EFTA01710073

iep•••067. - :,-fr:Ccrew.954.1.3,-..;-Woo...a.-• ••••••”Arre.:4 •••, #••-•..4... 3n./444A- r. • ? ..44 ".an /34 1..7.0 . ".4, 4 1:S; 143;S . EFTA01710073 A j ogi A • 1 EFTA01710074 DIST:2331 TCHR NBR:114 STDT CRS:1001400 SEC:004 BLDG:03 RM:221 08/01/05 IA THE SCHOOL DISTRICT OF PALM BEACH COUNTY(SDPBC) SP.:0.7, 4TNULIf FP SAC COI GlLua! Si ENTRY DALE EN CD mem 1o6A1 i2 o8/t0/05 got ° 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 area unanswered. ALL students MUST COMPLETE a registration form ANNUALLY. AL KNOWN AS SCalliiiillii sedOf as egetwarimate. atc is *cab) MEd' MUSING DEVELOPMENT ftepplbable) L0XAMTCHIll FL 3/3470 , MAWS ADDRESS faunmate ordstealon. sportiniolmomte; a t arch zip co:Is) HOME TELEPHONE NUMBER I DAY ENE TELEPHONE NUMBER EVENNOTREPHPIE NUMBER PARENT CELUPAGER NUMBER SEX 649 RAGGED/MC ORb3M w O A - Asian/Racilic Islander O i - American Indian/Alaskan Native F O B - Black Non-Hispanic O H - Hispanic O W - Whke, Non-Hispanic O M - Mutiracial DATE OF BIRTH nw< 'PLACE OF °MTH (alas a S cowly) RESCEPA' STATUS USA ENTRY DATE 3 O O. Fcgreign Exchange Student O 1. Out-d-courtyReeldent O 2. Out-of-state Resident O 3.in-county Resident 1. Federal Impact Survey A. The student resides on federal property. O Yes O No B. The student resides in low rent housing. O Yes O No C. The parent is employed on federal property-located in Palm Beach County. O Yes O No D. The parent is employed on low rent housing located in Palm Beach County. O Yes O No E. The parent is in the uniformed services of the United States. O Yes O No If "E" is YES, is the parent on active duty? O Yes O No (check service below) O Air Force O Army O Coast Guard O National Guard O Navy O Marines 2. Preschool Enrollment Information N (Check each program attended. Indicate wth an asterisk lithe program your chid was in the longest.) O Fee for Services O Head Start O Pre-K Disabilities O Private Pre-K O School-based (Pre-K) O Teenage Parent Program O None 3. Is the student who is enrolling in school a single parent? O Yes O No N 4. Students will receive non-invasive health screenings pursuant to Florida Statute § 381.0058(7)(d). Non-invasive screenings may include vision, hearing, scoliosis, height, and weight. These tests may be given individually or in groups. Parents or guardians, however, have the right to request an exemption in writing. (This exemption WI cover all types of screenings.) If you DO NOT want your child to receive the screenings, write the words " Do not screen" here- 5. I give permission for my child to participate in the sodium fluoride program to prevent tooth decay. YES ❑ Yes (Pemission is void through grade 5.) O No 6. Does your child currently have health insurance? )es D No If YES, check insurance plan: O Medicaid O Healthy Kids/Kid Care rivate O Interested in receiving information 7. All new students to Palm Beach County are required to answer the following home language survey questions. A. Is a language other than English used in the home? O Yes (language) /14-6. B. Does the student have a first language other than English? O Yes (language) C. Does the student most frequentlygal?5anguage of er than EnglishkO Yes (language) 8. Name of the last schoo attended . /6 4 CatO A City State B. County Pet ev? alearC-nt ? dry (A IS C. Last grade level completed / Last attendance date or D. Does your child have O Individual Education Plan (IEP) O 504 Plan Other Plan? (I Medi& provides copy) P650 0636 (Rev. oit2smos) pap 1of 2 EFTA01710075 LEGAL NAME pea( 6* " t b. Disclosures for entry into Palm Beach County School District (check all that apply) .,, fS 0 The student has had juvenile justice actions taken against him/her. 011ie student has been expelled from school. 0 The student has been arrested resulting in a charge. of applicable 10. AInd te 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 Other 11. IMPORTANT, EVERYONE MUST ANSWER THIS QUESTION. A. Is there a visitation order or other court order barring either parent from removing the student during th school day or coming into contact with the student? If Yes, provide school with a copy of court order. Yes No B. Parents DO NOT have shared parental responsibility 0 If checked provide school with copy of court order. 12. Providethe following parentilegal guardian Information PAM: WOG] M BGAPrIAN OFR RA middle NIOPECIF NOT DC SAME AS STUDENT(bows Amber and *vet nano. apartment no. city, 'PP, v0 0:40) NEWTON IC NOME TELEPHONE I BUSINESS TELEPHOtE CEU. NUFEER E-MAIL ADCRESSRP90W AN Rest Ant mid* indie0 AS SPKIENT(ors number end *oaf name. aparlmont no, any, slab, zip cot) FL 33470 TFIEPHOW aUSWFSS TFI FPNO CELL MJFAEII3 RAMIL ADORES S(oFbasi) 13 I ist names and data of birth of oaranre tonal onartflan's der Beach County schools. 14. Provide the name(s) of person(s), other than the parent, allowed to pick up the student. NAME Ms miles RELATIONSHP TO STUDENT IELSONE GELUPAGER WAFER I OTHER 15. Provide a password th student will use. (limited to 10 characters 16. Does the student have any allergies? (if yes specify) ID Yes No Allergy. 17. List students illnesses, behavior issues, medications or physical limitations. 18. Physician Name Telephone Number Parental Consent for Release of Student Information Verification of Student I hereby give permission for the school or District to use my chid's photograph, video image, varkig, Registration Information voice recording, name, grade level, school name, participation in officially recognized activities and sports, weight and height as a member of an athletic team, dates of attendance, diplomas and awards I verify that the information given 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)cx similar school-or and accurate to the best of my District-sponsored publcations or In schoolor District-approved news media Interviews and photographs. I understand without my signature my chlds name and photograph cannot and wM not be included in any pubications or presertations. lets° understand and agree that my chdds medical records or other medical Information that I provide to the school, and treatment records or other rnedcal records created by health care personnel at a legitimate educational pur for accessing Registration i‘not valid without a verification d-> signature and date. OA page 2 of 2 EFTA01710076 Student Reading & Mathematics Report Fail 2005-Retake This report shows your results from the retake of the Grade 10 Florida Comprehensive Assessment Testis). Passing both the Grade 10 Reading and Mathematics tests is a requirement for a standard Florida high school diploma. ID The FCAT measures your performance on selected benchmarks School 2331-ROYAL PALM in Reading and Mathematics as defined by the Sunshine BEACH HIGH State Standards. Scores on this test are one indication of your District SO-PALM BEACH achievement on the challenging content that Florida students Grade 12 are expected to know. Your Scores and Performance Levels Reading Mathematics Level 5 2311-3008 You do not have a Mathematics score for Level 3 the following reason: 2068-2218 NT (Not Tested) Level 1 844-1851 You have passed the If you took the test but did not receive a FCAT Reading Retake test. score, be sure to contact your school about locating your Mathematics FCAT score. Your FCAT score is which is in achievement Level' for Reading. Date: 11/02/05 This score shows your achievement on the day you were tested. If you were to take the same test a aln, It is like) that your Reading score would be between EFTA01710077 Student Report F880- Page 2 Podia heortlerohr assiamtai ku Fall 2005-Retake School 2331—ROYAL PALM BEACH HIGH District 50—PALM BEACH Grade 12 The chart to the left gives more specific information about your Your Reading Content Scores performance on the content areas tested by the FCAT. For each content You have passed the Reading area, students should be able to do the following: section of the FCAT Words and Phrases in Context Selects and uses strategies to understand words and text; makes and confirms inferences from a reading text; Interprets data presentations (e.g. maps, diagrams, graphs, Points Points and statistical illustrations). Content areas you earned possible Main Idea, Plot, and Purpose Determines stated or implied main Words/Phrases idea; identifies relevant details; identifies methods of development; determines author's purpose and point of view; identifies devices of Main Idea/Purpose 22 persuasion and methods of appeal; identifies and analyzes complex Comparisons 15 elements of plot le.g. setting, tone, major events, and conflicts and Reference/Research 8 resolutions). Comparisons and Cause/Effect Recognizes the use of comparison and contrast; recognizes cause-and-effect relationships. Reference and Research Locates, gathers, analyzes, and evaluates information for a variety of purposes; selects and uses appropriate study and research skills and tools according to the type of Information being gathered or organized; analyzes the validity and reliability of primary source Information and uses the information appropriately; synthesizes information from multiple sources to draw conclusions. The chart to the left gives more specific information about your Your Mathematics Content Scores performance on the content areas tested by the FCAT. For each content You do not have a score in this assessment area, students should be able to do the following: for the following reason: NT (Not Tested) Number Sense, Concepts, and Operations Identifies operations x, +) and the effects of operations; determines estimates; knows how numbers are represented and used. Points Points Measurement Recognizes measurements and units of measurement; Content areas you earned possible compares, contrasts, and converts measurements. Number Sense Geometry and Spatial Sense Describes, draws, identifies, and Measurement analyzes two-and three-dimensional shapes; visualizes and illustrates changes in shapes; uses coordinate geometry. Geometry Algebraic Thinking Algebraic Thinking Describes, analyzes, and generalizes patterns, relations, and functions; writes and uses expressions, equations, Data Analysis inequalities, graphs, and formulas. and Probability Data Analysis and Probability Analyzes, organizes, and interprets data; Identifies patterns and makes predictions, Inferences, and valid conclusions; uses probability and statistics. If you need to retake the FCAT Talk to your guidance counselor. Many school districts have Stay in the Loop Make sure you receive a copy of the Stay In the specialized programs to help students in earning passing Loop flyer distributed by your school to all students who scores on tffe FCAT, including before and after school have not passed the FCAT. Stay in the Loop contains tips, ideas, programs, summer school, tutoring, intensive reading or and recommendations for retaking the FCAT and earning your mathematics classes, and computer-assisted instruction. high school degree. You can also access the flyer online at http://www.fim.edu/doe/commhome/12grade/twelhome.him. Sign up for an intensive reading or mathematics class to sharpen your skills with extra instruction-to strengthen your weak areas. Facts.org Provided free to students by the Florida Department These classes count as electives to help you meet your minimum of Education, www.Facts.org is Florida's official online student credit requirement for graduation. advising system. You can start thinking about careers, evaluate Visit FLAT Explorer at www.fcatexplorer.com. This site offers your progress through high school, learn about higher education FCAT-like practice in reading and mathematics to help you opportunities in Florida, and more. prepare for retaking the FCAT. Log in using your sign-in name and password or call 1388.750.FCAT. Copyright 0 MK State of fkriela Department ol State C0:51-24-953 EFTA01710078 Spring 2005 NAME: Florida Comprehensive Assessment Test (FCAT) ID: SSS Reading and SSS Mathematics Retake Tests SCHOOL: 2331-ROYAL PALM BEACH HIGH Grade 11 Student Report DISTRICT: 50-PALM BEACH Florida Compreherobe Assersmelt Its! This report shows your results from the Grade 10 FCAT Retake test(s). Passing both the Grade 10 Reading and Mathematics Tests is a requirement for a standard Florida high school dploma. Students must earn an FCAT Score of 1926 or better in Reading and 1889 or better in Mathematics to meet the graduation requirement. The FCAT measures your performance on selected benchmarks in reading and mathematics as defined by the Sunshine State Standards. Scores on this test are one indication of your achievement of the challenging content that Florida students are expected to know. Your Reading Results Your Reading FCAT Score FCAT Achievement You did not pass the Grade 10 FCAT Reading test. Talk Score' Level Passed to youi teacher or guidance counselor to find out about ways to improve and when you may retake the test. I • Your Reading Content 3000 Content Areas Points Fonts Earned Possible 2400 Words/Phrases 13 Main Idea/Purpose 20 1800 Comparisons 12 Reference/Research 9 1200 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 • Ahin Idea/Purpose -determines a stated or implied essential message, details, Swam Soon PassnsiScore author's purpose; or plot. • Conliarlions -knows similar and different, cause and effect, and contrast. 'This score shows your achievement on rho day Reference/Research-uses information from a varietyof sources le reach you were tested. II you were to Wes tho same conclusions. test again a is likely that your 2005 Reading score would be between 1786 and 1948. Your Mathematics Results Your Mathematics FCAT Score We were unable to find a Mathematics adore that matched your FLAT Achievement Score' Level Passed student identification number. If you took the test this year, be sure to contact your school about locating your FCAT test scores. NT NT Your Mathematics Content 3000 Points Points Content Areas Earned Possible 2400 Number Sense Measurement 1800 Geometry Algebraic Thinking 1200 Data Analysis 600 Mathematics Content • Content scores give more specific information about the skits on the FCAT. Grade level expectations for students include: • Number Sense •uses number concepts and computation 0 StreientScore PassingSeem • Measurement -solves problems involving measurements, e.g., tine, length, area. • Geometry - analyzes and combines shapes to solve problemi. • Algebraic Thinking -analyzes patterns and uses equations and inequardies. • Data Analysts and Probability -uses data analysis tools to cfsplay information, make predictions and make inferences. NT=Not Tested NR=Not Reported Data Run Date: 04/21/2C05 0010583 EFTA01710079 (I) STLOENT NUAIBER CI) SAC CODE (3) GRADE LEVEL SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) New and Returning Student Registration 106A . 11 NEW STUDENTS: Complete all areas on both sides of the form except areas specified. RETURNING STUDENTS: Review both sides. If the pre-printed information is incorrect, correct the information by carefully and lightly crossing out the incorrect information and writing the correct Information above It. Complete any areas that are blank. DIST:2331 TCHR NBR:012 STDT CRS:1000410 .SEC:006 BLDG:03 F04:210 08/11/04 (4 SRICENEGAL EMT= (5) ALSO KNOWN AS (e) LOCAL ADDRESS (house na a drool name) ON no.) (44') (state) (ao <caw LOXAHATCHEE FL 33470 (7) ALARM ADDRESS (hoes* no. 6 'Minn) (apt no) feed (slate) RIP cod. (a) SOCIAL SECURITY NO (ophone0 (9) HOME TELEPHONE NO. (1C) SE:1 (11) RACE/Ell-RICORIGIN • I-American Indian/Alaskan Native 0 B-Black, Non-Hispanic • H-Hispanic F 0 A-Asian/Pacific Islander 0 W-White, Non-Hispanic 0 M-Multiraclal (12) DATE Of MTH (13) MACE OF BIRTH (city, LS ceneery) (14) RESIDENT STATUS (1S) USA ENTRY DATE (11MAXWYYY) 0 0. Foreign Exchange3Student (MAADONYYY) • 1. Out-of-county Resident 0 2. Out-of-slate Resident • (1s) FEDERAL IMPACT SURVEY YES NO 0 3. In-county Resident N 0 • A. The student resides on federal property. (17) PRESCHOOL ENROLLMENT INFCRIAATION Place on X by each program attended. Also, indicate with an • 0 B. The student resides in low rent housing. asterisk () the program your child was in he longest. 0 0 C. The parent is employed on federal property located in PB County. 0 C. Title I Prekindergarten 0 M. Migrant Prekindergarten 0 0 D. The parent is employed on low rent housing located in PB County. 0 D. Pre-K Disabilities 0 N. None 0 0 E. The parent is in the uniformed services of the United States. 0 F. Fee for Services 0 P. Private Prekindergarten 0 H. Head Start ❑ T. Teenage Parent Program 0 0 0 If E. IS YES, Is the parent on active duty? Check service below: 0 L. Readiness Program 0 Z. Not Applicable 0 Air Force 0 Army 0 Coast Guard 0 Marines 0 National Guard • Navy on Is the student a Single parent? N 0 YES 0 NO TRANSFER STUDENT Only students transferring from another school complete this section (19) NAME Cf SCHOOL TRANSFERRING FROM (20) WWI STATE I COUNTY =WRY (21) LAST ATTENDANCE DATE (22) LAST GRADE LEVEL (23) Have you ever been enrolled In a Palm Beach County School? DYES 0 NO (21) DATE ATTENDED IN PBC If yes, what school? All new and returning students compete the remaining form including page 2 rzsi Students will receive non-Invasive health screenings pursuant to Florida Statute § 381.0056(7)(d). Non-Invasive screenings may include vision, heating, scoliosb, 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" hue: (This exemption war cover at types of screenings) CM •I give permission for my child to participate in the sodium fluoride program to prevent tooth decay. 0 YES 0 NO (Permission is valid (hmugh grade 6) YES (27) Does your child currently have health insurance? 0 YES 0 NO If YES, indicate: 0 Medicaid 0 Healthy Kids/Kid Care 0 Private 0 Interested in receiving information (29) NOME LANGUAGE SURVEY (Chock so that Appy) 0 A language other than English Is used in the home. What language? 0 The student has a first language other than English. What language? 0 The student most frequently speaks a language other than English. What language? (2a) OSCLOSURES FOR ENTRY INTO PSC SCHOOL DISTRICT (cheek ellMel epohi) • The student has been expelled from school. 0 The student has had juvenile justice actions taken against himtner. • The student has arrested resulting in a charge. (33) STUDENT LNES WITH: (check one) C31) CUSTODY STATUS OF STUDENT (check One) 0 Mother 0 Father 0 Seth Parents 0 Foster • Group Home 0 Mother 0 Father 0 Shared Custody 0 Other 0 Other IMPORTANT INFORMATION - MUST BE COMPLETED (32) is there a court order barring either parent from removing or contacting the student during the school day? ❑ Yes it No If YES, provide the school with a copy of the court order. PBSD 0636 (Rev. 03/17/2004) page 1 of 2 EFTA01710080 PARENT/LEGAL GUARDIAN INFORMATION c FATHER CR LEGAL GUARDAN (PA ISOM RMS.. 1140 (34) DAN OF BIRTH (M) MOTHER OR LEGAL GUARDIAN RR mUdIelneSe4 bat) (45) DATE 0 F BIRTH (35) ADDRESS (43•444 number. alit Iipletbrent number) ADDRESS Net ramie stvM aparlmen! number) (38) CITY STATE OP CODE (47) CITY STATE OP CCOE NEWTON NC LOXAHATCHEE FL 33470 (37) CCCUP ANON (38)HCHEST (44 OCCUPATION (43) HOE ST ED. LEVEL ED. LEVEL C (39) PLACE OF EMPLOYMENT (50) RACE OF EMPLOYMENT (40) HOME TELEPHONE (4 I) BUSINESS TELEPHONE (42) CEWPAGER MIAMI SI HOME TELEPHONE S3 BUSINESS TELEPHONE CELUPAGER NUMBER (43) EMAIL ADDRESS (optena0 (54) EMAIL ADDRESS (xRGAs0 EMERGENCY HEALTH AND SAFETY INFORMATION Provide name(s) of person(s), other than parent, allowed to pick up student. 11%) PASSWORD (lime locharecan) 02) NAME fa=t mid:Nina( WI) 111111111 163) ADDRESS (street numbs; fleet apstmool numboul (58) CRY STATE ZP CCOE (84) CITY STATE ZP CCOE LOXAHATCHEE FL 33470 (59) RELATION:MR PO) TEIEPHONE (On) CaLPAGER NUMBER 835) RBATONSNP (DO TELERCHE (S) CELUPAGER MADER OTHER . OTHER mg stunerrs ALLERGIES (c43NR Orme apply and specify) O None O Animals O Binds O Replies O Amphibian O Plants O Food O Other Specify (69) UST srucerrs MAWS. BEHAVIOR ISSUES, MEDCATONS CR PHYSCAL UMITATIONS (70) FAMILY RDSICIAN (71) PHYSICIAN PHONE NAMES OF PARENTS/LEGAL GUARDIAN'S OTHER CHILDREN (722NME CR CHAD (fist onside blatlas0 (73) SOCOL AMONG (7RsTuceilNakano (75)GRADE r . •. I • • \ ON al %%Cr) W ‘r) la (78) SCHOC4. ATTENCING (79) STUDENT NO. (Rfons0 (80) GRADE 01 rta1rn !1/21 Y) 4 int 013)9ptOl ATTBCING (64 STUDENT NO. DRion80 PS) GRADE DATE OF BIRTH q Nome S.,(Thed INFORMATION VERIFICATION PARENT/GUARDIAN CONSENT I verify that the information given is true I understand and agree that all educational records of rry chid may be shared with the Districts and accurate to the best of my health care partners and other govemmental and social agencies Jointly seeing the child or having knowledge. a legitimate Interest In the records, as needed to provide and evaluate health services and government/social services to students. I also rrederstand and agree that my child's medical records or other metal information that I provide to the schod, and treatment records or other medical records created by health care p who have a legkimate educational purpos Documei COB US CAI TeacherNo. O Irwin SI. Entry Code EUI Reassign. Code ❑ arth RecadeVerifcalion ❑,Pain Tran St. Entry Dale MU 11/04 Beth Venicalon ESOI Entry Date DCF O Social Security Welber aParentiSluderaTraworiaticn O Physical Exams O Wak O Bike O Address Vreificalicn PBSD 06:36 (REV. 03/17/2004) page 2 of 2 EFTA01710081 Spring 2003 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS 2d Grade 09 Student Report 2331-RIPA1.7 AtglnigEACH HIGH District Number and Name: 50-PALM BEACH The Florida Departmentof Education believesthat evegy student has the ability to learn and succeed. The purposeof the FCAT is to ensure that Florida's public schools are providing the best education possible, and preparing students to succeed in the competitive 21st Century Job market. Working with teachers, the State has developeda measurement system that allows you to track a students academic achievement from year to year and determine if a year's worth of learning has occurred in a year's time. This system also allows you to compare a student's score to a Score that represents 'grade level' achievement if a students score is above the 'grade lever score, then they are performingat a level above their current grade. If it is below, they are In need of Improvement Using the 'Content Scores,' you are ablelo Identify any Specific academic skills needing Improvement. Below you will find your 2003 FCAT Reading and Mathematics scores,as well as your scores from previous years. The chart on the right side of the page shows your score compared to the score that represents grade level achievement. Reading Your Reading score Is on grade level. You have answered many of the questions on FCAT correctly. 3000 2500- 2003 Reading Content Scores Content Areas Points Points Possible Earned 200C- FCAT Score vioraswnrases 7 I Main Idea/Purpose 78 Comparisons 10 Reference/Research 1000- 10 Year 2001 2002 2003 500- Grade Tested Achievement Level Grade 3 Grad Grade Grades ad 10 it FCAT Store • ■ Your Score O On Grade Level Your Mathematics score is on grade level. You have answered many of Mathematics the questions on FCAT correctly. 2003 Mathematics Content Scores Points Points Content Areas Possible Earned Number Sense 8 Measurement 7 Geometry 11 Algebraic Thinking 10 Data Analysis 8 Grade Tested Achievement Level Ortie 3 Orris Gado Cade Grad 10' 11 FCAT Score • • Yratr score o on Grade Level • These scores show your achievement on the day you were tested. If you had taken this test numerous times It is likely that all of your scores would have been within a certain range. Your 2003 FCAT Reading scores probabl would have been between Your 2003 FCAT Mathematics scores probably would have been between NT= Not Tested NR on Not Reported NA= Data Not Available Data Run Date 05/09/2003 0162395 EFTA01710082 FCAT Reports Informes FCAT (Spanish) Rapó FCAT (Haitian Creole) Separate reports are produced for the Sunshine State Se preparan informes separados para los exámenes del FCAT Yo prepare rapó 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 rapó apa tou pou lekti ak matematik for the norm-referenced tests in Reading and imprime otro informe por separado para los exámenes de lectura pou "model egzamen ofisyèl FCAT itilize pou fè evalyasyon" Mathematics. y matemáticas de acuerdo a las normas de aplicación nacional. an. Informe sobre el FCAT ceñido a normas de aplicación FCAT Norm-Referenced Test (NRT) Report The FCAT nacional (NRT) El informe del FCAT NRT presenta los Rapó egzamen ofisyèl FCAT itilize pou fè evalyasyon NRT report shows reading and mathematics scores on resultados de lectura y matemáticas en una versión del estado (NRT) Rapo FCAT NRT a montre nót lekti ak matematik nan a Florida version of the SAT9 (published by Harcourt de Florida del SAT9 (publicada por Harcourt Educational vifisyon Florida genyen pou SAT9 Ia (Se Harcourt Educational Educational Measurement). Student scores are Measurement). Los resultados obtenidos por los estudiantes se Measurement ki pibdiye li.) Yo konpare no( elèv la ak yon compared to a national "norm" group, where a percentile comparan con el grupo modelo o "normas, en el que la gwoup nót yo konsidere kom "modèl pou egzamen ofisyèl" la, rank score of 50 is average. clasificación es de un 50% del promedio. kote swivan klasman pa pousantaj la, nót mwayèn nan se 50. Sunshine State Standards (SSS) Reports The FCAT Informes según las normas estatales Sunshlne State Rapó Sunshine State Standards (SSS) Rapó FCAT SSS SSS Reading, Mathematics, and Science reports show Standards (SSS) Los informes según las normas estatales pou lekti, matematik ak syans lan montre nót elèv yo fè nan test 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. Rapó sa yo These reports contain subject scores and content lectura, matemáticas y ciencias de las normas académicas de gen nót pou matyè ak nót pou kontni ladan yo. Nót pou matyè scores. Subject scores describe the overall Florida. Estos informes contienen calificaciones por materias y yo dekri tout sa elèv la reyallze anjeneral epi nót pou kontnl yo calificaciones por contenido. Las calificaciones por materia achievement, and content scores give the number of proporcionan un resumen general del rendimiento y las bay kantite pwen elèv la fè nan yon matyè byen detèmine. Ou points earned in specific skill areas. Success on the calificaciones por contenido que proveen el número de puntos ka konprann kisa elèv 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 siksè kote 3 oswa plis by using the achievement leveis where a 3 or higher is exámenes de lectura y matemáticas puede entenderse mejor se yon nót kl nan nivo klas la oswa yon not ki pi wo pase nivo on or aboye grade levei. utilizando los niveles de rendimiento en los que una calificación Idas la. Achievement Leveis Five categories of achievement de 3 o superior está al nivel del grado o por encima. Nivo siksè elèv yo Gen senk kategori siksè ki dekri nivo describe the success students have with the content Niveles de rendimiento El éxito que un estudiante ha logrado siksè elèv yo pote nan kontni yo teste nan egzamen lekti ak testad 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 is 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. Piske yo poko detèmlnen n'yo siksè nan egzamenn achievement leveis have not been determined, science alto y el nivel 1 es el más bajo. Como los niveles de rendimiento syans lan, yo klase nót pou syans lan swivan si li tonbe pi ba, scores are ranked as to whether they fali in the lowest, en ciencias no se han determinado, las calificaciones de nan mitan oswa pi wo yon tyè pèfómans elèv toupatou nan eta ciencias se clasifican con respecto a si entran dentro del tercio middle, or highest third of statewide student inferior, medio o superior del rendimiento estudiantil a nivel a. performance. estatal. 5 Elèv sa a gen siksè nan matyè ki te gen pi plis difikilte ladan yo nan egzamen Sunshine State Standards la. Yon elèv ki 5 This student has success with the most challenging content 5 Este estudiante tiene éxito con el contenido más difícil de las nan 5yem Nivo reponn pitó kesyon egzamen yo of the Sunshine State Standards. A student scoring In Level normas Sunshlne State Standards. Un estudiante del Nivel 5 kdreldeman, elèv la menm reponn kesyon kl 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 Ello/ sa a gen siksè nan matyè 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 elèv 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 4yem Nivo reponn pitó kesyon egzamen yo ktnekteman, answers most of the test questions correctly, but may have men li ka gen kek slksè sèlman nan kesyon ki 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 Elèv sa a gen enpe siksè nan matyè ki gen difikilte ladan yo 3 This student has partial success with the challenging de las normas Sunshine State Standards, pero su rendimiento nan egzamen Sunshine State Standards la, men pètómans content of lhe Sunshlne State Standards, but performance es inconsistente. Un estudiante del Nivel 3 responde muchas lan pa rete estab. Yon elèv ki nan 3yèrn Nivo reponn anpil is inconsistent. A student scoring in Levei 3 answers many de las preguntas del examen correctamente, pero por lo nan kesyon egzamen yo kóritskteman, men anjeneral li gen of the test questions correctly, but is generally less general tiene menos éxito con las preguntas que son más mwens siksè ak kesyon kl sanble yo gen pi plis difikilte ladan successful with questions that are the most challenging. difíciles. yo. 2 This student has limited success with the challenging 2 Este estudiante tiene éxito limitado con el contenido difícil de 2 Elèv sa a gen siksè limite nan matyè ki gen difikilte ladan yo content of the Sunshine State Standards. las normas Sunshine State Standards. nan egzamen Sunshlne State Standards la. 1 This student has little success with the challenging content 1 Este estudiante tiene poco éxito con el contenido difícil de las 1 Elèv sa a gen yon ti siksè tou piti nan matyè Id gen difikilte of the Sunshlne 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 clasifiquen en el Nivel 5 o cuyos resultados de ciencias sean superiores a 400, Sètifika FCAT Elèv ki fè nót 5yem Nivo oswa elèv ki fè gwo whose science scale scores are greater than 400 receive reciben Certificados de rendimiento. En redacción, los not ki pi plis pase 400 nan syans ap resevwa Sètifika pou Certificates of Achievement. For writing, certificates are given certificados se otorgan a todos los estudiantes que han obtenido Siksè. Yo bay tout elèv ki fè nót 5.5 oswa 6 ak elèv klas to ali students with soores of 5.5 or 6 and to fourth graders with calificaciones de 5.5 y 6, y a los estudiantes de cuarto grado que katriyèm ki té nót 5, 5.5, ak 6 yon sètifika pou redaksyon. Yo scores of 5, 5.5, and 6. Certlficates are not awarded based on han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados pa bay sèfifika swivan nót elèv fè nan egzamen ki bazo sou the FCAT Norm-Referenced Test scores. en los resultados del FCAT ceñido a normas de aplicación "modèl egzamen ofisyèl FCAT itilize pou fè evalyasyon" (NRT) nacional. an. EFTA01710083 Spring 2004 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Science Performance Task Student Report Huiba;:iPatiniv; ses -Th stes It; I Grade 10 This report provides your results on the FCAT 2004 Science FCAT 2004 performance tasks. Each performance task on FCAT requires you to SCIENCE PERFORMANCE TASKS respond with either a short response or a longer, more detailed response. Shed-response tasks are scored on a 2-point rubric and Student Name extended-response tasks are scored on a 4-point rubric. Student Number One of the short-response tasks Is shown below with a copy of your School Name ROYAL PALM BEACH HIGH answer. The number of points you earned for your answer is shown School Number 2331 in the box to the right. District Name PALM BEACH District Number 50 All Scienat 1h* Pert rnian co Tass Response Performance Task Responses Points Possible 2 10 Points Earned I I IkeNam diva Is owedMagian' plats that awned Wend with ea el Gahm ;Nor Ter tonte plebs GM* Wald Dewar a poker erect ant a mole& fortnatIon that cm row when plate cralide. \4r ern WAes rt.n ram ink a (Tv: e;;Olono . at NM ).4 a die Data Run Dale: 0413072004 0054490 685000916 EFTA01710084 . , Spring 2004 NAME: ID: Florida Comprehensive Assessment Test (FCAT) SCHOOL: 2331•ROYAL PALM BEACH HIGH SSS Science Student and Parent Report DISTRICT: 50-PALM BEACH Grade 10 Meth CompreM1ensl.ee Assessment Test The Florida Department of Education believes that El Florida Department of Education (Depanamento Depatman Edkasyon nan Florida kwe chat limoun every student has the ability to learn and succeed. de Education del wads de Florida) see que todos gen kapashe pou aprann epi gen sine. Objektif The purpose of the FCAT is to ensure that Florida's bs estudantes lienen la capaddad de spender y FCAT la se pou yo ka seten lekol piblik nan Florida public schools are providing the best education toner exits. El proposito del FCAT os asegurar que ap bay pi bon edkasyon ki posb Is epi yap prepare Potable and preparing students to succeed for the Las escuelas pub/Gas de Florida prOpOrtionen la el& yo you yo ka gen same nan lavni. future. major education posble y preparen a bs estudiantes pare tenor exits en el future Yo identify° yon nivo konesans ki elve nan Syans se A high level of science knowledge has been identified yon baggy ki esansyll pou yen moon ka gen same as Clftbal for success in the competitive 21st century Se ha demostrado quo. Para el exile en el nan konpotisyon ki genyen nan (might travay la nan job market Yanking with Florida educators, the state Gormand.* mercado labors.' del siglo X)0. es crucial 2lyem bre* La. Eta Florida a travay ansanm Sc has developed a test to measure a student's poser un alto nivel tie conocimientos do ciencias pwofesii yo pou yo devlope yon egnamen ki pemet achievement of the important science skills in the Trabajendo con educadores de Florida. el estado ha yo moths ranninan yon elin nan egzamen syans ki Sunshine State Standards. This report provides your desamollado un examen pare rnedr los logros de un enpMan nan Sunshine State Standards la. Rapti sa student's 2004 Science Score which Slows you to °Studien!e en materia de ciencias de acuerdo a las a bay Not cloy to nan Syans pou An* 2004 la epi sa compare your students performance to the rtormas Sunshine Slate Standards. Este inforrne pained ou konpare pbbmans elev ou yo ak paltimans performance of other students in the state. In proportIona a su °studente la caked& de tat clew nan Eta a. Anplis, not yo Id nan rape a cdo addition. the content scores help you to identify ciencias de 2004, lo que le permite corrparar el ou idantiye nan ki rialye akademk ettif la bezwon to acadom'c skills that may need improvement rendimiento de su estudiante con la de otros amolyorasyon. estudantes en el estado. Adicionalmente. as calFicaciones de contenido le ayudan a Identifies as hank:lades academicas en las que puede ser nooesario mejorar. Your 2004 FCAT Science Score Compared to Other Students Score • Low Middle High 500 Your 2004 Science Content Scores Points Points Compared to Other Students 403 Content Areas Earned Possible Percent Low Middle High Physical and Chemical 300 Earth and Space 200 Life and Environmental 100 Scientific Thinking Students Score Stotrerkeworia This score shows your achievement on the day you were tested. If you were to take this test again, It is likely that your 2004 FCAT Science score would be between 258 and 288. Science Content Contenido de ciencias Kisa Id gen nan egzamen syans Ian • Physical and Chemical Science- explains • Cienclas 1biros y quimicas -explican la • Syans I izik ak chimik. esplike malYe, matter, motion, force, and energy including materia, el movimlento, la rueaa y la energfa, mouvman, Ids, ak enep, sa vie di pwopriyete their properties and interactions; also identifies inctuyenoo sus propiedades e Interactions; yo ak lam youn nsyak ak l0t; epi lou Idantilye atoms, elements, compounds, and mixtures. tambien identitican los Stomos, elementos, atom, eleman, konpoze chimik ak melanj. compuestos y mezcias: • Earth and Space Science- explains Earth's • Syans late ak espos• esplike charilman Id lel changes over time including geologic patterns, • acacias de la Tierra y el espacio explican sou Late ane apre ane. sa vie dl arolivile the rock cycle, minerals and weather systems; los camblos de la Tierra a 'raves del tempo, jewolojik, faz with, &stem mineral ak ststem also describes the solar system and universe. Incluyendo bs patronesgeologicos, el clef° de ameteyo a, epi II deka sistern sole a ak neve a. las rocas, minerateS y SIStemaS • Life and Environmental Science- identifies rreteorot0gicos; tamblen descnben el &sterna Syans biyolojik ak anviwonman idantif ye and explains plants, animals, and the solar y el universo. • clot esplike plant, bet, ak anviwonman an, sa environment, Including life processes, vle dl pwosesls toryoloirk, konsevasyon resous conservation of resources, and the • Ciencias de la vide y el medic ambient° yo, ak entedepandans &can's ak sistern yo. interdependence el organisms and systems. identifican y explican las plantas, animates y el medic ambiente, Incloyendo los procesos Rezonman syanlifik- lake pwosede syantilik ll Scientific Thinking- applies scientific vitales, la conservation de recursos y la • pou rezoud pwobkm, rekonet regilarite ak processes to problem solving, recognizes interdependenica de organismos y astemas. cistern, epl konprann enpak teknoloji sou patterns and systems, and understands the lasosyete. Impact of technology on society. • Pensaniento cientifico- apace procesos cientificos a la resolution de problemas, reconoce patrones y sislemas, y comprende el impacts de la tecnologia en la socreoact. Data Run Date: 04/2912004 0057835 EFTA01710085 Spring 2004 NAME: ID: Florida Comprehensive Assessment Test (FCAT) SCHOOL: 2331 - ROYAL PALM BEACH HIGH NORM-REFERENCED TEST DISTRICT: 50 - PALM BEACH Grade 10 Student Report 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 National Scale Percentile Stanine Score Rank Reading Comprehension Mathematics The Scale Score describes your performance on the test and allows for comparisons from year to year. Reading Comprehensbn Scale Scores range from 527 to 817. Mathematics Scale Scores range from 568 to 863. The National Percentile Rank (NPR) and Stanine indicate your relative standing in comparison to the national reference group. National Percentile Ranks range from 1 to 99. The PR score indicates the percent or students in the national sample who scored equal to or below your score. Starines range from I to 9 where I Is low and 9 is high. Stanines in the range of 4-6 are considered average scores. II you were to take the test again, your National Percentile Rank might be slightly higher or lower. However, your National Percentie Rank would probably fall within a certain range. For Reading Comprehension, your National Percentile Rank should be between 27 and 51. For Mathematics, your National Percentile Rank should be between 26 and 56. CONTENT SCORES Number of Number of Number of Questions Questions Correct on Test Attempted Responses Reading Comprehension 51 51 Inaial Understanding 8 8 Interpretation 22 22 Critical Analysis 9 9 Strategies 12 12 Mathematics 48 48 Problem Solving 6 6 Algebra 6 6 Statistics 6 6 Probability 5 5 Functions 5 5 Geometry-Synthetic 7 Geometryalgebralc 4 4 Trigonometry 3 3 Discrete Math 3 3 Pre calculus 3 3 Data Run Date: 04/16/2004 0140635 EFTA01710086 Spring 2004 Florida Comprehensive Assessment Test (FCAT) FCAT florkle(omethessiveAssessmier lot SUNSHINE STATE STANDARDS Reading Performance Task Student Report Grade 10 This report provides your results on the FCAT 2O04 Reading FCAT 2004 performance tasks. 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 Student Name extendec-response tasks are scored on a 4-point rubric. Student Number One of II a a/tor-response tasks is shown below with a copy of you School Name ROYAL PALM BEACH HIGH arswer. The number of points you earned 'or you• answer is shown School Number 2331 in the box to the right. District Name PALM BEACH District Numoer 50 This task required you to read an article about a young man who creates a successful business by salvaging lost golf balls. All Reading Task: Select one of the following personality traits and show how it This Performance Performance Task Task Response Respoinies helped Jim Reid build a successful career. Use details and information from the article to support your response. Daring Hardworking Imagnative Points Possible 2 10 Points Earned -3,OTh tc2C'S a \Jell afteirmor Malt When hP c.r.)\- cb‘okt \ Pa \f"Iv- (Greer, eNtryone \"t3Jt ht 1/4.0CA-9 %)..)ei f bt,4 reyCY ty4 up. In Ira\ e\ c. 'pee% es\ breed oC 9e be &Aar% SA-ere .13r \-e-An \he &A% toil.1-% tnokes and eel-)— and \IRA rnra V -1011 on 1.4 %col', h;m a io!i. gsx-rseWirts Vitia also hyl by le\-M-Oca 1.3\-06 isncienvoiet Oala Run Date. 05/04/2004 0073095 737200623 EFTA01710087 Spring 2004 Florida Comprehensive Assessment Test (FCAT) FCAT (tarifa fceprehernire Asses:min! lest SUNSHINE STATE STANDARDS Mathematics Performance Task Student Report Grade 10 This report provides your results on the FCAT 2004 Mathematics FCAT 2004 performance tasks. Each performance task on FCAT requires you to MATHEMATICS PERFORMANCE TASKS respond with ether a short response or a longer, more detailed response. Short response tasks are scored on a 2-point rubric and Student Name extendoC-response tasks are scored on a 4-point rubric. Student Number One of the short-response tasks s snown below oath a copy of your School Name ROYAL PALM BEACH HIGH answer. The number of points you earned for your answer is shown School Number 2331 in the box to the right. District Name PALM BEACH District Number 50 This PerfermanCe NI Mathematics Task Response PerformanCe Tank Responses Points Possible 2 16 Points Earned The cause of the monorail at an arrusemert peek must be changed to make coon for a new puking lot Engineers have decided that only the main supporting Otiturn located at point C on the gnat below should be relocated. They have also decided that the rebuilt course should be in the sluipe of a parriE4ogram. Pan A Plot the new location of the supporting colony% and write Its oondlnitea label the new tor-abort C. MONORAIL COURSE U to i z 6 4 2 0 2 4 4 a JO 12 14 14 a. Poll( Use the definitket a properties of a parallelogram to verily Out the new monorail count is a pratlelogram. You must use the alaia of the sides, the kngdui of die *Ilea or both to help verify your amwec Ike onto ton (4Oxt A 4° ti. 1. ..) IA*. 5 40* 1toin D I.x C. Data Run Date: 05/04/2004 0072096 737300E03 EFTA01710088 NAME Spring 2004 ID Florida Comprehensive Assessment Test (FCAT) SCHOOL: 233I-ROYAL PALM BEACH HIGH FCAT DISTRICT: 50-PALM REACH Writing Grade 10 Student Report Florida Comprehensive Assessment Test Writing to Explain I SCORE: How Papers Are Scored Dear Student: The student responses are 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 standards set by Florida educators and gave it about the entire response and do not focus on any one aspect of the writing. an overall 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 side information. 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 also refers to (1) the use of transitional devices to relate the supporting ideas to the Remember, you were given 45 minutes to read the assigned topic, plan main idea, theme, or unifying point and (2) the evidence of a connection between what to write, and then write your response. The conditions under sentences. Papers representing the higher end of the point scale use transitions to which you write papers in class or at home may not be the same as signal the plan or text structure and end with summary or concluding statements. those for this test; therefore, the writing may not be the same. You and your teachers should consider the score on this test along with all of your other writing when planning activities to continue developing Support refers to the quality of the details used to explain, clarify, or define. The 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 choose a job and explain why you capitalization, and spelling and use a variety of sentence structures to present would not like to have this job. ideas. Data Run OS 04/07/04 50-2331 EFTA01710089 Description of Grade 4 Writing Scores Description of Grade S 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 arc Punctuation. capitalization. and spelling ate generally correct. structure. There are few, if any. usage. punctuation, or spelling few, if any, usage, punctuation. or spelling mots. errors 5.5: The writing was given a 5 by one reader aad 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: Ilse 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 am though lapses may occur. It demonstrates a nature command vary in structure. Usage. punctuation, and spelling are generally correct. of language. Sentences vary in structure. Punctuation. generally correct. capitalization, and spelling are generally comet. 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 me 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 generally focuses on the topic, though it may 4.0: The writing focuses on the topic, though it may contain loosely contain cutaneous information. An organizational µstern is 4.0: The writing generally focuses on the topic, though it may related infixwation. An organizational pattern is apparent. evident, but lapses may occur. Some supporting ideas contain contain extraneous information. An organizational pattern is Some of the supporting ideas contain specifies and details, hut specifics and details, but others are not developed. Word evident, but lapses may occur. Some supporting ideas contain others do not. Word choice is adequate. Sentences vary• in choice is adequate. Sentences vary somewhat in structure, specifics and details, but others are not developed. Word structure. Usage, punctuation, and spelling are generally though many are simple. Punctuation, capitalization, and choice is adequate. Sentences vary somewhat in structure, COMM spelling we usually correct. though many are simple. Punctuation, capitalization, and spelling are usually correct. 33: The writing was given a 3 by one reader and a 4 by the other 3.5: The writing was given a 3 by one reader and a 4 by the other reader. reader. 3.5: The wrung was given a 3 by one reader and a 4 by the other reader. 3.0: The writing generally focuses on the topic, though it may 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 vanation ideas or examples may not be developed. Word choice is bccn amcmµed, 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 he developed. Word choice is generally correct. arc simple. Punctuation and capitalization arc sometimes adequate. Sentences vary somewhat in structure, though many incorrect. but nest commonly used words arc spelled correctly. are simple. Punctuation and capitalization are sometimes 2.5: The wrung was given a 2 by on: 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 information. An urgamizational 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. Ftequcnt non may occur in pallslUaliali. choice may be limited ot IIIIIILalUIC. Sentences may be limited 1.5! The writing was given a I by one reader and a 2 lay the other capitalization, and spelling to simple constructions. Frequent errors may occur in reader. punctuation, capitalization, and spelling. 13: 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 are often presented through lists and limited 1.0: The writing may only minimally address the topic because there is or inappropriate word choice. Frequent errors may occur in little or no development of supporting Ideas or examples. No 1.0: The wasting may only minimally address the topic because there is sentence conuruction, usage. punctuation, and spelling. organizational pattern is evident. Ideas am often provided through little or no development of supporting ideas or examples. No lists, and word choice is limited or immature. Unrelated organizational pattern is evident. Ideas are often provided through U: The writing is unrelated to the assigned topic or cannot be read information may be included. Frequent errors in punctuation. lists, and word choice is limited or immature. Unrelated capitalization, and spelling may impede communication. information may be included. Frequent errors in punctuation. caprulization, 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 he read. ISDI400 EFTA01710090 4tIOOL et,:\ k THE SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) L(1) STUDENT NUMBER (2) SAO axe W O 1 \! „<:/ElEAGIC0LES I New and Returning Student Registration NEW STUDENTS: Complete all non-shaded areas on both sides of the form. RETURNING STUDENTS. Review both aides If the li e-printed information is nonted correct the information by carefully and lightly crossing out the incorrect information and writing the correct informaton above i 100A DIST:1891 TORS TN8R:107 STDT CRS:1400000 SEC:05 BLDG:00 RM:GUID 08/07/01 (3) STUDENTS LEGAL NAME Rog Int iluddir) (4) ALSO KNOWN AS (S) LOCAL ADCRCSS (haunt.° 4 *ORR name) (apt no) RAH (star) OM For) LOXAMATCHEE FL 33470 . ._ . (0) MAILING ADDRESS Douse no 8 street non* (apt no, (cdy1 (3a) (pc CCOO DI SOCIAL SEQ)RRY ND (cot ) (8)IIOME TELEPHONE NO SEX 113) RACEETHLC ORrinu W 0 I-American IndianrAlaslcan Native 0 B-Black, Nm-Hispanic 0 H-Hispartic F 0 A-AseNPaci(ic Islander 0 W-White, Non-Hispanc 0 M-Multiracial 0ii DATE OF BRTH 02) PLACE OF BRTH (cety stab tan) (13) RESIDENT STATUS 3 (II) USA ENTRY DATE Yr (MAVDCNTY V) U 0. Foreign Exchange Student 0 1. Cut-of-county Resident 0 2. Cut-or-state Resident (151 FEDERAL OAPAST SURVEY D 3 Jr -county Resident YES NO ic) NICSCIOOL CulOL.NICNT iNrCRAJAMON pj 0 0 R. The student resides on federal property Place an X by each program attended Als5 indicate with 0 0 B. The student resides n low rent housing an asterisk C) the program you chid was in the longest. U U C. The parent is employed on federal property located in P.B. County LJ N Non-subsidized Child Care U M. Migrant Pre-K 0 3 D. The parent is employed on low rent housing located n P B. County El D. Pre-K Disabilities M H. Headstart 0 o E. The parent is in the uniformed services of the Unted States 0 I Pre-K Early Intervention 0 C. Chapter 1 0 S. Subsidized Chid Care 0 0. Other 0 0 If E. is YES, s the parent on active duty? Check service below' 17) iS THE STUDENT A (IL) CURRENT CRAM LEVEL SI LE PARENT, NO 8 Air Force D Army Coast Guard 0 Marines 0 National Guard 0 Navy 08 0 YES 0 NO TRANSFER INFORMATION (zo)C01. OR LOCATION (211LAST ATTE/OO.CE 0ATE (2Z LAST ORACC LC 'JCL (23) LAST FLOCK SCHOOL ATTCNDCD IN PALM MAGI COUNTY (24) DATE ATTChOCD Di PDS HEALTH SCREENING INFORMATION FREE OR REDUCED as Students will receive non-invasive health screenings pursuant to Florida Statute 381.0066(7)(d) Non-invasive PRICE LUNCH screenings may inCude vision hearing, scolosis, height, and weight. These tests may be given individually or Have you filled out an in groups. Parents or guardians, however, have the right to request an exemption in wrking. If you DO NOT application foe free and want your child to receive the screenings. wnte ine words -Do not screen- here: (This exemption wit cover aN types or screenings) reduced lunch? 0 YES 0 NO C26 I give permission for my child to participeae in the sodium fluoride program to prevent tooth decay. 0 YES 0 NO Application is provided (permission .s vac, through 6th grade) YES with this form) NEW STUDENTS TO PALM BEACH COUNTY (20; HOVE LANSUA GE SURVEY YES NO 0 0 1. Is a language other than English used in the home? If YES. vnat language? • • 2. Does the student nave a first language other than English? If vES, vnat language? 0 0 3. Does the student most frequently speak a language other than English? If xES. vinet language? cm 4. What language is spoken in the home by the parent or guardian? 00 5. What language is the students fist language? 02) STUDENT LIVES W1TH (Meek one' rot what IS the date of entry into an ESOL program? 0 Mother 0 Father 0 Both Parents pa: OISCLCSURES FOR ENTRY NTO PBC SCHOOL D5TRIL. I YEs No 0 Other 0 0 1. Has the student ever been expeled from school? 04)CoSTODY Straus OF STUDENT (checA one) 0 0 2 Has the student ever had an arrest resulting in a charge? 0 Mother 3 Father 0 Shared Custody 0 0 3. Has the student ever had any juvenile justice actions? 0 Other as: Is thero a court order barring other parer* from removing or contacting the student during the school day? 0 YES 0 NO If YES, provide the school with a copy of the court order PBSD 0636 (REV 5/292001) page 1 of 2 EFTA01710091 f HE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION _iSi FATHER OR LEGAL GUARDIAN C'.. - .- - ., 4.0 MOTHER CR LEGAL GUARDAN tmedlis m4*t 1441) PU: Y PU: Y ADDRESS new number. Sniff ire velment matted mnr numbs) Car STATE ZIP CODE CITY STATE ZIP CODE LOXAHATCHEE FL 33470 OCCUPAnON OCCUPATION Pt ACE OF FisPtOymENT MACE OF EmP.OyuENT HOME TELEPHONE BJS1NESS TELEPHONE CELJPASER NUMBER HCME TELEPHONE BUSINESS ItEPHON. CELUPAGER NUMBER EMNL ADDRESS (orboado WAIL ADDRESS foobons0 EMERGENCY HEALTH AND SAFETY INFORMATION Person(s) other than parent authorized to pick up student no PASSWORD 0117Y( 10 characters) (39. NAME rest mad* dreSat kist, (0I) NAME fest mdfle nubs, bro FRIEND EIGHBORS ADDRESS NH* none nay nam• optimal: ntinb00 ADDRESS cmniw numbs. ilnOt name. awhile& weer) CfT( STATE ZIP CODE CRY STATE ZIP COLE TELEPHONE RELAIONSHIP AO) AUTHCRZED FOR TELEPHONE Ramooratro (az AUTHORIZED PCP EMERGENCY PICKUP EMERGENCv PICKUP OTHER 0 YES 0 NO T OTHER 0 TES 0 NO T (44) MEDICAL INFORMATION OW Hydro 'P direAses, b•hera. sew, (43) It school personnel are unable to contact you in case of illness or accident, 64604 *Ines ensicettots. aoffice pgyscill &Moons; may we have your permission to call your doctor or emergency Services (91 ) for transport to the hospital? 0 YES 0 NO (4s) FAMILY PHYSICIAN (46) PHYSICIAN PHONE 46) Does your Child currently have health insurance? CI YES 0 NO It YES. indcatet (47) ICSPITAL PREFERENCE 0 Medicaid • Private 0 Healthy Kids/Kid Care 0 Interested in receiving information PARENT'S/GUARDIAN'S OTHER CHILDREN IN PALM BEACH COUNTY SCHOOLS 11111 KHCOL ATTESDPNG STLDEP:T NO (canons) GRADE DATE OF BIR-H kkA\ ?CAM trl (3h \D\ X.LIC ATTE/Ct.:3 STUDENT NO foasonsr) GRADE CS1,5\j ike_r 48. S.,C0I. ATTEND.* STUDENT NO (canons/ GRADE \ RAttn it i ln (4 I fijATTEMDING STUDENT NO (apbeni) GRADE C SE ' - ‘te,C0A FOR OFFICE USE ONLY tt,V\e. Co 1531SO4 ND ( . I'S) COB SO ENVY CO (62) ENTRY uTE De ot Dv (SI EA I verify that the information given 1691 US E0i 08/14/01 O8 01 is true and accurate to the best of DO) WO NO 41) REASDON CODE (62 TRANSPORTATON (En WADI ARE MR id4S 0 PfiC PAS li 0 Palm Iran 1 2 3 4 5 A 0 Pareni/Stuowl Tram 0 'Nat 0 Bke 6 7 8 97 8Z (55)DOCIMENTAT)ON CHECK ST (that al de* sten recove0 0 ETIMMLZatiOnS (date) 0 Birth Records Verif (da e) 0 Soc Sec. No. (date) 0 Physical Exams (date) D6) Cars E MIRY =atm BY DATE page 2 oft EFTA01710092 STUDS SEX RACIAL/ETHNIC GROUP 0 Hispanic STUDENT NUMBER Legal IX White, Not Hispanic 0 American Indian Native Alaskan _ 0 Black, Nol Hispanic - F 0 Asran/Pac 'tic Islander MS BIRTHDATE: Verified by Birth Certificate 0 Yea If Not, What Type Verification? I, 3-44t3 L GUARDIAN OR OTHER RESPONSIBLE ADULT AT HOME: P G OA CURRENT S HO L (use pencil in this space, until final.) Name Street Dee First Entered This District Withdrawal Date dr ewal4pare Withdrawal Date 33415 City • 48 — a s- q 3 1-1'71-9 4 cal; qi y,rii.h t CA. od Grade: K School: Aorer9 'gaps I.5 t Grade: Vet I a.eALS! Grade. 2. Schoot Altalaic VC-cl Grade: Grads/ •19 W C req ./ e P; a a 5' scs`70yonei311e9sAi A,aditi School Year' 19- 33 -19 14._ School Year 19 3__q_ •19 2,. School Year 19 is , -19 qi. School Year: 19 AL-If/R:7_ -1$ Days Present. Days Absent Days Present Days Absent: Days Present Days Absent Days Present: Days rA a i: Days Pr t Days Absent: 190 //7 Oa 0 -5 - 11 S !tact 0 Subje:t Teacher Mark Subject Teacher Mark Subject Teacher Mart Subject Teacher Mar Teacher Mark MATHEMATICS z. .) 7 MATHEMATICS MATHEMATICS MATHEMATICS MATHEMATICS READING READING READING READING READING I LANGUAGE LANGUAGE LANGUAGE LANGUAGE LANGUAGE I SPELLING SPELLING SPELLING SPFI LING I SPELLING I HANDWRITING -- - HANDWRITING HANDWRITING HANDWRITING I HANDWRITING I es LA T el SICallIF F1e II. Ielliff-MtalI/N14- ICAUIFFIlllella. I IA I SCIENCE andO BEHAVIOR CODE " SCIENCE and HEALTH BEHAVIOR CODE SCIENCE and H LTH BEHAVIOR CODE HEASCIENCE and LTH BEHAVIOR CODE L I SCIENCE and HEALTH BEHAVIOR CODE L_ AV RA AV RA AV RA A R I Indicate Itsthcate Indicate Indicate- e Indicate' Promote IPI Promote IPI p Promote (P) Promos IP) Promote IP) FLORIDA PERMANENT RECORD CARD Rota n IR1 9 Retain (R) Ratan, IR) Retain (RI Retain IlD Summer SChOOI (SS) 4i "") Summer SCkOOIISS! Skimmer School 155) Summer SChgel (SS) Summer Scheel IS School Grade. School Grade: School. Grade School Grade. School Grade School year 19. .19 School Year 19 -19 School Year 19 -19_ School Year' 19 -19_ School Year 19 -19 Days Present DaysAbsent Days Present - Days Absent: Days Present Days Absent. Days Present: Days Absent: Days Present: Days Absent CATEGORY A - Education Records Subject Teacher Mark Subject Teacher Mark Subject Teacher Mart Subject Teacher Mark Subject Teacher Mark MATHEMATICS MATHEMATICS MATHEMATICS MATHEMATICS MATHEMATICS READING READING READING READING READING LANGUAGE LANGUAGE LANGUAGE LANGUAGE LANGUAGE SPEI LING SPELLING SPELLING SPELLING SPELLING HANDWRITING HANDWRITING HANDWRITING HANDWRITING HANDWRITING SOCIALSTUDIES SOCIAL STUDIES SOCIAL STUDIES SOCIAL. STUDIES SOCIAL STUDIES GRADES K-5 SCIENCE and SCIENCE and SCIENCE and SCIENCE and SCIENCE and HEALTH HEALTH HEALTH HEALTH HEALTH BEHAVIOR CODE BEHAVIOR CODE BEHAVIOR CODE BEHAVIOR CODE BEHAVIOR CODE AVERAGE_ AVERAGE AVERAGE AVERAGE AVERAGE Indicate Indicate Indicate Indicate Indicate. Promote (P) Promote IP) Promote (P) Promote (P) Promote IP/ Retain (RI Retain Or) Ramon (RI Retain(R) Retain (R) Summer Scoop 155) Summer SC1)OO(1551 Summer School 155) Summer School ISS) Summer School (SS) PBSD0932 VN 01-9340 EFTA01710093 STUDENT NAME. SEX RACIAL/ETHNIC GROUP ❑ Hispanic STUDENT NUMBER ❑ White. Not Hispanic ❑ American Indian/Native Alaskan El Black, Not Hispan c ❑ Asian/Pacific Islander CURRENT SCHOOL (use pencil in this space, until final.) ADDRESS. BIRTHOATE Name Street City School Grade Subject Teacher Mark School Grade Subject Teacher Mark SPELLING PF t i INC) HANDWRITING HANDWRITING SOCIAL STUDIES SOCIAL STUDIES School Year 19. .19 School Yost 19. .19 SCIENCE and SCIENCE and Days Present Days Absent. HEALTH Days Present Days Absent HEALTH BEHAVIOR BEHAVIOR CODE AVERAGE CODE AVERAGE Subject Teethe, Mark Indicate Subject Teacher Mark Indicate MATHEMATICS Promote (PI MATHEMATCS Promote (P) READING Retain (RI READING Retain (RI ANGUAGF Summer School ISSI ANGUAGF Summer School ISS) 0 (co_ op 0 oc2 z Wg8 2 . Q< W co > cc < 0 4* 0 0W (CIL° L 3._ P83130932 VII 01-9340 U. a EFTA01710094 VERIFICATION FOR NEW'/RETURNING STUDENTS: oat ") TN,b School District of Palm Beach County TO THE PARENTS OR GUARDIANS: ‘.) A;ts NEW/RETURNING STUDENTS NEW STUDENTS: Comploto all non-shaded arm:. IQ .' RETURNING STUDENTS. Please review both sides for 4 .`"", \ Cr" suck. c kr I 4.' REGISTRATION RIP' IT ION: 1441 TCHR : NETTUND, C TNBR: 017 correctness of typed information shown below and on the other side. If the information printed is incorrect please 17 correct it by carefully and lightly crossing out the incor - ect .... 0An 5/09/96 STD information and writing the correct information above it. ) u N 12) ALSO KNOWN AS ; IA kW LO Al ADORISS le itAitinctiONSS . KM.' IA tit C--k--- n , Ia' AAA( a, .., WEST PALM BEACH FL 33413 nt . Ltett 1... (SI STUCENTS SOCIAL SEE UM TT NO. 161 HOME PHONE NJ. 0/ SLR F IlD R CE V (OPTIONAL) ASIAN 0 „tome 0 INDIANC" 0 A psLANorq 9 W Zia rr-LISPANIC I MALI I g Nt....e_nmspaic o HISPANIC IAA Ti -RACIAL 9 H 0 M !SI OA MTN I {Ill RESIDENT STATUS 3 1121 ENTRY DATE INTO USA Li ). FOREIGN EXCHANGE STUDENT „.. 0 I OUT -Or -COUNTY NESIDEN, 'IT/ FFOIRAL IMPACT AID SURVIY Ill APPLICABIFI 1111 HAS THIS CHID 'MI IMMO (CHICK THE LETTER COM FOR ONE CODE Oar in MY PRESCHOOL? O 2. CUT -OF -STATE RESIDENT 08 23 93 N 0 .i. IN -COUNTY RESIDENT O A. SX;earyeiniV ii ans Iyindiegnepircticiriepareni amployet on m enial Please (lace Macleod Ifol by each regain sr Also. intact,. II St IS lit SI WINE O i St; pl. . ....rire sidta an lideral reper4. parent rot on I carrel with an sue sk I * I nip grogram year child wag in me Mood sal A SINCE, 0AIIMITt / NO ri J btrewit tesms in low lent lloutIRe paint not employe, or I ..... I O US O NU prowl', Or COPY! i D M MICRANT PRF-i I3 ' Sin""esi4416fi nonfederal proaert, in Pala Bench Coonlv PrCiPen) ' "re" "P" " felt"' DO. PFIE-IL ISM3ItrTIES CI N NON-SU3SICIIEC CHU CARE (IS/ GRACE LEVEL o 0 slut., j: sideft i Int I/snit:en] propel. n: v.! on so., d.:. .. Lit RE- AFLY INTERVENTION ID 0 OTFIR Oh. fADSTART O S. SUBSIDIZED NIRO CAM 02 TRANSFER INFORMATION: I 117` WAIF U 'CHM. - RANSF.FRRIRC Fun. l. I I. i 115. TAT; LII LAST %IMMO/14M (201 We1 O t ItVLI •211 LAST P.IBLI: SCHOLL AT Et RUE U IN PALM BE AC‘ LUUN IT 122) DATE ATTENOID FREE OR REDUCED PRICE LUNCH AND HEALTH INFORMATION: (23) NATE YOU FILLED OUT AN APPLICATION FOR F FE I or FEOU:E(I tUN:11? lAsplicatiot is world*, with tars Regollini an Entrn IMI IMI ail (24) HEALTH SCREENINGS: NO 1251 SDOIUM FLUORIDE. No I sun pereitti011 ICI my child to be given health screenings 'raise tit:: I give permissicte lot in, child to outlaying is the Sofitm Fluoride Propmen I' ma, be onto iaditidtallly or in gtozps to pima, dental deer,. Permission is valid !flog) grade sin _ — I] TE4 IC ❑NO — — NEW STUDENTS TO PALM REACH COUNTY: HOME: .LANGUAGE SURVEY :To be fi.loo oat by now ctudontt. ON-Y)!, •26, Aal7 .erri.t...11i IS 'Jur., ,,, :, vo,', imitil CI :II Cilliiih lle. il l TE OF ENTRY (23) • TYE !WE FP n6 P.t- t.,• c. P. 1HE , E;!IE E , ME iNTO THE (SOL GEE:Arch $1- t:ES'' NDGF.Y.. 2 Gams •.. Ruda.. wawa • oar manual,. uurw• wan entat.n, D - 0 ,-. FOR OFFICE USE ONLY: IUD) 9[600[ NO 1311 STUDENT fiwt..6EP .3216110W LAP:LI:ACE 03, COS (341 ENTRY CODE (351 ENTRY 0A11 ----. (36 :AC COD — EN E01 08 23 95 159A (17) PALENTrtusikOilli ;ANCVAI≥E 1351 CALENDAR 1381 OWE LEVEL 140 If atsfll NO. 1441 EN US 02 01 017 IIIIIIII/ F41) Aff$315/110.NT CV 32/ 104NSPORT4TICN N 471 VIRIFINTICA 0, BIRTH 1 I4412,41S 45) DOCUMENTATION OrCtaIST (M( AND OA'F WHEN RECEIVI 0.6[£410) El A• kVA El Eis( 9 IS 0 NO .. Ova rt./Army/J.11MS 9 MOP vCctfiCATiON Of BIRTH aitcOMOS 4 1 9 A. Fu"`V n 0 6•FSOI. M , Mat 0 1 2 3 5 6 3 4 5 A 7 ,8 T A 6 2 Bon S0LI St u on PKYSICAt. EXAMI 146) OLT:. WRY COMPI£T10 11,: GATE) 471 I VERIFY THAT THE INIORMATIIN ;WEI IS ME ./ iii.v m AND L CURA I TO THE GIST Of MY MONTE( CI RATE MO 0636 ilfv. 3'96 FRONT EFTA01710095 •••••••• 14ii STLIOCRT WES WITH (OEM ONO 0 10TH ~WS *WEN go /Oa te Am b., E IA HER .,.. ri ,,,,, 'ha duaal) a SHARED EUSToOy 1.. ''' Cantet,iti- p. (AIII INDISPONno NV S:sdant wdl b. Has ( 411 it THkRE A COURT ORDER RAIIII.NL EITHEA PARENT SHIM RCI,O s vIN A CONTACTING , 1 • /50 /ye_e•V-i-r •C iGuARoso. --- DOL: e ATHER NA CUSTODY) U S 11 I fro THE STUDER' DURING THE SCHOOI DAY) TES • IF YES, PLEASE PROvIDE THE SCHOOL WITH A COPT OF TIE COUR1 ORDER LI DIM/GUARD AN DOES ',OTHER HAVE CUSTODY? Ci TES CI NO NO YES LAST wIR ró31 YAgF LAO Loaf pall MOOS I .\ . is a EST PALM BEACH FL 33413 f iJeOrN) ' era, ZS exd ma« OTT Ven lA cow ótim....0. C - ( 1 -1i . -O i Ve-mt- r )9t. K • 0. Cif 10,~111TY _ 9 133rlikelarr Irdr. CLF - EGUEATOk t algETE5 EiSbriáLts0 A OSOOITAKT SOTOCa MAW ... BE ,............ Sean li•O• c [5<tt..bra 154 RICHES A LEVEL Of EDLKAT1ON COMPLETED (OPTOLLAO .... soca • • e Li so., son too* C•TSL *.ia C sil itlewita DD r.......----- ........ E ❑ co ea. M:~it D SC•it IOST.IIKOPOw, nore.aiNatiel E 9 :,,...,,—.^—_—"...,...,`" 551 LEGAL GUARDIAN (IF WM DOES (EGA( GUARDIAN HAVE CUSTO 'n YES [ NO LAST ~LI , "O-, '.." aYtna.l VT. OAR 2. MY eraerc• .,, c, i .„,,-„, •-••••e” ....... BMBNGENCY -HEALTH AND SAFETY INFORMATION 56) PAFi~ Puaodil *Inc ' or o••••1 ..1.,..ne T. p... .,p tr.,tr., IS)J PASSWORD PH I) tATtONSHtPts. la r( . / choir / I— /4-14 N ;LS Do -fi,YES 0 NO 0 YES 0 ivo 0 YES 0 NO ]],,.. 11 PART it in I. •ble t• . .... . •••• • ;0 ••• .. nt:d•it. .sy • I«. yin.. ~inn t• ma yew "at III Seraey Sraell Inn NMI %ISMS/. N. ...» lim WT SONO I) FAMILY DOCTOR 165 PHONE VIC 6 (66) COMM PREFOtEla f V) tk? .._ ( ( C nticv---, 71 AS Pt" SI SE ...At or, h€ASE tin .. R. F,_ ,._ (- OTHER PALM BEACH COL1NTY SCHOOLS: L_ 169) SCHOCt /MEAD', Dl S uCENT NO lOPTIONAll (71) GRADE V7) ORTH DATE e25Lar k_ajte inehielke4 3 _.,12/IteM kitt6t. EFTA01710096 EFTA01710097 H1 STATE OF FLORIDA DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES " %rarr LTH EXAMINATIONS Date Students Full Name — 'hone Race Address Rrthcate Name of Parent or Guard.a.. A. HEALTH EXAMINATION VA-Y3hI _ Blood Pressure (1) Narmal=N; AbnormalaA A COMMENT: Abnormal Findings. by number 1. Appearance 2. Skin/Nose 3. Head/Scalp 4. Eyes 5 Visual Acuity (R d L.' 6 Ears 7. Auditory Acuiy (r) 8 Li 8. Nose ' Throat 9. Mcuth Teeth arc Grms 10. Chest / Lungs 11 Heart 12. Abdomen 13. Genitals and Anus 14. Musculo-Skeletal 15. Neurological 16. Alertness 1' Em0bona1 / Mental Behavior Prob t8. Handicap. "seal. other (Specify) 19. Actrvty Restrictions (Specify' 20. Abuse. substance/ physcal / emotional 21 Nitrition 22 °the- B. HEALTH HISTOR(if (Serous Illnesses Injur•es explain) (attach narrative if additional snipe needed) C. LABORATORY (as indicated) It. He-nOglobtrilklematocrit Stool 1O 8 P) d Tuberculin test. Lead Sickle tell r NAME: TITLE: ADDRESS: • (Please Print) LIM A Oat am MRS -N Form 5040, Mar 91 (0bsotetes previous editions EFTA01710098 FLORIDA CERTIFICATION OF IMMUNIZATION .006, F.A.C. MO/DNYIt SS# (optional) STATE IMMUNIZATION ID#' Directiong • Enter all appropriate doses and dates below. • Sign and date appropriate certificate (A-I, A-2, 8, or C) on reverse side of form. • If the child is presenting for the 7th grade requirement only and has previously filed a Certificaamutization (680A or 68014) with their current Florida school, flu in boxed areas below and complete A- the reverse side of this form. • For additional information: See Immunization Guidelines for School Care Facilities for information and instructions on form completion and immunization requirements. &Una are updated annually and are available from the local county health department. VACCINE DOE Dose I Dose 3 Dose 4 Dose 5 CODE MOMANR /YR% MO/DA/YR mom A/YR MARIA/YR DTaP/DTP2 A DT3 Td' Polio' MMR (Combined)' F (Separate)e G.H.I Measles Measles (dose 2) Mwrips Rubella Hepatitis B9 The state immunization ID# is an identifier supplied by the state immunization registry (optional). DTP 5 doses required. If the fourth primary dose is administered on or after the fourth birthday a fifth dose is not required. DTaP is an acceptable alternative for one or more doses of DTP. 3 DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) • Td (Adult) Vaccine is recommended for children 7 years of age or older. Polio 4 doses required. If the third dose is administered on or after the fourth birthday. a fourth dose is not required. IPV is an acceptable alternative for one or more doses of OPV. Polio vaccine is not required for children 18 years of age or older. 6 Hib is required for child care and preschool entry and attendance only. • 1st dose valid if given on or after 1st birthday. Second dose (measles) valid if given at least 1 month after 1st dose. A second dose of measles (preferably MMR) is required for students in grades K-4 in the 1997-98 school year, and 7th grade entry and attendance effective with the 1997/98 school year. In each subsequent year thereafter, the next highest grades are included. s Includes single measles vaccine (C), single mumps vaccine (FI) or single rubella vaccine (1). 9 Hepatitis B vaccine series is required for seventh grade entry and attendance effective with the 1997-98 school year and kinder- garten entry and attendance effective with the 1998-99 school' year. In each subsequent year thereafter, the next highest grades are included. EFTA01710099 Certificate of Immunization for K-12 Excluding7th Grade Requirements PART A-1 (Immunizations are complete for school entry and attendance grades kindergarten through 12 with the exception of the 7th grade requirement.) DOE Code I have reviewed the records available, and to the best ofmy knowledge, the above named child has been adequately immunized against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella and hepatitis B (for kindergarten effective with the 1998/99 school year) for school attendance as documented on the reverse side of this form. Physician or Clinic Name: Physician or (Print or stamp) Authorized Signature. Address- Date - Certificate of immunization Supplement for 7th Grade Requirement Part A-2 (Immunizations arc complete for students who enter or attend the 7th grade after the beginning of the 1997/98 school year. Each subsequent year thereafter, the next highest grade will be included in the requirement.) DOE Code 8 I have reviewed the records available, and to the best ofmy knowledge. the above named child has received thefollowing immunizations requiredfor entry and attendance in 7th grade effective with the 1997)98srhool year: tetanus-diphtheria booster: hepatitis B vaccine series. and second dose ofmeasles vaccine as documented on the reverse side of this form (boxed areas). Physician or Clinic Name: Physician or (Print or stamp) Authorized Signature. Address. Date. Temporary Medical Exemption PART B (For preschool children, children in day care and school children who are incomplete for immunizations in Part A-I or A-2.) Invalid without expiration date. DOE Code 2 certify that the above twined child has received the immunizations documented on the reverse side of this form and has commenced a schedule to complete the required immunizations. .4 endel:a! immunizations are not medically indicated at this time Physician or Clinic Nabial Beach County Health Department (Print or Stamp) Community immtmlfation Service Expiration Date: (IS days after next 21-4goo/ A. 4/1 Physician or Address: Riviera Bea L 33404 Authorized Signatu w•,7 3.0) Phone: Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 / certify that he physical condition of this child is such that immunizations) as indicated in Part C above is medically contraindicated. Physician or Clinic Name: (Pratt tit Stalltp) Physician Signature- Address. Date. DII , replace. earlier editions !Stock Number: 5740.00046SO-61 EFTA01710100 FLORIDA CERTIFICATE OF IMMUNIZATION (HRS 680 - PART A) (Florida Statues 232.032) isliftt 14.•••• AIM FOR CHILDREN WHO HAVE COMPLETED ALL REQUIRED IMMUNIZATIONS FOR SCHOOL ATTENDANCE DATE OF BIRTH I 1,111LO-b NAME MO DA YR PARENT CR GUARDIAN DOCTOR: PART A CF HIS FORM IS USED ONLY IF THE :HILO HAS RECEIVED ALL RQUIRED IMMUNIZATIONS LISTED BELOW. IF NOT, SEE REVERSE SIDE. DTP — 5 USES REQUITED #1 ^ raet• RECkJIRED. IF THE FOURTH PRIMARY DCSE OF OTP IS ADMINISTERED ON oirik7ER-THEIOUfflirtimmpAy. A EIFTWOOBgtNOT DT (PEDIATRIC) VACCINE IS ACCEPTABLE I: PERTU§SISVACDINEJS MEDIC4OWIRAINOCATED,LCOMF't*7:FiTT pj0P4RITUSsiS CDNTRALNDCAnoN) Td (ADULT; VACCINE (A SERIES OF 3 DOSES) IS ACCEPJABUE:ANCEFECOMMEiND ILDREN7 YEA .,S;0 t F„OIRIAER., • POLIO DOPY) - 4 DOSES REQUIRED -L. DA : YR 7.o.C7 :MO BY MO DA YR IF THE THIRD PRIMARY DOSE CT: TOPV IS ADMINISTERED:ON' BIRT,DAY, A EOURTH,D0 POLIO VACCINE IS OMITTED FROM THE REQUIRED IMMU °F; : MEASLES, MUMPS. AND RUBELLA - 1 DOSE REQUITED • `; rz MMR COMBINED - 1 DOSE AT 12 MONTHS DRAGE.OR OLDER tORIAtER: (R,(hyAtcip MD DA YR MEASLES SINGLE - 1 DOSE AT 12 MONTHS CrE4 MD DA YR A 'it MUMPS SINGLE — 1 DOSE AT 12 MONTHS OF AGE ORv4E W I tit , N. Svc, c .4;1 - yir 1 1 A. MD DA YR RUBELLA SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER 1 MO DA YE ALL APPROPRIATE DOSES AND DATES INCLUDING BIRTHDATE MUST BE ENTERED, AND THE CERTIFICATE SIGNED BELOW BY A PHYSICIAN OR AUTHORIZED PERSON AND DATED IN ORDER FCR THE CHILD TO ATTEND SCHOOL , I. I HAVE REVIEWED THE RECORDS AVAILABLE AND TO THE BEST OF MY KNOWLEDGE T JATELY IMMUNIZED AGAINST DIPHTHERIA, TETANUS, PER RUBELLA AS REQUI 'DANCE. -//,/12,73 PHYSICIAN OR CONIC NAME (PLEASE PRINT) DATE EFTA01710101 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, a 10D-3.088, F.A.C. and S. 10M-12, F.A.C. ATE FIRS I MI DOB moinAnta PARENT OR GUARDIAN Child's 5Stt (optional) STATE IMMUNIZATION MOO Directions: • Enter all appropriate doses and dates below. • Sign and date appropriate certificate (A-1, A-2, B, or C) on reverse side of form. • If the child is presenting for the 7th grade requirement only and has previously filed a Certificate of Immunization (680A or 680A-1) with their current Florida school, fill in boxed areas below and complete Part A-2 on the reserse side of this form. • For additional information: See Immunization Guidelines for School and Child Care Facilities for information and instructions on form completion and immunization requirements. Guidelines are updated annually and are available from the local county health department. VACCINE DOE Dose Dose 2 Dose 1 Dose 4 :lose S CODE J/DAIYR MD;DA/ "R. 1.1O/12.VY MO/DNYR Mon DTaP/DTP2 A DT' Td' Polio' MMR (Combined)? (Separate)5 G, H, I Hepatitis B9 The state immunization ID# is an identified supplied by the state immunization registry (optional). 2 DTP 5 doses required. If the fourth primary dose is administered on or after the fourth birthday a fifth dose is not required. DTaP is an acceptable alternative for one or more doses of DTP. s DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated (Complete Part C for Pertussis contraindication ) ▪ Td (Adult) Vaccine is recommended for children 7 years of age or older. Polio 4 doses required. If the third dose is administered on or after the fourth birthday, a fourth dose is not required. IPV is an acceptable alternative for one or more doses of OPV. Polio vaccine is not required for children 18 years of age or older. 6 Hib is required for child care and preschool entry and attendance only. 7 1st dose valid if given on or after 1st birthday. Second dose (measles) valid if given at least 1 month after Ist dose. A second dose of measles (preferably MINER) is required for students in grades K-4 in the 1997-98 school year, and 7th grade entry and attendance effective with the 1997/98 school year. In each subsequent year thereafter, the next highest grades are included. s Includes single measles vaccine (G), single mumps vaccine (H) or single rubella vaccine (I). 7 Hepatitis B vaccine series is required for seventh grade entry and attendance effective with the 1997-98 school year and kindergarten entry and attendance effective with the 1998-99 school year. In each subsequent year thereafter, the next highest grades arc included. EFTA01710102 LAST NAME FIRST MI DOB (MO/DA/YR) Certificate of Immunization for K-12 Excluding 7th Grade Requirements PART A-1 (Immunizations arc complete for school entry and attendance grades kindergarten through 12 with the exception of the 7th grade requirement.) DOE Code 1 I have reviewed the records available, and to the best of my, knowledge, the above named child has been adequately immunized against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella and hepatitis B (for kindergarten effective with the 1998199 school year) for school attendance as documented on the reverse side of thisform. Physician or Clinic Name: Physician or (Print or stamp) Authorized Signature: Address: Date: Certificate of immunization Supplement for 7th Grade Requirement PART A-2 (Immunizations arc complete for students who enter or attend the 7th grade after the beginning of the 1997/98 school year. Each subsequent year thereafter, the next highest grade will be included in the requirement.) DOE Code 8 I have reviewed the records available, and to the best of my knowledge, the above named child has received the following Immunisanors requiredfor miry and attendance in 7th grade effective with the 1997/93 school ;ear: tetaius-diphthena booster, hepatitis B vaccine series, and second dose of measles vaccine as documented on the reverse side of this fonts (boxed areas). Physician or Clinic Name: Physician or (Print or stamp) Authorized Signature: Address: Date: Temporary Medical Exemption PART B (For preschool children, children in day care and school children who are incomplete for immunizations in Part A-I or A-2.) Invalid without expiration date. DOE Code 2 I certify that the above named child has received the immunizations documented on the reverse side of this form and has commenced a schedule to complete the required immunizations. Additional immunizations are not medically indicated at this time. Physician or Clinic Name: Expiration Date: (Print or stamp) (15 days after men lerentankadoa a Physician or Address: Authorized Signature: J 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 child is such that immunization(s) as indicated in Part C above i$ medically contraindicated. Physician or Clinic Name: (Print or stamp) Physician Signature: Address: Date: DH 6$0, 1196. otookas either adttan (Swck Number 574)-000-0(80-6) EFTA01710103 FLORIDA Ott'AKI'MENT VI- ? t--- ) ..------...--v-W, HEALTHl FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.032, 402.305, 402.313, Florida Statutes; rules 64D-3.01I, 65C-22.006, 65C-20.01I, Florida Administrative Code DOB MO/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 7th grade requirement only and has previously filed a Certificate of Immunization (DH 680, Part A-1) with their current Florida school, fill in boxed areas below and complete Part 42 on the reverse side of this form. • For additional information: Sec Immunization Guidelines for School and Child Care Facilities for information and instructions on form completion and immunization requirements Guidelines arc available from the local county health department. VACCINE DOE Dose I Dose 2 Dose 3 Dose 4 Dose 5 CODE DTaP/DTP2 DT' Td' Polio' D Hib° MMR (Combined) (Separate)" G. H. I Hepatitis B' Varicella" Varicella Disease 1. The state immunization ID# is an identifier supplied by the state inununimtion registry (optional). 2 DTP/DTaP 5 doses required. If the 4th primary dose is administered on or after the 4th birthday a 5th dose is not required. 3 DT (pediatric) is acceptable if pertussis vaccine is medically contraindicated. (Complete Part C for pertussis contraindication.) 4 Td (adult) vaccine is recommended for children 7 years of age or older. 5 Polio 4 doses required. If the 3'd dose in an all OPV or all IPV series is administered on or after the 4th birthday, a 4th dose is not required. Polio vaccine is not required for children 18 years of age or older. 6 Hib is required for child care, family day care and preschool entry and attendance only. 7 First dose valid if given on or after 1" birthday. Second dose (measles) valid if given at least I month after l" dose. A 2'd dose of measles (preferably MMR) is required for students in grades K-6 and t h grade entry and attendance effective with the 1997/1998 school year. In each subsequent year thereafter, the next highest grades are included. 8 Includes single measles vaccine (G). single mumps vaccine (H) or single rubella vaccine (I). 9 Hepatitis B vaccine senes is required for 7th grade entry and attendance effective with the 1997-1998 school year and kindergarten entry and attendance effective with the 1998-1999 school year. In each subsequent year thereafter the next highest grades are included. Hepatitis B vaccine series is required for preschool entry and attendance effective with the 2001/2002 school year. 10 Varicella vaccine is required for entry and attendance in preschool and kindergarten effective with the 2001/2002 school year. In each subsequent year thereafter, the next highest grades arc included. Susceptible children 13 years of age or older should receive 2 doses, given at least 4 weeks apart. Varicella vaccine is not required if child has documentation of history of varicella disease. EFTA01710104 LAS1 NAME t lliAl MI DUD (MINDA/YR) Certificate of Immunization for K-12 Excluding 7th Grade Requirements PART A-I (immunizations arc complete for school entry and attendance grades kindergarten through 12 with the exception of the 7th grade requirement.) DOE Code 1 1 have reviewed the records available, and to the best of my knowledge, the above named child has been adequately immunised against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella and hepatitis 8 (for kindergarten effective with the 1998:99 school year) and vancella, variceUa vaccine not indicated if history ofdisease either physician documented or parental recall (for kindergarten effective with the 2001(2002 school year)for school attendance as documented on the reverse side of this form. Physician or Clinic Namcs Health Department Physician or (Print or stamp) Fake Beach County Authorized Signatu Service tfrommunity immunization Address: H v1611 ono, n. au. 4 Phone: Date: Certificate of immunization Supplement for 7th Grade Requirement PART A-2 (Immunizations are complete for students who enter or attend the 7th grade after the beginning of the 1997/98 school year Each subsequent year thereafter. the next highest grade will be included in the requirement ) DOE Code 8 1have rniewed the records available, and to the hest of my knowledge, the above named child has received the following immunizations requiredfor entry and attendance in 7th grade effective with the 1997/98 school year: tetanus-diphtheria booster. hepatitis 8 vaccine series. and second dose ofmeasles vaccine as documented on the revene side of this form (boxed areas). Physician or Clinic NamePalln Beach County Health Department Physician or (Print or stamp) community Immunization Service Authorized Signature: Addresk: Riviera Beach. FL 334C4 Phone: Date: iyiat -o/ Temporary Medical Exemption PART B (For children in child care, family day care, preschool and grades kindergarten through 12 who are incomplete for immunizations in Part A-1 or A-2.) Invalid without expiration date. DOE Code 2 cemfy that the above named child has received the immunizations documented on the reverse side of this form and has commenced a schedule to complete the required immunizations. Additional immunizations are not medically indicated at this time. Physician or Clinic Name: Expiration Date: (Print or stamp) (15 Jays after next lmmunDation 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 1cent that the physical condition of this child is such that immunization(s) as indicated in Pan C above is medically contraindicated. Physician or Clinic Name: (Print or stamp) Physician Signature: Address: Date DH 680, 8/2000, obsoktm tallitt C.C1b0t3 (Stock Numb= S740.0D-0680-6) EFTA01710105 cikViVseP,4 RESTWOOD COMMUNITY MIDDLE SCHOOL Vera C. Garcia, Principal AutharOcermMetallamde • dte Dear Parent/Guardian o A review of your child's health records shows that they are out of compliance with the health requirements necessary for attendance. school Please provide documentation of the below. YOUR CHILD HAY NOT ATTEND item s chec ked SCHOOL UNTIL THIS INFORMATION HAS BEEN PROVIDED. 1 . T.B. Test 2. Physical Examination 3. Hepatitis B - 1st , 2nd 3rd . 4. DPT/ OT 5. Polio 6. MMR For the safety and protection of your child and the school system, school records must be comp lete. If you have any questions, please contact•the school or one of the public health units listed below. Glades Health Center - (561) 996-1600 Jupiter Health Center - (561) 746-6751 West Palm Beach Health Center - (561) 653-2000 N.E. Health Center - (561) 844-3561 Lantana Health Center - (561) 547- C800 inn 64 Sparrow Drive, Royal Palm Beach, Florida 33411 (561) 753-5000 / Fax (561) 753-5035 EFTA01710106 - • aiSailtWialoi**Sitasievia:SatiiitaiSSISKS Appointment Date Cc ksa c75 At 3:30 A6 j m.D., Y.A. pecia is, In Lompictc Family Health Care l k e WoM, FL 774o3 EFTA01710107 .••••••••••m...m.• ••••••••.".....n... New York State Department of Health Albany, N. Y. 12237 Ohrtificatr of ISirtii legistration 1 This certifies that a certificate of birth has been filed under the name of: Born on: At: Name of lather:. Female Maiden name of mother: Date filed: Local Registration No.: Date issued: Registrar of Vital Statistics Address: Clarence, N. Y. This notice is void if if contains any erasures or corrections. 005000000666 00000000000g6 YOUR SOCIAL SECURITY CARI Detach the card below and sign it in ink immediate Do not laminate your card. Carry it in your purse or wallet. Keep this stub with your personal records. The other side contains important nformation. aCYNTUN BCH FL 33435 EFTA01710108 4$00t.0/ : THE SCHOOL DISTRICT OF SY: 06 PALM BEACH COUNTY 9-12 Academic DOB; PALM BEAPIM 12 FNRT - ABS: 6 RET: Improvement Plan (AIP) MATH: FCAT: READ= DSSMATH: OSS SCI : MAP: R-FI PRIM: M-ZF S-ZZ LEP; 504: RRR: O READING O WRITING O MATHEMATICS O SCIENCE 0 Textbook Asse.ssreerts O Palm Beach Wntes O Textbook Assessments O Textbook Assessments ❑ EOL O Pallas° ❑ Portfolio O Portfolio ❑ FCAT Diagnostic I Practipa O Performance Assessments O Performance Assessments O Perfomiance Assessments Tests ❑ FCAT Diagnostc/Practce Tests O FCAT DiagnosticiPractice Tests ❑ FCAT Diagrostic/Practce Tests O Diagnostic Software O Diagnostic Software O Diagnostic Software O Diagnostic Software O Other (see attached) O Other (see attached) O Other (see attached) O Other (see attached) Phonemic Awareness Types of Writing o Number Sense. Concepts and I: The Nature of Matter ❑ Rhyming E Syllabcatpon O Word/Sentence writing Orerallons O Energy O Segmenting/Blending O Paragraph Writing [1 Measurement O Force and Motion Phonics O Composition Wilting O Geometry O Processes that Shape the Earth ❑ Sound/Symbd Correspondence ❑ Algebraic Punting O Earth and Space ❑ DecocIngnooding Awareness /Application of O Data Analysis and Probability O Processes of Lite Fluency FCAT Writing Rubric O Reading in Cement Area [ How Living Things Interact with ❑ High Frequency Wads ❑ Focus Li Support Specifc Concepts their Environment O Rate O Organization O Conventions O The Nature of Science concepts Vocabulary ❑ Structural Analysis Compositions O Reading in Content Area O Word Meaning O Narrative Specific Concepts Text Comprehension D Expository O Questioning O Persuasive ❑ Strnmarinng Tutoring Tutoring Tutoring Adoring ❑ During Smoot Day O During School Day ❑ During School Day U During School Day O After/Before School / Saturday ❑ Aftedielore School / Saturday ❑ After!Belore School / Saturday ❑ AfterrBefore School / Saturday Instructional Alternatives instructional Alternatives Instructional Alternatives Instructional Alternatives El Temporary Skill Groups O Temporary Skin Groups O Temporary Skill Groups O Temporary Skin Groups O Cooperative Learning Groups ❑ Cooperative Learning Grays O Cooperative Learning Groups ❑ Cooperative Learning Groups O Guided ReadngliVriting Groups O Guided Realiricifirihng Groups jg-Technology ❑ Other (see stacked) O Technology O Other (see attached) iff:reattached) Doth Assignment Alternative O Guided ReadingNVriting Groups O Technology O Other (see attached) Assignment Alternative Assignment Alternative Assignment Alternative O Time O Time O Time O Time O Quantity ❑ Quantity O Quantity O Quantity O Product Requirements D Product Requirements ❑ Product Requirements O Product Requirements O Chid Study Referrals O Child Study Referrals ❑ Child Study Referrals O Child Study Referrals ❑ Instrottional Mathematics O Instructional Reading O Instructional Reading O Instructional Language Arts Student progress will be monitored throughout the school year, and student progress will be reflected on the report card. O Successfully Remediated O Successfully Remediated . ❑ Successfuly Remediated O Successfully Remediated O Requires New AIP Next School ❑ Requires New AIP Next School O Requires New AIP Next School O Requires New AIP Next School Year Yew Year Yew El Special Services / Placement O Special Services / Placement 11 71S111/121SIIIINCES_LaThellea_iaSOLCiaLSIIII/C85 / Placement p O Other (see attached) O Other (see attached) ached) O Deficiencies due to non-attendance (refer to Attendance Specials ParentiGuardian CommItment/ContributIon TE Check all that appty. O Monitor Attendance / Tardles O Check Homework 54NATuRE O PFINC PAL DATE ❑ Encourage Reading at Home O Reinforce Skills O Attend Parent Conferences O Sign DaiyAVeekly Notes SiGNATuRE Or TEACHER DATE ❑ Attend Parent Curriculum/ Information Meetings DATE SGNATURE OP TEACHER PBSD 1687 (REV. 8/12/2003) ORIGINAL • Cumulatve Folder COPY - Teacher COPY - ParentiGuardian EFTA01710109 THE SCHOOL DISTRICT OF STUDENT NUMBER: r MLITI (z. .n.ri l".1%.111 I I , 4 T. VERIFICATION FOR NEW/RETURNING STUDENTS: TO THE PARENTS OR GUARDIANS: z.,.,,,,,,,9NEW/RETURNING STUDENTS new Complete all non-shaded ran al both sides of REGISTRATION RETURNING STUDENTS: Please review both Bidos for correctness form of typed information. If the information printed Is incorrect, Please correct it by carefully and lightly crossing out the incorrect information and ...N. writing the correct information above it. —, (3) i ) MAILING ADDRESS c,..... a AT, V WI I, IM i E 5 soon Poem NO. U/ HOME PHONE NO (II SEX MS Alf (CPTIONAU lAALE I I riAVArstur,r,,,, i A AS PACIFIC IANORISL li ta r som"-ri.uSPANte I MALE I B rcintHisrAmc g H PINPANIC i M mutimAC IA- (I U RESIDENT 0. FOREIGN EXCHANGE STUDENT Er -- 2. OUT -DI-STAIR RESIDENT 0 I. OUT-Of-COUNT' RESIDENT i 3. IN-COUNTY RESIDENT IS) /I RAI IMPACT AID SURREY 0 il TES 040 TES Erk A. Ell STUDENT RESIDES Oil FEDERAL PROPERT E. B 114 slimier RESIDES IN LOW RENT HOUSING TES I7 NO C. THE PARENT IS EMPLOYED ON FEDERAL PROPERTY LOCATED IN Pal BEACH COUNTY. ITS D. DIE PARENT IS EMPLOYED ON ION RENT HOUSING LOCATED IN PALM REACH COPIRT. ns Erie F TIN PAROLE IS III THE UNINSURED SERVI:IS of Ta UNDID STATES If YES, IS TM( PARENT ON ACTIVE CUPP i TES 9 NO AIR FORCE i ARAM 0 COAST GUARD i MARINES 0 NATIONAL GUANO i NAVY IM HAS THIS CHILD KEN ENEOLLED N ANT PROP OE? IMAM Paa A EMECILMAIN (H/ ST EACH PROGRAM ATTENDED. M.50, INDICATE WITH AN ant* I *I TIE PLOGRAM TOLM CRUD WAS IM THE LONGEST.1 e C. CHAPTER I e H. INA3START i 0. OT/NR 0. PRE-N VISAHILITIES e £. MILREAN/ PIE-A 0-417111SIDIZED CHILD EAU 0 E. PRE-A EARLY INTERVENTION 0 N NON-StIOSIENLED one CARE III) IS THE STUDENT A SINGLE PARENT? I EIS NO III) CURRENT GRADE NNE TRANSFEft INFORMATION: eplANIE 01 SCHOOL,LNSFERRIN ERON m i ci dt e 111) CITE Or L ATIO i ND DATE Of T A TTENCIANCE yr.)/ (20/ GRAM LEY (21) LAST BUG SCHOO ATTUNED IN A a7) COUNTY pa-• 6c ND /DPWI7 .4 / eci" a--- / FREE REDUCED PRICE HAND 14)14114 6POIWA nfr (231 NAVE YOU FILLED OUT AN APPLICATION FOR FREE OR REDUCED LUNCH? 0 YES (APPLICATION IS PROVIDED WITH THIS REGISTRATION FORM) (241 MEATH SCREENINGS: I GIVE PERMISSION FOR MT CHILD TO BE GIVEN MALIN SCREENINGS. THESE TESTS MAT BE GIVEN ufflitiOLIALLT OP IN GROUPS. TES I NO 25/ $00101/ FLUORIDE. I LIVE PERMISSION FOR MY CHILD TO PRAM:PATE M THE SODJUM FLUORIDE PROGRAM TO PREVENT DENTAL DECAY. PERMISSION IS VALID THROUGH GRADE SIX. i ns ,Er 63 "---- NEW STUDENTS TO PALM flEACI" COUNTY: HOME LANGUAGE SURVEY (261 WHAT LANGUAGE IS SPOKEN IN THE NOME (27) SPAT LANGUAGE IS SPOKEN UM DATE Of ENTRY BY TM PARENT w GUARDIAN IN THE NMI ST THE STUDENT? INTO THE ISM. PROGRAM 02057) C.-J -7 9/ 4A UR/ LMIGUAGE SURVEY 130) DISCLOSURES IN( lira lazy fop I. IS A LANGUAGE OTTER NMI ENCUSH USED IN TIE NOME? I ns Y Ern Ills SCHOOL DISTRICT X. DOES THE STURM 11A0 A FIRST LANGUAGE OTHER TIAN EllaISN? •us NO RAS THE STUDENT EVEN 3. DOES THE STUDENT MOST INIDUENTIY MAX A LAIIGNAGE OTHER THAN IRWIN? Ins e I. SEEN EXPELLED FROM SCHOOL? ,TES 5 2. HAD AM ARREST RESULTING IN A CHARGE? OnS Ell • Y•N •••• (HY...". Nitta'. ••••••.«, n-. rr, EFTA01710110 THE SCHOOL DISTRICT OF PALM REACH COUNTY - NEW/MITURNINO STUDENTS REGISTRATION BACK ISII T LIMES WITH IOICtIt ONO --• ' OCITI4 PARENTS YOTIER U FATHER ES 31 IS TIIFNC • COURT LiSHARED CUSTODY OTHER ITARREICOMIETFPARERT- FROil REMOVING R OS) TRANSPORTED IV Slaw a be wismsami Haws awe, My Loan II sow ion 'weed CCMACTING THE STUDENT WRING THE SCHOOT DAY/ M YES IF YES, PLEASE PROVIDE THE SCHOOL WITH A COPY OF ____I;pr POI — atzei- a KdPATHW irte-A4A-1 /22 Nal w I.NINOVIST / 9 /fi ..,.... se. eW MS IJC 'TICKET LEVEL OF EDUCATION COMPLETED ICITIONALI C1M HIGHEST LEVEL OF EDUCATION COINISETED (OPTIONAL) i Aj earn INNia B n ..... SOON AL In amerr Fraot B D sows eatiocaL s . I--I RICE 9-01 C 0 ......M:4* .". mm Wile •aw41 C 0 .....ni IS am rOtTWINNOW4 D] E Iiir• et rorMONII D Er l ...ran...X."' E 0 "Dir. UM LEGAL GUARDIM1 M AM) DC*1 LEGAL GLIMMAR HAVE CUSTOM? 0 yss Li NO 1St WIT MOM ARNIM Sin "WM i. a 0011sTait Wen Pa'.. EMERGENCY HEALTH AND SAFETY INFORMATION PART if RE)NISI OTHER WAS PARER, AUTHORIZE) TO PESK UP MOEN) RS) 44M arc IEW an= may IIIMMITAN Ern , Air 0 NO Is REIATIONSMI e nv arie 0 ND RELATiowsnr trn ! I', ..J. P • ND RELATION 0 YE: 0 ND NM NASA ADDRESS Pilot RELATIONIMP ITTI U TV ---- 0 Pm PART 0 F SCUM. PERSOMSEL ME UNWISE TO CONTACT YOU IN CASE Of ILLNESS OR ACCIDENT. NAY WE 41011 YOUR PERMISSION TO CALL YOUR F DOCTOR CO MERGENCY SERVICES (SID FOR TRANSPORT TO THE HOSPITAL/ CITES 0 ta rOTTIRE91:4RTM — 1TOW-FIOIE HUMAN "HI %ist YOUR 04IIITS ALIN SUS, ALLERGIES OR OTHER PHYSICAL LIMITATIONS q D., CHILDREN IN (ER PALM REACH COUNTY St'HOOklk ATTE STUDENT NO. 10,1101U0 GIRTH DATE SCH AMMON: I ( /CD StOENT 110. 10.91011AU STUDENT NO. IDPTIONAO ISO I WIWI' TWAT 111 iMontATION GIVEN IS nut AND ACCURATT TO TN MST OF MT IMOWL100 FOR OFFICE USE ONLY: "Tfil i,ARENT/61.61JIOW IANCOMIT CH. cant (tilt T612 CALENDAR ET: TI ONA N3 ES I IIT 11434. 0 WO. IVA 0 TES 1 0 Nil rerilaisitakip, 1W HAN I j 4 0 0 / VSS—r KG DCVO: 1:1 be witilTAT iT i 1ST bon! AMU SAW MEG ;WALWIZA TOME SOCIAL. SECURITY 0 DEL E- 1 iffirrm MO GA Troia Of •wr.4 ow.GORITIS 0 2 2 4 0 I I I DOA,/ Li LTA'S YHYYSICAL ESSAYS NO 4DMIOAALI 011 DATA KM OMMIETI IT Hit EFTA01710111 ILI IRE PARENTS OR GUARDIANS: NEW/RETURNING STUDENTS NEIN STUDENTS: Complete all non - shaded areas. 1.......,t TURNING STUDENTS: Please review both sides for l TICPOluter REGISTRATION correctness of typed information shown belOw and on other side. If the information printed is incorrect. Please the correct it by carefully and lightly crossing out the incorrect =nu information and writing the correct information above it .. .... 1.,.....t, tier..... ok3 MOM'S SOCIAL OCIIRITT ND IC PAM ..83$ 4 <F AI SEX I0 MI 0• 0,01 It. (Cot al PAC( lOPTIJNAU Eig,miu. I ......... Ill &VAN 0 t1/4 PACIFIC iSLAMOIR El--w -..... 4.5,.° MALE DB otACA NON-WSPANIC 0 H HISIMPIIC 'ATE CC BIRTH 10) PLACE Of GIRTH (II) RESIDENT STATUS (Ill GRAVE LEVEE 0 0. FOREIGN EXCHANGE STUDENT 0 I. OUT-CIF•COUNTY RESIDENT 0 2. OUT•OF•STA1E RESIDENT Cl a Ell. IN•COUNTY RESIDENT ItOtRAL IMPACT AID SURVEY III A/P*2[AM) HO HAS TENS DIU SEEN INTERCO IV ANT PRESCHOOL? 1M Is the sane* a OW* puede (CHECK THE LETTER CODE FOR ONE CODE ONLY) Please place a checkout Doi by *act prelims otte•441. Alm, lodlcole .in' as .Heist ( *I its Horse ye.. child NH is NH Hindu I .- A . 4. 01 0, 4 ”400. M. S....... O c. GUAM I 0 M. MIGRANT PRE -A j B .....:fel...luso rev... at ffi.N ept eearda.deela tur. ver;A. r ril: T. [1 0. PM -S DISABILITIES DE. PRE S (MY istrivornar, 0 N. NOR-SVEISIBIZEO CHILD CARE 0 0. OTHER I YES gao M. NEMISTRAT al.SUCSIOill0 ORO CARL VISMOAINP 10. 0 e, 4..:41WnAk NAM( OF SCNOOL TR ERRING PROM III CITT OR LOCATION (IS) GATE OF {AU ATTENIMPla i• _Oa /LEO /20 Clai eae4 4.-- AgeteL it -1 19 9 5 20 ?AST PUBLIC SCHOOLATTENSE0 IR PALM Mot tOterff f GRAD( LEVEL 12 OAT( ATTED010 aldi/e- -77 e), / Nate it, Inv filled eel as aottliceilos IN free or Iltdste1 leech? . aStaATIQN: (eternalise is erttleed wills this Ilniurstle• Tool . . .,,,.4... . .... ..,.. L. . ., , . .,.. i TES 1- --1 10 .-' *ACM SCREENINGS: 241 SODIUM RUORIDE I gin pecolisloa lee ley child to be give@ health scietoioqs. Timm NM I Ain onmissio• foe my child to officio,. is He Sotos Fluoride Provos lo ri y• zi-7_„---,, , may he lives Individual', et Is genes. aproven ..... I decay. Penults's. is .slid latotigh path Hs Ill RS VA/C OlAr L`ANGUAGE :SURVEY ( c by fillcd cut nyw ctudentc. ONLY) Ilikm laarase is anima la the US/ Mbar Isaias,. is spurn I. (27) Ora .1 tr., co . leer ay the punt et giseibia at hem by the Miter? Mt Tromso E .., r_4,-,,,, /- L..... ... „......, h.... ..... ....„ ..... th... E E no T ti [3 ek, (./...S;1-- J. 04.• sn stoo•ni Host *t. env •o..0. • Is...Hos .•Ant on. (..v.,..• E ..: E4-2_, vim smosti-w, ..: ,..,.. ..., St000I4440; DO 'sttoOnt Nillin00 . 01) PAdENTICUSRION cAticUACC• I32 CEP 201:ENTIT CODE .00 ENTRE CATE 13 W SAC C(-1) a- Nfa:Ctir i l, • In/ ;Rt..,-C toy; D6) CAUFOIR 13t TItulf; Ni. 121ASSICHHENT cp( /EH jannspEEETATION 1121 CEA FICAT1.1.4 iI laiT1( 13; IC-,S I4 41 00:U 4".00.1 :01 (14ECIIJ,1* (C11(0. AK) 0:\ot scion ,i(covE0 A.,841, LI C.- n .1 ..........0.1, 0.5 ', 0 V K A v.0^ 44 •ii, fl., f(<0.0 { ' [k r " 1.-1 N° 0 - - n pa C . 3•150.. 0 11.MA( 0 I 2 a s 5 .... Hawn.. 11,, c ..........A., tr.... . .../.:. .A DATA Pliny CONirttifil BT . 0..0 -------------- I NO T1001 To( IN OAPASHON CVO, li IF 010 ACTURAH TO Tilt OUT Cl MT 'NOM( /01/ /* -c BSD 0636 REV. 4195 FRONT EFTA01710112 UtAINEN I I SHARED CUSTODY LI by I. .• 7 oils. slat tfOESE- ACOUNI ARRING OTHER PAALNI !ROY RE OMER DUl STUDENT DUADtt SOIODI my) 0 N YES. PLEASE PROVOS THE SCUD*. WITH A copy os t 040 Gc / )1)6O OH! TOOT .83;rA-3 jj . .4‘15/201,0/‘- oactla-ki l 61172oPA--- harts. MOH P.M IsciikDEET UWE orsiSteatioil Zotakes5 Thasfotrar lE3i HIGHEt1 LEVEL OF EDUCATION CONKETCO lOPTIONM) B icr ...xissocit VOCCH onetwon eta enon B 0 ter...secet C. n~I Lome, A0 gusent's1°." 1 C 0 arsenal, Pelt •NOHNtlay HICHIcas/Ccula lf amaaraompti E Ceeanat H.OP DO SONII f011empav Rata. E onttecttffi 141 LEGAL GUARDIAN W ATM DOES TEM GUARDIAN NAVE CUSTODY? OYES U NO {TAM Ze HOC OCOAHHION 1.ca a IIMPLONCHT IA PART swivel.) SFr iltaia Pares. aothertto• N pit% Fp ordeal. ISO PASSWORD • Pea hinOtact :T ISO AbORESS ErEES 0 NO 0 YES 0 NO 0 YES 0 NO 0 YES 0 O ID PART it N staea . soak I. mac' y„ ...,...i a... « misfit say we In 1•01 Pnettll• As toll TON ack• •F amorier nnelltt all) It' Hann, . It Om btlPlttP ns 0 I, al PHONE MAIM On WEAL P . i ft .44.1, it it e b 7L 1 et dolecis t ti • • . .ad 1.4. aware. • . plot• Ini •••5- Iii.?x?) — • :71 MIAMI OF 011OCREIO la MOOS ATTENDING UM STUDENT NO. OPTIONAL) GARDE 1711 ORM OATE 3 1)4/14-4cettY 11,22/62Zete-M--- ti tysth 61-em 62 EFTA01710113 e ; • I kJ I MC l'AktitN I .b UH liUAtil.)1ANS: NEW/RETURNING STUDENTS NEW STUOENTS: Complete all non - shaded areas. ;., •....... • _. RETURNING STUDENTS: Please reusevv both sides for "cove Lou, -- REGISTRATION correctness other side. If of typed information the lot/Danaher] printed shown is incorrect. please below and on the correct it by carefully and lightly crossing out the incorrect ...aiotii information and writing the correct information ab ove it 10 HALING MOMS (II it ..... R. em4 so DWI ma. ...I il f( ..,, 5.9y,c? ._..{_.) i 3.. fw T.. t.,,,,,,, I STUDENT'S SOCIAL SECURITY O. (7(7) SET IS) R CE 8...ftwac AmERiCue As,„ INDIAN 1 A PACIFIC $9....noto 9 - 1/11 0,W741-1415PANC " a t II B ZlitiliSPAitiC D H HISPANIC I OAT( OF BIRTH 10) PLACE OF BIRTH ON NESIOENT STATUS (IL MOE LEVER 0 0. FOREIGN EXCHANGE STUDENT 0 I. OUT•OF -COUNT Y RESIDENT 0 2. OUT -OF -STATE RESIDENT En: IN•COUNTY RESIDENT al FEDERAL IMPACT AID SuAhly (IF APPLIGAIRD MI KAS THIS (KILO eft. TNT t KW IN ANT PRESCHOOL? .151 Is lie *Meat a sink punt? ICHECX THE LETTER CODE FOR ONE CODE ONLY/ "(Pima place a DecimanI VI Dy each PM , an Rliamdt RI"). lai c al* ❑ wille. a• aslelitt I * ) tic p.00f am von child nu im Ike longest.) A e an .n )o. aodmi a. ion Service. DC CHAPTER 1 o IA MIGRANT PRE-( B te :: oa • C WOICah ni •...v er» oi,tin I., or: 0.42 ,. dt....,11:zsior e.....,..zt to:. DO. PRE-IK DISABILITIES DE. PPE-( (ART INTER itH TICS O N. NON-SUBSIDIZED CHILD CARE f] 0. OTHER ll YES 9-go rocs.,0 •-,“, OH. iitaosrAnt DI( SUEZ:lei:It o ui ;o v. n; . . . . .. "-ICANSgEgitNRORMATION: SI NAME OF SCHOOL TR ERRING FROM In r :sr et I ! (...Too. IesT ATTIN - 7 ' ,../ 7 . a ,e AM i` /- / -O C-' ea-l i a/ a -e M- - (:,./C......... 24-1L-1 I . i G. 7.5 in DRAIN LEVEL 001 tAST NARK 51100E Al UNIX° DAIM MAUI LINNET Z IT DATE •TTENOtO .7 -•-a--,/fue co aluiz_. ri 2 " 96 aggeiMgjjWCE»PATCE':IUNCfig.SN:t>/HMttIItNf.bgi5WAttO .. • Agin sw .• i.:t ::,, ' "`"-:: :21 Hire hoe lined oil ai application Ice lice ot Nedoced leach? (Applicatioa is provided with IhiS RegillialiOe Fels) Ell TES lair; "31 HEISTS SCREENINGS: 24/ SODIUM FLUORIDE' I give peinisiese lot Wy child ID be gevert he nis weeping,. These tests I give pusissioi lor ay child to panicle.* is obe Sodium Fluoride Pregeam to may be give. Re..Ideally oe in gams. to prevent 100111 decay. Fermi .. i .. it valid Ilmagh glade til. TES s/j4 . TES ES — WaNESV-405« `' '.f.a MVO 1.03.F.A.0. 13agi N 1- Y : HO MF.);,..t.f_ain.00ASVEY t > 8. Èt.0 t ! Si What latietag• it spoke* ie Ole 1251 %Mt Memo is spek.. • 711 Ile, ei. Fiery ism MI bomt by IIN p rat pastime: Me tome by the 'Meal? I SDI. Peeler.. e is a empRace. oil,•, Ih.. I •01 • 0-• ..,, a .^ ', I. ', Inn El ITS Efir0 .. T. 13••• 0.• •..... • ha •• • fn. ••••”••• oth•e i••••• cstai.ro Ores &To CAL4 7 1i_ 15-/ L git .6 ( 7,--(>--/ -. ! " 3 ems no Roue.. ems m........ ..... • emus,. eve.. um. e.son) Ei ycs p..... r.,:OR OFFICE USE ONLY: ..n % '0 <, . t.... .14:::..SCilWrii:No. 001 $11,1hr tn,Nl . t311 0f.gtert:CiltR00.0 **SWAG* , it) MI 4M iNTFE CO0f • WIHI'Ai' veS•W, US/ SRS.00 ti g Mt S115.401. I h..o.Lt... e'l :RAT( it VI t DO) CAUNOIR 11' HOC I .2- / 7 0% A€Ass.G2d4E10' c(0( C40 tl.‘sipolTeli)ti (111 1.1iMiCtTIO CI Bilall T/I I.I) NoS Ills 00:I.M NI.I.Et0nt ClECAUS 7 KNECI Ak0 tArt 1.104 atureft0 jtrisE Li 1],„•___ _ rC -44 . --• ---------- ,.,:. alk•ADM itsia Ljun:AG i t_ITIS I 2 a 4 NO S 5 ." ..‘fr‘ 1.1..4 ...Tv .--) ,„„_______ n~ ,- Int. 1 :.?':. . entra ISIR.T OMNI EW _ _----...- !Rat _ I G, i WI 'T THAT TIlE MORMAT Ins Clif N is TRIP. ono ACCURATE TO III( OM Of 1/T INOVRIOU 2 2/ / *3 ..-- n PBSID 0636 REV. 4195 FRONT EFTA01710114 urallf OA NIL. PITMAN ~ENT TRESIFISCITNOVVetrarN.: TIIS STUDENT OPENING THE SCHOCIN DAN> Isti4 • YES If YES. flan PRGivIOf THE SCHOCH. WITH A COPY Of INE COUNT «Ca IS tr. . 144.4E ClISTOOr) . or No ...o t e_. /2i)A.) , L-----• .AN i14041 r CO« faK.,gL .9 15/20 A ) /L.-.'-. ‘dtkL 4(11 A. i4 -4 -A ( 9 101 4), nu[ mar< ..[ ••M1•I ..5.4t f wan uwr ansuearicw, ZOIIPETE6 FDPTIONA.LI 531 HIGHEST lEvEt Of ECOCATIO« COlatETED (OPTIONAL) B I =7"....' 10 at iciwrAn c. poOCA C 0 .7' AO ' an= ' B 0 .... ..o. C ig'''' .o.:., I vi,„.. c..........- . ED l•Mals11.4444 D 0 irstoo . ~Gs... E 0 2.== I lEGAI. GUARDIAN OF AIM DOES LEGAt GLLARDIAN HAVE CUSTODY) DYES O NO .41 4.44 4.04 ../4.4. 1 u.v 51,t( VI CO« Sat.44 -1. .1 ".. '` '..: X. -- xz`1•.>:>., .,°^,R;,'?.r.*M5.r. . ). :.* ., . 1 PART k {MN(I) aiNt An wail arthArIzed LA 'NCI LIP tia.m. (541 ATSWORD: .. - ..... • awn= I 50) AO0It Pit ~ilia I tan 0ErrNo es 0 YES Ø NO El Yes Q NO 0 YES El PART IL N schol is «CH I. want sAp s4)4 41 il$4.44 « &Hark may w v...snit Aria w ea nut 4.Aus 44 w.~.)Iscy 44 II. 15111 In unipen k) elm AHAN411 YET 0 NCI ii 4.,en O. 4) PION( ~UR 4851 HOSPITAL PREF4R0I 4ICE "....... Itiele, ,Q Ir. 4--7T641- -/ ' III~ 41 Ill WK. . 7,COUN »am Of afitCHRENTI l6N SnOE NO. (OPTIONAL 171 Nfi 0A /421-Ialtat ' . . j9zialug,-- . li /seem sysia EFTA01710115 : s TR itTrn311- 117.1-- T-CHRIWANKLI11 3ARBAKA IRElS. a te w own. -.‘\ SCHOOL DISTRICT OF PALM BEACH COUNTY (yq3 I 1 REGISTRATION FORM DATA Win COdLEDIO de -. Dit el . NEW/RETURNINGSTUDENTS " VERIFICATION FOR NEW I RETURNING STUDENTS: NEW STLADErT larinURNIO SWORE - (7O•THE PARENTS OR GUARDIANS: NEW ETIX)DITE: Carded el non almboild anat atsfOOL ND PENN COOS Oat DATE RETI)roING EXUDE WES. Pla miss br amdinnta Irs shaded biOnnaacal Ewan b 2141 E01 03/22/94 ih • boxes b re Kea and taloa Ito Inbrmabm dinteal N incorrect ban carrel in SAC COOS lailla TEACIER ND. Pa COUNT, DOM= 030E be STUDENT INEOPAATION seta Immadabh. hob* 063D 01 01 106 50 Plana wily tin wan added d Si. *daft by %Miura Wove SEX RACE %ER. OF lunTHCATE ASE nurCoic 8/22194 F I W 1. Z ATIYIEW251.251A2 NAPO ALSO *OM .43: PALM BEACH GARDENS FL 33418 FL 63418 STUDENT 40•02. SECIAITY NO 4OPTONAL) HOME ROW SINUS PaRENT IIIANWORTATION CAT N N 3 MCRAE IMPACT AO HEALTH $CPEENTESTAKI SCO FILCCUIX INTR• DATE NSA) MEV:EDI/CEO LIME INC. POE CO6 N Y :, EN EN US STUDENT INFORMATION- (Parents, please write corrections in the appropriate area fisted below) (N. Cr004147- 5 (CCU. NAPA( ' 1'.. ' LA .1 ra. NO SE 50•4411.140 A.001425/3 HEWS NO STREET NAVE APT ND . , I . „ . - ,11 r 1.• ' • / .:.:%..". '//A an STATE DAP CCM CITY STATE DP CO 61StuCENTS SOCIAL SECEOETY IC Cdr•ONAO En HONE /Wad MO. M SID( _ _ _ — _— — — __ _ • FEMALE II MALI IS) FACE kAIDICAN NOO PUCK A AWN WA MITE -- •aALASKAN NAME N ❑C d a NEN-HISPANIC ❑ Pt ECM SLOW ❑H H NG ❑ .. 210151119,5241C IN NI GATE Of 041M I Ic rl-OCE Ct (16(7.1 W. AMDENT VOUS 02; ENT12e DAM DAN C:3 0. PleNaatIp0OCT 0 1 curmann /Cam DEWCO SINE LAY MAP CITY NO Oat OR Men*/ DT moot etc AO anon Dana my rcd:flock frE3a MATE icertro (.4 HINENOU En, - (Plum plows/by each progw attended. Air. ;Woo Indicate bi wit e • 616 MOWEm your did was In the longest) iota nt inn coot me out CODE CrkT) ). El E.Miro nt, teranlirtiON is $ SUASOZEO CHI.D CARE Ill A i am n the Federal Military Service. 0 14. Sri, El C Dant n i El B I am a civilian employee in :he Federal Military Service and the cost of my n— emanation . o Onto clean Werner is provided in par, or wholly by Federal subsidy nine Socp1P10AT" 9 0 DA AICIPMT Ptah 0 N NOv SLOSODED CAC CARE TRANSFER INFORMATION i 15) 'CAME OF SCHOOL Wen/EN:MO Filed OE OTT OR LOCATCal anoat DE LAST ATTENDANCE I lel ::RAGE LEVEL DIA LAST DUBUC SCHOOL ATTENDED IN PALM ElEAC4 COJfl 126 DOE ATTENDEE) FREE OR REDUCED PRICE LUNCH AND HEALTH INFORMATION (21) Hine you flaw ere an application Tor Free Or Reduced Odes Lunch? (Apollcaon hp provided with des Roniebstion Foto) I= YES 17:3 no (21) HEALTH SCREENING Alt &WEE TES•IND inl SOD0LAI a Udt OF Ia.. pnewn Al nrosa * te anon t*. strong WO ••••••2 tag iow, massy I pe penusson Iv no clA0 0 panw in F. Sohn. anon Pngnvt la dna -tang detAY Those ism N., Os Mn now.* . in TN.. hams. a nisi .....4.. cr..... CI YES ICI PC In/ YES ID .5-1 NEW STUDENTSTO PALM BEACH COUNTY: HOME LANGUAGE SURVEY (To be filled out by new students ONLY) tat) vete lovaSOC ie One. Al Tie HON Erf lid *MDR OR OUNOVN NN dotal 1/1/0.141A0t13 WOKEN Al IKE Ott WV INF 111.02N77 • MI IS 014/5505.2eihr tan frollenral no taw? CI YES CI 1.3 WI moan al) Paaran OR GUASOAN Rd COWER, OF S 2 Ono a dart new . are *quip dor /an sin.' 0 as 0 PO LARK4UAGE UNMADE ION* Ow awn acre 1.02•w is 41•221004 SW ten &coo? C3 YES Cl NO FOR OFFICE USE ONLY Pa) CHM 000c 00 Cram malt '72, SAC OWE oh mun3FORTADON 133104210242:52 CODE 13S1 YIPS/CAPON Of BOMA Fel SEE STUDENT A Si'.'.' , 0 /as Mem CITED CI .43 MOO OM GRADE LEVEL 1311CALMAR Nov: WIER PC. 0 esa Li Milo CATEOCIre 0 WS MI HO 0 1 23115 1 3 4 5 5. i l lI T DOCUMENTATION CHECK UST: (CHECK AND DATE WHEN RECEIVED) 4'1 OAR MAINVADCOS DATE VileriCAMOI OF MN RECCa3 SOOAL lecorriAn3 OdllONAL) CATE POMPOM Wad •_. I EFTA01710116 (441Pca- I SCHOOL DISTRICT OF PALM BEACH COUNTY rju j STUDENT REGISTRATION FORM - PAGE 2 (42) (43 STUDENT NO I %MU I 51PIPIC SCHOU PARENTAL INFORMATION: (45) HOME PHONE NUMBER: (46) TRANSPORTED BY: BlUdent vnIl be tranSpOrted10/1”1SCh001 by (named Other that parent)- / i . C I /(41C / ( 1 1 v/ ., ffri (( (47) STUDENT LIVES WITH CHECK OhF) / J 007i- PARENTS ,..1 MOTHER u FATHER j SHARED CUSTODY J OTHER (48) IS THERE A COURT ORDER BARRING EITHER PARENT FROM REMOVING OR CONTACTING THE STUDENT DURING THE SCHOOL DAY? J YES _ j NO IF YES PLEASE PROVIDE THE SCHOOL WITH A COPY OF THE COURT ORDER . . . OCCUPATION BUSINESS PHONE (50) HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) A j ELEMENTARY SCHOOL 8 j SOME HIGH SCHOOL C j HIGH SCHOOL Dj SOME POST -SECONDARY erifICHNICAUCOLLEGE (Grades N-8) (Grades 9-12) (Graduate) (Technical ! College) (Graduate or above) (51) / (CY /A: ' • LA BUSINESS PHONE (52) HIGHEST LEVEL Of EDUCATION COMPLETED (OPTIONAL) A j ELEMENTARY SCHOOL B J SOME HIGH SCHOOL 0 ;HIGH SCHOOL 0 J SOME POSTSECONDARY E J TECHNICAL COLLEGE (Grades K-8) (Graces 9-12a (Graduate) (Technical College) (Graduate or above) (53) LEGAL GUARDIAN (IF ANY': LAST NNE FIRST MD. NT. OCCUPATION PLACE OF DMLOYMENT BUSINESS MOPE EMERGENCY HEALTH AND SAFETY INFORMATION: (54) PART I: Person(s) other than parent authorized to pick up student. i 61 %WE (57) ADDRESS (54) PHONE (59) RELATIONSHIP ./H/ IA C. -- (74) " • ' . 'arsons to contact n t event o an emergency i parents cannot be reached. Those listed are also authorized to remove student from campus in an emergency situation. IJ Check here if the inbrmattion is the sane as in Part I. Complete Pad II I' different fbm those authorized in Part I. ( ) NAAE (61) ADDRESS (62) PHONE (63) RELATONSHIP 1'91 PART III: If school is unable to contact you in case of illness or accident, may we have your permission to call your doctor or take your child to the hospital j YES j NO (64) =AMILY DO:TCR (65) PHONE NUMBER (66) HOSPITAL PREFERENCE ihYIlloartlefeets;lbef.vie should bp' onlaaa Ist.71 2cr-7--- it C YOUR OTHER CHILDREN IN PALM BEACH COUNTY SCHOOLS: (VI VANE S Of CHILDREN (68) SCHOOL A (69) GRADE 170) BIRTH DATE ..._, I 1f -7 9 1 (71) I VERIFY THAT THIS REGISTRATION INFORMATION IS TRUE AND . 1,4 .flay ACCURATE TO THE BEST OF MY KNOWLEDGE. s rE PBSC 0636 (REV. 7194) GCS06-2 EFTA01710117 \LN , t 51S. -c C1-0\\E-Vc (2) SCHOOL * 4 454°°IK-I (0;:,....,9 ; SCHOOL BOARD OF PALM BEACH COUNTY STUDENT REGISTRATION (3) 1 NEW STUDENT TO PALM BEACH COUNTY 1 RETURNING STUDENT (4) 1 DATA ENTRY COMPLETED isi Please complete all non-shaded areas and verify the resident address (6) TO AY'S DATE DIRECTIONS: of the student by your signature below. //f/29 1 (7) STUCENT'S LEGAL NAME (81 ALSO KNOWN AS Mi l l. MID. !Non. (10) STUDENT SOCIAL SECURITY NO. (11) (12) SAC _ - (14) MArhDDRESS„. /)1 e----• (16) CITY STATE ZIP a niew-ae ) raft- 11T) SEX (18) RACE n3 ci 3 We (19) IS THE STUDENT J MALE : 1 i AMERICAN NDIAN j B EN0LAN4CKimpoac Cl HmsPANic alr,"0INT.FEIISPANIC A SINGLE PARENT' Zieraa '--' I ALASKAN WIC 3 A pA NDER J yts ,a-t10 (21) VERIFICATION 23) HRS 1 3 4 5 G 7 0 9 T A e z (21) ON CODE: CHECK THE LETTER FOR ONE CODE ONLY. Have continuous?' lived in Fbrida kr the past LID Am n tee Federal Milian, Seneca J G Pad fee this 931COI year in another Florida year or lenge. coLray as ‘erified by CI E Am a Slim enployee & in INe Federal Military U B Have purchased a home in Ftnda when is Sena and the cost my :hols education is row( e occupied as ny residence. provded in part Dr Melly by Federal subsidy. J H Pad fee in Palm Beam County as velsec by Q C Have filed a mailestation cf domicile in lbs wave _.. Montt OF Am a migratory agricultural worker. _ J I Exempt (25) ENTRY CODE: (26) ENTRY DATE: (27) CUT DIST. (23) TRANSPORTATION: (29) RESIDENT STATUS: LIAM J YES J NO U 0. NON U.B. FtEsiCENT (30) GRADE: (31) CALENDAR: (32) TEACHER NO.: CD ESOL LI I. OUT OF COUNTY CATEGORY: Li ESE 0 1 2 3 4 5 6 U2 as RESIDENT U MAG J 3 INCOUNTY FL U.S. RESIDENT TRANSFER INFORMATION: (33) NAME OF SCHDL TRANSFERRING FROM (34) CITY aC TION 7v/2 i (35) DAT; OF LASTrIDANCE (36) GRADE LEVEL LI 1 1/7 ) 479)/) iC it i h (37) LAST PUBLIC SCHOOL ATTENDED IN PALM BEACH COUNTY: (A) ,i) /is (30) DATE ATTENDED. FREE OR REDUCED PRICE LUNCH: (39) lace you :riled 00 an application for a Free ce Reduced Price Lunch? (Appkation is provided with die Registration Form) fitC LI No SCREENING AND ASSESSMENT: SODIUM FLUORIDE PROGRAM: (40) I give Derrnissron for in) child to be given screening and assessment (41) I give permission to my child to par.icipate in the Sodium Fluoride tests when w_essavy. These tests nay be given individually air Program to pr 1 dental decay. Pemvession valid througx grade six. groJoS :Y irs ❑ No ES j NO FOREIGN STUDENT INFORMATION: This irtorrnabon is voluntary and used solely for !he purpose cf obtaining Federal funding. (42) ORIGINAL ENTRY INTO USA SCHOOL (43) STUDENT CITIZENSHIP STATUS (Circle One) 1 2 3 5 6 8 (44) ENTRY DATE (USA) IrResident Allen 2:Non-resident Alien 3rExchange Student 5:Relugee 6:Entrant S.:Immigrant MONTH DAY YEAR (Counselors can provide assistance in determinlig status) MONTH DAY YEAR NEW STUDENTS TO PALM BEACH COUNTY ONLY: (45) U.S. CITIZEN (46) IF NO, CITIZEN OF WHAT COUNTRY? (47) .N WHAT COUNTRY WAS THE STUDENT BORN? TES U NO (4a) WHAT LANGUAGE IS SPOKEN N THE HOME BY THE PARENT OR GUARDIAN? (49) WHAT LANGUAGE IS SPOKEN IN THE HOME BY THE STUDENT? (50) 1. Is a ianbuage other than Enpish used in the home? Q YES Q NO (51) STUDENT (52) PARENT (53) COUNTRY OF LANGUAGE GUARDIAN NATIONAL 2. Cid the student have a first language other than English? 1:1 YES CI NO LANGUAGE ORIGIN 3. Does the stulent most frpouertly speak a language other than Engish? Q YES Dr* DOCUMENTATION CHECKLIST: (54) CHECK AND DATE ONLY WHEN RECEIVED: 1 DATE: IMMUNIZATIONS 1 DATE: BIRTH CERTIFICATE 1 DATE. SOCIAL SECURITY NUMBER 1 PROOF OF DOMICILE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. 9 Oft P8SD 0536 (REVISED 493) GC MOB EFTA01710118 SCHOOL BOARD OF PALM BEACH COUNTY 1 ‘,..d STUDENT REGISTRATION FORM - PAGE 2 IN) (54 STUDENT NO SCHOOL PARENTAL INFORMATION: I (60) TRANSpO5TED Br: it ya12:ted , 1 --- totdCe ,.... SX I bit (name if ent) Q EOTH PARENTS tyri)THER CI FATHER ID SHARED CUSTODY I3 OTHER (62) IS THERE A COURT ORDER BARRING E PARENT FROM REMOVING OR CONTACTING THE STUDENT DURING TIE SCHOOL DAY? j vES (0 IF YES. PLEASE PROVIDE THE SCHOOL WITH A COPY OF TIE COURT ORDER. It OCCUPATION 7 a BUSINESS PHONE (64) HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) A 3 ELEMENTARY SCHOOL B 3 SOME HIGH SCHOOL C 3 HIGH SCHOOL D . .J-SOKIE POST-SECONDARY E 9 TECHNICAL COLLEGE (Grades K-8) (Grades 9-12) (Graduate) iTechnkal / College) !Graduate or above) OS) a -C-S2 L 0 111110 niti P BUSINESS PHONE (66) HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) A J ELEMENTARY SCHOOL B 3 SOME HIGH SCHOOL C -416ISCHOOL 0 j SOME POST-SECONDARY E 3 TECHNICALCOLLEGE (Grades K-8) (Grades 9-12) (Graduate) (Technics College) (Graduate or above) (67) LEGAL GUARDIAN (IF ANY): i LAST NAME FIRST MK/. INIT. OCCUPATION PUCE OF EMPLOYMENT BUSINESS PHONE EMERGENCY HEALTH AND SAFETY INFORMATION: 168) PART I: Person(s) other than parent authorized to pick up student. (73) RELATIONS,. /;41/4fer 74) PART II: Person(s) to contact in the event of an emergency it parents cannot be reached. Those listed are also authorized to remove student from campus In an emergency situation. tick here d the iMormation is the same as in Part I. Ccmplete Part II 4 dlferent from those auttorzed in Pad I. (75) NAME (76) ADDRESS (77) PHOTE (78) RELATtOtISHP 179) PART III: If school is unablo o contact you in case of illness or accidont, may wo havo your pormission to call your doctor or take your child to the hospital j YES j NO (80) FAMILY DOCTOR i81) PHONE NUMBER - (82) HOSPITAL PREFERENCE r C (83) It your child suffers from any illness or has any physical defects that we should be aware of please list. /1 ‘91 1 -1 YOUR OTHER CHILDREN IN PALM BEACH COUNTY (85) SCHOOL ATTENDED (se) I VERIFY THAT THIS REGISTRATION INFORMATION IS TRU ACCURATE TO THE BEST OF MY KNOWLEDGE. PDSD 0636 (RE,. 393) OC64116-2 EFTA01710119 shore: • dummorm...64.4.—rom..646.......emsot (2) SCHOOLS SCHOOL BOARD OF PALM BEACH COUNTY STUDENT REGISTRATION Is) 1 NEW STUDENT TO PALM BEACH COUNTY 1 RETURNING STUDENT (4) 1 DATA ENTRY COMPLETED (5) Please complete all non-shaded areas and verify the resident address (6) TODAYTITE/timy DIRECTIONS: of the student by your signature below. YtiO I I S IS: A l GRACE (11) HOME (14) MAILING ('5) CITY STATE . .21P (16) CITY STATE ZIP /Mt 1 A .-4. 33c /if 17) SEX DM RACE (19) IS THE STUDENT J MATE n AMERICAN BLACK A ASIAN NRE A SINGLE PARENT^ afEMALE ROAEN I ALASKAN NATIV El NONHISPME O PACIFC ISLANDER H HiSPAIIC 121-Vr I NON-HISPAMC Sin _I NO • INATt re- ran. (21) VERIFICATION 1221 P1A3E OFBlfr (23) HAS 1 3 4 5 8 7 8 9 7 MONTH DAY YEAR (24) TU ON CODE:,CHECK THE LETTER FOR ONE CODE ONLY. A 1-avo oortniuusy Toed n Fonda for the past • D Am in the Federal Military Service. (Do Paid lee this school year in another Florida year or longer. comfy as verified by • E Am a *tan encegyee in tie Federal Military D 9 have puichmed a home in Florida weigh is Seneca and the cos) 01 my .:Oles oducabor is receipt a cccuped as my residence. H Paid fee in Pan Beach Count/ as verified by provided in part or who!), by Federal subsidy. C Have filed a manifestation el domicka n tins MONO # count/ ❑ F Am a migratory agricultural worker _..I I Exempt (25) ENTRY CODE: (26) ENTRY DATE: (27) WT DIST. (28) TRANSPORTATION: (29) RESIDENT STATUS: j ADM J YES J NO j 0. NON US. RESIDENT (321 TEACHER NO.: j ESCL j (3O) GRADE (30) CALENDAR, CATEGORY: 1 OUT OF COUNTY J ESE O 1 2 3 4 5 6 j 2 U.S. RESIDENT J MAD J 3 INCOUNTY PL L.S. RESIDENT TRANSFER INFORMATION: (33) NAME OF SCHOOL TRANSFERRING FROM (341 CITY OR LOCATION (35) CATE OF LAST ATTENDANCE (36i GRADE LEVEL (37) LAST PUBLIC SCHOOL ATTENDED IN PALM BEACH CCUNTY: (38) DATE ATTENDED: FREE OR REDUCED PRICE LUNCH: (39) Hale you filled oLt an app):cahoh fcr a Free o" Reduced Price Lunch? (ApplicatOn a provided wdtn this Pegistrarion Form) 0 YES SCREENING AND ASSESSMENT: SODIUM FLUORIDE PROGRAM: (4O) I gme Permisson for rn) child to given Screening and assessmett (41) I give permission for my child to paropate in the &chum Fluonde tests when necessary. these tests may be given mon/dually 0 If Program to pr ert dente decay. Permsmcn valid through grade so. groups. res J NO YES _IND FOREIGN STUDENT INFORMATION: This information is voltntary and used solely for the purpose of obtaining Federal funding. (42) ORIGINAL ENTRY INTO USA SCHOOL (43) STUDENT CITIZENSHIP STATUS (Circe One) 1 2 3 5 6 8 (44) ENTRY DATE 'USA) 1:Resident Alien 2rNoniresIdent Allen 3:Exchange Student SzRelugee 6:Entranl BrImmIgranl MONTH DAY YEAR (Counselors can provide assistance In determining status) MONTH DAY YEAR NEW STUDENTS TO PALM BEACH COUNTY ONLY: (45) U.S. CITIZEN (46) IF tiO, CITIZEN OF WHAT COUNTRY? (47) IN WHAT COUNTRY WAS THE STUDENT BORN? J YES J NO (43) WHAT LANGUAGE IS SPOKEN IN THE HOME BY THE PARENT OR GUARDIAN? (49) WHAT LANGUAGE IS SPOKEN IN THE HOME BY THE STUDENT? (50) 1. Is a language other than EngIsh used in the home' (51) STUDENT (52) PARENT (53) COUNTRY OF OYES 2* ) LANGUAGE GUARDIAN NATIONAL 2. Did the student have a first language otter than English? AYES 2010 LANGUAGE ORIGIN 3. Does the studert most 4recuerrly speak a language other than Englsh? OYES DOCUMENTATION CHECKLIST: (54) CHECK AND DATE ONLY NHEN RECEIVED: 1 DATE IMMUNIZATIONS 0 DATE: BIRTH CERTIFICATE 1 DATE: SOCIAL SECURITY NUMBER 1 DATE PHYSCAL EXAMINATION II DATE: PROOF OF DOMICILE Ifs) IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. SI / - RELATONSHIP )< 0 (1 DATE PESO 0636 ,REMSED GC 96506 EFTA01710120 r• . A MCA) Mov..1„, v.. Art • •• lele rXTh ial SCHOOL BOARD 00 PALM BEACH COUNTY STUDENT REGISTRATION FORM - PAGE 2 (58) (57 (58) STUDENT NO J 'WULF. IIMONG PARENTAL INFORMATION: (60) TRANSJORTED BY: Student will be transported to/IroM school by (name /Cya//4//i) ictleiti //tcye (61) STUDENT LIVES WITH (CHECK ONE) j BOTH PARENTS a -MOTHER j ::AT-IER j SHARED CUSTODY 0 OTHER (62) IS THERE A COURT ORDER BARRING EITHER PARENT FROM REMOVING OR CONTACTING THE STUDENT DURPIG THE SCHOOL DAY? Li YES alcr IF TES. PLEASE PRO\IDE THE SCHCOL KITH A CCPY OF THE CCURT ORDER. i fi i-019 /1/ (7 ///r ' /1 .4- ( ./ 0/(0 1 \.1 - PUCE Of EIAPLO1ENT BUSINE S PH ry (64) HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) A j ELEMENTARY SCHOOL 8 J SOME HIGH SCHOOL C Ij HIGH SCHOOL Diad31:51E POST-SECONDARY Ej TECHNICALCOLLEGE (Grades K-8) (Grades 942) (Graduate) (Technical . College) (Graduate or above) ssal____ m LAST NA , PAD. NM AS /Aft. OCCUPATION &Aid)/ AS) PLACE 0 BUSINESS PHONE (66) HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) A j ELEMENTARY SCHOOL B j SOME HIGH SCHOOL C letraSCITOOL D 0 SOME POST-SECONDARY E _J TECHNICAL COLLEGE (Grades K-8) (Grades 9-12i (Graduate) (Technical College) (Graduate or above) (67) LEGAL GUARDIAN (IF ANY): LAST MALE FIRST MID. INIT. OCCUPATION PLACE OF EMPLOYMENT BUSINESS PHONE EMERGENCY HEALTH AND SAFETY INFORMATION: (68) PART I: Person(s) other than parent authorized to pick up student. 70) NAME (71) ADDRESS (72) PHONE (73) RELATIONSHIP te e/ 0 7.1ne/t (74) PART II: Person(s) to contact in the event of an emergency if parents cannot be reached. Those listed are also authorized to remove student from campus In an emergency situation. a -C-Keck here il the i formation is the same as n Part I. Complete Part II I deferent korr those authorized in Part I. (75) NAME (78) ADDRESS 77) PHONE (78) RELATIONSHIP kievek pheue r9) PART III: If school Is unable to contact you In case of Illness or accident, may we have your permission to call your doctor or take your child to the hospital led u Ho (80) FAMILY DOCTOR (31) PHONE NUMBER (82) HOSPITAL PREFERENCE , ia.31 I! ycur child suffers ron any illness or has any physical defects that we should be aware of please Ilst. YOUR OTHER CHILDREN IN PALM BEACH COUNTY SCHOOLS: 84 NAMES OF CHILDREN (85) SCHOOL ATTENDED (86) GRADE (87) BATH DATE / /4) b) . V (8s) I VERIFY THAT THIS REGISTRATION INFORMATION IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. 193.50 0636 (REV. 3 93) GC6498-2 EFTA01710121 40 01 THE SCHOOL DISTRICT OF PALM BEACH COUNTY SY: 04 9-12 Academic Ir. „...? Improvement Plan (AIP) ALP BEACH SA) n IPA* DOB:J ABS: 3 R ' Marking Period Monitoring Dates: FNRT. MATH: FCAT: REAC: MATH: / / WAP: AIP: R-ZZ W-ZZ M-Fl S-ZZ First / Second PRIM: LEP: 504: Third / / Fourth / O READING U WRITING ['MATHEMATICS • SCIENCE /Textbook Assessments 2 71:akin Beach Writes D eFextbcoli Assessments 0 Textbook Assessments C DL 0 Portfolb 0 Portfolio 0 Pontoto FCAT Diagnostic I Practice Von -taros Assessments agerfarnance Assessments II Performance Assessments Ten FCAT Diagnostic/Practice Tests aliCAT DiagnosticiPractice Tests • FCAT Diagnostic/Practice Tests 0 D'09nntk, Software 0 Diagnostic Software O Diagnostic Software p Diagnostic Software 0 Other (see attached) • Other (see attached) 0 Other (see attached) 0 Other (see attached) 0 Phonernt Awareness Types of Writing [Number Sense, Concepts and 0 The Nature of Matter 0 Letter Recognition 0 Word/Sentence writing Operations 0 Erergy a -Measurement 0 Phonics: Sound / Symbol O ,• /nraph Writing • Force and Motion Correspondence i , / Dcelposition Writing ErGeometry 0 Processes that Shame the Earth ErAlgebraic Thinking Mg/Encoding Awareness !Application of 0 Earth and Space atata Analysis and Probability • a § Meaning Structure Proayscs of Life FCAT Writing Rubric 0 Reatling in Content Area L.) n t__, Visual (Mot) 0 How living Things Interact with hY Fluency E Fiscus 0 Sipper% their Enviroorneri Speak Concepts 0 High Frequency Words J Organ taboo 0 Conventions M The Nature I:: Science concepts 0 Rate Compositions • Readng in Content Area Meaning 0 erratve Specific Concepts • Vocabulary tory 0 Text Comprehension Persuasive ii it 11" 8 , Xe 0- Tutoring Tutoring Tutoring Tutoring n pfuring School Day 0 ring Schoct Day 0 During School Day 0 During School Day D'AflerlBefore School / Saturday Ater/Before School I Saurday [3-After/Before School/ Saturday 0 AtterGefore School I Saturday Instructional Alternatives Instructional Alternatives Instructions:Alternatives Instructional Alternatives 0 Tempora-y Skill Groups 10 PR 0 Minpvicily Skill Groups (44krali" Learning Groups 0 • Temporary Skill Groups Cooperative Learning Groups [cooperative Learning Groups 0 Temporary Skil Groups 0 Cooperative Leaning Groups 0 ❑ Guided ReadingNtiling Groups • Guided Read ngaritrig Grams 0 Technology 0 Guided ReadingtWnting Groups g 3 0 Technology 0 Technology Other (see attached) n 0 Technology Is O Other (see attached) • , Other (see erected) 0 Other (see attached) fe Assignment Alternative Assignment Alternative Assignment Alternative Assignment Alternative r—i Time • Time 0 Time 3 k 0 O Time ❑ Quantity [ ammity 0 Quantity 0 Quantity 0 Product Requirements IT Product Requiremerts • Product Requi ts 0 Product Requirements 0 Child Study Referrals E (Mild Study Referrals 0 ChM Study Referrals 0 Child Study Referrals 0 hairdo-tonal Reading 0 Instructional Language Ms 0 littictional Mathematics 0 Instructional Reading Student progress will be monitored throughout the school year. and student progress will be reflected on the report card. D Successfully Rernediated O Successfully Remediated O Successfully Remediated • Suoresslully Remediated ,,_. Requires New AIP Next Schoen( [Ti Requires New AIP Next School 0 Requires New AIP Next School 0 Requires New AIP Next Schott 11 ii Year 0 Year Year • Year Special _evicts / Placement 0 Special Scivi,es / Placement 3 Special Seivices I Placement 0 Special Senices 1 Placement 0 Other (see attached) II other (see attached) 0 Other (see attached) 0 Other (see attached) In Deficiencies due to non-attendance refer to Attendance Specialist) Number of Days Absent SIGNATURE OF PARENT/ GUARDIAN DATE Parent/Guardian Contact CommItnentIContdbution O,ecl te 'het eppy. El Monitor Attendance I Tarries ❑ Check Homework DAZE 0 Read with Child Every Night 0 Reinforce Skills /().-.12 -43 0 Sign Daily/Weekly Notes DATE ❑ Attend Parent Conferences -Ch; -A/10 41 D Attend Parent Curriculum/ Information Meetings SIGNAItIRt 0FIEACmER OATS PBSD 1687 (REV. 911312002) ORIGINAL • Cumulative Folder COPY - Teacher COPY - Parent/Guardian EFTA01710122 STATE OF FLORIDA Special Health DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES Problerns • See CUMULATIVE SCHOOL HEALTH RECORD Warr at ve (This form is not intended for physician's use) e.6 let.kc a eIeeben • Nar Race Sex School Address Father's Name IAJ Pf3 P1 33L1 Mother's Na Date of Birth Place of Birth ath Reco•ded Yes No0 Immunization Certification: Yes® No0 Special Immunization Programs A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES 1 2 3 Screening and cs ci cen Outcome Assc0sitient c c _ EP -tv E Grades To 'et 'E a' ti e g re c c 7, .- C3 o r8 IT, ,a 0 4-i c i rb° E87. K.3 z., = a: ix a •' -.•-3 0 CS cc t. cc 0 t% t' cc a Vision 3-1- 95 5.1) .; `g4- Hearing \230ti• 3--y — T5 Height. Weight Mir 4.), 9-845 I- a Graphing (4, 7 chi 4 194 Nutrition Dental Health Mental I teal th Communicable Disease aikk's\5 1 Records Review Physical Assessment % k t s )471 c Other Other 4 5 6 7 8 Screening and m cs _ 0 cri Outcome Outcome Assessment g c' Referral - c To Grades ,- 0 Ts ..: I) 5 :c a c — I') 8 To ... i- icc c ... a r's k- 8 E -C w c — ia2 5 5 .9. g .e; zric, .- e ._ 4R 0, a i cc ; o r:6 cx cc1 5 cs fA = 0 ' C cc I Vision HAI Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Physical Assessment Scoliosis Other Other HRS-H Form 3041, MAY 80(Replaces previous editions and MCH 304) EFTA01710123 FLORIDA CERTIFICATE OF IMMUNIZATION (HRS 680 - PART A) kFtiridi S•attees 232 0321 FOR CHILDREN WHO HAVE COMPLETED ALL REQUIRED IMMUNIZATIONS FOR SCHOOL ATTENDANCE IttACIMIT DATE 3F BIRTH (BLU S NAME PA:411,T f R NIARDAN DOCTCR: FART A OF THIS FOAM IS USED ONLY IF TI1E CHILD HAS RECEIVED ALL REQUIRED IMMUNIZATIONS LISTED KM. F. NOT. SEE REVERSE SIDE. DTP - 5 DOSES REQUIRED •1 IF THE FOURTH PRIMARY DOSE OF DTP IS ADMINSTERED ON OR AFTER THE FOURTH BIRTHDAY. A FIFTH DOSE IS NOT REQUIRED. DT (PEDIATRIC) VACONE IS ACCEPTABLE IF PERTUSSIS VACCINE IS MEDICALLY CONTRAINDICATED. ICCMPLETE PART C FOR PERTUSSIS ONIRAINDCATION Td (ADULT VACCINE (A SERIES OF 3 DOSES) IS ACCEPTABLE AND RECOMMENDED FOR CHILDREN 7 YEARS OF AGE OR OLDER POLIO ITOPR - 4 DOSES MOORED IF THE THIRD PRIMARY DOSE OF TOPV IS ADMINISTERED ON OR AFTER THE FOURTH BIRTHDAY. A FOURTH DOSE IS NOT REQUIRED. POLIO VACCINE IS OMITTED FROM THE REQUIRED IMMUNIZATIONS OF CHILDREN 18 YEARS OF AGE OR OLDER. 7 fr124., MEASLES, MUMPS. AND RUBELLA - I DOSE REQUIRE° PMR COWRIE() - I DOSE AT 12 MONTHS OF AGE OR OLDER AND IN 1968 OR LATER (RECOMMENDED AT 15 MONTHS. -OR- MEASLES SINGLE - 1 DOSE A7 12 MONTHS OF AGE OR OLDER AND IN 1968 OR LATER (RECOMMENDED AT 15 MONTHS) MO DA YR MUMPS SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER MD DA YE RUBELLA SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER MD DA VP ALL APPROPRIATE DOSES AND DATES INCLUDING BIRTHDATE MUST BE ENTERED, AND THE CERTIFICATE SIGNED BELOW BY A PHYSICIAN OR AUTHORIZED PERSON AND DATED IN ORDER FOR THE CHILD TO ATTEND SCHOOL. I I IAVE REVIEWEC THE RECORDS AVAILABLE AND TO THE BEST OF MY KNOWLEDGE THE ABOVE NAMED CHI9 HAS BEEN ADEQUATELY IMMUNIZED AGAINST DIPHTHERIA, TETANUS, PER RUBELLA AS REQUIRED BY Fl nnina I Ameono cflannl ATTENDANCE. PHYSICIAN OP CLINIC NAME (PLEASE PRINT) PHYSICIAN OR AUTHORIZE NATURE DATE EFTA01710124 STATE OF FLORIDA DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES Mr. T HEALTH EXAMINATIONS Date OP- /9 YS C- Sex r Phone Ago Race ricci-bs Birthdate Nam. of Parent or Gu3rdan On •• A. HEALTH EXAMINATION Height Weight BI0Cid Pressure Normal-N; Abnormal-A N A COMMENT: Abnormal Findings, by number I Appearance 2. Skin /Nose 3 Fir.xl /Scalp 4 Eyes 5 Visual Acuity (R & 6 Ears 7. Audilory Acuity (R 8 L) 8 Nose Throat 9 Mouth. 'teeth and Gums 10 Chest / Lungs tI Heart 12. Abdomen 13. Gemtad and Ante 14 Muscula-Skeletal 15. NeurolC9Cal 16. Alertness 17 Emotional / Mental/ Behavior Pr0b.) 18 Handicap. physical/ other (Speedy) 19 Activity Restrctians (Specify) 20 Abuse. substance/ physical / emotional 21 NuPlti0n 22 Owe. I B. HEALTH HISTORY (Serious Illnesses Intures. explain) 'attach narrative if addition; space nocdcd) C. LABORATORY (as in0Celei3) type Hemoglobir/Hcmctocrt Stool1O8 n date Tuberculin teal Leac Sckle Cell row NAME: TITLE: ADDRESS: 7 f' (Please Print) d'19. 13 D.• HIS- H Fore 3040, mar 91 (besot *tea previous editions) (Stock Muter 5744 OW -3440-2) EFTA01710125 ir ,/7/2 4.)i C es-err -/41/ , 06 W/ 7/7/ tA./ / 7 /-1 /;-/ FA: rowf Kr_ c ,,//c r7tfW A7 /- 33 yr/ STATE OF FLORIDA COUNTY OF PALM BEACH On this the 20th day of August 1993, before me the undersigned Notary Public of the State of Florida, personally appeared and whose name is subscribed to the within instrument, and he acknowledge that he executed it. WITNESS my hand and official seal "• _ . rOTARY PUBLIC, TATE OF‘PIORIDA Ns:: 3 PUBLIC, STATE OF FLORIDA. 311. COMMISSION EXPIRFS: Dee. 13, 1991. BONDED 711RU NOTARY PLISLK UNDERWRITERS. Produced identification: Ti nrivera Lirtanctw Did take an oath EFTA01710126 New York State Departmeb, Albany, N. Y. 12237 (gunfire, of !frill! tr - 'n This certifies that a certificati of bieilelsatt uncrfil.:she name of: Sex: Female on: --;:cliki,%.7;i"*.f,•i' • I At: - w. " "' • :;:r7ti" Name of father:- • uK • Maiden name of mother: ,Z.4.7.i:•=;Vt: • ' Date filed: - :Date issued: .11taisiPt oeiStit Shfiltki ?Meek.: -1111i-nefice is voicrif if tonfoinsopOwasswes .gamsiist . "3" 66060060660000660000000_00 EFTA01710127 • NARRATIVE RECORD Notations by educators, nurses and other designated personnel should be dated and signed. Narration section should include information concerning referrals, follow-up and special consideration to be given students in classroom as a result of screening. as well as teachers' observations, parent conferences, home visitations and services rendered. Educatcrs need only record information concerning teacher observation and educational depSi0ns made for students in the classroom as a result of screening and other health Information. DATE 742/91 AL/724,4=4;42-75t. 14f4;a424,7217teize-0A-Inenye,07 , HRS-I-I Form 3041, MAY B0 (3) EFTA01710128 TEST RECORD INFORMATION A,^ READ MATH T T L NG LANG RAEW 173 MEP Pi.".° CTBS/4 LEVEL 13 FORM A FLORIDA COMPREHENSIVE ASSESSMENT TEST FLAT) OCTOBER 2004 SUNSHINE STATE STANDARDS STUDENT: GRADE: 11 DISTRIC SID. SCHOOL: 2531 ROYAL PAIN BEACH NIG DOB READING SS: MATH SS: NOT TESTED READING DSS: MATH 03S: FRT PBSO 0280 EFTA01710129 Spring 2002 Florida Comprehensive Assessment Test (FCAT) MN= F Florida Comprehensive Assessment Test Sunshine State Standards - Grade 08 Student Report School Name and Number 1691 - CRESTWOOD MIDDLE District Name and Number SO - PALM BEACH The FCAT is a test developed in Florida to measure student achievement of the Sunshine State Standards (SSS) for reading, mathematics and writing. The test is one measure of how much students have learned and how prepared they are for more challenging work. The standards tested on FCAT were developed by groups of teachers and Identify the knowledge and skills students should achieve as they move from, grade to grade. The A+ Plan for Education established an annual assessment of student learning in grades three through ten as well as regular reports to parents. This report provides parents with independent information about the achievement and learning gains of their students. 2002 compared to 2001 2002 Achievement Levels and Scale Scores 2001 Achievement Levels and Scale Scorer" Your FCAT score is reported in several ways. The This section of the report shows the scale scores Grade 08 Scale Score is a score between 100 and 500. The Grade 07 and achievement level scores you earned last Achievement Levels Achievement Level score is one of five success Achievement Levels year. The table on the left shows the scale score Scale Score Ranges levels described on the back of this report. Scale Score Ranges ranges for the test you took last year. Reading Mathematics Reading Mathematics Level 5: 394-500 371.500 Level 5: 389-500 379-500 Level 4: 350.393 347470 Level 4: 344-386 344-378 Scale I Achievement Score Level Level 3: 310.349 310-346 Level 3: 300-346 306-343 Level 2: 271.309 280-309 Level 2: 267-299 275-305 Reading Level 1: 100.270 100-279 Level 1: 100-266 100-274 Mathematics Your test scores show how you performed on the day you took the test. If you had taken this test numerous times, most of your scales scores would likely have fallen betiveen two scores. Your FCAT Reading scores mght have been between 303 and 335. Your FCAT Mathematics scares might have been between 301 and'319. The range reflects the amount of statistical variability in the scale score. 2001 to 2002 Learning Gains*" The Learning Gains section of this report shows an estimate of your progress from 2001 to 2002. Your learning gains are based on a comparison of your 2002 Content Scores Achievement Level scores from year to year. Number of Number of Points Points Possible Earned Reading Learning Gains: Reading Your FCAT Reading achievement level score improved over Content scores show your last year's score, and you have made good progress. performance on more specific Words/Phrases 8 areas of the Reading and Main Idea/Purpose 22 Mathematics tests ComparliOns 10 Reference/Research 10 Mathematics Learning Gains: The table shows the number Mathematics Your FCAT Mathematics achievement level score improved over of points possible and the Number Sense t2 last year's score, and you have made good progress. number you earned tor each category. Questions on this Measurement 12 test were worth from 1 to 4 Geometry 12 points. Algebraic Thinking " 2001 scores and learning gains are reported if matching records were found 12 Data Analysis 12 on the computer file. Data ALA Data: 05/11/2002 Oie0152 EFTA01710130 Student Name FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2002 NORM-REFERENCED TEST OM= School Name and Number Student Report 1691 - CRESTWOOD MIDDLE Florida Comprehensive Assessment Test GRADE 08. DlatrIct Name and Number 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 Stanlne Possible Earned Attempted Readin• Comprehension - 54 Reading initial Understanding 8 ■ Comprehension Interpretation . 27 Mathematics Critical Analysis 7 ■ Problem Solving Strategies 12 Mathematics Problem Solving 52 The Scale Score expresses your performance and allows comparisons from year to year. Measurement 5 ■ Reading Comprehension Scale Scores range from 510 to 820. Mathematics Problem Solving Scale Scores range from 527 to 836. Estimation 5 ■ Problem Solving 6 ■ The National Percentile Rank and Stanlne Indicate your relative standing In comparison to the national reference group. National Percentile Ranks range from 1 to 99. Stanines range from Number Relationships 6 ■ 1 to 9. Number Systems 4. ■ Patterns & Functions 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 ■ For Reading Comprehension, your National Percentile Rank should be between 47 and 71. For Statistics 4 ■ Mathematics Problem Solving, your National Percentile Rank should be between 62 and.79. Probability 4 ■ a Geometry 9 Each question was worth 1 point. Data Run Data: osninon 0189636 EFTA01710131 Student Name: ,,,,,• , FCAT WRITING Student I.D. No.: , 4ofr.7Z i... - 4`, . STUDENT REPORT School: CRESTWOOD MIDDLE ,.. „ ,, h ---. t. —`.: { : ...... 4t , District: PALM BEACH 2002 4 ,21 Grade 8 e; r . P SCORE: Florida Comprehensive Assessment Test WRITING TO CONVINCE How Papers Are Scored Dear Student The student responses are 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 (1) 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 continue developing your writing skills. Support refers to the•quality of the details used to explain, clarify, or define. The quality of the support depends on word choice, specificity, depth, and thoroughness. Papers representing the higher end of the point scale provide examples and illustrations in which the relationship between the supporting ideas and the topic is clear. Conventions refers to punctuation, capitalization, spelling, and variation in sentence structure used in the paper. The conventions are basic writing skills 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 convince the reader to accept capitalization, and spelling and use a variety of sentence structures to present your opinion on teenagers having jobs or chores. ideas. RUN DATE: 04/11/02 50-1691 . • EFTA01710132 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2002 READING SUNSHINE STATE STANDARDS PERFORMANCE TASKS Student Report Grade 8 This report provides your results on the FCAT 2002 Reading FCAT 2002 performance tasks. Each performance task on FCAT requires you READING PERFORMANCE TASKS to respondwith either a short response or a longer, more detailed POINTS EARNED response. The short-response tasks are worth up to two points and the extended-response tasks are worth up to four points. Student Name One of the short-response tasks Is shown below with a copy of ID Number your answer. The number of points you earned for your answer IS School Number 69 shown In the box to the right School Name CRESTwOOD MIDDLE District Number so There were tour performance tasks on this year's test. The District Name PALM BEACH highest number of points possible on all lour tasks was 10 points. The total number of points you earned is also shown in the box to Points earned for answer shown below: 0 the right. • Total number of points you earned: 5 This task required you to read an informational passage about surWval skills that can be used under several adverse conditions. How are the survival skills needed for extreme heat and extreme cold similar? Use details and information from the article to support your answer. - \\ 1e tuswoRIN o rot exki-efore lvDtk. rb r cOhl• beComac 6 ‘, ei 4 Vt) eca tonl te. In% VAAter Grove 464-mi-ratie 7\v,cea,sea Itref ,opal cian load -6 conwltiena ark ccen a ,14 • 1WAxis t\ttr% exl-rerne colot. rerak• r ViNt ats-vwcA -aSe;ilt,5 At/QUA \)es_oa cm* 'e. butrvigo6 verdket/21• enern14cs zs co1h Lea Nzo-NI N-Qmt &ozone Mart Ct tot or aree4rett t 06.0cp 1-ard. ‘ruAcakstrIrs•A ,Mtt c.oaticsAct co"fitcac tycva 1- tett, otarnt f-t-GrAiNt• %-auAlty buttliuoik etre rsedeL 8 • Data Run Date: 05/05/2002 0037109 766300080 EFTA01710133 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 SUNSHINE STATE STANDARDS Student Report 1691 - CRESTWOOD MIDDLE Grade 07 District Name and Number Florida Comprehensive Assessment Test 50 - 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. Achievement levels for this portion of FCAT have not yet been determined. Student Achievement Level Descriptions LEVEL 5: Performance at this level indicates that the student has success with the most challenging content of the Sunshine State Standards. A Level 5 student answers most of the test questions correctly, Including the most challenging questions. LEVEL 4: Performance at this level indicates that the student has success with the challenging content of the Sunshine State Standards. A Level 4 student answers most of the questions correctly but may have only some success with questions that reflect the most challenging content. LEVEL 3: Performance at this level indicates that the student has partial success with the challenging content of the Sunshine State Standards, but performance is inconsistent. A Level 3 student answers many of the questions correctly but is generally less successful with questions that are most challenging. LEVEL 2: Performance at this level Indicates that the student has limited success with the challenging content of the Sunshine State Standards. LEVEL 1: Performance at this level indicates that the student has little success with the challenging content of the Sunshine State Standards. Your scores are shown below. SUBJECT SCORES 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 Words/Phrases Mathematics Main Idea/Purpose Sunshine State Standards Reading and Mathematics Scale Scores range from 100 to 500. Comparisons If you took the test again, your scores might be slightly higher or lower than the scores on Reference/Research this report. However, your scores would probably fall within a certain range. For reading, your scale score should be between 277 and 301. For mathematics, your scale score should Mathematics be between 286 and 316. Number Sense Measurement The check marks ( J ) show if you scored in the lowest, middle, or highest third of grade 07 Geometry Florida students who took this test. Algebraic Thinking Data Analysis S The Content chart shows the number of points possible and the number of points earned for each category. Each question was worth 1 point. "13D: To Be Determined Run Date: 04/26/2001 0178486 EFTA01710134 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 NORM-REFERENCED TEST Name and Um er Student Report 1681 - CRESTWOOD MIDDLE Grade 07 District Name and Number Florida Comprehensive Assessment Test 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 Readin! Comirehension 54 Reading Initial Understanding 10 I Comprehension Interpretation 24 I Critical Analysis 10 I Mathematics Problem Solving Strategies 10 I Mathematics Problem Solving 50 I The Scale Score expresses your performance and allows comparisons from year to year. Measurement 5 Reading Comprehension Stale Scores range from 490 to 619. Mathematics Problem Solving I Scale Scores range from 517 to 830. Estimation 6 I Problem Solving 5 I The National Percentile Rank and Stanine Indicate your relative standing in comparison to the Number RelatIonships 6 national reference group. National Percentile Ranks range from 1 to 99. Stanlnes range from 1 to 9. Number Systems 4 Patterns & Functions 3 It you took the test again, your National Percentile Rank might be slightly higher or lower than stated here. However, your National Percentile Rank would probably fall within a certain range. Algebra 4 For Reading Comprehension, your National Percentile Rank should be between 54 and 76. For Statistics 5 Mathematics Problem Solving, your National Percentile Rank should be between 54 and 75. Probability 3 0 Geometry 9 Each question was worth 1 point. Run Date: 04/26/2001 0181361 EFTA01710135 I. 7 FHA It. FasHA a. "Cony. thane. a. FIN Numb*, 7. Loan Nurnbto 6. Menage Inautanca Ono Numb°. 45M4 VA, 6. Con. ino. ... . .. .,.. leiR04043 . • C. NOTE; This form Is furnished to glue you a statement of actual settlement costs. Amounts paid to and by he settlement agent are shown. Items marked (P.O.C.) were paid outside tho closing; they are shown hero for Information purposes and are not included In the totals. II IIIIN ewer t Her F. Name and Address of Lender GNAC MORTGAGE CORPORATION TAMPA. FLORIDA 33609 MIDLOTHIAN, VA 23112 ""4"""" WIERSDALE. FLORIDA 32195 ;,,,,,,,.., „„....n, ,,,^m G. Property Location H. Settlement Agent HARM TITLE L.C. LOXAHATCHEE. FLORIDA 33470 Place of Settlement t. Settlement Date - Royal Palm Beach. Florida 33411 08/14/00 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: io0. Gross Amount Due From Borrower Ann nr..e sn,...... ra.... v. .. caole — NATIONWIDE INSURANCE COMPANY OF FLORIDA DECLARATIONS PAGE 1 OF 1 NON-ASSESSABLE POLICY PERIOD BEGINS 12:01 AM POLICY PERIOD INCEPTION 8-14-00 STANDARD TIME AT THE EXPIRATION 8.14-01 RESIDENCE PREMISES. I ELITE POLICY: I REPLACING POLICY NO: ADDITIONAL INSURED ESS BED PROPERTY 1ST MORTGAGEE AND ADDRESS GMAC MORTGAGE CORP LOXAHATCHEE NOT APPLICABLE ITS SUCC &/OR ASSIGN PO BOX 57003 FL 33470-0000 IRVINE LOXAHATCHEE CA 92619-7003 FL 33470.0000 *****TO REPORT CLAIMS. CALL 1-800-421-3535 FOR INQUIRIES. CALL 561-793-5000**k* INFLATION PROTECTION COVERAGE IS APPLICABLE. the premium and compliance with all applicable We will provide the insurance described in this policy in return for OF LIABILITY and ADDITIONAL COVERAGE OPTIONS. policy provisions. See policy for details regarding the SPECIAL LIMITS LIMIT SPECIAL LIMITS OF LIABILITY ADOITIONAL COVERAGE OPTIONS SECTION I COVERAGES LIMIT $155.000 OPTION A-DWELLING $2.500 $8.000 SEE POLICY A-J EWELRY-FURS B-OTHER STRUCTURES REPL. COST APPLIES $77.500 I-EXT. C-PERSONAL PROPERTY $15.500 J-REPL. COST PLUS APPLIES D-LOSS OF USE L-PROTECT. DEVICE APPLIES 0-ORD OR LAW-25X OF COV-A SECTION II COVERAGES APPLIES $300.000 P-WATER BACKUP E-PERSONAL LIABILITY PD/BI-EA OCCURRENCE F-MEDICAL PAYMENTS $1.000 TO OTHERS-EA PERSON OTHER COVERAGES LIMIT -FIRE DEPT. SERV. CHARGES $500 -CREDIT CARO-FORGERY $1.000 AND ELEC. FUNDS TRANS. ern.wew TT rorrniTAMC. The ”acidanra nromiAOA is the only nremises EFTA01710136 CHESTERFIELD COUNTY SCHOOLS STUDENT EVALUATION SCHOOL YEAR: 19991 MARKING PERIOD: P4:4-: STUDENT: GRADE Team ABSENCES 06 YEAR TO DATE: 15.0 SCHOOL: SWIFT CREEK MS NEXT REPORT CARD DATE: COUNSELOR: MARKING PERIOD: rei: 4.0 HIV 117 1P CLASS 0105 LIGON P L GRADES GPA E E E a F EARNED COMMENTS TEACHER RSUBJECT SUBJECT V x s x s I I 1 2 A E 3 4 A E U N CREDITS 0 NUMBER NAME E M M LI M A T CUMULATIVE: D L L • 01 SST206 SOCIAL STUDIES 6 02 MAT306 MATH 6 03 ENG106 ENGLISH 8 05 HPE706 HEALTH/PHYS ED 8 06 5C1406 SCIENCE 6 07 EXP006 EXPLORATORY 6 SEE REVERSE SIDE FOR EXPLANATION OF COMMENTS, GRADE SCALE, LEVEL, GPA & PARENT SIGNATURE. EFTA01710137 N , • -• . ." •1 Page: 1 of 1 Student Name: IDtt Grad Date: Demographic Diploma Type: Address: Grade: Sex: e MIDLOTHIAN., VA 23112-4049 Counselor: Soc Sec No: Birth Date: Parent/Guardian: Cumulative Data GPA: Rank: Specialty Center: Semesters Enrolled: 0 Earned Credits: School: SWIFT CREEK MS School Year: 1999 - 2000 Grade: 06 Class Name AB Si S2 FG redi ENGLISH 6 EXPLORATORY 6 HEALTH/PHYS ED 6 MATH 6 SCIENCE 6 SOCIAL STUDIES 6 Total Credits: 0. 0 Present: 157.0 Absent: 15.0 Membership: 172.0 Credit Summary Standard Diploma Requirements Advanced Studies Diploma Requirements Number of counts successfully 2000/2001 2000/MOI n2 4 credits En2tI ntud, 4 credits completed in each area. Enge Ma tics Laboratory Science 2 credits 2 credits M Laboratory Science 3 credits 3 credits English 0000 Math or Science I credit Social Studies 3 credits Math 0.000 Social Studies 3 credits [ World History/Wodd Geography, 1 credit Laboratory Science 0.000 ( World History/World Geography, 1 credit United SOW & Vioicil History, t credit Social Studies 0.000 United States & Virginia Watery, l credit United Sete & Virginia Government 1 credit Foreign Language United States & Virginia Government I credit 0.000 Foreign L 3 credits Health/PE 0.000 Health & Physical Education 2 credits (3 years olo knguage or 2 years each of 2 Languages) lgi;tileir Fme Arts/Practical Am 0.000 Fine Am or Practical Arts 1 credit Health & Physic! EdUCID01. .--... 2 credits Electives 6 credits Fine Arts or Practical Arts . I credits Electives 0.000 Eleaires 4 credits Total: 0.000 T = credits Total = 23 aedia nay be met by an approved o vocational vononal se21 quence GRADES AB • Abler Level Level - Acfacneed Prow= brawn Level1- Wel, * pasta/OMGra* level Very Good Level Meeling Raxtomontal Grade level Level X • Basic Sob Level C -Ccengreeeeve Wel 0 -No Geouring Signature of Official Certifying Transcript w Printed: 06/23/2000 08:43 AM EFTA01710138 STANFORD 1 ACHIEVEMENT rrsr SERIES, NINTH EDITION - ABBREVIATED VIRGINIA' sir ASSESSMENT PROGRAMt - .new TEACHER: NO NAME GIVEN SODOM: SWIFT CREEK MIDDLE -02I0270 CRADE: OS aScarS,EYll4kenifttsr4t. DIVISION: CHESTERFIELD - 021 TEST DATE: 09/99 TEST TYPE: MULTIPLE CHOICE • ;:"bitccvs 1 Ski Y 0:0R4 NIPON^6 WI:" , • f; nng2 :Oa wale tonne! STUDENT'S PERFORMANCE NATIONAL GRADE PERCENTILE RANKS Recently this student took the Stanford Achievement Test. Total Roadine; The graph to the right presents the student's test results. These Percentile Rank Scores compare the student's Total Math performance with scores of students in the same grade from Language across the nation. Percentile Ranks range from a low of I Sci erne to a high of 99. For example, a Percentile Rank of 70 Social Selene means that this student obtained a score that is equal to or higher than 70 percent of the'students in the comparison Partial Ai tem; group. Please keep in mind that this test is only one Total Batti indicator used in isiessing a student's achievement. The school has additional information about how the student is performing in class. I I 10 30 50, 70 90 99 NOTE: The Partial/Basic Battery is comprised of the reading. mathematics, and Below Average Average Above Average . language sublests. When Science and Social Science are taken, the Total/Complete Battery is also reported. Nol ft: • The student had it non-standard adscomn dation in thl, content are.'. .. Reading Mathematics tanguage ._.Science: . .. Your child's score In Reading was in Your child's score in Mathematics was The Language score was .n the The Science score was in the averageI the average range. Encourage your in the average range. Help your :Mkt average range.. -Let your child .. ... • range. Encourage your child's .,... . child to read books about topics of use math to solve problems in write letteps„stories,,anitlists curiosity about the world. interest. everyday life. whenover'possible.' "" Social Science Your child's Social Science score was in the average range. Talk often with your child about people, places, and events. JF dennedisite 2 1; Coo _y_0 1995 NORMS: Fall National Process No. 19960026-321:059-5392-S6M Scorn band on normative Jan copyright *1996 by lareoun Brace & Company. All nghu reserved. EFTA01710139 L a; • TEACITERginO,NAME OWEN , SCHOOL' SWIFT CREEK )4 61i -I. VIRGINIA STATE ASSESSME.NT PROGRAM Al 1 dhazio DIVISION: CHESTERFIELD Oil TEST DATE: 09j99 TEST TYPE: MULTIPLE CI IOICE . — . NATIONAL GRADE PERCENTILE BANOS SUBTESTS AA D No. of Raw Scaled National TOTAIS Items Score 90 99 Score PR -s 1 10 30 50 70 Total Reading cc Vocabulary 20 ReadngC4MIP., 30 Total Mathematics 50 Problem So's-ing 30 Procechres 20 Language 30 prewriting 8 Composing 8 Editing 14 Science 3C Social Sciencs 3C Partial Battery 130 Feral Rattery 190 Bch. An tats" Attar Ainisge Recently this student took the Stanford Achievement Test. This brief description of the scores presented above tells how the student did on the test, compared to the 1995 performance of students in the same grade from across the country. The Battery score is an overall indication of how well the student performed on the test. The score for this student is in the middle range for the grade. which meant that performance on al =busts combined was well within the average range. In reading, the score ism the average range for the grade. Continued opportunities to read a variety of materials should be helpful. In mathematics. the score is within the avenge range for the grade. Continued experiences in working with mathematics procedures and problem solving could be helpful to future learning in mathematics. Performance on the Language test was in the average range fur the grade. Examination of the Preventing, Composing, and Editing scores for this test can be helpful in guiding the student in the writing process. The Science stablest score is m the middie range for the grade. The Social Science subtest score is somewhat below average It appears that the student may be having difficulty understanding the concepts and skills measured by this subiest It is important to keep in mind that test scores give only one picture of how a student is doing in school and that many things can affect a student's test stores. Therefore, it is important to consider other kinds or informaCon as well. The school has more detailed information about how the student is doing. NOTE: The ParualfBasic Battery is comprised of the reading, mathematics, and language subtests. When Science and Social Science are taken, the TotaliCompkte Battery is also reported. • The student had a non-standard accommodation in this content area; scores belonging to this area are excluded from summary calculations. STANFORD LEVEL/FOR-Vt. Intermediate 2TA Copy 01 1995 NORMS: Fall National Process No. 15961026.3211059-5392-560SA Scores based on tormatne data copynght C 1996 by Harcourt Brace & Company. All nghts reserved. EFTA01710140 THE SCHOOL DISTRICT OF PALM BEACH COUNTY Grade ELEMENTARY REPORT CARD 17 -19 ?EC? Year 19 Student School Nig/eV Fiem.4 CatlfraU Teacher Principal MARKING CODES - ACADEMIC SUBJECTS SOCIAL DEVELOPMENT/CLASSROOM STUDY HABITS GRADES 1 and 2 Please work on the area(s) that have a check (I) E - Excellent S - Satisfactory Marking Period V - Very Satisfactory N - Needs Improvement ist 2nd and 4th Overall effort GRADES 3-5 A - Outstanding (94% • 100%) Works cooperatively B - Above Average (85% - 93%) Works independently C - Average (75% - 84%) Completes classwork on time D - Below Average (65% - 74%) F - Failing (0% 64%) Completes homework on time I - Incomplete Follows classroom rules and routines Uses time wsely ACADEMIC SUBJECTS Marking Period Follows directions let and 4th Accepts responsibility for own actions Mathematics tInclCate lace! with a check) Comes to class prepared with On or above grade oval _------ materials ftaIow gracte *vet Reading (Ineciato level with • chock) linititL e V 01' - — .. On or above grade revel Flaw grad* ievat ALTERNATE ASSESSMENTS Marking Period Irdicate those used with a check (!) In :nn see 4eh Composition Skills Checklist(s) Language Portfolio Spellirg Audio Cassette Recording Video Recording Handwriting/Penmanship Computer Program Social Studies Standardized Test(s) Science/Health ObservationsANntten Comments Grades not given this nine weeks Other MARKING CODES - FINE ARTS 3- Outstanding effort end paliczpation Z • 541.2feet:icy effort end parttcpaton ATTENDANCE Marking Period 7 - Inadequate effort and parucipetion: raiment conference Regular attendance and punctualtty requested are essential for quality educator. "` aid 4th Days Present V l2ndia FINE ARTS REPORT Marking Period Days Absent 3rd 4th Days Tardy I 0 Art MuS c !1: Information Included Physical Education PLACEMENT • PARENT/GUARDIAN/TEACHER Marking Period Grade Special Session CONFERENCE Confer/ma conducted (Indicate date(s)) 1st 7 3rd 4th • If Special Session program rs indicated, grade placement Mil be determined by the borne school. PHD 0788 (Rev. 7/94) GoidenrodHst Period PInkJind Period Canary/3rd Period Greionflte Period White/Office Copy EFTA01710141 THE SCHOOL DISTRICT OF PALM BEACH COUNTY Elementary Student Transfer To Be Completed for All Transfers (Print or Type) LAST GRADE. ' TEnT RACE CODE SE% CATE OFriTwytWAL DAYS PRESENT DAY AP, FN1 TARDY kA C..) or') /9S ti O (% PAPEFC ESOL Status A0 R❑ EU ZZA. Lunch Free 0 Reduced ❑ N/A El Psychological on file Yes 0 No p. Copy of form attached Yes ❑ N/A Physical Exam on file Yes W. No 0 Date 1/ 6? Jci 3 Immunization Dates: Health Problems/High Risk Yes JI N/A lY PRNCIPAL SCHOOL NAME ii ; titste.2.44.- - -- -e-- 2;&- -/ / Ltitt.. M , SCHOOL ADDRESS &FM V fibi). 11.iftte-A . F2 53Y") REGULAR INSTRUCTION PROGRAM INFORMATION Copy of Roped Card Attached CLIREENT GRADE U Teacher Name(s): Instructional Materials (indicated level) GRADE KG 1 2 3 5 PAGE Mathematics KG 1 2 3 7 . 5 ( - -It Level Level Level Level LevelAj-bef i!i Level Macmillan J /4Wfrqr l ' 7:I . ' fr b* . Reading FOCUS a i -1--- , pee ; r _y ,S f L; 4e-, irk, Other at / JP tVIii ki Student meeting Pupil Progression S andards Yes No -1 / Student currently repeating grade ... Yes 0 No Pupil Progression Letter sent Yes LI No D i , School Pat of Yes 0 No a l. Letter signed Yes U No Di Workbooks sent with student Yes 0 No ILS Disk Yes 0 No W SPECIAL INSTRUCTIONAL PROGRAM INFORMATION Sfudent is in special Program (circle) EH LAD Speech Alt. Ed. Migrant Current I.E.P. Date N/A 51, EMH SEH SOI ESOL 504 Staffing/Testing in Progress Gifted SLD VE Chapter 1 Other (name program) OBLIGATIONS FULFILLED Tex arks rpltrned Yes J No ❑ I ihrary hooks returned Yes No 0 EAr OFF Pbb 1E LLOW/sanamg scnoof office rupwcumulative I older EFTA01710142 I`le-1c1au.cc t ?..2tt1GrAn Interim Progress Report 1 2 3 4 Student Classroom Teacher Mathematics Behavior ❑ Satisfactory CI Satisfactory ❑ Unsatisfactory O Unsatisfactory Attendance O Satisfactory ❑ Unsatisfactory Art O Satisfactory O Satisfactory ❑ Unsatisfactory O Unsatisfactory Social Studies Music O Satisfactory O Satisfactory ❑ Unsatisfactory O Unsatisfactory Spelling PE ❑ Satisfactory O Satisfactory ❑ Unsatisfactory • Unsatisfactory Your child needs to: O attend school regularly. O bring the necessary supplies and materials to class. O listen carefully and follow directions. O complete homework assignments, ILIASS a.n tn Prtn13 C work cooperatively. I request a conference with the parent. O Yes El No I request a conference with the teacher. 11 Yes - E No Parent Sign Date 9AM EFTA01710143 cso -fe,ou,h not& ii34-your Ida /lief bu+ r nam6e ao-Fmoraifrovii • EFTA01710144 Ili —uniting Writing Fluency Kindergarten --. First Grade Dates checked Draw picture and tell about it. Draw picture and write random marks. . Draw picture and write letters. Begin to leave spaces. Write the first letters in words. Write the first and last letters in words. Write some middle letters. Write some whole words. Use a period. ' , '•• Use capital letters correctly. i .,/ Write sentences. / Second Grade Yes, I can ... Dates checked Use capital letters at beginning. Put periods at end. Use a capital I for myself. Write two sentences that go together. Write three sentences the go together. Spell sight words correctly. Use spelling dictionary to correct words. Can change or add words to make meaning dearer Can write four or more sentences that go together. -280 EFTA01710145 ad I \ t 166 +h c. rmi kr-1 ( A\ \APIELE'h+ EFTA01710146 Teaching questions ACREAGE PINES COMMUNITY Soiens, for ELEMENTARY SCHOOL tomorrow's answers 10-3 - CLi Date To The Parent(s) Of: Your child, , has been absent 6 times in the last weeks. Excessive absences are detrimental to your child's academic progress. Thank you for your cooperation in this matter. Sincerely, ad* g-Sz77 a1/- GUL 4 oitex V4br. assn Ue Y--xx J cad"1/4 14t, yifaf S/Li sk-4,./LY kx„, EFTA01710147 'SCHOOL BOARD OF PALM BEACH COUNTY ELEMENTARY STUDENT TRANSFE To Be Completed for All Transfets itri C.C% (Print or Type) Last IN Student Number Grade Race Code Sex Parent/Legal Guardian ESOL Status A R E 22 Lunch: Free Li' Reduced O N/A ❑ Psychological or file Yes D No Er Copy of form attached Yes O N/A O Physical Exam en file - Yea D No O Date Ticket attached Yes O NiA ❑ Immunization Dates: 4th DPT ' MMR Health Problems/High Risk Yes 0 WA O Date of Withdrawal / / Days Present Days Absent Principal_ Telephone School Name PX No. School Address Street City State Zip REGULAR INSTRUCTIONAL PROGRAM INFORMATION Current Grade Copy of Report Card Attached Instructional Materials (indicate level) GRADE I 2 3 a 5 PAGE Mathematics I 2 3 4 5 Macmillan O Lcvc: Level Level Level Level Reading FOCUS O Other El Student meeting Pupil Progression Standards Yes O No O Student currently repeating grade Yea D No ❑ Pupil Progression Letter sent Yes O No El School Patrol Yea D No O Letter signed Yea O No O Workbooks sent with student Yea O No O SPECIAL INSTRUCTIONAL PROGRAM INFORMATION Student is in special program (circle) Eli LAD Speech Alt. Ed. Migrant Current LE.P Date N/A O EMI! SEli 501 ESOL Staffing/Testing in Progress Gifted SLD VE Chapter I Other (name program) OBLIGATIONS FULFILLED Textbooks returned Yes ri No O Teacher Signet, Library books returned Yes ID/ No D Office Contact Signature Today's Date °RIC TN AL'.ra Stand YEI-LOWThending .. Mott tlk. POIKJe-salegin folder PM 99331Rn. 111/1,11 WIN 014404 1111124101; MI/Gil/F.14 EFTA01710148 'SCHOOL BOARD OF PALM BEACH COUNTY ELEMENTARY STUDENT TRANSFE To Be Completed for All Transfers (Print or Type) Last Name (Legal) First Name Middle Initial A/6 Grade (ace Code Sex ESOL Status A R E ZZ Lunch: Free IV Reduced 0 N/A 0 Psychological on fde Yes 0 Copy of form attached Yes 0 N/A 0 Physical Exam on fde y Yc Dater-/9- Y3 Ticket attached Yes 0 N/A 0 Immunization Dates: • Health Problems/High Risk N/A Ducat Withdrawal / / ie 96/ Days Present Days Absent Telephonelli PX No. Street !Se City S State 3.31A-7/ Zip REGULAR INSTRUCTIONAL PROGRAM INFORMATION Current Grade Copy of Report Card Attached Instructional Materials (indicate level) GRADE 1 2 3 4 5 PAGE Mathematics 1 2 3 4 5 Macmillan❑ Level .. Level Level Level Level Reading FOCUS • Other • Student meeting Pupil Progression Standards Yes 0 No 0 Student currently repeating grade Yes ❑ No 0 Pupil Progression Letter sent Yes 0 No 0 School Patrol Yes 0 No 0 Later signed Yea 0 No 0 Workbooks sent with student Yes 0 No 0 SPECIAL INSTRUCTIONAL PROGRAM INFORMATION Student is in special program (circle) EH LAD Speech Alt. Ed. Migrant Current 1.E.P Date N/A 0 EMH SEH SOI ESOL Staffing/Testing in Progress Gifted SLD VE Chapter I Other (name program OBLIGATIONS FULFILLED Textbooks returned Yes 21/ No 0 Teacher Si Library books returned Yes e No 0 Office Contact Today's Date ORIGINAL/with ateclert YELLOW/maims othael O11k* PINI/JeumulalIve rows 13.113 0938 (Rev. 10/92) WN 01.9400 IVN292;110/GWF.I.1 EFTA01710149 THE SCHOOL BOARD OF PALM BEACH COUNTY KINDERGARTEN REPORT CARD Year 196 1_3-1a9 Student hool WeAVrus\--ion Teacher ncipal MARKING CODES H - Highly Successful P - Progressing Satisfactorily N - Needs Improvement SOCIAL DEVELOPMENT Marking Period ACADEMIC DEVELOPMENT Marking Period 1st 2nd 3rd 4th 1st 1 4th o. Displays self-confidence Communicates ideas and feelings Practices self-control Speaks in complete sentences Listens attentively/follows Shows interest in stories, books, and poetry directions Understands what is said and read Follows classroom rules and aloud routines Retells a'story • Works independently Recognizes letters introduced Works well in a group Recognizes beginning sounds Completes work in a reasonable introduced amount of time Demonstrates an understanding of mathematical concepts Classifies objects and pictures M R ALTERNATE ASSESSMENTS Marking Period Indicate those used with a check (•f). 1st 2nd 3d 4th A check (1) indicates those areas that, Marking Period if improved, would help your child to Skills Checklist(s) V / t., make additional progress. 1st 2nd 3rd 4th Portfolio Regular attendance ObservationsANritten Comments Getting to school on time Other Additional work at home with adult supervision ATTENDANCE MARKING CODES - FINE ARTS 3 = Outstanding effort and participation Regular attendance and punctuality Marking Period 2 - Satisfactory effort and participation are essential for quality education. 1st 2nd 3/d as 1 - Inadequate effort and participation; parent conference requested Days Present 4 I 45 Days Absent I 0 FINE ARTS REPORT Marking Period Days Tardy I O lit 2nd 3ro 4th Information Included Art Music Physical Education PLACEMENT Grade Special Session PARENT/GUARDIAN1TEACHER Marking Period CONFERENCE • If Special Session progrim is indicated, grade placement will fat '2nd 3d be delemined by the home school. Conference conducted (Indicate dede(s)1 Goldenrod/1st Period PInkand Period Canary/3rd Period Creenbith Period, Whito/Offico Copy Pilot FY 94 EFTA01710150 PANE • SUMMARY YEAR: 94 STDT: SCHL: 1671 GR: KG ST: I CAL: 01 1111111111222222222233 ASSIGNMENTS 1234567890123456789012345678901 ABS PRS MBR : SCHL ENTRY WITHDRAWL I JUL 0 0 0 1 1671 E01 082393 WO2 011894 1 AUG 0 7 7 : I SEP 0 20 20 1 ' OCT A. .T. .... 1 18 19 : I NOV 0 18 18 : 1 DEC 0 13 13 1 ,I JAN 0 10 10 : , . FEB 0 0 0 1 1, MAR 0 0 0 1 .4 APR 0 0 0 1 ., MAY 0 0 0 : .i JUN 0 0 0 : ,i JUL 0 0 0 1 AUG 0 0 0 : TOTAL: 001 026 087 % = 1 99 PFI=HELP 3=EXIT 7=BKWD 8=FWD 12=ESCAPE RECORD IS DISPLAYED...NEXT? TERML: R571 EFTA01710151 Teaching questions ACREAGE PINES COMMUNITY phi hp Sweet:le-. PfDV Pa' for ELEMENTARY SCHOOL tomorrow's 14200 Orange Boulevard, Louhatchea, FL 33470 answers (407)795-4994 March 1, 1994 Dear Parent, The State of Florida has asked that we obtain the following information on all students in kindergarten: Has your kindergarten c • d had pre-kindergarten experience? Yes No If yes, please answer the following: The program my child attended was pablic School 17Private Pre-school Home-based Day Care Other Please state other. Teacher's Name Please return this form to your child's classroom teacher by Friday, March 4th. Sincerely, S ata Processor illi EFTA01710152 PICTURE CARD Name LAST IMST MIDDLE SchooINtslekAi_n*Catv_itt School School Year Year 9, "IL Grade Grade School/Del 4{ et CEN School School Year ThAs 7 -- Year Year Grade--.3 ________ _ ________ Grade Grade EFTA01710153 I verify that I have received and read the initial eligibility requirements of the Florida Bright Futures Sc EFTA01710154 THE SCHOOL DISTRICT OF PALM BEACH COUNTY SY: 04 9-12 Academic Improvement Plan (AIP) LH. PALM litACH COM Get lO 008: PISS: 3 Marking Period Monitoring Dates: FNRT. MATH: FCAT: REAL: PATH: First / / MAP: A . R—ZZ 14—ZZ M—FZ. S-IL Second PRIM: 504: LEP: Third / / Fourth _......_ 0< • 0 READING exttook Assessments 0 WRMNG Palm Beach Writes 0 Portfolio aTe ErMATHEMATICS 0 Portfolio Assessments 0 SCIENCE • Textbook Assessments ❑ Portfolio . FCAT Diegi lc 1PractiCe EjP.eformanceAssessments agerformance Assessments 0 Perftenance Assessments Tests ❑,."FCAT DiagnoshciPnectice Tests OFCAT DI29110StkiPtadiCA Tests 0 FCAT Diagnoshr/Practice Tests 0 Diagnostic Software 0 Diagnostic Software 0 Diagnostic Software • Diagnostic Software 0 Other (see attached) 0 Other (see attached) 0 Other (see etached) 0 Other (see attached) 0 Phonemic Awareness Types of Writing Erhumter Sense, Concepts and D The Nature of Matter 0 Letter ReccgnMon 0 WOd/SentenCe writing Operations 0 Energy 0 Phorics: Sound I Symbol r‘grapti Writing ameasuremert 0 Force and Motion Ceneupinsiendie Composition Writing aGeornetry 0 Processes that Shape the Earn ring/Encoding [Algebraic Inking 0 Earm and Space Awareness /Application of FOCUS OF 0 , 0ata Analysh ard Probability e•-i Meaning 0 structure Li Processes of Lite FCAT Writing Rubric 0 Readng n Content Area RELEGATION 0 visual (phonk::5) 0 How Living Things Interact win Fluency ill Focus a SuPPut their Environment Spec Concepts 0 High Frequency Words 0 Organization Illi Ccaventicns 0 The Nan of Science C0,0303 0 Rate Compositions D Reading in Content Area Meaning 0 arrative Specific Concepts 0 Vocabulary dory • Ej Text Comprehension Persuasive -Untie/mom STRATEGIES Tutoring Tutoring Tutoring Tutoring 0 School Day In pang School Day El Moro School Day 0 During School Day AftenBefore School/ Saturday SS After/Before School/Saturday 0-MeriBefore School/Saturday 0 After/Before School/ Saturday instructional Alternatives Instructional Attematives Instructional Alternatives Instructional Afternatives INSTRUCTIONALDBNERY El Temporary Skill Grcups 0 Temporary Skill Groups 0_,..Temporany Skill Groups 0 Temporary Skill Groups • Cooperative Learning Groups 0 Cooperative Learning Groups 3 - Cooperative Learning Croups • Cooperative Learning Groups 0 Guided Reading/Writing Groups 0 Guded Reading/Writing Grabs . Technology El Guded ReadingAMiting Groups INTERVENTIONSTRATEGIES 0 Technology • Technology 0 Technology 0 Other (see attached) • Other (see attached) 0.Other (see attached) 0 Other (see attached) Assignment Alternative Assignment Alternative Assignment Alternative Assignment Alternative 0 Time 0 Time D Time Time 0 Quantity 0 0 Quantity 0 Quantity D Quantity 0 Prockact Recuirements 0 Product Requirements 0 Product Requirements • Product Requirements Child Study Referrals 0 • Child Study Referrals 0 Child Study Referrals 0 Child Study Referrals Instructional Reading 0 3 Instils:IWO Language Ms 0 Piste:hone/ Melellatcs 0 Instructional Reading Student progress will be monitored throughout the school year, and student progress will be reflected on the report card. 0 Suocessfulty Remedlated 0 Suotessfuly Ben:dieted 0 Successfully Rernediated 0 Successkily Remedlated .., ,_. 0 Requires New AIP Next Scholl 0 Requites New AIP Neel School 0 Requires New AIP Neil School C Requires New Ala Next r.1 Year 0 Spedal Services I Placement 0 omen (see attached) Year • Spedal Services/Placement 0 Other (see attached) Yea Year - I Placement hod) 0 Deficiencies due to non-attendance (refer to Attendance Specialist Number of Days Absent DATE Parent/Guardian Contact Commitment/Contribution awe es that ropy O Monitor Attendance / Tardies 0 Check Homework O Read with Child Every Night 0 Reinforce Skills O Attend Parent Conferences 0 Sign DaityMteekly Notes O Attend Parent Curriculum/ hduitnetion Meetings LNER PBSD 1887 (REV. 9/13,2002) ORIGINAL • Cumulative Folder COPY • Teacher COPY - Parent/Guardia-1 EFTA01710155 STUDENT RECORD FOLDER 4 COMPOSITION Grades 3-6 PALM BEACH COUNTY PUBLIC SCHOOLS GRADE 3 INTEGRATED COMPOSITION Fall Testing Spring Testing School tie-keAev-cA School N\e-- Na*C A Teacher Teacher f Date S.S.0.44tWO Rank 3 Date )4`y Rank The student needs further work on: The student needs further work on: Response to Prompt Response to Prompt - Audience Audience - Development Development - Organization/Sequence - Organization/Sequence Details Details - Vocabulary - Vocabulary Sentence Structure Sentence Structure - Grammar _Grammar Mechanics Mechanics UNIT EVALUATIONS UNIT ONE — Photo Story Date Rank UNIT TWO — Journal Entry Date Rank UNIT THREE — How-To Report Date Rank UNIT FOUR — Friendly Letter Date Rank UNIT FIVE — Story Ending Date Rank UNIT SIX — News Story Date Rank UNIT SEVEN — Book Report Date Rank UNIT EIGHT — Descriptive Paragraph Date Rank RANK: 4 - Outstanding 3 - Reasonable , 2 - Minimal 1 - Insufficient FY 93 PRINTING lemPRF EFTA01710156 )ky FOVOP iteTk 'og My Fay° Pi7Le Y-1)/i-6 is Pv Lloch coteM • TT Lt -1-)as IDecoine 5?ec; a / O me hecouse for, Irny rnoro 99 otjf O7e. 11i is a/So Si oec,a/ , be Cause. ir*, cot 'di-,ed end vegot-anotAet C&71;-, s My ca isrny PaVon EFTA01710157 3 , 0010 r th \NOS Her le)apn p \N hen '()Of She. unpe2 \Al 0 dy) otcAp y t t ±VMQ.1O001., StcLwien \NIG ctA aA \-O r vc. Ir\o r fo rv- 3 e \\-;(2 Coo.por:Ires T r ib Thew EFTA01710158 My F-O‘..\10C1-1-e r \--I,n3 \No“ --777 ACIP-elevi rf y t, 070 PI- fiTITT-- • TiA tifPd 077- re-V) :VT - c/o-L.04 :9 o1--) ; de. a rA A p 1 (N, -tn p ki‘7 ov kiAA io sett- -1,--)-p-r - T-----OFT-TrrnTral en vve I erir, • _N-46 rny rj,\)ur fte—±tir EFTA01710159 6/6/96 6:46am COURSE PERFORMANCE Page Class(es) : Student('s) Course(s) : Total Total Total Corr/Att Percent Enrol l IPM Current Course Time Exercises Correct Level Level Level Gain 24/95) MCS 27:54 1.49 1.83 2.81 0.98 IR 21:25 1.00 1.67 2.99 1.32 FAB 7:28 N/A N/A N/A N/A RW 5:59 2.80 2.83 3.02 0.19 PS 0:52 3.11 3.52 3.31 -0.21 LS 1:05 3.00 3.80 3.82 0.02 TRN 1:47 1.00 1.64 1.73 0.09 RA N/A N/A N/A N/A GRAND TOTAL RECORDS = 1 Copyright (c) 1991-94 by Computer Curriculum Corporation. All Rights Reserved. If the format of this report is altered by the customer. CCC shall not be held liable for any inaccuracies that may occur in the report as a result of such alterations. EFTA01710160 5/27/97 1:33pm COURSE PERFORMANCE 302 200R2I (continued) Total Total Tot Cor/At Per Enr IPM Curr Tot Crs. Time Exer Corr Lvl Lvl Lvl Sess Gain - 10/9/96) RW 10:59 3.00 3.54 4.02 57 0.48 MCS 12:03 2.50 3.53 3.80 54 0.27 LS 0:50 3.00 -- 3.67 5 0.00 EFTA01710161 2000-2001 YEAR Si ULU" I AorcQ an HOME PHONE Seventh graders will have FOUR academic subjects (Language Arts, Math, Comprehensive Science and Social Studies) and up to 4 ELECTIVE! Choose one of the elective options below: ND Select 1st, 2nd and 3rd choke. 5 8600110 SHOP 81 fi-Aat 8200220 *COMPUTER APPLICATIOD set- Lato OR 0708000 BEG. SPANISH/JAPANESE Students in .eption: Students who are reading below grade level will not be exempt frc reading. TI hr school tutorial program or they will be removed from their year long electi to take nim 13 13 13 1303000 CHORUS I (Grades 7 - 8) 1303010 CHORUS 11 (Grades 7 - 8) 13021I0 HANDBF.LLS 1(Grades 6 - 8) 1302120 *HANDBELLS II (Grades 7 - 8) NOTE: • Requires teacher recommendation. Elective courses are subject to administrative change based on availability. Unless this form is signed and returned, we will select the stude electives. Limited space may be available for Art, taught outside regular school hours. If interested, request an application from your Guidance counse s S nature Student's Signature EFTA01710162 October 2004 NAME: Florida Comprehensive Assessment Test (FCAT) ID. SSS Reading and SSS Mathematics Retake Tests SCHOOL: 2331-ROYAL PALM BEACH HIGH Grade 11 Student Report DISTRICT: SO-PALM BEACH lbw4a (cart-4r sive Attisoniro This report shows your resists from the Grade 10 FCAT Retake lest(s). Passing both the Grade 10 Reading and Mathematics Tests is a requirement 'or a standard Florida high school dipoma. Student's must earn an FCAT Score of 1926 or better in Reacing and 1889 or better in Mathematics to meet the graduation requirement. The FCAT measures your performance on selected benchmarks in reading and mathematics as defined by the Sunshine State S'andards. Scores on this test are one indication of your achievement cil the challenging content: that Florida students are expected to know. Your Reading Results Your Reading FCAT Score F Ac'reverr ent You did not pass the Grade 10 FCAT Reading test. Talk Szere• Love I Passed to your teacher or guidance counselor to find out about ways to Improve and when you may retake the test. Your Reading Content 3000 Content Areas Points Perils Earned Possinie 24C0 Wads/Phrases Mail Idea/Purpose 1800 Comparisons Reference'Research 1200 Reading Content Content scores give more specific information about COO the skills on the FCAT Grade level expectations for studenis include: • Words and Phrases -uses skills to deterrrine word meaning, including word naffs and relationships between words. • Main Idea/Purpose -determines a slated or implied essential message, details. student scot. rasingSas authors purpose, Cr pbt. • Comparisons • knows simile- and different, cause and oiled, and contrast. 'This score Mows your achievement on the day • ReforencetResaarch •uses infomat ion from a variety o! sources to reach you were tested, d you were to take the sane test was. Is Italy cial your 2005 Reading conclusions score would turf between 17S4 and 1891 Your Mathematics Results Your Mathematics FCAT Score FCAT Achievement We were unable to find a Mathematics score that matched your Store' Level Passed student identification number. If you took the test this year, be sure to contact your school about locating your FCAT test scores. NT NT Your Mathematics Content 3000 Points Penis Content Areas Earned Possible 2400 Number Sense Measurement 1800 Geometry Algebraic Thinking 1200 Data Analysis SOO Mathematics Content - Content scores give more specnic Ho:metier about the skills on the FCAT Grade level expectations for students include: 0 • Number Sense -uses number concepts and computation skills. Stickni C< or. Psauril Cc or. • Measurement -saes problems involvng measurements, e.g., time, length, area • Geometry - analyzes and combines shapes to solve problems. ▪ Algebraic Thinking -analyzes patterns and uses equations and inoquaktios • Data Analysis and Probablity -uses data analysis tools to display in'ormation. make predichoss and make nferences. NT-Not Tested NR-Not Reported Data Run Date - 11/22/2034 0115252 EFTA01710163 V10.41-1 \ CI ine_.., 3 SSeSSOrientS qiackf-6 Chapier ) C.kaep-kv-- 2 / 0/2 thg FirE 3. C1-wpi-er 3 /// 1 Pe DATE Ckcp+er /745-(th c.C\-)c1/4epier //If ppRTE ;.C .;? -Ver G Ckcpfer q47 b ckApitc 1. Ckcke -ler 9 RTE 0 Ohap-f-cr 10 I.Ckap -kr I Pot 2,CA-No,picr DATE EFTA01710164 Page: 1 Document Name: untitled PANEL: A07. ASSIGNMENT HISTORY YEAR: 07 WArinacAm.u. Minn 1t5, 2006 10:30 am STDT: SCHL: 2331 GR: 12 ST: I A ENTRY WITHDRAWAL P E C CD DATE OD CD DATE R PF SY CL DS SCHL DESC GR PRS ABS Y DS CO E01 081005 W06 060106 P 06 01 2331 ROYAL PALM HIG 12 172 Y 50 US E01 081104 __ WO1 060105 P 05 01 2331 ROYAL PALM HIG 11 169 6 Y 50 US E01 081303 __ WO1 060104 P 04 01 2331 ROYAL PALM HIG 10 178 2 Y 50 US E01 081402 W01 060403 P 03 01 2331 ROYAL PALM HIG 09 177 3 Y 50 US E01 081401 W02 060302 P 02 01 1691 CRESTWOOD MID 08 172 8 Y 50 US E01 081800 W01 060401 P 01 01 1691 CRESTWOOD MID 07 173 5 Y E01 082097 W03 022598 N 98 01 1441 MELALEUCA ELEM 04 114 Y E01 082196 W01 061197 P 97 01 1441 MELALEUCA ELEM 03 174 6 Y E01 082395 W01 061396 P 96 01 1441 MELALEUCA ELEM 02 172 8 Y E01 082395 W02 082395 N 96 01 2141 ACREAGE PINE E 02 E01 082294 WO1 061595 P 95 01 2141 ACREAGE PINE E 01 170 10 R02 011894 W01 061094 P _ 94 01 2141 ACREAGE PINE E KG 93 Y _ E01 082393 W02 011894 _ _ 94 01 1671 WELLINGTON ELE KG 86 _ PF1=HELP 3=EXIT 5=REFRESH 7=BKWD 8=FWD 12=ESCAPE NO ADDITIONAL PAGES...NEXT? TERML: DQ35 Date: 8/16/2006 Time: 10:30:12 AM EFTA01710165