed Information about your scores and to view your essay. To learn more about colleges, universities, and scholarship programs and to send additional score reports, visit www.collegeboard.com. SUMMARY OF SCORES SAT Reasoning Test SAT Sub) ct Tests' ;;51 ..rgt,ATig elplicir i I- c( Aar i li l'. ^I; - it 1 i- TTil' a :.*m. 1;%3 WS 4 .--z nie, at • ' > cliira ) \ UV X" .. 4. -. -t. • Ne ki h.. e • i ,T i -r/14 ' ,. 71 .1* • TqWeill M' gl# a , -1 tig., to: TeiltiA . . c: ?..2 - fli 45.....w ter tr./ A,":rre..cmi, oek t Stare limo 05 12 530 550 500 52 Oa Kay 05 11 520 490 490 52 06 Prior to LI rch 203. Usecrtikti mad ag section cop 'Hot a 1 tints Items subscorm. kr. "'" corral 54.6°"' San" roil these tw° 'Stier s ft m %As SAT Subject Test In Writing and th writing motion on the SAT Poisoning Tom ars not demperabla. sect one3:are heconctrab 9. ID INFORMATION Register online to take the SAT again. If you do not have access to online registration, you can re-register via mai or phone. YOU Will need the registration number below and the test date. ,...v t„,,,,,,,- -siztq,c.rit,,-ap -4, .T.--es.,7*.ttgo . l. t4t ,;$ 445%; ir'6084 1-7Pk--iftiolitio*•• ~. ;Tat Center. ; , ,;:tr etriA:zrolember ,c , Yr .-2.! - '!)i • ...taitiont !.....ete-n •. .. ..,-f.p.ora... 4emoi;- Lej.iii,$) :mturgies* 0 " •• -- • -m. F 10735 ROYAL PALM BEACH COMMUNITY HS 101493 4"(grelli.talk EFTA01710036 I. • 4 fr a t .461 ..14.1"44 e' at Florida SU Florida Atlantic U U Control Florida Fleglor C Tallahassee, FL Soca Raton, FL Orlando, FL St Augustine, FL S CONE 5219 CODE 5229 CODE 5233 CODE 5235 (--,. 1 4-yr College 4-yr. public 4-yr. public 4-yr. public 4-yr. private xe, ., •::':':Ite university university university liberal torts I • 'Iktp,:.!,: kali* college t • t. Geed f.dt e'bc 'a Undecided 29,820 19,610 34,940 2,106 ?s. :.a t Cs. ..44 • • undergraduates undergraduates undergraduates undergraduates 0 '441 .: ,JkZ:TA VOI{101-41-44., Medium city Urban campus in Suburban teapot in Suburban campus in Suburban campus in . : In state -.1:,-..A-/ snail city swell city very largo city large town : . N07461: FL resident 132 out oi state 92 out of stato 62 out of state 322 out of state . , A/4%W .. . art, ‘J US Citizen 542 live In 502 live in 662 live in 812 live in tilifl,f/41 / 2 1. .g.. Mite 4P . college housing college housing college housing college housing ktt...'Itstr'. .. : es. ..s. No housing plans A 4' 4 1rP7V" 4; r ,¢ ''''. gt I Ce 962 of freshmen SO2 of froshann 952 of froshnon 782 of froshoon .5' ;A; had GPA of 3.0 or hod GPA of 3.0 or had CPA of 3.0 or had GPA of 3.0 or • " ') higher higher higher higher 0 1 J.V 1"& IS 19 units 19 units 19 units 16 (20) units 10-1-e-- • ' Oligglzt 4 English htlalligE4 2 Foreign Lang. 4 Engl 2 Fortan 4 Engl 2 ForLan 4 Engl 2 Forlan 4 Engl (2) Fortran I'l 001951 I 2 Math 3 (4) Math 3 Math 3 Math 3 (4) Math 'Iri(0 ' 2 Natural Sd. 3 (4) Soi 3 Sci 3 Sei 2 (3) Sol . NO eiigi2, 3 Social Science 2 Sac St 1 Soc St 3 Sac St 3 (4) Sec St 33... -.1 2 Arts, Music al Additional course Additional course Additional course Additional course requirements; requirements; requirements; requirements; . e',....1,ek chock with college chock with college check with college check with college 6 0: 5•Ass... 4k (fIre'a:A School record, School record, School record, School record, ‘:4fick . 1:.;:;•.q. test scores, test scores, test scores, test scores, w.;,, "14/7.7 fili- 4,:1 a...,.s.s....... '. I%-s ----- activities, rocomaendetiens, essay activities, reccommendations, essay interview, activities, recommendations, interview, activities, recommendations, t#1g."-/e/St7r I . • 3. .-.../.• • efgAV CISSAV 4' 4 t's ii V SAT REAS occoptod SAT PEAS accepted SAT REAS accepted SAT PEAS accepted SAT PEAS by 3/1 SAT PEAS by 6/1 SAT REAS by 3/1 SAT PEAS by 3/1 COG t: • ., ROjkif SAT Crit. Read. SAT Crit. Read. SAT Grit. Read. SAT Crit. Road. • tea,A 530 - 630 460 - 560 520 - 620 540 - 620 ; .iP hri,Ska:' d' SAT Math SAT Math SAT Math SAT Math • ' tic: e ‘f I ' . r 540 - 630 460 - 560 530 - 630 520 - 600 tv:e , Atfriiktion,Ritt. 652 of applicants 662 of applicants 552 of applicants 302 of applicants k. a , _'Application , 12/31 priority 6/1 closing data 1/1 priority 1/15 priority :2 '..t, Deadline ,'_..... 3/1 closing date 3/1 closing date 5/1 closing date 2005-08Apfwol 312,789 (out-of 013,708 (out-of 515,111 (out-of 618,490 al ExP01 0PP:f4%) state add'1) state add'l) I stato add'1) a .... FinanclOhNif: . On average 832 On average 722 On avorate 752 n of need mot of nuud mot of need cut TE Vi FlnanciatAaid : , 2/15 priority 3/1 priority 3/1 priority 5/1 priority y ot Deadling>.: -.31 No closing date No closing date 6/30 closing date He c is information you provided. Fir t Langua • only Religion Presbyterian Church (U.S.A. ) Telephore: Student Search Service: YES EFTA01710037 C CollegeBoard SAT YOUR SCORES STUDENT SCORE REPORT REPORT DATE: 12/16/05 ( HIGH SCHOOL COPY - 101493 ) Test Date: DECEMBER 2005 c:PercentUes. Pet'l Seer-tit" 0 4 89.8;hottNiSentiltis cS:#1;".*1'S v4ROTeR ROYAL PALM BEACH FL 33411 530 500-560 56 61 intliM 550 520-580, 59 68 Avrittnt,4*.m.,..c4 500 460-540 a a 400{iliat4143 52 reniv 06 WHAT DOES YOUR SCORE RANGE MEAN? WHAT ARE THE AVERAGE SCORES? Your performance is best represented by the score ranges above. For college-bound seniors in the class of 2005, the average www.collegeboard.com or refer to the SAT Program Handbook for irterprotive informa To consider one score better than another, there must be a critical reading score was 508 and the average math score difference of 60 points between your critical reading and math was 520. • scores 80 points between your critical reading and writing scores, and 80 points between your math and writing scores. WILL YOUR SCORES CHANGE IF YOU TAKE THE TEST AGAIN? HOW DO YOU COMPARE WITH COLLEGE-BOUND SENIORS? Among students with critical reading scores of 530, 55% score The national percentile for your critical reading score of 530 IS 56 , higher on a second testing, 35% score lower, and 9% receive Indicating that you did better than 58% of the national group of the same score. On average, a person with a critical reading college-bound seniors. The national percentile for your math score score of 530 gains 11 point(s) on a second testing. of 550 13 59, indicating you did better than 59% of the national group of college-bound seniors. • Among students with math scores of 550,57% score higher on a second testing, 34% score lower, and 9% a Percentile, average score, and score change information for the receive the same score. On average, a person with a math writing section are not available. The test must be given to students score of 550 gains 13 points) on a second testing. • for a full year before this Information can be provided. See reverse side for additional score details. ADDITIONAL SCORE INFORMATION ADDITIONAL SCORE REPORT INFORMATION Visit twrivcollegeboard.com for detailed Information about To learn more about colleges, universities, and your scores and to view your essay. scholarship programs and to send additional score reports, visit veinveollegeboard.com. SUMMARY OF SCORES SAT Reasoning Test SAT Subject Tests 2 " • '. - kAzgeii • a Et '' 1. • ptb.. ' 4*firpt it...0,I,, SUS ' . P int t'.... t> . ..* mewil elt& e f i a.r•iR. 'I 4t ;4 ifi • • ' r • . la 1 S. 1 . ' •• V .: Si) .,z#Cisatzi,),.-iti • I t re'ita • *-:- .: Pnro tiki , kg? Doe 05 12 536 550 510 52 06 Nay 05 11 520 490 490 52 06 Prior to M rch 003, the critical road nor section was 'Not II t. to have subbcons. knownasthe verbal section. 522222 from Dane 112° 'Scar s from the SAT Subject Test in Writ nq and th writing &eche on the SAT Reasoning Test are not comparable. geCtlOrts aro comparable. ID INFORMATION 0 Register online to take the SAT again. If you do not have access to online registration, you can re-register via mai or phone. You will need the registration number below and the test date. :;itag; apr . 414 , ilnIM I:75g44422, t;Ornii#40 t(r/ flaRRIST6tiorr- . It. arcg r1 - WrCil, -1, f54/13,0 23 4.Avetrisi fAvAiiiiiit p.I t wrttigterlk ' talitreltkin F 10735 ROYAL PALM BEACH COMMUNITY HS 101493 EFTA01710038 PERSONAL AND COLLEGE PROFILES ,...:s.sy.tvk:-;,..-.1-, 'E,I;;F:'itCkiliilabaliadFaYaiieSifitsiaidinrin*ittitirttsiTHr. r .vr,,,,•At -,:., •,u-sctev.1" ,!::-_,..io,tiOlobiled*ttigffilnuits:ung§itattolivots010;ThIp*nevw..),,"-tt ....-,i:- -' i5iviNg! ...- Xrat. • I . , ,Thotellegtacii4,0Mositindbeek 2005:infpripiicionpftrilia•:)'-'4t :i tif,4 4::,7, t„, .y,;:.4...S,I's?: 7" 2,;;;4.7 :ii:iciaitaitince talliciediii414,:loikilostraimitiliaterial:rs.1X.:2;ZC:+24: ; U North Florida U South Florida No college/scholar- No college/scholar- Jacksonville, FL Tampa, FL ship was designated ship was designated a 000E 5490 CODE 5828 to receive a report. to receive a report. ?V t/lng14k 4-)!r College 4-Yr. public 4- yr. public ;') ?..Ifi :( 44:4 university unive univorsity 1. :f 7 ,. 1 Itt ,.C.4/..) ;;::.! Pltilo i d' f4'..:V;.t imv-Itett,..=f4P Coed W ?pr;w!:• Undecided 12,237 32,458 ia ,1C41:4 1.647.: , undorgradeatos undergraduates • •-(e‘ Urban campus- in Urban commas in i .41A I) Medium city 4 y . In state i.:,..54 vary largo city very large city A. - ' 'V ,„,.....;.: -,. ' , . Fl resident 4X out of state n out of state v US Citizen 852 live In 542 live in i."': :14 White collage housing collage housing ry ::ti 7. /.:. ( 1 No housing plans .)... ... • 'Artc 82% of freshmen 912 of freshmen ak.c. • C+ .e15l1 had CPA of 3.0 or had CPA of 3.0 or higher higher .4 ft 5 li54)1,14i'7X 15 19 units 19 units • .....,,., t; tr . 4,0;t1..tt% 4 English 14094,IT!AWal 4 En91 4 Engl 1- -7thltraill$AinG" 2 Foreign Lang. 2 Forlan 2 Forlan P. ,1 certakiitS.V2Z,Z 2 Math 3 Math 3 Math 4. ,.. - IyibliftWgi 2 Natural Sal. 3 Sol 3 Sot -h. 3 Social Science 3 Sac St 3 Sac St 1 4-",.. 2 Arts, Music ya i i:c..4, Additional course Additional course g h-..;t4Urio$ V . . roquirozents; roquirooentsi .1 ».; ..: .. *3 •• k" -:- .v,.. ' chock with college chock with college , 4 td , r ,.., i.. ' - FR aHMA,P?:AD!fil.SSjtj,f&‘atirV141 ' /. School record, School record, test scores, test seems, . j'.4.' activities, activities, Tr! /41.44t reconnandations, recommendations, essay essay kti v 4 ii'apMekc..r, . YlE4641•:(t•:l . 1 SAT REAS accepted SAT REAS by 7/15 SAT REAS accepted SAT REAS by 4/15 r•C•V‘..ar 4 3i:tidal somlp.ob,iii.g SAT Crit. Rood. SOO - 600 SAT Crit. Road. 500 - 600 Fros8pl!mti,gi SAT Math SAT Math SOO - 600 SID - 600 4'11 .. 94.000M' . . 692 of applicants 512 of applicants ,94$10410K ,;t 11/14 priority 4/15 priority ,D1dilho. f' 7/2 closing date No closing date :68.Itifillil; $13,888 (out-of 611,896 (out-of state odd•1) state add•l) 4.000;o6 , ' On overage 752 of need met On overage 322 of need seat 10. , • '- .i, 1-pdg: . 4/1 priority 3/1 priority s el Opp : .: No closing date Here Is Information you provided: First Lang • only Religion: Presbyterian Church (U.S.A.) Telephone: Student Search Service: YES EFTA01710039 DIST: 2331 TCHRIM D NBR: 128 STDT: 24998585 CRS: 2003340 SEC:002 BLDG:04 RM: 220 08/01/05 el ) THE SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) L ati New and Returning Student Registration Complete ALL AREAS on both sides of the form (except areas in gray). Correct any preprinted information. Do not leave any 6- STUDENT LEGAL NAME NH Ent. medals ALSO KNOWN AS SOCIAL SECURITY NO. rowashx9 LOCAL ADDRESS (house mate( and 8We name epartment nitrite, city, slate. *code/ NAME CC MUSING CEVELCPMENT (if appkebNO ROYAL PALM BEACH FL 33411 • MAILING ADDRESS (house slumber end semi ming epietnseel number, city, stale. :in code) NOME TELEPHONE NUMBER DAY TWE TELEPHONE NUMBER EVENING TELEPHONE NUMBER A LUPAGER NUMBER so: (Ms, IMMO ItACEIETHrriCoexrlN w 0 A - Aslan.IPacific Islander II I - American Indlan/Alaslcan Native F D B - Black, Non-Hispanic 0 H - Hispanic 0 W - White, Non-Hispanic 0 M Multiracial DATE CC BIRTH EnmiddiWyy) PLACE OF BIRTH (cfty, state, stone)) MUNSTER IN US INDIANA RESIDENT STATUS USA ENTRY DATE 3 0 a Foreign Exchange Student 0 1. Out-of-county Resident 0 2. Out-of-state Resident a3. In-county Resident 1. Federal Impact Survey A The student resides on federal property. 0 Yes gNo B. The student resides In low rent housing. 0 Yes %No C. The parent Is employed on federal property located in Palm Beach County. 0 Yes j21lo D. The parent is employed on low rent housing located in Palm Beach County. 0 Yes A PNo E. The parent is in the uniformed services of the United States. 0 Yes No a If "E" Is YES, Is the parent on active duty? 0 Yes 0 No (check service below) 0 Air Force 0 Army 0 Coast Guard 0 National Guard 0 Navy 0 Marines 2. Preschool Enrollment Information (Check each program attended. Indicate with an asterisk fl the program your child was in the longest.) 0 Fee for Services 0 Head Start 0 Pre-K Disabilities 0 Private Pre-K 0 School-based (Pre-K) 0 Teenage Parent Program 0 None 3. Is the student who Is enrolling in school a single parent? 0 Yes 0 No N 4. Students will receive non-Invasive health screenings pursuant to Florida Statute § 381.0056(7)(d). Non-invasive screenings may include vision, hearing, scoliosis, height, and weight. These tests may be given individually or in groups. Parents or guardians, however, have the right to request an exemption in writing. (This exemption will cover all types of screenings.) If you DO NOT want your child to receive the screenings, write the words " Do not screen" here: 5. I give permission for my child to participate in the sodium fluoride program to prevent tooth decay. NO 0 Yes (Permission is void through grade 5.) 0 No 6. Does your child currently have health Insurance? ;Yes Q No p If YES, check insurance plan: 0 Medicaid 0 Healthy Kids/Kid Care IXPrivate ❑ Interested in receiving information 7. All new students to Palm Beach County are required to answer the following home language survey questions. A. Is a language other than English used in the home? ❑ Yes (language) 0 No B. Does the student have a first language other than English? 0 Yes (language) 0 No C. Does the student most frequently speak a language other than English? 0 Yes (language) 0 No 8. Name of the last school attended A City State B. County Country C. Last grade level completed Last attendance date D. Does your child have 0 Individual Education Plan (/EP) 0 504 Plan 0 Other Plan? (if checked provide a copy) PBSD 0636 (Rev. 01/26/2005) page 1of 2 EFTA01710040 STUDENT LEGAL NAME MN Rat middle) 9. Disclosures for entry into Palm Beach County School District (check all that apply) O The student has had Juvenile Justice actions taken against him/her. 0 The student has been expelled from School O The student has been arrested resulting in a charge. Ef Not applicable 10. Indicate with whom the student lives (check one only) Both Parents 0 Mother 0 Father 0 Foster 0 Group Home 0 Student is ward of the state O Other 11. IMPORTANT, EVERYONE MUST ANSWER THIS QUESTION. A Is there a visitation order or other court order barring either parent from removing the student during the school day or coming Into contact with the student? If Yes, provide school with a copy of court order. 0 Yes No lir B. Parents DO NOT have shared parental responsibility 0 If checked provide school with copy of court order. 12. Provide the following parent/legal guardian information ROYAL PALM BEACH FL 33411 MOUE TELEPHONE BUSIPNSS TELEPHONE Ertialmmov i PARENT OR LC-GAL GVARWN OW Amt. middle Wag) AI L: SS IF NOT TsE SAME AS STUDENT(haus* ovonber end street name. spartmont sugo, zp code) • • OVAL PALM BEACH FL 33411 HOME TEL CROWE BUSINE TEL_ PriON:r 13. List names and date of birth of parent's I legal guardian's other children enrofled in Palm Beach County schools. 14. Provide the name(s) of person(s), other than the parent, allowed to pick up the student. 15. Provide a password the person allowed to pick up the student will use. (limited to 10 characters) L. soy 16. Does the student have any allergies? (if yes specify) f'Yes 0 No Allergy c•12,n APIA. 01/4.A 1 18. Physician Name 1 J Telephone Number Parental Consent for Release of Student Information Verification of Student I hereby give permission for the school or District to use my chikfs photograph, video Image, writing, Registration Information voice recording, name, grade level, school name, participation in officially recognized activities and I verify that the information given sports, we:ght and height as a member of an athletic team, dates of attendance, diplomas and awards received, date and place of birth, and most recent previous school attended, in annual yearbooks, on this student registration is true graduation programs, playbills, school productions, web sites, etc. and/or similar school-or and accurate to the best of my District-sponsored publications or in school or District-approved news meda interviews and photographs. k ow I understand without my signature my child's name and photograph cannot and will net be included in any publications or presentations. I also understand and agree that my child's medical records or other medical information that I provide to the school, and treatment records or other medical records created by health care personnel at TURE OF PARENT/GUARDIAN DATE fog the hoot will be shared with school officials who have a legitimate educational purpose for accessing Registration is not valid without a verification g 1)11 05 signature and date. sr.../m /LEGAL GUARDIAN DATE PBSD 0636 (Rev. 01/26/2005) page 2 of 2 EFTA01710041 Test Date: Nov 22, 2004 Royal Palm Beach I-Is Royal Palm B FL 23F) ASVAB SUM ARY RESULTS ARMED SERVICES VOCATIONAL. APTITUDE BATTERY Pam 19.0003 11th MILITARY CAREERS Percentile Scores AND — ASVAB Results Standard Scores 11th Grade Standard Score Bands llth Made ITO Gads Females Mat 11th Grade Students ENTRANCE SCORES 1 10 2) 30 90 60 60 70 80 90 99 Two more scores can be especially use- Career Exploration Scores ful to you. The Military Careers Score is Verbal Skills 55 69 69 69 a composite of the ASVAB verbal,math, mechanical, and electronics tests. The Math Skills 58 --- —.....•• ---- — ---- — 80 80 80 Military Careers Score provides a link Science and Technical Skills 46 42 24 33 to occupations described in Military Careers:You willbe able to seehow well your skills, abilities, and career interests ASVAB Tests match those of Service personnel cur- General Science (GS) 50 -- - -- 57 48 52 rently working in military occupations. Arithmetic Reasoning (AR) 58 81 77 79 Military Careers provides you with a clear image of whit workers do in these Word Knowledge (WM 51 55 51 53 occupations, as well as other useful in- Paragraph Comprehension (PC) 59 79 86 82 formation about the occupations. Mathematics Knowledge (MK) 58 . ME 77 80 79 The Military Entrance Score (also called Electronics Informations (El) 50 62 38 50 , wWit stands fr the Arm Forces AFQT Qualification Test is the score Auto and Shop Information (AS) 44 ---- ----- --- --- 45 20 32 used to determine your qualifications Mechanical Comprehension (MC) 39 16 11 14 for entry into any branch of the United States ArmedForces or the CoastGuard. The Military Entrance Score predicts in Military Careers Score 3 a general way how wellyoumight do in to so 30 40 BO BO 70 BO 90 99 training and on the job in military occu- Military Entrance Score (AFOT) 66 pations. Your score reflects your stand- ing compared to American men and women Ili to 23 years of age. EXPLANATION OF YOUR the same orbetter thanOS outofevery100 females don test. Taking a course or obtaining a part- USE OF INFORMATION ASVAB STANDARD SCORES in the 11th grade. timejobin this area wouldincrease your knowl- edge and improve your score if you were to Personalidentity information(name,so- Your ASVAB results aremportedasstandardscores For purposes of career planning, knowing your take it again. cial security number, street address, and in the above graph. Your score on each test Is relative standing in these comparison groups is telephone number) and test scores will identified by the '1r in the corresponding bar important. Being male or female does not limit USING ASVAB RESULTS IN not be released to anpp a ency outside of graph.Youshould view thesescores as intimate-sof your career or educational choices. There are CAREER EXPLORATION Treni:Z artment of (DoD), the your true skill level in that area.If you took the test noticeable differences in how men and women t Forces, the Coast Guard, and again, you probably would receive a somewhat score in some areas. Viewing your scores in light Your career and educational plans may change your school. Your school or local school different score.Many thino.,such ashow you were of your relative standing both to men and women over time as you gain more experience and system can determine any further re- feeling during testing,tontribute to this difference. may encourage you to explore areas that you learn more about your interests. &Florin:Ca- lease of information. The DoD will use This difference is shown with gray score bands in might otherwise overlook. reers: The ASVAB Career Exploration Guide your scores for recruiting and research the graph of your results. Your standard scores are can help youlearnmore about yourself and the purposes for up to two years. After that You can use the Career Exploration Scores to world of work, toidentifyand explore potential based on the ASVAB tests and composites based on evaluate your knowledge and skills in three gert goals, and develop an effective strategy to real- the information willbe used by theDoD your grade level. eral areas (Verbal, Math, and Science and Techni- ize yourgoals.The Guidewillhelp youidentify for research purposes only. The score bands provide a way to identify some of calSkills). You can use the ASVAB Test Scores to occupations in line with your interests and your strengths. Overlapping score bands mean gather information on specific skill areas. To- skills. As you explore potentially satisfying your true skill level is similar in both areas, so the gether, these scores provide a snapshot of pray careera,you will develop your career explora- real differencebetween specific scores might not be cunent knowledge and skills. This information tion and planning skills. meaningful.If the score bands do not overlap, you will help you develop and review your career Visit: www.asvabprogram.com probably are strongerin the area that has thehigher goals and plans. Meanwhile, your ASVAB results can help you score band. in making well-informed choices about future The ASVAB is an aptitude test. It is neither an high school courses. Use Access Code: YOUR ASVAB PERCENTILE SCORES absolute measure ofyour skills andabilities nor a perfect predictor of your success or failure. A We encourage you to discuss your ASVAB Your ASVAB results are reported as percentile high score does not guarantee success, and a low results with a teacher, counselor,parent, family Access code expires: July 1st scoresin the three columns to theright of the graph. score does not guarantee failure, in a future edu- member or other interested adult. These indi- Percentile scores show how you compare to other cational program or occupation. For example, if viduals can help you to view your ASVAB students - males and females, and for all students - you have never worked with shop equipment or results in light of other important inforntation, in your grade.For example, a percentile score of CS cars, you may not be familiar with the terms and such as your interests, school grades,.motiva- SEE YOUR COUNSELOR FOR for an 11th grade female would mean she scored concepts assessed by the Auto and Shop Henna- tion, and personal goals. FURTHER INFORMATION 00 FORM 1304-5,1 JUL 02 -PREVIOUS FO:TION4 OF THIS FORM ME OBSOLETE EFTA01710042 ASVAB SCORE AND TEST DESCRIPTIONS Verbal Skills is a general measure of language and reading skills which Paragraph Comprehension tests the ability to obtain information from combines the Word Knowledge and Paragraph Comprehension tests. People written material. Students read different types of passages of varying lengths with high scores tend to do well in tasks that require good language or and respond to questions based on information presented in each passage. reading skills, while people with low scores have more difficulty with such Concepts include identifying stated and reworded facts, determining a tasks. sequence of events, drawing conclusions, identifying main ideas, determin- ing the author's purpose and tone, and identifying style and technique. Math Skills is a general measure of mathematics skills which combines the Mathematics Knowledge and Arithmetic Reasoning tests. People with high Mathematics Knowledge tests the ability to solve problems by applying scores tend to do well in tasks that require a knowledge of mathematics, knowledge of mathematical concepts and. applications. The problems focus while people with low scores have more difficulty with these kinds of tasks. on concepts and algorithms and involve number theory, numeration, alge- braic operations and equations, geometry and measurement, and probabil- ity. Mathematics knowledge is one factor that characterizes mathematics Science and Technical Skills is a general measure of science and technical comprehension; it also assesses logical thinking. skills which combines the General Science, Electronics Information, and Mechanical Comprehension tests. People with high scores tend to do well in tasks that require scientific thinking or technical skills, while people with low Electronics Information tests understanding of electrical current, circuits, scores have more difficulty with such tasks. devices, and systems. Electronics information topics include electrical cir- cuits, electrical and electronic systems, electrical currents, electrical tools, symbols, devices, and materials. General Science tests the ability to answer questions on a variety of science topics drawn from courses taught in most high schools. The life science items cover botany, zoology, anatomy and physiology, and ecology. The earth and Auto and Shop Information tests aptitude for automotive maintenance and space science items are based on astronomy, geology, meteorology, and repair and wood and metal shop practices. The test covers several areas oceanography. The physical science items measure force and motion me- commonly included in most high school auto and shop courses such as chanics, energy, fluids, atomic structure, and chemistry. automotive components, automotive systems, automotive tools, trouble- shooting and repair, shop tools, building materials, and building and con- struction procedures. Arithmetic Reasoning tests the ability to solve basic arithmetic problems one encounters in everyday life. One-step and multi-step word problems require addition, subtraction, multiplication, and division, and choosing the Mechanical Comprehension tests understanding of the principles of me- correct order of operations when more than one step is necessary. The items chanical devices, structural support, and properties of materials. Mechanical include operations with whole numbers, operations with rational numbers, comprehension topics include simple machines, compound machines, me- ratio and proportion, interest and percentage, and measurement. Arithmetic chanical motion, and fluid dynamics. reasoning is one factor that helps characterize mathematics comprehension and it also assesses logical thinking. Military Careers Score is a composite of the verbal, math, Mechanical Comprehension, and Electronics Information tests. It compares your skills in Word Knowledge tests the ability to understand the meaning of words these areas to the skills of military personnel currently employed in a number through synonyms - words having the same or nearly the same meaning as of occupations. The score is used with the publication MilitaryCareerswhich other words. The test is a measure of one component of reading comprehen- highlights and describes a number of military occupations. sion since vocabulary is one of many factors that characterize reading comprehension. Military Entrance Score (AFQT) is the score used if an individual decides to enter any of the armed services. See your local recruiter for details. 0 I I0 AnVFRNELKKIT P11047000 ,010. 2C0.0110 EFTA01710043 October 2004 NAME: Florida Comprehensive Assessment Test (FCAT) tD: SSS Reading and SSS Mathematics Retake Tests SCHOOL: 2331-ROYAL PALM BEACH HIGH Grade 11 Student Report DISTRICT: 60-PALM BEACH needs (engrebensise Assessment Test This report shows your results from the Grade 10 FCAT Retake test(s). Passing both the Grade 10 Reading and Mathematics Tests is a requirement for a standard Florida high school diploma. Students must earn an FCAT Score of 1926 or better in Reading and 1889 or better in Mathematics to meet the graduation requirement. The FCAT measures your performance on selected benchmarks in reading and mathematics as defined by the Sunshine State Standards. Scores on this test are one indication of your achievement of the challencjng contort that Florida students are expected to know. Your Reading Results Your Reading FCAT Score FCAT Achievement Score Level Passed You have passed the Grade 10 FCAT Reading lost. 2186 3 YES Your Reading Content 3000 Ports Points Content Areas Possible Earned 2400 Words/Phrases 11 13 Main Idea/Purpose 15 I8 1800 , Comparisons 11 14 Ftelerence/Reserach 7 9 MO Reading Content - Content scores give more specific information about 600 the skills on the FCAT. Grade level expectations for students include: • Words and Phrases -uses skills to determine word meaning, including word parts and relationships between words. 0 • Main IdearPuiposo -determines a stated or Implied essential message, details, Swans Snore Passing Scots author's purpose, or plot. • Comparisons -knows similar and different, cause and effect, and contrast. *This score shows your Schleversigni on the day you were tested. If you wore to take the same • Reference:Research -uses information from a variety of sources to reach test again it is licely that your 2005 Reading conclusions. score would be between 2105 and 2267. Your Mathematics Results Your Mathematics FCAT Score FCAT Achievement Score' Level Passed You have passed the Grade 10 FCAT Mathematics test. 2110 4 YES Your Mathematics Content 3000 Penis Points Content Areas Earned Possinto 2100 Number Sense 7 10 Measurement 6 10 1800 Geometry 8 14 Algebraic Thinking 12 14 1200 Data Analysis 8 10 600 Mathematics Content- Content scores give more specific information about the skills on the FCAT. Grade level expectations for students Include: 0 • Number Sense -uses number concepts and computation skills. Sgent Scars Passing Score • Measurement -solves problems involving measurements, e.g., time, length, area. a Geometry - analyzes and combines shapes to solve problems. 'This score shows your achievement on the day • Algebraic Thinking -analyzes patterns and uses equations and inequalities. you were tested. If you were to take the same • Data Analysis and Probability -uses data analysis toots to display information, make test again S is likely that your 2035 Mathematics predictions and make inferences. score would be between 2091 and 2139. NT-Not Tested NR-Not Reported Data Run Date: 11/22/2004 0115144 EFTA01710044 Run Dt: 07-30-03 Lake Central High School H.S.: 153-112 8400 Wicker Ave Withdrew: 06-06-03 St. John, IN 46373 219-365-8551 063003 Par/Guard: L"PCWin~Z7fL~ IN 46307 Telephone: Birthdate: Ssl: Cn Soc Sec #: Sex: F Gr: 09 Principal: COURSE TITLE CRED GR-S FG COURSE TIT RED GR-S FG a Cmp Kybd 2 B20800 1.00 09-2 A- I M81410 1.00 09-1 C- * Dept - BUSINESS 1.00 *TOT Alg I M81410 09-2 F *gDept - MATH 1.00 *TOT Fo* 2 C63200 09-2 F P40100 . 08-3 A- oDept - CON/FAMSC *TOT PE Pool 1 Health I PE Gym 1 P44100 P40300 1.00 08-3 B+ . 0 09-1 B Eng 9 E31210 1.00 09-1 C+ Eng 9 E31210 1.00 09-2 C * Dept - PHYS ED 00 *TOT 2.5 * Dept - ENGLISH 2.00 *TOT Int Cm/Ph 585610 1.00 09-1 C+ F76010 1.00 08-1 B- Int Cm/Ph 585610 09-2 F Span I 8 1.00 *TOT Span I 8 F76010 1.00 08-2 C+ * Dept - SCIENCE Span II 9 F72010 1.00 09-1 D * Dept - FOR LANG 3.00 *TOT Intro Jour T30710 1.00 09-1 C Intro Jour T30710 1.00 09- C Am Geog 1 H50100 1.00 09-1 C+ * Dept - FINE ARTS 2.00 *TOT Wld Geog 2 H50400 09-2 F * Dept - SOC STUD 1.00 *TOT 01/02-1 Cum Credit- 1.00 GPA= 2.6700. 01/02-2 Cum Credit= 2.00 GPA= 2.5000. 01/02-3 Cum Credit= 3.50 GPA= 2.9028. 02/03-1 Cum credit= 10.00 GPA= 2.3320. 02/03-2 Cum Credit= 13.00 GPA= 1.8229. Passed Pending Waived Graduation Qualifying Examination EFTA01710045 Spring 2004 NAME: ID: Florida Comprehensive Assessment Test (FCAT) SCHOOL: 2331 -ROYAL PALM BEACH HIGH NORM-REFERENCED TEST DISTRICT: 50 • PALM BEACH Grade 09 Student Report Florida Carrprehensire Assessmrnl Test This report shows your results from the FCAT National Norm-Referenced Test. The FCAT Non-Referenced Test measures your achievement on a test that was given to a national sample of students. Your norm-referenced scores in Reading Comprehension and in Mathematics Problem Solving describe your performance in relation to the performance of students throughout the nation. Your scores are shown below. SUBJECT SCORES National Scale Percentile Stanine Score Rank Reading Comprehension 727 78 7 Mathematics 713 75 6 The Scale Score descrbes your performance on the lest and allows for comparisons from year to year. Reading Comprehension Scale Scores range from 519 to 830. Mathematics Scale Scores range from 553 to 858. The National Percenlile Rank (NPR) and Stanine Indicate your relative standing In comparison to the national reference group. National Percentile Ranks range from 1 to 99. The NPR score Indicates the percent of students in the national sample who scored equal to or below your score. Stanines range from 1 to 9 where 1 is low and 9 is high. StaNnas In the range of 4-6 are considered average scores. It you were to lake the lest again, your National Percentile Rank might be slightly higher or lower. However, your National Percentile Rank would probably fall within a certain range. For Readng Comprehension, your National Percentile Rank should be between 66 and 88. For Mathematics, your National Percentile Rank should be between 65 and 83. CONTENT SCORES Number of Number of Number of Questions Questions Correct on Test Attempted Responses Reading Comprehension 51 50 43 Initial Understanding 10 10 9 Interpretation 22 22 20 Critical Analysis 9 9 9 Strategies 10 9 5 Mathematics 48 48 30 Problem Solving 6 6 0 Algebra 6 6 6 Statistics 5 5 4 Probability 6 6 3 Functions 5 5 4 Geometry-Synthetic 6 6 6 Geometry-Algebraic 5 5 2 Trigonometry 3 3 2 Discrete Math 3 3 2 Pre calculus 3 3 1 Data Run Date: 04/16/2004 0139667 5 EFTA01710046 ACADEMIC HISTORY RECORD STUDENT NO STUDENT NAME_ PREVIOUS COURSES COMPLETED SY T COUR O# COURSE TITLE SA CREDIT CREDIT CREDIT FINAL FLGS HC PS TAKEN DS CODE ATTP EARN GRADE SCHL rasoo3I0 AOC Ino3to 2_3 I a o9bao —3 5 r bt icaOciDa0 -"B 5-r R.t aociba-0 -BST VO A .a /006,50o P !Q- /00 (23()U -.)Oarn 1- " r R000bio Aot,aitoo DATE: 1(14( 0 3 EFTA01710047 -sa ACADEMIC HISTORY RECORD C/NYWYI- " / STUDENT NO: STUDENT NAME: PREVIOUS COURSES COMPLETED SY T COURSE NO# COURSE TITLE SA CREDIT CREDIT CREDIT FINAL FLGS I-IC PS TAKEN DS CODE ATTP EARN ' GRADE SCHL a .. j /OO /3,0 C-- — - 67c15,0 z 6 /a005/0 17 a ib '5 3ba 0___ — /O 0 6 "360 e---, /50034 .eci•i 14- — — t•)90, 2_.t) 13 5 -7- C.-- F F F ::OUNSELO MO DATE: ? - SeR-0.3 DP: , DATE: ?-2-'63 EFTA01710048 Run Dt.: 10-07-03 Lake Central High School H.S.: 153-112 8400 Wicker Ave Withdrew: 06-06-03 St. John, IN 46373 219-365-8551 0630031 Par/Guard: Crown Point, IN 4 07 Telephone: Birthdate: Cnsl: Principal: Soc Sec it: Sex: F COURSE TITLE CRED GR-S FG COURSE TIT CRED GR-S FG Cmp Kybd 2 B20800 1.00 09-2 A- Alg I M81410 1.00 09-1 C- M81410 -2 F * Dept - BUSINESS 1.00 *TOT Alg I * Dept - MATH 1.00 *TOT Foods I 2 C63200 09-2 F * Dept - CON/FAM SC *TOT PE Pool 1 P40100 .50 08-3 A- Health I P44100 1.00 08-3 B+ Eng 9 E31210 1.00 09-1 C+ PE Gym 1 P40300 .50 09-1 B E31210 1.00 09-2 C * Dept - PHYS ED 2.00 *TOT : gDpt - ENGLISH EI 2.00 *TOT nt Cm/Ph 885610 1.00 09-1 C+ Span I 8 F76010 1.00 08-1 B- Int Cm/Ph S85610 09-2 F Span I 8 F76010 C+ 1.00 08-2 D * Dept - SCIENCE 1.00 *TOT SRageN F72010 1.00 09-1 FOR LANG 3.00 *TOT Intro .lour T30710 1.00 09-1 C Intro Jour T30710 1.00 09-2 C Am Geog 1 H50100 1.00 09-1 C+ * Dept - FINE ARTS 2.00 *TOT Wld Geog 2 H50400 09-2 F * Dept - SOC STUD 1.00 *TOT 01/02-1 Cum Credit= 1.00 GPA= 2.6700. 01/02-2 Cum Credit= 2.00 GPA= 2.5000. 01/02-3 Cum Credit= 3.50 GPA= 2.9028. 02/03-1 Cum Credit= 10.00 GPA= 2.3320. Ranked 477 of 695. 02/03-2 Cum Credit= 13.00 GPA= 1.8229. Ranked 543 of 672. 02/03-3 Cum Credit= 13.00 GPA= 1.8229. Passed Pending Waived Graduation Qualifying Examination Counselor Date- EFTA01710049 Lake Central Middle School Academic Record -- School AND BIRTH DATE / / EXPL. ART i 0.250 J—TOTAtcutwrr GERMAN B 1 0.250 I 14.000 HOME EC. B 0.250 an n M -51- LANG ARTS C+ 1.000 106 / 301 LIT 8+ 1 1.000 rat TOW MATH L000 3.00 . 0 PHYS. ED. :A 0.250 SthOol Year SCIENCE 1.000 1999-2000 55,-.0oNotnoocroa-o -an II SOCIAL STUDIES B+ : 1.000 -ir000sootioocpcorti<NN O • 66666t r.oNo- .• 0 66 00000000r)(94 -0 000000C1M11-0 0 0 . • • • • • • . .a.. 0 DAYS ABSENT I + O =moo tEtzna< 003 (1)O1O til 4-, f•• w ZO• {- iIQ wp •-• dptC MC mraw tarn -4000 • u E 01400 > 4.) ni•••• to au 0 0 w ,<ct • 00 JEcommmonior , ^ cc a ni a co ML II ctoon000tinoo -a 0 il- i-$OOIN.1"--OOO(1O.-$ Oa O-4 OOONOOO1-“0.4 Nr )000.0000cocainoa. ..-$0004)..0000 1:00 0-C OM NM000,00 00NMNCIO. m-00. MO. . . ) • 666.i N O 666596cr . ow, O •-$6,-$ 6(114. ..41.12: Li_r) 6r. a 6 6 (3.n 0 ,0 Ca( a0000000nu-nnin 000000000tnin • 0000000mmion-o o in 00000001001011-0C u2 00000000ncre) U) 0000000MM-0C .00 DAYS ABSENT . . . . . . . . mOC .r.4 .4..-$.-0.-$ E .Z 11.,--I-i.-4.-4.-47-I E 1-4 OW 1-1<t- IHN:c Z Y I I I I 6 et 1 1 ocammaistcomo< Z C-)C3fDS.Wetitit a)cocamo<acitt UT c) NC it CDC nu. m G003 PS It Mei' An U, (04-a < In 4. 5- ..c w 5- a$ 4.zr, e> C-0_.-$ 434 1-• . O 4.,f- c w to zda v u taCtl • .= ezi Z0)O < 0 u+, 4a.c.c< CI ED Q tn LLIIIMI :IC In u4 'O0-•-$G 'M am Li 7++ cf.° CEO CE C Cli 4O in 0.• 0 O• C a; -a tntlitn000 >g=u7t, 74J-Q8 88 mmauomowc.xm O Z C.LA ron-i u c mye ELLIC• mmmuom.cowM C M▪ CmuCam=c.cm Mi400 I JEwwwmoil-wo.ei -666 • JEMWMBITCLEMor.: JE WWWCLALLOK 0 .- : MP- Coa cu IP cJ rnn int o mcs• EFTA01710050 Middle School Test Record Student School Birth Date / / Terrallova READIN LANGUAGE MATHEMATICS TOIL SOC CTBS CB READ VOC CMP LANG MECH CMP MATE COMP CMP SCOR SC! STDV OPEL FORM/ SCORE I LEVEL NP 91 66 83 93 71 85 91 66 83 84 94 82 65 - NORMS DATEi 3996 A-17 NO 8 6 7 8 6 7 8 6 7 7 8 7 6 - QUARTER HONTMi 06 GRADE GE 12.8 8.7 10.4 12.♦ 9.7 10.8 10.7 7.9 9.4 10.3 12.+ 10.2 8.3 - PATTERN (IRT) 7.1 NCE 78 58 70 80 62 72 79 S9 70 71 83 69 58 - DATE M832520001-03-00091 09/00 EFTA01710051 BANb sz"LlnYoli5r947r7"-='-' COMPUTER A 0.250 : TOTALW FRENCH A • 0.250: 7.000 Lake Central Elementary School Academic Record — HEALTH HOME EC. B D.250 •Rank in Class of 0.250 88 / 300 LANG ARTS B 1.000 ' Absence Tardies LIT • 1.000 I 1.50 : 0 Name Birth / / MATH B 1.000 School Year SCIENCE - 1.000 1999-2000 Birth Cm SOCIAL STUDIES B 1.000 ' Sahli 3 • Year 9/ 414- 95 (995-910 199.4 94 97 iffr —ref' 7i Y i Semester 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 Grade K l< I t 2 2. 3 —g /re g ..! -___C Days Present 07 $ 7.5 in 814 26 8.1 : ga it 5 n Ai V/ %L Days-Absent / 4.5 2. i 3 LI I ..C.C.31 -6- 0 '1 Times Tardy 0 (7 o Co 0 I O d e) O n () Reading Q-- )Q± if ' A /F. iii English 4 J3 ,514 R-- ---- Mt- Spelling . azz ip h ,.D4- Handwriting Mathematics 'Social Studies ge A 6 5 A S a- Aci- ,81" Ertl C Science / 5 5 S *Sri— ,r4 Health 4, a a- a- /7- Music 5. 5 sst- ,..5.4 5 II- ...0-: Art 5 SI- ,5 4- S )e--- .5/— Physical Education 5 5 -.5' S . C f Promoted or Retained 2 4, (7 ‘ Teacher EFTA01710052 Elementary Test Record os."Kes School WATSON SCHOQL Birth Date Student O CTBS/4 READING LANGUAGE MATHEMATICS TOTL WORD VOC COMP TOTL MECH EXPR TOTL COMP CLA TOTL BATT ANLNe FORM/ SCORES LEVEL NP 88 98 95 88 88 89 70 77 75 91 * 94 A-11 NS 7 9 a 7 7 7 6 6 6 8 9 GRADE GE 2.5 4.2 3.1 2.7 2.6 2.6 1.8 2.2 2.0 2.5 X • 1.6 NCE 75 92 85 75 74 76 61 66 64 78 99 DATE 3/95 READING LANGUAGE MATHEMATICS TOTL WORD CTSS/4 VOC COMP TOM MECH EXPR TOTL COMP CAA TOTL BATT ANLV SPEL T TEST COI SCORES NVREI MEM VRB TOT FORM/ SCORES 66 94 92 96 90 59 C TCS/2 122 81 95 91 99 93 99 LEVEL NP NS 7 a 8 9 6 9 7 8 a 9 8 5 S LEVEL -11 AGE NPA I 82 11 *99 91 A-12 X 2.7 / 1 7 GRADE GE 5 83 3 79 4 87 77 55 2 2.6 NCE 368 6 85 4 78 8 99 6 82 796 3 73 94 78 96 88 72 76 75 89 82 86 DATE AANCE 90 93 3/96 ISTEP4 READING LANGUAGE MATHEMATICS TOTL VOC COMP TOTL MECH EXPR TOTL COMP CAA TOTL BATT T • TEST CS! SCORES • TC8/ 134 NP 73 * 99 99 66 * 99 92 66 87 81 95 AGE QUARTER MONTH: 05 GE 04 504 8- 5 GRADE NCE 463 1299 797 459 1096 6 80 358 573 468 3 AANCE 74 74 75 75 74 77 81 80 83 81 2 DATE NO06002000-05-06360 9/96 LANGUAGE MATHEMATICS TOTL SOC TTSSenaNova READIN LANG MECH CMP MATH COMP COP SCOR STDV C CS READ VOC COP FORM/ SCORES LEVEL NP NORMS DATE: 1996 A-14 NS QUARTER MONTH: 06 GRADE GE PATTERN (IRT) 4.1 NCE DATE M8325 09/97 20001-03-00065 jgrrallow READING LANGUAGE MATHEMATICS TOTL SOC LTBS CB READ VOC CRP LANG MECH CMP MATH COMP COP SCOR 8 C1 STDV SPEL FORM/ SCORES LEVEL NP 82 81 83 72 68 71 88 81 87 81 91 92 73 - NORMS DATE; 1996 A-15 NS 7 7 7 6 6 6 7 7 7 7 8 8 6 - QUARTER MONTH: 06 GRADE GE 9.0 7.9 8.6 8.1 7.0 7.5 7.7 6.5 7.1 8.0 9.3 9.2 6.6 - PATTERN (IRT) 5.1 NCE 70 68 70 63 60 62 74 68 73 68 78 80 63 - DATE M832520001-03-00099 09/98 TEST CBI SCORES OEQ lANA NVRB NEN VRB O TCS/2 115 8 AGE NPA 411 921 731 60 94 / 11 6 2 ISTEP• READING LANGUAGE MATHEMATICS READ VOC COP LANG MEP* COP MATH COMP CMP TOTL SCOR ISTEPiE/LA RESULTS MATH SCO ES NP 71 67 72 85 61 76 9.1 7.4 82 29 59 70 STANDARD 480 479 8.2 10.7 7.3 9.0 NORMS DA Quaaraa 'i••••511 GRADE 6 NC GE AA CE 65 59 63 72 56 65 8.3 69 5.2 38 6.6 53 8.0 OBTAINED 61 CATEGORY 523 528 PATTERN M 70 69 70 68 64 67 62 57 ABOVE ABOVE DATE 60 68 (IRT) 10/99 M008016001- 0S -05471 EFTA01710053 NM 2 NORMS DATE' 1996 QUARTER MONTH; 03 PATTERN (IRT) !.. .. • Terrablova CMS FORM/ LEVEL A-19 GRADE 9.0 DATE SCORE 1 NP NS OE NCE READING READ VOC CMP LANG NECK CMP MATH COMP CMP SCOR SCI STD? SPEL 60 6 55 64 6 57 62 6 LANGUAGE 62 6 74 6 69 6 MATHEMATICS 87 7 72 6 82 7 TOIL 72 6 15 3 SOC 30 4 61 6 10.3 10.2 10.2 10.6 12.0 10.8 12.4 11.8 12.2 10.9 5.1 6.6 10.3 57 57 64 61 73 62 69 62 29 39 56 - - - - N832520001-03-00101 09/02 EFTA01710054 liC SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) pu..04-A (2) SACO:00E New and Returning Student Registration /a 612 NEW STUDENTS: Complete all non-shaded areas on both sides of the form RETURNING STUDENTS: Review both sides. If the pre-printed information is incorrect, correct the information by carefully and lightly crossing out the incorrect information and waling the correct infomiation above ft (4) ALSO KNOW?: AS , (its) fit °pa) Rol, g i- f_ ,..,,..d., (,,)se,OflIRACEEMNICCAIGIN O I -American Indian/Alaskan Native 8-fliark, Non-Hispanic U H-Hispanic O kAsian/Pacilic Islander -ESW-White, Non-Hispanic O M-Multiracial i ElPIKEOR ORM (SI St aunts 03) RESIDENT STA= 00 USA ENTRY DATE dedVOMYYY) ❑ O. Foreign Exchange Student O M um 3 fir I -1±1 Lt.ko_ c o wily • O I.OUL-0(COUlty Resident O 2. Oa-of-state Resident OS) IMPACT SURVEY S3.In-county Resident YES NO (IS)PAESCI4COLENFIOUJIENt WIFORMATON O KI A. The student resides on federal property. Place an z by each program attendee. Also, ingrate with ea seen* p) the worm you child ...az in ti• longed. o Er B. The student resides in low rent housing. O N. Non-subsidized Chad Care O M. Migrant Pre-K O O C. The parent is employed on federal property located In PE County. O H. Headstan O D. Pre-( Diabaties O gl D. The parent Is employed on low rent housing located In P5 County. O I. Pre-K Eady Interventon O C. Chapter I O El E The parent is in the urdorrned services of the United States. Os. Subsidized Chid Care O 0. Other OnIS TIE STUDENT A C el) CURRENT GRADE LEVEL O O If E. is YES. is the parent on active duty? Check senice below: SINGLE PARDT 0 Mt Fate ['Army • Coast Gird Oma,‘,... O 'atonal Guard O Navy O YES O NO BITIANSEXMINEORMAT1ON pa LAST AT DATE net wet or SCHOOL IRANSFEFdetoG FROM ROI CIIT OR LOCADON CT INT( L 0Ckt Centre h School ISt ..1.hk_.fi l--K1 sawn AlT0400a IN MAIMACHCOMM LLOCt ejtvid /* (Q -5, 03 DATE ATTENDED m PBC EA •EENING NEORmATION screenings may Include os )Students wilt receive non-invasive health screenings pursuant to ROdda Stituta § 381.0056(7)(0 Noninvasive Parent or wardens, however, have the vision. hearing. scoliosis. height, and weight These tests may be given Individually Or in grail's. write the words 'Do not screen' hero: right to request an exemption in writing. If you DO NOT want your clod to receive the saeenings, (Ins exemption wIll COM all t)1es of screenings) tooth decay. 0 YES O NO pent give permission for my chid to participate in the sedan fluoride program to prevent (Permission Is valid through grade 6) I j27) DOES yours:hid currently have health Insurance? lit YES O NO If YES. Indicate: • Medicaid O Healthy Kidsti0d Care liZI Private . O Interested In receiving information itiaitIsTAZENtslirsoiattitENC HP0UNtx ON) tIONE CA./ ACC SURVEY 1.3 YES BI NO 1. Is a language other than English used in the home? If YES, what Language? If YES, what language? O YES 14 NO 2 Doti the student have a first language other than English? what language? O YES 0 NO 3. Does the student most frequently speak a language other than English? If YES. (22) 4. What language Is spoken in the home by the parent or guardian? t a 15 I i 11 CM 6. What-language is the students first language? I I sn (32) Moan DYES VIM-1: Wed or) (31)What C the date of entry ha ESOL program? O Mother U Father ,(!caoth Parents pal asougSusEs FOR ENtRY MO PSC SCHOOL DGTRICT O Other YES (34) CUSTODY spays or sTuCCHT (used awe O 1. Has the student ever been expelled from school? O Mother O Father O Shared Custody O 2. Has the student ever had an arrest resulting in a charge? MI Other O 3. Has the student ever had any juvenile justice rations? school day? U YES Wil0 (34) Is there a court order barring either parent from removing or contacting the student during the If YES, provide the sotto& with a copy of the court order. page t o12 PBSD 0636 (REV. 02/04/2002) EFTA01710055 THE SCHOOL DISTRICT OFPALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION v-! -. an . 6 STATE ZIP COCE On STATE ZIP CODE k C A-t 0OCUPATON dpa FL d3V I1 l0Jtii Palm ATION PL 334 1 ' nr, ecse4 nr bit nu, makix PLACE OF BIAPLOWENT &• 1;3 41) NOSE m.DIC1IE NUSINESS TaDNON CELLNAGER NOUSCR IOW VEUNIINNE NUOINESSTELEPIONE CEDPOERMarna (MAX ADDRESS (ooRRAO EMAIL ADDRESS (cptiol) E GEt MN Person(s) other than parent authorized to pick up student pet PASSWORD I rottaiono &LS e- NAME (fest Nab Neat are . . .• • .• no MAW Fist male Mist WU I ADDRESS Orve senNw. ..at apart remlon ADC41= ......, RAnDic MN( 1.90.-mmni sainismisi_ E . STATE zp,... ON gimingieri STATE MADE e. I I I nib, 6 F • 3,3 Vl i pg AMNON.= (-- 414 Wo TN CPins AO.ATIONAaP 'i_ 'L.-- 33(1108 (Az) ALITHOTEZED TOR DISCO( POOR PICKUP YES • NO YES • NO (RD NEW'II INFOraMTION (Pa studeces Arnevun. bane, Matt (t3) If school personnel are unable lo contact you In case of ilness or' eccklent; bean a.** feioltgrev *S.W. birde. Main Co PAPAMEAM may we have your pennissicn to cal your doctor.or. AndradOIS• or ohmfilysicalintatkat) 'emergency services (91 I) for transport to the • rile!? IN YES O NO psi Friar PHYSICIAN MAINCISICIME NOE EreirftED E-• CD+P C ALL U G (4.5) Have you fated out an application for free end reduced lunch? n YES Ns( rio 11Yn,S tUOSI- (4pp:calico is provide w1.1 this brm) ii .. • - .. • — 1;iiiia1 4W . FP ...g.1 :Aa 5 N W 11- ***1 411 - (NA NAME OF CHILD ANA maxAN) SCNO01. All — ENGING SFUCENT NO. letialiN GRACE DATEOTORTil Opt NAME or awl) (Inc an*. CO 031. ATTENDING SIOCCHT NO MS'n$ WWI( DATE OF ',MTN (Si) NAME OF OND (int /NAM ittu SCI001ATTENDING STUDENT NO. (cpoona9 GRADE DATE OF DIM (52) NAME OF CHAD Oat "Aida WO SO-DO. ATTENDING STUDENT 113. (optarisO GRADE DATE OF OATH RIO S PARENT/GUARDIAN SIGNATURE cs3):04,0 (SODOM ICI. DECO. ca WRY CO OT DOMDAN MI GALre ON CA4_ I verify that the information given Is true and accurate to the best WI TFADERNI EIREASSOICOIN otatarianteurica WON MiTIE !WC of my knowledge. O PBC Bus s O Palm Tran , 2 3 4 5 T' A O PirelWSNIeferlan. O Waill OSIke 6 7 8 9 0 2 AS) OCOMEMATIONOLIOW Atami toMMI, onon malice O Immursita6ons (date) O Bath Records Venl. (date) 0 SOC. Sec. No. (tire) O Physical Exams (date) g ii 63 INNATA WPMMINATO PT DAIL 9GNATLAIE OFPARENT /GUARDIAN DATE PBS0 0636 (REV. 02/04/2002) page 2 of 2 EFTA01710056 Principal GRADE REPORT 02/03 F!£KLUV 4 219-S65-8551 Homeroom: 9217 0630031 F Counselor: MAY Gr: 09 SUBJECT COU GP GP EX FG GP GP EX FG CRED CRED ABS TEACHER COMMENT 1 2 3 4 SEMI SEM2 GP4 Cmp Kybd 2 B20800 A B B+ A- 1.00 MMERWRIMPOMMEMO Foods I 2 C63200 D- F F F Poor test/quiz scores Does not complete work mmilimilimillmmi31210 C C 8+ C+ C- C A- C 1.00 1.00 Snan II 9 F72010 C- D+ F D 1.00 ..ai H50100 C+ C+ C C+ 1.00 Wld Geoa 2 H50400 D- F F F Alg I M81410 C C- C C- F C F 1.00 w ripi P40300 A C B .50 Tnt Cm/Ph S85610 B C F- C+ F F F F 1.00 Does not complete work Intro Jour T30710 D+ C B C B D C- C 1.00 1.00 Days Absent: 0 (9.5 YTD) Cur. Sem. GPA: 1.095 Qtr. #4 GPA: 1.142 Class Rank: 543 of 672 Cum. Sem. GPA: 1.822 Lake Central High School GRADE KEY 8400 Wicker Ave A - Superior St. John, IN 46373 B - Good C - Average D - Below Average F - Failure P - Pass N - No Grade Given TO THE PARENTS OF: WF - Withdraw Fail I - Incomplete W - Withdraw Crown Point, IN 46307 CUMULATIVE CREDITS: 13.00 EFTA01710057 YOUR SOCIAL SECURITY CARD tecord your number elsewhere for Detach the card below and sign it in ink immediately. Do not laminate your card. ea new application and submit Carry it in your purse or wallet. ou may also have to submit aai Security office immediately to d card with the same number. i make sure your employer copies anted correctly. eordkeeping purposes. Such use's on's Social Security number by r between the organization and the is to get information from your -our number must tell you whether testing the number, and tell you w to work in mis moony. your Social immigration officials willbe ast a year or more. —to sign up for Medicare. EFTA01710058 'EP" Aftaa VILLAGE UTILITIES OF ROYAL F . 1050 Poyat Pain Reach RNA ,toyet P:00) • •• (.9 I> E :-1 ACCOUNT NUMBER CYi 9/01/03 'tali* 74 45394-25005 RVI ADDRCSS SERVICE PER J1.4lith :AYS 6/23/03 To' 7/25/03 32 Service Curr Read Prey Read Usage WA LOW 33 26 Description Of Charges Amount ROYAL PALM BEA WA WATER 25.90 SW SEWER 26.71 CD SANITATION 7.03 VILLAGE TAX 2.59 EMMITInIrreirlerr H cia„;; 41,1 3ILt DATE • DATE 0/ i" 03 C /15/, , GTE', 05-2 TOTAL DUE 62. *nut DATE Appt IFS TO CURRENT CHARGES ONLy TOTAL CURRENT CHARGES PREVIOUS BALANCE 00 000(.......000622 3 TOTAL DUE 67: :23 • P DUE ,A11- • , 1111htla:11:ii:M illeif la /flit if ifii:ii Ifilii Messages o Florida Power Light Company PO Box 025576 t Miami, 33102 27 30 PPL I added my donation for the Care to Share Energy Fund Please request changes on me back. to help those In need. (Fill In or other amount) Notes on the front will not be detecte d. 0 0 0 0 0 $1 $2 $5 $10 other B 4,8 4203 7 IBWNDJNQ *** AUTO **CO 1 9618 11380 i3613343BC11574061 PLEASE ENTER TOTAL AMOUNT PAID Make check payable to FPL In U.S. funds and mall along with this coupon to: ROYAL PALM BE IFFL 33411-6806 FPL GENERAL MAIL FACILITY IdlndluLdn 1111 MIAMI FL 33188.0001 NEW Charges Past Due Total Now Due AUG 21 2003 $228.20 EFTA01710059 • • I' FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.032, 402.305, 402.313, Florida Statutes; rules 640-3.011.65C-22.006, 65C-20.01I, Florida Administrative Code LAST NAME 11 1.1O15 (MO/DA/Vit) PARENT OR GUARDIAN CHILD'S SS# (optional) STATE IMMUNIZATION 10k' Directions: • Enter all appropriate doses and dates below. • Sign and date appropriate certificate (A-I, A-2, B, or C) on reverse side of form. • If the child is presenting for the 7' grade requirement only and has previously filed a Certificate of Immunization (DH 680, Part A-I) with their current Florida school, fill in boxed areas below and complete Part A-2 on the reverse side of this form. • For additional information: Sec Immunization Guidelines for School and Child Care Facilities for information and instructions on form completion and immunization requirements. Guidelines arc available from the local county health department. I The state immunization ID# is an identifier supplied by the state immunization registry (optional). 2 DTP/DTaP 5 doses required. If the 4' primary dose is administered on or after the 4* birthday a 51" dose is not required. 3 UT (pediatric) is acceptable if pertussis vaccine is medically contraindicated. (Complete Part C for pertussis contraindication) 4 Td (adult) vaccine is recommended for children 7 years of age or older. 5 Polio 4 doses required. If the 3t' dose in an all OPV or all WV series is administered on or after the 4th birthday, a 4" dose is no required. Polio vaccine is not required for children 18 years of age or older. 6 Hib is required for child care, family day care and preschool entry and attendance only. 7 First dose valid if given on or atter I" birthday. Second dose (measles) valid if given at least I month after Is dose. A 2n° dose ofmeasle (preferably MMR) is required for students in grades K-6 and 7"' grade entry and attendance effective with the 1997/1998 schoo year. In each subsequent year thereafter, the next highest grades are included. 8 Includes single measles vaccine (U), single mumps vaccine (11) or single rubella vaccine (I). 9 Hepatitis B vaccine series is required for Th grade entry and attendance effective with the 1997/1998 school year and kindergartei entry and attendance effective with 1998/1999 school year. In each subsequent year thereafter the next highest grades ar included. Hepatitis B vaccine series is required for preschool entry and attendance effective with the 2001/2002 school year. 10 Varicella is required for entry and attendance in child care and family day care effective July I, 2001. Varicella vaccine is require, for entry and attendance in preschool and kindergarten effective with the 2001/2002 school year. In each subsequent year thereato the next highest grades are included. Susceptible children 13 years of age or older should receive 2 doses, given at least 4 week apart. Varicella vaccine is not required if child has documentation of history of varicella disease. EFTA01710060 LAST NAME FIRST MI DOB (MO/DA/YR) Certificate of Immunization for K-12 Excluding 7th Grade Requirements PART A-1 (Immunizations are complete for school entry and attendance grades kindergarten through 12 with the exception of the 7th grade requirement.) DOE Code I I have reviewed the records available and to the best ofmy knowledge. the above named child has been adequately immunized against diphtheria. tetanus. pertussis, polio, measles, mumps. rubella andhepatitis El (for kindergarten effective with the 1998/99 school year) and varicella, varicella vaccine not indicated if history of disease either physician documented or parental recall (fork' i year) for school attendance as documented on the reverse side of thisform. Physician or Clinic Na Physician or (Print or stamp) Authorized Signatu Add Date: Df~ 1)-3 Certificate of Immunization Supplement for 7th Grade Requirement PART A-2 (Immunizations are complete for students who enter or attend the 7th grade after the beginning of the 1997/98 school year. Each subsequent year thereafter, the next highest grade will be included in the requirement.) DOE Code 8 I have reviewed the records available, and to the best ofmy knowledge, the above named child has received thefollowing immunizations requiredfor entry and attendance in 7$ grade effective with the 1997/98 school year: tetanus-diphtheria booster, hepatitis B vaccine series, and second dose of measles vaccine as documented on the reverse side of thisform (boxed areas). Physician or Clinic Name: Physician or (Print or stamp) Authorized Signature: Address: Date: Temporary Medical Exemption PART B (For children in child care, family day care, preschool and grades kindergarten through 12 who are incomplete for immunizations in Part A-I or A-2.) Invalid without expiration date. DOE Code 2 I certifr that the above named child has received the immunizations documented on the reverse side of this form and has commenced a schedule to complete the required immunizations. Additional immunizations are not medically indicated at this time. Physician or Clinic Name: Expiration Date: (Print or sump) (15 days after next immunization appointment) Physician or Address: Authorized Signature: Date: Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 - --- / certify that the physical condition of this child is such that immunization(s) as indicated in Part C above is medically contraindicated. Physician or Clinic Name: (Print or stamp) Physician Signature: Address: Date: DH 680 7/2601. °WW1tuba editions (Stock Nunties: S740-000-06804) EFTA01710061 LAST NAME FIRST MI DOB (mainAnt) Certificate of Immunization for K-12 Excluding 71° Grade Requirements PART A-I (immunizations are complete for school entry and attendance grades kindergarten through 12 with the exception of the 7th grade requirement.) DOE Code 1 / have reviewed the records available and to the best of my knowledge, the above named child has been adequately immunized against diphtheria. tetanus, pertussis. polio. measles. mumps. rubella and hepatitis)? (for kindergarten effective with the 1998/99 schoolyear) and varicella, varicella vaccine not indicated if history of disease either physician documented or parental recall (for kindergarten effective with the 200//7002 school year) for school attendance as documented on the reverse side of this form. Physician or Clinic Physician or (Print or stamp) uthorized Signatur Ad Date: Certificate of Immunization Supplement for 7ib Grade Requirement PART A-2 (Immunizations are complete for students who enter or attend the 7th grade after the beginning of the 1997/98 school year. Each subsequent year thereafter, the next highest grade will be included in the requirement.) DOE Code 8 1 have reviewed the records available, and to the best of my knowledge, the above named child has received the following immunizations requiredfor entry and attendance in 7' grade effective with the 1997/98 school year: tetanus-diphtheria booster, hepatitis 8 vaccine series, and second dose of measles vaccine as documented on the reverse side of this form (bused areas). Physician or Clinic Name: Physician or (Print or stamp) Authorized Signature: Address: Date: Temporary Medical Exemption PART B (For children in child cart, family day care, preschool and grades kindergarten through 12 who are incomplete for immunizations in Part A-1 or A-2.) Invalid without expiration date. DOE Code 2 I certify that the above named child has received the immunizations documented on the reverse side of this form and has commenced a schedule to complete the required imn:unizatinns Additional immunizations are not medically indicated at this time Physician or Clinic Name: Expiration Date: (Print or stamp) (15 days after next immunization appointment) Physician ur Address: Authorized Signature: Date: Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 I certify that the physical condition of this chili as such that immunization(S) as indicated in Part C above is medically contraindicated. Physician or Clinic Name: (Print or stamp) Physician Signature: Address: Date: DU 680 7/2001. obsoletes ea-Itcr cdttIons (Steck Number: 5740-000-0680-6) EFTA01710062 FLORIDA DFPARChegr OP SALT FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.032, 402.305, 402.313, Florida Statutes; rules 64D-3.0 I I, 65C-22.006, 65C-20.011, Florida Administrative Code LAST NAME 1RST NAME MI TOH O/DA/YR) PARENT OR GUARDIAN CHILD'S SS# (optional) STATE IMMUNIZATION ID#' Directions: • Enter all appropriate doses and dates below. • Sign and date appropriate certificate (A-I, A-2, B. or C) on reverse side of form. • If the child is presenting for the 7' grade requirement pnly and has previously filed a Certificate of Immunization (DH 680, Part A-I) with their current Florida school, fill in boxed areas below and complete Part A-2 on the reverse side of this form. • For additional information: See Immunization Guidelines for School and Child Care Facilities for information and instructions on form completion and immunization requirements. Guidelines are available from the local county health department. DTaI DT Td' Polio MMI Hepa Varic Vs I The state immunization IDN is an identifier supplied by the state immunization registry (optional). 2 DTP/DTaP 5 doses required. If the 4' primary dose is administered on or alter the 4' birthday a 5' dose is not required. 3 DT (pediatric) is acceptable if pertussis vaccine is medically contraindicated. (Complete Part C for pertussis contraindication) 4 Td (adult) vaccine is recommended for children 7 years of age or older. 5 Polio 4 doses required. If the 3" dose in an all OPV or all IPV series is administered on or after the 4' birthday, a 4' dose is not required. Polio vaccine is not required for children 18 years of age or older. Hib is required for child care, family day care and preschool entry and attendance only. First dose valid if given on or after I" birthday. Second dose (measles) valid if given at least I month after I" dose. A 2i0 dose ofmeasles (preferably MMR) is required for students in grades K-6 and 7' grade entry and attendance effective with the 1997/1998 school year. In each subsequent year thereafter, the next highest grades are included. 8 Includes single measles vaccine (O). single mumps vaccine (H) or single rubella vaccine (1). 9 Hepatitis B vaccine series is required for 7' grade entry and attendance effective with the 1997/1998 school year and kindergarten entry and attendance effective with 1998/1999 school year. In each subsequent year thereafter the next highest grades are included. Hepatitis B vaccine series is required for preschool entry and attendance effective with the 2001/2002 school year. 10 Varicella is required for entry and attendance in child care and family day care effective July I, 2001. Varicella vaccine is required for entry and attendance in preschool and kindergarten effective with the 2001/2002 school year. In each subsequent year thereafter, the next highest grades arc included. Susceptible children 13 years of age or older should receive 2 doses, given at least 4 weeks apart. Varicella vaccine is not required if child has documentation of history of varicella disease. EFTA01710063 EASkf NAME DOB 0110/DANR) Certificate of immunization for K-12 Excluding 716 Grade Requirements PART A-1 (Immunizations are complete for school entry and attendance grades kindergarten through 12 with the exception of the 7h grade requirement.) DOE Code I 1have reviewed the records available and to the best ofmy knowledge. the above named child has been adequately immunized against diphtheria, tetanus. pertussis. polio, measles, mumps, rubella and hepatitis 8 (for kindergarten effective with the 1998/99 schoolyear) and varicella, varicella vaccine not indicated if history of disease either physician documented or parental recall (for kindergar r effective with t 1/2002 school year) for school auendance as documented on the reverse side of this form. Physician or Clinic N Physician or (Print or stamp) Authorized Signaitir Add Date: c4024 3 Certificate of Immunization Supplement for "Pb Grade Requirement PART A-2 (Immunizations arc complete for students who enter or attend the 7th grade after the beginning of the 1997/98 school year. Each subsequent year thereafter, the next highest grade will be included in the requirement.) DOE Code 8 I have reviewed she records available. and to the hest ofmy knowledge, the above named child has received the following immunizations requiredfar entry and attendance in 7' grade effective with the 1997/98 school year: tetanus-diphtheria booster, hepatitis B vaccine series, and second dose of measles vaccine as documented on the reverse side of this form (boxed areas). Physician or Clinic Name: Physician or (Print or stamp) Authorized Signature: Address: Date: Temporary Medical Exemption PART B (For children in child care, family day care, preschool and grades kindergarten through 12 who are incomplete for immunizations in Part A-I or A-2.) Invalid without expiration date. DOE Code 2 I certifr that the above named child has received the immunizations documented on the reverse side of this form and has commenced a schedule to complete the required immunizations. Additional immunizations are not medically indicated at this time. Physician or Clinic Name: Expiration Date: (Print or stamp) (IS days after next immunization appointment) Physician or Address: Authorized Signature: Date: Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 1certify that the physical condition of this child is such that immunization(s) as indicated in Part C above is medically contraindicated. Physician or Clinic Name: !Print or stamp) Physician Signature: Address: Date: DM 080 1/2001. obioleits culla editions iSitxk Number 5740-0110-IX.80-6) EFTA01710064 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.032, 402.305, 402.313, Florida Statutes; rules 641)-3.011, 65C-22.006, 65C-20.011, Florida Administrative Code LASTNAME r TA-NiE FIRQ:fri MI 1.1O11 (MO/DANR) PARENT OR GUARDIAN CHILD'S SS# (optional) STATE IMMUNIZATION ID#' Directions: • Enter all appropriate doses and dates below. • Sign and date appropriate certificate (A-1, A-2, B, or C) on reverse side of form. • If the child is presenting for the 7* grade requirement only and has previously filed a Certificate of Immunization (DH 680, Part A-I) with their cunent Florida school, fill in boxed areas below and complete Part A-2 on the reverse side of this form. • For additional information: See Immunization Guidelines for School and Child Care Facilities for information and instructions on form completion and immunization requirements. Guidelines are available from the local county health department. DTaPilD DT' Tdi Polio' Nib. MN1R Hepatit Varicell Vatic 1 Th 2 DTP/DTaP 5 doses required. If the 4* primary dose is administered on or after the 4* birthday a 5' dose is not required. 3 DT (pediatric) is acceptable if pcnussis vaccine is medically contraindicated. (Complete Part C for pertussis contraindication) 4 Td (adult) vaccine is recommended for children 7 years of age or older. 5 Polio 4 doses required. If the 3r° dose in an all OPV or all IPV series is administered on or after the 4" birthday, a 4th dose is not required. Polio vaccine is not required for children 18 years of age or older. 6 Nib is required for child care, family day care and preschool entry and attendance only. 7 First dose valid if given on or after Is' birthday. Second dose (measles) valid if given at least I month after rdose. A 2"d dose ofmeasles (preferably MMR) is required for students in grades K-6 and 7th grade entry and attendance effective with the 1997/1998 school year. In each subsequent year thereafter, the next highest grades are included. 8 Includes single measles vaccine (G), single mumps vaccine (H) or single rubella vaccine (1). 9 Hepatitis B vaccine series is required for 7" grade entry and attendance effective with the 1997/1998 school year and kindergarten entry and attendance effective with 1998/1999 school year. In each subsequent year thereafter the next highest grades are included. Ilcpatitis B vaccine series is required for preschool entry and attendance effective with the 2001/2002 school year. 10 Varicella is required for entry and attendance in child care and family day care effective July 1, 2001. Varicella vaccine is required for entry and attendance in preschool and kindergarten effective with the 2001/2002 school year. In each subsequent year thereafter, the next highest grades are included. Susceptible children 13 years of age or older should receive 2 doses, given at least 4 weeks apart. Varicella vaccine is not required if child has documentation of history of varicella disease. EFTA01710065 School itntry Health hxam Page 2 of 2 HEALT Name rif Child il-tst Piro %%idle 1/14 Birth Date! PART II — MEDICAL EVALUATION To be completed and signed by the Health Care Provider ONLY: The child named above has had a complete history and physical exam on the following date: (Elam must he Mithin one year of ennillment -7 —air, 74 lay Year 'S Screcnin Ilcig Lead: Urinalysis: Vision - Without Glasses Right 20/_ Left 201 Passed 134 Hearing — Right Passed$ Failed n Referred ❑ Failed 0 Vision - With Glasses Right '0/ 2s2._ Left 1 0/ fin_ l fearing — Left Passed/9j Failed n Referred ❑ Referred Fl Gross dental (teeth and gums) -Normal [3 E Abnormal Refer/Tx: Head/scalp/skin izr Normal E Abnormal Refer/Tx: Eyes/Fars/Noce/Throat [J' Normal D Abnormal Refer/Tx: Chest/Lungs/Heart g- Normal D Abnormal Refer/Tx: Abdomen [no Nomial D Abnormal Refer/Tx: Postural assessment R....Normal 7 Abnormal Refer/Tx: TB risk assessment done 3- - (Please review lbrgeted Testing Guidelines listed below.) This child has the following problems that may impact the educational experience: D Vision 0 Hearing ❑ Speech/Language ❑ Physical 0 Social/Behavioral Cognitive Specify: n This child has a health condition that may require emergency action at school. e.g. seitures, allergies. Specify below. (This form will be stored in the child's Cumulative Health Folder and mar be accessed by both school and health personnel) Recommendations (Attach additional sheet if necessary): (Please Check One) Di chis child may participate fully in school activities including physical education. 0 This child may participate in school activities including physical education with the following resuictionladaptation. (Specify reason and restriction) xLIN-ms... I ailaritn1 Signature/Tkle of Health Care Provider Da amt Please print or stamp lltberculosis Targeted Testing Guidelines for Health Care Presiders Thberculosis Infection Risk: Review the following risks and administer a hfantoux TB skin test if child is in one or more categories. The 1B lest is administered contldentiallv as pan of the health examination. Do not recant administration of any TB test or related information on this form. • Recent immigrant (< 5 years), frequent visitor to TB endemic areas • Close contact to active TR case • Frequent contact with adults at high-risk for disease, HIV+, homeless, incarcerated, illicit drug user • HIV+ or have other medical conditions that increase the risk to progress from infection to disease. e.g.. chronic renal failure, diabetes. hematologic or any other malignancy. weight loss > l0k of ideal body weight, on immunosuppressive medications /tense TB Disease Risk; • Does the child exhibit signs/symptoms of tuberculosis (e.g. cough for three weeks or longer. weight loss. loss of appetite)? • If symptoms are present, work-up or refer for TB disease evaluation. DH 3040, 6/02 (Obsoletes previous nektons which may not be used) Stock Number 5744-000-3040-2 EFTA01710066 IHEALMI) STALE OF ittOlUL1A School Entry Health Exam Page 1 of 2 lb Parent/Guardbn: Please complete and sign Pan I - Child's Medical History. State law for school entry requires a health examination by a legally qualified professional. Additional requirements may be determined by local school districts. (Please Print) antioaseirtrasrmawmm tc ■iTirritilTrIregielni kirt.11.31r. EMINIPPIRMIN PART I — CHILD'S MEDICAL HISTORY lb ParenUGuardian: Please check answers to questions I through 8 below in the column on the left (Please explain any "Yes" answers in the space pm;ideil below.) 1. Yes 0 2. Yes 3. Yes ja N. No Any concerns about general health (eating and sleeping habits, weight. etc.)? No 0 Any other specific illness or social/emotional or behavioral problems? No af Any glIergjes (food, insects, medication, etc.)? 4. Yes No 0 Any prescription medication (daily or occasionally)? No 0 Any problems with vision, hearing, or speech (glasses, contacts, car tubes, hearing aids)? No oAny hospitalization, operation, or major illness (specify problem)? Any significant injury or accident (specify problem)? Would you like to discuss anything about your child's health with a school nurse? To Parent/Guardian: Please explain any "Yes" answers from above. I am the parent/guardian of the child named above. I give permission for the information on PARTS I and II of this form provided about my child to be reviewed and utilized only by the staff of this school and any school health personnel providing school health services in the district for the limited nernosit of meeting any child's health and educational needs. IX> g /5 / 6:).3 Signature of Parentfliardlan Partnership for School Readiness Recommendations for Prekindergarten and Kindergarten To Parent/Guardian: Please obtain the services Hued below in order to find any problems. Please work with your health care provider to correct or treat any problems that may reduce your child's ability to learn in school. (These services are recommended but not required.) 1. Comprehensive Vision Examination (3-5 years of age) Please describe any corrective action for any problems detected Date of Exam: and any accommodations required. Results of Exam: Health Care Provider: (check one) Optometrist • Ophthahnologisin 2. Comprehensive Dental Examination Please describe any corrective action for any problems detected Date of Exam: and any accommodations required. Results of Exam: Dentist: 3. Hearing Screening Please describe any corrective action for any problems detected Date of Exam: and any accommodations required. Results of Exam: Health Care Provider: DH 3040. 6/02 (Obscaetes previous editions which may not be used) Stock Number 5744-000-3040-2 EFTA01710067 TEST RECORD INFORMATION FLORIDA COMPREHENSIVE ASSESSMENT TEST IFCAT) OCTOBER 2004 SUNSHINE STATE STANDARDS STUDENT:l.p.... GRADE: 11 DISTRICT: SID: SCHOOL: 2331 ROYAL PALM BEACH HIG DOB: READING SS: 348 PASSED MATH SS: 354 PASSED READING DSS: 2186 MATH DSS: 2110 FRT PBSD D280(REV. 7/15/97) EFTA01710068 TEST DATE SAT 550 SA T I1 SAT w DE C 05 c1P2 ADI C OP 500 SAT MC SA' Program 52 I he College Board SAT (MY 06 EFTA01710069 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES CUMULATIVE SCHOOL HEALTH RECORD (This form Is not Intended for physician's usc) Nam Sex g School Address Father's Name Mother's Name Date of Birth Place of Birt erg 14 Birth Recorded: YES O No El Immunization Certification: Yes 0 Non Special Immunization Programs A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES I< 1 2 3 Screening and Screening Screening Assessment co Outcome Screening Outcome To c — Outcome T.1 't E Grades t 'E 4) 0 :i3 <I) 8 Date CD CO CT> to K-3 Date '71) c. 22 0 o E Et CE 0 Date cc Vision Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Physical Assessment Dther Dther 4 5 6 7 Screening and 8 Assessment Outcome O) c F Outcome a c Referral Outcome Outcome To Outcome Grades C O _ To c To c 0 t C 0 tz =m ,-- =a 0 7, c arm co O "tis O in to 0 0 to tTs <D 4.8 oO mO 15 mO o mO 7,5 mO (1) co co CC co ii ci) E c. E /ision -fearing -leight. Weight & Graphing lutrition )ental Health dental Health ;ommunicable Disease lecords Review 'hysical Assessment ;coliosis )ther )they IRS,14 Rum Ar1d1 MAY rcionioroo nra.6nu. etA;4;•••••• •••...11 \Ara I nn.. EFTA01710070