EFTA01710219

FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.03Z, 402.305, 402.313, Florida Statutes; rules 640-3.011, 65C-22.006, 65C-20.011, Florida Administrative Code LAST N FIRST NAME MI DOB (MO/DA/YR) PARENT OR GUARDIAN CHILD'S SS# (optional) STATE IMMUNIZATION IMP Directions: Enter all appropriate doses and dates below. Sign and date appropriate certificate (A-1, A-2, B, or C) on reverse side of form. If the child is presenting for the 7 th grade requirement only and has previously filed a Certificate of Immunization (DR 680, Part A-1) with their current Florida school, fill in boxed areas below and complete Part A-2 on the reverse side of this form. For additional information: See Immunization Guidelines for School and Child Care Facilities for information and instructions on form completion and immunization requirements. Guidelines are available from the local county health department. DOE Dose 1 Dose 2 Dose 3 Dose 4 Dose 5 VACCINE CODE %4 all‘h ta III Lit II • Al . A P .a • lb . SAP • . • DTaP/DTP2 A Teti Polio' Hill MMR (Combined)' F. (Separate)° G,H,I Hepatitis B9 Varicella" Varicella Disease L Year I The state immunization ID# is an identifier supplied by the state immunization registry (optional). 2 DTP/DTaP 5 doses required. If the 46 primary dose is administered on or after the 46 birthday a 56 dose is not required. 3 DT (pediatric) is acceptable if pertussis vaccine is medically contraindicated. (Complete Part C for pertussis contraindication) 4 Td (adult) vaccine 'is recommended for children 7 years of age or older. 5 Polio 4 doses required. If the 3" dose in an all OPV or all IPV series is administered on or after the 4" birthday, a 48, 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 21" dose of measles (preferably MMR) is required for students in grades K-6 and 7'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 (11) or single rubella vaccine (I). 9 Hepatitis B vaccine series is required for 7th grade entry and attendance effective with the 1997/1998 school year and kindergarten entry and attendance effective with 1998/1999 schoollear. In each subsequent year thereafter the next highest grades arc included. Hepatitis B vaccine series is required for preschool entry and attendance effective with the 2001/2002 school year. 10 Varicella is required for entry and attendance in child care and family day care effective July 1, 2001. Varicella vaccine is required for entry and attendance in preschool and kindergarten effective with the 2001/2002 school year. In each subsequent year thereafter, the next highest grades are included. Susceptible children 13 years of age or older should receive 2 doses, given at least 4 weeks apart. Varicella vaccine is not required if child has documentation of history of varicella disease. EFTA01710219 LAST NAME FIRST MI DOB moroArxit) , Certificate of Immunization for K-12 Eicluding 7th Grade Requirements PART A-I (Immunizations are complete for school entry and attendance grades kindergarten through 12 with the exception of the 7th grade requirement.) DOE Code 1 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) and varicella, varicella vaccine not indicated if history ofdisease either physician documented or parentalrecall (for kindergarten effective with the 2001/2002 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 Tb 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 reviewed the records available, and to the best ofmy knowledge, the above named child has received thefollowing immunizations requiredfor entry and attendance in 7. grade effective with the 1997/98 school year: tetanus-diphtheria booster, hepatitis B vaccine series, and second dose of measles vaccine as docurn. Physician or Clinic Na Physician or (Print or stamp) horized Signatur Addr•• . Date: --1 1St (C)--' Temporary Medical Exemption PART B (For children in child care, family day care, preschool and grades kindergarten through 12 who are incomplete for immunizations in Part A-I or A-2.) Invalid without expiration date. DOE Code 2 I certtfr 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: . . i 05•days after next immuilization.appoiutrnent) (Print or stamp) . .• _ . .. 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 I certifr that the physical condition alibis child is such that immunization(s) as indicated in Part C above is medically contraindicated. Physician or Clinic Name: (Print or stamp) Physician Signature: Address: Date: DH 6$0 72001, obsoletes earlier editions (Stock Number 5740-000-06SO-6) EFTA01710220 ALTH EXAMINATIONS Date Student' Full NamllM glIllt Phone Race Address Birthdate Name of Parent cr Guardian School A. HEALTH EXAMINATION Height Weight Blood Pressure (1) Normal-N; Abnormal=A N A COMMENT: Abnormal Findings, by number 1. Appearance 2. Skin/Nose 3. Head/Scalp 4. Eyes J 5. Visual Acuity (R & L) 6. Ears 7. Auditory Acuity (R & L) 8. NOSe / Throat 9. Mouth. Teeth and Gums 10. Chest / Lungs 11. Heart 12. Abdomen 13. Genitals and Anus 14. Musculo-Skeletal 15. Neurological 16. Alertness 17. Emotional / Mental/ Behavior Prob.) 18. Handicap. physical/ other (Specify) 19. Activity Restrictions (Specify) 20. Abuse. substance/ physical / emotional 21. Nutrition 22. Other B. HEALTH HISTORY (Serious Illnesses Injuries: explain) (attach narrative it additional space needed) C. LABORATORY Hemoglobin/Hematocrit Stool 1O & P) Tuberculin test: Lead Sickle Cell Authorized Signature OH 3040. 10190 (Replaces NRS-li Form 3040 which may be used) (Slack Number 5741-000-3040-2) EFTA01710221 ERs STATE OF FLORIDA DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES HEALTH EXAMINATIONS Dale if Mr - Student's Full Name Phone Race Sex Address Birthdate Name of Parent or Guardian A. HEALTH EXAM NATION Height Weight Blood Pressure Normal=N; Abnormal-A N A COMMENT: Abnormal Findings, by number 1. Appearance 2. Skin/Nose 3.1-lead/Scalp 4. Eyes 5. Visual Acuity (R & L) 6. Ears 7. Auditory Acuity (R & L) 8. Nose / Throat 9. Mouth, Teeth and Gums 10. Chest / Lungs 11. Heart 12. Abdomen • 13. Genitals and Anus 14. Musculo-Skeletal 15. Neurological 16. Alertness 17. Emotional / Mental/ Behavior Prob.) 16. Handicap. dirge& • other (Specify) '19. Activity Restrictions (Specify) 20. Alatise. substance/ physical / emotional 2 1.Nutrition 22. Other B. HEALTH HISTORY Serious Illnesses Injuries: explain) • (attach narrative if additional space needed) C. LABORATORY (as Indicated) tYP mylotin/Hematocril Stool (0 &12) Lead Tuberculin test: Sickle Cell resu NAME: TITLE: ADDRESS: (Please Print) MRS-li Form 3040, Mar 91 (Obsoletes previous ' (Stock Minter: 5744-000-3040.2) EFTA01710222 SUR C fleala • FLORIDA CERTIFICATE OF IMMUNIZATION (HRS 680 - PART A) (1+) HRS. OCl/AlliCra Of MUM, WO (Florida Statutes 232.032) FOR CHILDREN WHO HAVE COMPLETED ALL REQUIRED IMMUNIZATIONS FOR SCHOOL ATTENDANCE CHILD'S NAME (PRINTED) SS YR' PARENT OR GUARDIAN DOCTOR: PART A OF THIS FORM IS USED ONLY IF TILE CHILD HAS RECEIVED ALL REQUIRED IMMUNIZATIONS LISTED BELOW. IF 110T. SEE REVERSE SIDE. DTP - 5 DOSES REQUIRED 110) IF THE FOURTH PRIMARY DOSE GF DTP IS ADMINISTERED ON OR AFTER THEFOURTHRIRTHDAY, A FIFTH-DOSETS NOT REQUIF.ED. DT (PEDIATRIC) VACCINE IS ACCEPTABLE IF PERTUSSIS VACCINE-IS-MEDICALLY- CONTRAINDICATE!). (COMPLETE PART C FOR•PERTUSSIS CCNTRAINDICATION.) (V) Td (ADULT) VACCINE (A SERIES OF 3 DOSES) IS ACCEPTABLE.AND'RECOMMENDED FOR CHILOREN:.7 YEARS OF A0E.OR OLDER. (C) POLIO - 4 DOSES REQUIRED IF THE THIRD PRIMARY DOSE CF OPV IS ADMINISTERED ON OR AFTED.THE'FOURTH BIRTHDAY, A FOURTWDOSE is NOT REQUIRED. IPV IS AN ACCEPTABLE ALTERNATIVE :F OPV IS NOT INDICATED. FOLIO VACCINE IS OMITTED FROM THE REQUIRED IMMUNIZATIONS OF GIOLDREN 18 YEARS DF.A5E OR CUTER. MEASLES. MUMPS, MD RUBELLA — 2 DOSES REQUIRED FOR MEASLES 1 DOSE REQUIRED FOR MUMPS MD RUBELLA • MMR COMBINED — 1st DOSE AT 12 MONTHS OF AGE Oft OLDER.(RECOMPSENDED AT 15 MONTHS). (F*) 2nd DOSE REQUIRED PRIOR TO KINDERGARTEN:ENTRANCE , (VAUD IF GIVEN AT LEAST 30 DAYS AFTER 14;005E) MEASLES SINGLE — 1st DOSE AT 12 MONTHS OF AGE OR OLDERBECOMMENDEDAT 15 MONTHS) (G) 2nd DOSE REQUIRED PRIOR TO KINDERGARTENPJIRANCE (VALID IF GIVEN AT LEAST 30 DAYS AFRER.1g.DOSE) MUMPS SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER. (11`) •. RUBELLA SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER (P) 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 HAVE REVIEWED THE RECORDS AVAILABLE AND TO THE BEST OF MY KNOWLEDGE THE ABOVE NAMED CHILD HAS BEE DIPHTHERIA, TETANUS PERTUSSIS, POLIO, MEASLES, MUMPS, AND RUBELLA AS REQUIRE PHYSICIAN OR CLINIC NAME (PLEASE PRINT) )E AUTOMATED STUDENT DATA BASE CODES: • IMMUNIZATION STATUS CODE / 11 VACCINATION CODE EFTA01710223 DATE OF BIRTH CHILD'S NAME (PRINTED) SSO MO DA YR PARENT OR GUARDIAN DOCTOR: IF THE CHILD HAS NOT RECEIVED THE REQUIRED DOSES LISTED IN PART A, PLEASE COMPLETE PART B OR PART C, AS APPROPRIATE, AND SIGN AND DATE. TEMPORARY MEDICAL EXEMPTION (HRS 680 - PART B) (21 . FOR PRESCHOOL CHILDREN AND FOR SCHOOL CHILDREN WITHOUT ALL IMMUNIZATIONS REQUIRED IN PART A I CERTIFY THAT THE ABOVE NAMED CHILD HAS RECEIVED THE IMMUNIZATIONS LISTED BELOW AND HAS COMMENCED A SCHEDULE TO COMPLETE THE REQUIRED IMMUNIZATIONS. ADDITIONAL IMMUNIZATIONS ARE NOT MEDICALLY INDICATED AT THIS TIME. #1' #2 #3 #4 #5 TYPE VACCINE CODES' DATE (MO/DA/YR) DATE (MO/DA/YR) DATE (MO/DA/YR) DATE (MO/DA/YR) DATE (MO/DA/YR) DTP A DT B Td C POLIO D Hib E MMR F AUREOLA (MEASLES) G EXPIRATION DATE (MO/DA/YR) MUMPS H (SHOULD BE 15 DAYS AFTER NEXT APPOINTMENT) RUBELLA I • PHYSICIAN OR AUTHORIZED SIGNATURE DATE PERMANENT MEDICAL EXEMPTION (HES 680 - PART C) (31 I CERTIFY THAT THE PHYSICAL CONDITION OF THIS CHILD IS SUCH THAT IMMUNIZATION(S) IS MEDICALLY CONTRAINDICATED. LIST VACCINE(S) AND STATE VALID CLINICAL REASONING OR EVIDENCE FOR EXEMPTION FOR EACH VACCINE. PHYSICIAN OR CLINIC NAME (PLEASE PRINT) PHYSICIAN'S SIGNATURE DATE HRS Form 680. JAN 93 (Repbces Mat 91 edition which may be ized) (Stock Number 5740-000.0680-6) DOE AUTOMATED STUDENT DATA BASE CODES: ' IMMUNIZATION STATUS CODE / ' VACCINATION CODE EFTA01710224 THE SCHOOL DISTRICT OF PALM BEACH COUNTY Grade (.5 ELEMENTARY REPORT CARD Year 2000-2001 Student School Teacher Principal MARKING CODES - ACADEMIC SUBJECTS SOCIAL DEVELOPMENT/CLASSROOMSTUDY HABITS GRADES 1 and 2 Please work on the area(s) that have a check (/). E - Excellent S - Satisfactory Marking Period V - Very Satisfactory N - Needs Improvement tat I 2nd I 3rd I 4th GRADES 3-5 Overall effort A - Outstanding (94% - 100%) Works cooperatively B Above Average (85% - 93%) Works independently C Average (77% - 84%) D Below Average (70% - 76%) Completes classwork on time F Failing (0% - 69%) Completes homework on time Incomplete Follows classroom rules and routines Uses time wisely ACADEMIC SUBJECTS Marking Period Follows directions 14h 1st I 2nd I 3rd Accepts responsibility for own M-lh=m-IicS ' care level Hdf a check) actions Comes to class prepared with materials 1...ztak....!1.LJAP - o A' pr ALTERNATE ASSESSMENTS Marking Period Composition Indicate those used with a check (/). MEMZEIMIT2IMI Skills Checklist(s) Language Portfolio Spelling Audio Cassette Recording Handwriting/Penmanship Video Recording Social Studies Computer Program Standardized Test(s) Science/Health Observations/Written Comments Grades not given this nine week Other ATTENDANCE Marking Period Regular attendance and punctuality are essential for quality education. Billaliilla Days Present FINE ARTS REPORT Marking Period Days Absent 1121EIMES Days Tardy Art Information Included Music Physical Education PLACEMENT PARENT/GUARDIAN/TEACHER CONFERENCE Conference conducted (Indicate date(s)) Marking Period 1st 12nd 3rd 4th Grade A Special Session • If Special Session program is Indicated, grade placement will be determined by the home school. PBSD 0768 (Rev. 7/99) Goldenrod/1st Period Pink/2nd Period Canary/3rd Period Green/4th Period White/Office Copy EFTA01710225 THE SCHOOL DISTRICT OF PALM BEACH COUNTY 2000- ort for Grades 1-5 Se DEM GRADE 2000-2001 ACADEMIC IMPROVEMENT PLAN STATUS Your child's academic performance was at or above grade level in reading, writing, and mathematics, and an Academic Improvement Plan (AIR) was not necessary. Your child's academic performance was below grade level and an individual Academic Improvement Plan (AIP) was necessary for ❑ reading ❑ writing ❑ mathematics This AIP identified remediation strategies used to assist your child this year. Your child may need another AIP next school year. Your child's academic needs were addressed through his/her Individual Education Plan (IEP), Limited English Proficient (LEP) Plan, or 504 Plan. END-OF-YEAR PERFORMANCE Your child's end-of-year performance level in reading, writing, and mathematics is identified below: TING(COMPOSITION) MATHEMATICS If less than one year below grade levelhas boon indicated for reading, writing, and/or mathematics, you may be asked to participate in the development of a plan to improve your child's academic performance. This plan will be developed at the beginning of the 2001.2002 school year. If more than one year below grade level has been indicated for reading, writing, and/or mathematics, you must have an LEP Plan, IEP, 504 Plan and/or AIP. You will be asked to participate in the development of a plan(s) to improve your child's academic performance. This plan(s) will be developed at the beginning of the 2001-2002 school year. PROMOTION/RETENTION DECISION As a result of your child's performance this school year, your child is being recommended for: j' Promotion to the next grade level ❑ Promotion to the next grade level with an LEP Plan, IEP, 504 Plan and/or AIP ❑ Good Cause Promotion from fourth grade to fifth grade with an LEP Plan, IEP, 504 Plan, and/or AIP ❑ Retention in the same grade level SUMMER SCHOOL/EXTENDED SCHOOL YEAR RECOMMENDATIONS The promotion/retention decision for your child will be made following the completion of Summer SchooVExtended School Year. ❑ Summer School (for Limited English Proficient students) ❑ Extended School Year (for Exceptional Student Education students) OATE PBSO 1674 (REV. 4/262030 ORIGINAL - Cumu%6ve Folder COPY - School Use COPY - Report Card EFTA01710226 )puny 4WD Florida Comprehensive Assessment Test® FLAT Sunshine State Standards Reading Cove5nsive Asia mutt Tell Performance Task Student and Parent Report Grade 10 This report shows your results on the FCAT Reading performance tasks. Each performance task on the FCAT requires either a short response or a longer, more detailed response. Short-response tasks are scored out of 2 points and extended-response tasks are scored out of 4 points. ID School One of the short-response tasks is shown below with a copy of your answer. The number of points you earned on all District 50-PALM BEACH performance task items is also included. Your Score This task required you to read an informational passage and then answer how ,Marteatitereain 0 ,1 On all Reading performance a blind painter's determination led to her success. out of 10 points task responses (al-11:n d er uarit tvira tyr -to co cior ar take Ox-k 14 Ural M -C, %Ulla VG:O not- + OVA- one could do, Artie 1013%-kr) teepnCS /4 W Osts %re\ -One err, src cecerre yuccaatftt.4% coot r4 ‘s rcui in rruse U tit 5 (Sit trg sold 1 ice a -true or -fists twootg., teNdq, I Z DIE. 51-1,:i1C,.? EFTA01710227 4-pooLDia THE SCHOOL DISTRICT OF PALM BEACH COUNTY El High School 14 Grade andlor Course Change 0 Middle School Documentation 0 Elementary School ENT NUMBER GRADE LEVEL STUDENT NAME la test trocgo .W419 \ SCHOOL. NUMBER SCH YEAR COURSE TAKEN SCHOOL sippiam eounEtwis 2331 Q_ CHANGE DOCUMENTATION GRADE EXAM • CONDUCT GRADING PERIOD From From To -2: al C\ j To From_ From From To To To Change course code From To Reason for change ❑ Recalculated Grade Average ❑ Student Completed Work CI Other (explain below) APPROVAL SIGNATURES (two of three required) DATA PROCESSOR CONFIRMATION I confirm that the grade/course change has been implemented. Lo \ \ \Ott . DATE DATE bh siGvA DATE -oc DATE PRINTNAME PBSD 0797 (REV. 511412004) ORIGINAL - Cumulative Folder Copy - Office File EFTA01710228 JOENT NAME: SEX: RACIAL/ETHNIC GROUP: Hispanic G Mao Not Hispanic o can IndlanfNatIvo Alaskan tai G Black Not Hispania G Asian/Pacific Islander O Muhl Racial PHONE NUMBER: (options!) ' :THDATE Verified by WW1 CoAlkalis: G Yes G No a No. What Typo Verification? -c iTHPLACE: Dad,p, OR OTHER RESPONSIBLE ADULT AT HOME: OA RREN SCHOOL use In Lnis e until (Ins lie let Grader Schock Grade: Dale First Entered This ()kirk' School: (Pada I o, Shoot. Grade: Selma Grade: &Moo: Year ?Etat) . Ct 1 &hoot Year 19 • Saud Year. 19 • School Mac 19 • School Year. 19 • Days Present Days Absect: s Days Piaui* Days Absent Days Present: Days Absent Days Present Days Absent: Days Present: Days Absent 7 C OPY OF REPORT CARD COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED INDCA111,1 INDICATE INDICATE 1110CATE INDICATE Adra st Adninisuatree AdrrOntstadv• . Achohlandie Administrative Place Placomenl (ADMP) Rammed (ADMP) Reamers (ADMP) Pimento-or (ADMP) Promote (P) Picmole (P1 Remote (P) Promote (P) Nandi) (P) actin (R) Nato (R) Rosin (R) Borah (R) Retain (R) Special Scission (SS) Special Swan ($S) Spacial Session (SS) Special Session (SS) Spacial Session ($5) School: Grano: Schoot Grade: School: Grans: School: Wade: Schoot I Duck: &Mod 'frac 19 • School YON 19 • School Veer 19 - School Year 19 School Year 19 • Days Present Days Absent Dais Present Days Absent Days Present Days Absent Days Present Days Absent: Days Present I Days Absent COPY OF COPY OF COPY OF COPY OF COPY OF REPORT CARD REPORT CARD REPORT CARD REPORT CARD REPORT CARD INCLUDED INCLUDED INCLUDED INCLUDED INCLUDED yL INDICATE INDICATE INDICATE INDICATE INDICATE Administrative AchnInlsitallve AttmlnIstratVe ActnlaWratIve AdmInIstrerive Placement (AMP) Placement IADMP) Nommen: (ADMP) Placement (ADMP) Placement (ADMP) 0 Promote (P) Promote (P) Promote (P) Promote (P) Promote (P) 4 Rash (R) Retain (R) Rusk (R) Roth (R) MUM (R) CC Special knort-in ($5) Special Session (SS) 17 Spode] Session (5$) Spodel Swan (SS) Special Session (SS) 0973 (REV 3/20417) EFTA01710229 414OOLDIS\ THE SCHOOL DISTRICT OF PALM BEACH COUNTY (SONIC) (1) STUDENT NUMBER (2) SAC CODE (3) GRADE LEVEL New and Returning Student Registration 1 NEW STUDENTS: Complete all areas ontoth sides of the form axcept areas specified office use only . A t, A-) RETURNING STUDENTS: Review both sides. If the pre-printed r formation is incorrect, correct the information 4°°tIV by carefully and lightly crossing out the incorrect information and Writing the correct Information above it. IIIIIIMa m (S) ALSO KNOWN AS • (6) KEY/ (slab) (rbood.) (7) INULING ADOFTESD(hease rox d abed name) OFT• no) Royal Aim /30ach H. 33 V// (Nay) (31•10 NO code) (8) SOCIAL SECURITY NO. topSons9 (9) HOME TELEPHONE NO. !PM SEx O n RACEJETISNIC ORIGIN O I-American Indian/Alaskan Native O 8-Black, Non-Hispanic N -I-Hispanic e • O A-Asian/Pacific Islander O W-White. Non-Hi panic O M-Multiracial (12) DATE OF BIRTH (I3) PLACE OF BIRTH (city, stale. counIty) 04) RESIDENT STATUS (13) USA ENTRY DATE AIM Y (MMODYVYY) • Ph n Aw El. (la)FEDERAL IMPACT SURVEY . ppcie govoi O O. Foreign Exchange Student ❑O 1. Out-of-county Resident. O 2. Out-of-state Resident YES NO CI 3. In-County Resident O O A. The student resides on federal property. (17) PRESCHOOL ENROLLMENT INFOALIADON Place an X by each program attended. Also, indicate with an o Ei B. The student resides In low rent housing. asterisk ("the program your child was in the longest O O c. The parent is employed on federal property located In PS County. O C. Title 1PrekindergartenO M. Migrant Prekindergarten O 0 D. The parent is employed on low rent housing located in P8 County. • D. Pre-K Disabilities • N. None - • O O E. The parent is in the uniformed services of the United States. O F. Fee for Services • P. Private Prekindergarten O H. Head Start O T. Teenage Parent Program O O If E. Is YES, is the parent on active duty? Check service below MI L. Readiness Program O Z. Not Applicable O Air Force O Am's, O Coast Guard O Marines O Nalional Guard O Myr/ OS) Is the student a single parent? O YES O NO ("Para; 13e4ch Ft- TRANSFER INFORMATION (21) LAST ATTENDANCE DATE a - L4 - (21) DATE ATTENDED IN Pac (23) ave you ever een enrolled In Palm Beach County School? W YES O NO If yes, what school? HEALTH SCREENING INFORMATION (25 ) Students will receive non-invasive health screenings pursuant to Florida Statute § 381.0056(7Xd) Non-invasive screenings may indude vision, hearing, scoliosis, height, and weight These tests may be given individually or in groups. Parents or guardians, however, have the right to request an exemption in writing. If you DO NOT want your child to receive the screenings, write the words "Do not screen' here: (This exemption will cover ell typos of screenings) RS) I give permission for my child to participate in the sodium fluoride program to prevent tooth decay. O.YES D NO (Permission is valid through grade 6) an Doei your child currently have health insurance? O YES O NO If YES, indicate: O Medicaid tilitHealthy KidslKid Care O Private O Interested in receiving Information NEW STUDENTS TO PALM BEACH COUNTY (28) HOME LANGUAGE SURVEY • OYES O NO 1. Is a language other than English used In the home? If YES, what language? n S O NO 2. Does the student have a first language other than English? If YES, what language? VI YES tANO 3. Does the student most frequently speak a language ether than English? If YES, what language? (29) DISCLOSURES FOR ENTRY INTO P/3C SCHOOL DISTRICT rikES NO 1. Has the student ever been expelled from school? • O YES ANO 3. Has the student ever had any juvenile O YES NO 2. Has the student ever had an arrest resulting in a charge? Justice actions? (30) DIU LIVES WITH: (cheek one) (31) CUSTODY STATUS OF STUDENT(check one) S other O Father O Both Parents Mother O Father II Shared Custody • Other O Other (sat Is there a urt order barring either parent from removing or contacting the student during the school day? O YES NO If YES, provide the school with a copy of the court order. • PBSD 0636 (Rev. 03/19/2003) page 1of 2 EFTA01710230 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGIS 1 ) FATHER CR LEGAL GUARDIAN (Sat 77404 int.9. 7779 (34)DATE OF BIRTH (45) DATE OF BIRTH 5 - • Oa - (.0 7 DO ADDRESS (Proof nor.844 OHL aparlmanflonbee) . . i (36) CITY STATE PP CODE STATE 2IP CODE (V )OCCUPATION (38) HIGHEST 127. t 1(4, - I rn 6 eCL-C-il I- . (CD OCCUPATGli TO HIGHEST ED. LEVEL ED. LEVEL l '.\ AI iS1-16 ST (39) PLACE OF EMPLOYMENT (50 (IN HOME TELEPHONE (4I) BUSINESS TELEPHONE (42) CaUPAGER NURSER (SI) HOME TELEPHONE (S2)BUSINESS TELEPHONE (5.5) CELL/PAGER NUMBER (a3) EMAIL ADDRESS (999704 (64) EMAIL ADDRESS ( EMERGENCY HEALTH AND SAFETY INFORMATION lowed to pick up student (ts) PASSWORD ami ioduracten) (62) NAME (Fat middle MG/. fast) IS (03) ADDRESS WNW comber. emelt:par:mint numb00 (S5) CITY STATE 2V CODE (64) cry STATE ZIP 000E RONC4 Palm &ash P1 -a341 (69)RELAO AGER NUMBER (65) RELATIONSHIP (66) TELEPHONE (67) CELUPAGER NUMBER 0 li ef (e.n If school personnel are unable to contact you in caso of illness or accident. (69) MEDICAL INIORVATION Dif sluderes Oesset, bensik.f. Seatta issues Senjot (nciutTeo stair, birds, mattes ar wapAbians). may we have your permission to call your doctor or mmeasons, or caller chysical knfatioAs emergency services (911) for transport to the hospital? t.YES .0 NO (70) FAMILY PHYSICIAN DI) PHONE PlifaaAN FREE OR REDUCED PRICE LUNCH (72) HOSPITAL PREFERENCE (7)) Have you filled out an appricatron for free and reduced lunch? OYES • NO I 41MS LOe Sr fAoseoslIon fa proWded with /Ms ken) PARENTS / GUARDIAN'S OTHER CHILDREN IN PALM BEACH COUNTY SCHOOLS (74) NAME OF CHILD (Mt Ode, lasf) (75) SCHOOL ATTENDING ( 76)STUDENT NO.HOP* (TT) GRADE MOTE OF BIRTH (79) NAME OF CHILD (KO midcto. lag) (80) SCHOOL ATTENDING (61)STUDENTN040055(47) (62)GRADE (63) DATE OF BIRTH (8A) NAME OF CHILD PR AIM*. NV (85) SCHOOL ATTENDING (OS) STUDENT NO. (opi5onal) (97)GRADE (90)DATE OF BIRTH (89) NAME oFcitto(rest midst fast) (9)) SCHOOL ATTENDING (91)STUDENT NO. WOW (92)GRSOE (93)DATE OF BIRTH FOR OFFICE USE ONLY PARENT/GUARDIAN SIGNATURE (M)SCHN1 DEISROENT Na (96)CCG (5?)aTRY CD (93) EMIG DATE MI C41. I verify that the information given is true and accurate to the best (ID)1E40131MI OD REASSIGN CIL . DOB TRANSPCRTADON PR DEN VERE 001)DCF of my knowledge. 0 PI3C Bils a El PaknIran . 2 3 4 5 A • 0 Pa-ent/Sludent Trans. 0 WailtEl BIN 6 7 8 9 T CZ DOD DOCUVEMAKNOECKLIST Doh) ESOL PRCGIAM OMIT CIDE 0 Immunizations 0 Birth Records Verificeilon 0 Social Security Number 0 Physical Exams (107)0ATAIDMITCCOMMEOBY DOD DATE DATE :H, PlitSO 0636 (Rev. 03/192003) page 2 of 2 EFTA01710231 THE SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) 2972222:1) New and Returning Student Registration NEW STUDENTS: Complete all non-shaded areas on both sides of the form. information by RETURNING STUDENTS: Review both sides. If the pre-printed information is incorrect, correct the Incorrect information and writing the correct information above it carefully and lightly crossing out the CRS:1700100 SEC:1G BLOCI:01 R1.1:175 08/12/02 DIST:2451 TCHR NBR:225 STOT: (3) STUCENTS LEGAL NAME (FM . (1) ALSO KNOWN AS ( OCAL ADDRESS mouse no. 6 greet Maw* (apt noJ fait MOO (410ado) LOXAHATCHEE FL 33470 (6) ALLLNG ADDRESS MOM no. a greet name) frig 001 (O (stale) (A0 =da) . (7) SOCIAL SECURITY NO. (0)HOME TELEPHONE NO. (0) SIX (103RACEIETAINC ORIGIN H H-Hispanic 0 I-American Indian/Alaskan Native 0 Balack, Non-Hispanic 0 W-YVhie, Non-Hispanic M-Muttiracial F • kAsian/Pacific Islander DATE OF BIRTH (12) PLACE (1D)RESIDENT STATUS (14) USA ENTRY DATE on 3 (MARDEAVYYY) (LIW00NYY) 0 0. Foreign Exchange Student DADE COUNTY FL US FLORIDA 0 1. Out-or-county Resident 0 2. Out-of-slate Resident (15) FEDERAL IMPACT SURVEY 0 3. In-county Resident YES NO (i 6) PRESCHOOL ENROLLMENT INFORMATION 0 0 A. The student resides on federal property. Place an X by each program attended. Also, indicate with en asterisk (') the program your child was In the longest. LI O B. The student resides in low rent housing. 0 N. Non-subsidized Child Care 0 M. Migrant Pre-K n o C. The parent Is employed on federal property located In Palm Beach County. 0 H. Headstart County 0 D. Pre-K Disabilthed 0 0 D. The parent Is employed on low rent housing located in Palm Beach • I. Pre-K Early Intervention 0 C. Chapter 1 0 • E. The parent is in the uniformed services of the United Slates. 0 S. Subsidized Child Care 0 O. Other 0 0 If E. is YES, is the parent on active duty? Check service below: (17) ISIHE STUDENT A Om CURRENT GRADE LEVEL Marines 0 National Guard 0 Navy SNORE PARENT? NO 07 Air Force • Army 0 Coast Guard 0 0 0 YES 0 NO 4TRANSEEWINEORMATION ;a6„...-Waiftt (20) CITY CR LOCATION COLAcy- - (2I) LAST ATTENDANCE DATE 09) NAME OF SCHOOL TRANSFERFtrio FROM (22) LAST GRADE LEVEL i (23) LAST PUBLIC SCHOOL ATTEACED IN PALM BEACH COutfry (24) DATE AT1ENDIEDINPDC 4, .s.ut HEAIMESOREE listGINFORMATions . I;ie Att., 34 ,,b 381.0356(7)(d). Non-invasive screenings may include (25) Students will receive non-invasive health screenings pursuant to Florida Statute § or In groups. Parents or guardians, however, have the may be given Individually vision, hearing, scoliosis, height. and weight. These tests the screenings, write the words "Do rot screen- here: right to request an exemption in writing. If you DO NOT want your chid to receive (This exemption !ma cover el types ofscreenings) prevent tooth decay. ' YES 0 NO (26) I give permission for my child to participate In the sodium fluoride program to (Permission is vaNd through 6 grade) YES Medicaid 0 Healthy lOds/Kid Care 0 Private YES 0 NO if YES. indicate: (27) Does your chid currently have health insurance? Interested in receiving information SEVIMertiOENTs401PALNhBEACiiicouNTY (28) HOMELANGUAGE SURVEY tsh If YES, what language? ...pci..n *..YES 0 NO 1. Is a language other than English used in the home? YES 0 NO 2. Does the student have a first language other than Engbsh? at language? If YES, what pa ant sh OYES ANO 3. Does the student most frequently speak a language other than English? U YES, riledIck at language? ma 4. What language is spoken in the home by the parent or guardian? ct,ft t 4'1 - (90) 5. What language is the student's first language? IS . pct_ r.11S (32) STUDENT LIVESMATH. (chock coat (31) What is the date of entry into an ESOL program? %pother li Father xi Both Parents (33) Oscuosunas FOR ENTRY 0/10 PSC SCHOOL DISTRICT 0 Other YES NO rag CUSTODY STATUS OF STUDENT (check oae) CI Pi 1. Has the student ever been expelled from school? 0 Mother 0 Father 0 Shared Custody • . 4 2. Has the student ever had an arrest resulting in a charge? 0 Other 0 !e1 3. Has the student ever had any gwenile justice actions? student during the school day? 0 YES NO pp Is there a court order barring either parent from removing or contacting the If YES, provide the school with a copy of the court order. page 1 of 2 PBSD 0636 (REV. 02704/2002) EFTA01710232 • rtc cnern.nor- snoinnei ur rnLrvI permirn wauPil I T - New ANL, Kt I UNNINto l I ULlt.N I /Chia IS I KA I ION Into( lase (37) MOTHER OR LEGAL GUARDIAN (kg molelabel. last) PU: Y PU: n umber) ADDRESS street numter ate anrbnvN numbed cry STATE 21P CODE an STATE ZIP CODE LOXAHATCHEE FL 33470 LOXAHATCHEE Ft. 33470 OCCUPATION OCCUPATION RACE OF EMPLOYMENT kAAvesTOISI CELLPAGER NUMBER CELUPAGER NUMBER But ADDRESS (0044140 :EMEMENCY: IEA43EE {tNR` afilFORMA'f Person(s) other than parent authorized to pick up student (35) PASSWORD (NM 10 characters) NAME inideN• TY lea (41) NAME PA maw India( An( ADDRESS (a9444 rumba. 4444( apatite?: number) C(FY STATE. ZIP CODE STATE 2IP COCC 2ocak Pa_k m P)dr‘ RELATIONSHIP FJ45.3(11 (40) AUTHORIZED FOR TELEPHONE RELATIONSHIP (42) AUTHORlaiD FOR cart 111O1 ) EC El YES ENCY PICKUP El NO ❑ YES EIAIRODCYNacuP O NO (40) MEDCAL INFORMATION (bat studsits Mnestea. behavior, heath (43) If school personnel are unable to contact you incase of ithess or accident, issues. oferpin fir:Wing entries, bats. recedes of amphibiamj may we have you• permission to call your doctor or emergency services (911) for transport to the hospital? RYES O NO inedIaionr, crolhorphyskolkrolakoN Ye) PHYSICIAN PfCtE ERI.R:NEPMN.:?. Have you filled out an application for free and reduced lunch? 0 YES o NO TaVAS U1/4)gi *E- (Application is Provided with this Thm) :MEM/WARMAN: .:0THER:Mill:DREN)N:RALIN CH:POU (49) NAME CF CHILD (Mg ant Mildkrintiel) SCNOCI. ATTEIONG STUDENT NO. (GlAbsIG GRADE DATE OF BIRTH (50) NAME CF CHILD Ma( kg mdcUoMAINO SCHOOL ATTENCANG STUDENT NO. Copilot* GRADE DATE OF BIRTH (51) NAME OF CHILD (Ng kg middleIna* WHOM ATTENDING STUDENT no. (OpboeMI) GRADE DATE CF BIRTH (52) NAME OF CHILD gas rus4 marl* nano SCHOOL ATTENDING STUDENT10. (0P9orta0 GRADE DATE OF BIRTH PARENT/GUARDIAN SIGNATURE '''''' ''' dan i ' • • • ••• ...,....... I verify that the information given Psysot4 sk**: is true and accurate to the best of :(4.3?WitekkaktAtbel:l.•:::•: my knowledge. lte3P0R4413.f.n.TPFPiffiliSM:: :itteittf!!!!FtittriNt:641*:::::*i:•• • • ... :Wide 6-Cr TE page 2 of EFTA01710233 4 .0- tOOL Dis,> , THE SCHOOL DISTRICT OF PALM tStACH CAJUN I Y (aUhtli.i) New and Returning Student Registration 73 068C NEW STUDENTS: Complete all non-shaded areas on both sides of the form. I 09 zerdoi RETURNING SUDENTS: Review both sides. If the pre-printd information is Incorrect, correct the information by carefully and lightly coli -, crossing out theTincorrect iriormation and wilting the correct information above II. DIST:2451 TCHR:ROLAND TNBR:047 STOT: CRS:2103030 SEC:05 BLDG:01 RM:131 08/16/01 (3) STUDENTS LEGAL NAME (16.4 KraL inklello) (4) ALSO KNOWN AS (5) LOCAL ADDRESS (Aeon na et its& non) (s4 on) kW (stain) (Op cede) LOXAHATCHEE FL 33470 (8) MAILING ADDRESS (Asia na A snot ninny (ept (to) (ay) (stele) (*.code) CS SOCIAL SC-CURRY NO. (cotionen (8) HOME TELEPHONE NO. (TO SEX (10) RACESTHMC CMOS H 0 I-American IndiarJAlaslcan Native O 6-Black Non-Hispanic OW-Hispanic F ait A-AsIan/Pacific Island* O W-White, Non-Hispanic O M-Multiraclal (11) DATE OF BIRTH (12) PLA (13) RESIDENT STATUS 3 (II) USA ENTRY OATS (1460VO/Y7110 faartronyyr O 0. Foreign Exchange Student DADE COUNTY FL US FLORIDA O 1. Out-of-county Resident O 2. Out-of-state Resident (15) FEDERAL IMPACT SURVEY O 3. In-county Resident YES NO (16) PRESCHOOL ENROLLMENT IIFORMAT)ON O fn. A. The student resides on federal property. Place an X by each program attended. Also, indicate with • 0 B. The student resides in low rent housing. an asterisk (*) the program your child was in the longest. O Iii C. The parent is employed on federal property located in P.B. County. O N. Non-subsidized Child Care O M. Migrant Pre-K C e D. The parent is employed on low rent housing Vacated In P.B. County. O D. Pre-K Disabilities • H. Headstan C71 E The parent is in the uniformed services of the United States. O I. Pre-K Early Intervention O C. Chapter 1 O S. Subsidized Child Care • a Other O 0 if E. is YES, Is the parent on active duty? Check service below: (17) IS THE STUDENT A (10) CURRENT GRADE LEVEL SPIGLE PARENT/ NO O Air Face O Army • Coast Guard O Marines O National Guard O Navy 08 O YES ONO _ ..,. .. . . .. . teez...... i f ..:1-1WISFER:INFOlkMATION'; (19) NAME OF SCHOCL TRANSFERRING FROM (20) CITY OR LOCATION (21) LAST antispareCE OATS (22) LAST GRADE LEVEL I (23) LAST PUBLIC SCHOOL ATTENDED RI PALM BEACH COWRY (24) DATE ATTENDED IN PEC. SCREENING INFORMATION ,HEALTH . _ FREE OR REDUCED (25) Students vvil receive non-invasive health screenings pursuant to Ronda Statute 381.0056(7)(d). Non-Invasive PRICE LUNCH v.:: screenings may Include vision, hearing, scoliosis, height, and weight. These tests may be given individually or R Or) Have you bled out an in groups. Parents or guardians, however, have the right to request an exemption in writing. If you DO NOT application or free and want your child to receive the screenings, write the words to not screen" here: reduced lunch? (This exemption will cover al types of screenings) 0 YES O NO (76) I give permission for my child to participate in the sodium fluoride program to prevent tooth decay. O YES C NO (Application is provided (permission is veNd through 6th grade) YES with this form) ..::.- . fi tgtaXIMIA :ttAargitA01149 1:fan. A, -•.v., (25) HOME LANGUAGE SURVEY YES NO 0 O 1. Is a language other than English used in the home? If YES, what language? petet LE it ti) O 2. Does the student have a first language other than English? if YES, what language? Spam( c.ii O 63. Does the student most frequently speak a language other than English? If YES, what language? (2$) 4. What language is spoken in the home by the parent or ggardian? cpa n Is VS- g n51(1,11 prat 5. What language is the student's first language? r? ail tS In pt) amenUVES wmt (MannMAP rag What is the date of entry into an ESOL program? ❑ Mother O Father ltApoth Parents O (33) DISCLOSURES FOR ENTRY INTO PSC SCHOOL DISTRICT YES O Other O ,HI 1. Has the student ever been expelled from school? (31) CUSTODY STATUS OF STUDENT (chook am) O mother • Father • Shared Custody O 92. Has the student ever had an arrest resulting in a charge? O 3. Has the student ever had any juvenile justice actions? O Other (35) Is there a court order barring either parent from removing or contacting the student during the school day? O YES ari.NO If YES, provide the school with a copy of the court order. PBSD 0636 (REV. 5/29/2001) page 1of 2 EFTA01710234 •..ten, onenar.• ••••••••••• 1 1 nine on. I tttttt •••• %I 9.06.0...1‘ I EL•0111%.* IIN"I 1%/111 (36) FATHER CR LEGA GUARDIAN .•. mi:Wto in:' bael) onMOTHER OR LEGAL GUARDIAN (lis4 man,inatite. Last) PU: Y PU: Y wter) partment number) allinalli CITY STATE ZIP CODE CITY STATE ZIP CODE LOXAHATCHEE FL 33470 LOXAHATCHEE FL 33470 OCCUPATION OCCUPATION C I ze-4 - a_Atill ° 0 nbutfor HA( Qs rti I LS b PLACED PLACE OF EMPLOYMENT HOME TELevr1UNE I CELUPAGER NUMBER HOME PHO CELJPAGER NUMBER EMAIL ADDRESS (00.10.0 EWE. ADDRESS (optional) EMERGENCY REACTANNO.-SAFErt.INFORMATION: . . •I'e' :? Person(s) other than parent authorized to pick up student (313) PASSWORD (3mit 10 characters) (39) NAME gab middle Mine. 1.140 (41) NAME rest meidl• butt ADDRESS (01064 number, street nairm. Opelfillell number) ADDRESS (shed number, street norm% apartmalt number) CITY STATE ZIP COLE CITY STATE DP CODE TELEPHONE RELATIONSHIP (40) AUTNOREED FOR TELEPHONE RELATIONSHIP (42) AUTHORIZED FOR EMERGENCY PICKUP EMERGENCY PCIWP 0 YES 0 NO • YES 0 NO (C) If school personnel are unable to contact you In case of illness or accident, (44) MED.CAL MIFORMATION Oaf Midgets alt.tial, behavior, bath issues, eagle* medicebons. en ether physkal breations) may we have your permission to call your doctor or emergency lervices (91 ) for transport to the hospital? teYES 0 NO (45) FAMILY PHYSICIAN (46) PHYSSOAN PHONE (48) Does your child currently have health insurance? IX YES 0 NO If Y S. indicate: (47) HOSPITAL PREFERENCE icaid 0 Private Healthy Kidslied Care 0 Interested in receiving information AtEat4.49.a.010000,0.01 DE .100.44101DtAD,‘D,WW3 - (49) NAME OF CHILD rot mMIM WU SCHOOL ATTENDING STUDENT NO. Mptcmd) GRADE DATE OF BIRTH (93)NAME OF CHILD Oat Map; kit) SCHOOL ATTENDNO STUDENT NO. Mauna° GRADE DATE OF &RN (51)NAVE CO CHILD fist middle. les0 SCHOOL ATTENDING STUDENT NO. (upfront.° GRADE DATE OF GIRTH (52) NAME CF CHILD rust middle. IMO SCHOC4. ATTENDING STUDENT NO. (optional) GRADE DATE OF BIRTH PARENT/GUARDIAN SIGNATURE IFARV,:figigEWSAten verify that the information given is true and accurate to the best of sr ols COB US 56)ENTRY CD. E01 (57)ENTRY DATE 08/14/01 MGM 06 (59)C/4- 01 my knowledge. (CO) TEACHER NO. (t1)REASSIGN CODE (62)TRMISPORTATION 031174R711VERF. (54) INS 0 P8C Bus # 0 Peke Tree 1 2 3 459 A • ParenVStudent Tray. 0 Walk II Bee 6 7 8 9 T BZ (65) OFtNINNTATION CHEMIST (0NG sedMe ..hen Re4886) 0 Immunizations (date) 0 Birth Records Verif. (de e) 0 Soc. Sec. No. (date) 0 Physical Exams (date) (65)LIATA ENTRY DOWLETED BY DATE PBSD 0536 (REV. W6/2001529/2001) page 2 of 2 EFTA01710235 SI14-33-H1R3 HEALTH INFORMATION 06/12/00 12.32.34 STUDENT ID STU ID TATUS A SEX H LEGAL NAME: LAS FIRST MIDDLE APP CURRENT SCHOOL E 04 HR SECT 408 DATE ENTERED 08 30 / BIRTHDATE MEDICAL REASON EFFECTIVE DATE IMMUNIZATION: 1 EFFECTIVE DATE EXPIRATION DATE / / TB TEST RESULT S HEALTH EXAMINATION Y VACCINE STATUS: DTP: DT: TD: POLIO: MMR: MEASLES: MUMPS: RUBELLA: HIB: HEPATITIS B: SCREENING FOR HEARING PROBLEMS: Y I MEDICAL ALERT PH: ( SCREENING FOR VISION PROBLEMS Y CONTACT EFTA01710236 igtecinAlt or nes FLORIDA CERTIFICATE OF IMMUNIZATION (HRS 680 - PART A) (11 H3S (Florida Statutes 232.032) FOR CHILDREN WHO HAVE COMPLETED ALL REQUIRED IMMUNIZATIONS FOR SCHOOL ATTENDANCE DATE OF BIRTH SS PARENT OR GUARDIAN FKPART A OF THIS FORM IS USED ONLY IF THE CHILD HAS RECEIVED ALL REOUIRED IMMUNIZATIONS LISTED BELOW. IF NOT, SEE REVERSE SIDE. .5 DOSES REQUIRED (K) *;.>-• • IF, THE FOURTH PRIMARY DOSE OF DTP IS ADMINISTERED'ON OR'AFTER'THEEOCIATH:BIRTHDAY, A FIFTH.DOSE IS NOT REQUIRED. 5:DT (PEDIATPJC) VACCINE IS ACCEPTABLE IF PERTUSSIS VACCINE IS MEDICALLY CONTRAINDICATED. (COMPLETE PART C FOR PERTUSSE CONTRAINDICATION.) (B') :.i:eldc(AEOLT) VACCINE (A SERIES OF 3 DOSES) IS ACCEPTABLE AND.RECOMMENDED FOR CHILDREN 7 YEARS OF AGE OR OLDER. (C') 4 BUSES REQUIRED lin rt IFTHE THIRD PRIMARY DOSE OF OPV IS ADMINISTERED. ON OR AFTER THE FOURTH BIRTHDAY, A FOURTH DOSE IS NOT REQUIRED. , -WV IS AN ACCEPTABLE ALTERNATIVE F OPV NOT-INoICATEEI: . • • POLIO VACCINE S WITTED FROM THE REGUIREDJMMUNIZATIONB0FCHILDREN 18•YEARS OF AGE OR OLCER. • CMEASLES. MUMPS. AND RUBELLA - 2 DOSES_MOMBED RIB MEASLES 1 DOSE REQUIRED FORMEASLES RUBELLA MMR COMBINED — 1st DOSE AT 12 MONTHS OF AGE CR OLDER (REQUMMEPIDED AT 15 MONTHS) (P) 2nd DOSE REQUIRED PRIOR TO KINDERGARTEN ENTRANCE (VALID IF GIVEN AT LEAST 30 DAYS AFTER 1st DOSE) .7911- MEASLES SINGLE — 1st DOSE AT 12 MONTHS OF AGE OR'OLDER.'IRECOMMENDED AT 1.51MoNTHB); (G."•} 2nd DOSE REWIRED PRIOR TO KINDERGAMENIENTRANCE " (VALID IF GIVEN AT LEAST 30 DAYS AFTER 1st DOSE) MUMPS SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER (H') • RUBELLA SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER (I') K:r4 $.): i'APtisCFRLATE DOSES AND DATES INCLUDING BIRTHDATE MUST BE ENTERED, AND THE CERTIFICATE SIGNED BELOW BY A PHYSICIAN OR AUTHORIZED ;AND:DATED IN ORDER FOR THE CHILD TO ATTEND SCHOOL 6e:st-i• r SEWED.THE RECORDS AVAILABLE AND TO THE BEST OF MY KNOWLEDGE THE ABOVE NAMED CHILD HAS BE Rip TETANUS, PERTUSSIS, POLIO, MEASLES, MUMPS, AND RUBELLA AS REQUIRE PHYSICIAN CR CLINIC NAME (Fl FASF PRINT) ?cE"AUTOMATED STUDENT DATA BASE CODES IMMUNIZATION STATUS CODE / VACCINATION CODE EFTA01710237 *Mkt t (Jr rIS11111.0% . 11 1 DEPARTMENT OF HEALTH & REHABILITATIVE SERVICES EALTH EXAMINATIONS Date LiifM r Students Full Name Phone Race Sek—e— Addre Birliadate Name of Parent or Guardian A. HEALTH EXAMINATION Normal-N; Abnormal- A N A COMMENT: Abnormal Findings, by number 1. Appearance 2. Ski/Nose a Head/Scalp 4. Eyes 5. Visual Acuity (R 8 L) 6. Ears 7. Auditory Acuity (R 8 L) 8. Nose / Throat 9. Mouth. Teeth and Gums 10. Chest / Lungs 11. Heart 12. Abdomen 13. Genitals and Anus 14. Muscuto-Skeletal 15. Neurological 16. Alertness 17. Emotional / Mental/ Behavtr Prob.I 18. Handicap. physical/ other (Specify) 19 Activity Restrictions (Specify) 20. Abuse, substance/ physical / emotional 21. Nutrition 22. Other B. HEALTH HISTORY Serious illnesses injuries: explain, (attach riarrate's if additional space needed) C. LABORATORY (as indicated) HemogistinrHernalocrit Stool (0 8 PI Tuberculin test: Lead Sickle Cell al NAME: TITLE: ADDRESS: (Please Print) 12S -I1 Form 3040, Mar 91 (0bsotetcs previous (Stock Number: 5744.0C0.3040.2) EFTA01710238 Spring 2004 ID: Florida Comprehensive Assessment Test (FCAT) SCHOOL: SSS Reading Student and Parent Report Grade 08 DISTRICT: 50-PALM BEACH High Your Reading FCAT Score History Your 2004 Reading Results 5 Year 2001 2002 2003 2004 Your Reading score Is on grade leveL You answered 4 many of the questions on the FCAT comoctly. Grade Tested Achievement Level 2 I Low Tu califoacion de Lecture esta al niveL Respondste a rrouthas de 'These scores show your achievement on the day you were tested. If las pregunlas del FCAT correctamento. you were to take this same test again, it is likely that your 2004 FCAT Reading score would be between 1815 and 1967. 3000 NOILekti ou nan nivo Has la. Ou repair: eve nan kesyon FCAT yokonlitteman. 2500 2000 0 O 1500 Your 2004 Reading Content Scores u. LL Points points Compared to other students Content Areas Percent 1000 Earned po *ye IMININIEINNIONI Words/Phrases 500 Main Idea/Purpose Comparisons 0 10 3 4 5 6 7 ReferenCe/Research Grade Tested LeLow, /ADMiddle, li.HIgh ■ Your Score 0 On Grade Level (Achievement levels 3 and Wove aro considered on isr above grade levet) Chan of FCAT Achievement Levels and FCAT Scores La labia de b derechs muestra Tablo Id adwat la monk° Nivo Reading los 'Welts 48 rendirriento del Rannman nan FCAT a ak Nochol Level{ Level 5 grade Level 1 Level 2 41iiiikeii; , FCAT y bs rangos do carder-16n Not FCAT a pou cask NNo. 3 864045 1046-1197 illiiklitlie: 1489-1865 1866-2514 del FCAT porn cads nlve'. Nivo rannmen 3 reprezente 2954314 1315-1455 4450017310: 1690-1964 1965-2638 4 El nivel do renSirniento 3 travay 'nen Miro leas' Ia. 5 474-1341 13424509 ?j910;40: 1762-2056 20592713 represent° et 0-abaio"al Myer. Anvan 2002, yo to reptile ycn 6 539-1449 1450-1621 Ft604:10SC 1860-2125 2126-2758 Antes de 2002. a los ostudentes soles otorgaba ens calficackfin nechel not ki gat Ma chit laden pou ekkr yo. 7 671-1541 1542-1714 4 i$€ 1945-2180 2181-2767 quo segula una escalade a amuses iese-1881 lisg2447.; 2073-2281 2282.2790 Iros Motes. 9 772-1771 1772.1971 Itgt2k2A4.3,:; 2146-2297 2296-2943 10 8444851 1852.2067 ,iaillIficil-f !W,. 2219-2310 2311-3008 On grado4evel Prior to 2002, a th.030-dg. scale score was reported for students Callficacionos do contenido do lecture Not Kontnl pou Lektl Reading Content —Content soores gNe more Not pou koninl yo bay enfOmasyon ki pi ograk sou specific Information about the skills on the FCAT. Grade Las calificaciwes do contonide proporcionan Information 0141.5 especifica sotto las habilidedes en el kcnperans el& la nan FCAT a. Men sa yo Mann do level expectations for students include: eley la dapre nivo klas la: FCAT. Las expectafivas al nNel del grado pars nos a Words/Phrases — uses skila to determine word estudiantes Lncluyen: • hie/Prez —Mize apthici pco doh:graben styllikasyon moaning, includng word parts and relationships moyo, sa Ns di disk pall nan mo yo epi retasyon Id between words. • Palabrastrases —usa la habilidad pant determiner et signIdcado de una palebra. Incluyondo Lis panes genyen ant moyo. • Main Idea/Purpose — determines a slated or • Ida PrenslpaUObjektlf — doteminen yon mesa) implied essential message, details. author's do patebras y las rolaciones entre patabras. • Idea principal/Proposito —determine un mensal° esansyel kl degree oswa sljere, bay delay sou purpose, or plot. cteektif °Sera plan °to a. • Comparisons — knows smllar and different. cause esencial exprow o cmplicito, dinettes del propose* del outer 0 el rugumento. • Konparezon — konnen menm ak &bran, Wiz ak ate, and died, and contrast. epi kontras. • Reference/Research — uses information from a . Compareciones — conoce similar y dderente. Cause y °facto y contrasto. .Referans/Rechech — blew enfernasyon Id soli nen variety of sources to reach conclusions. rye sous pou dedwi konklizyon. • Referenciannvestigacien — usa is informacidn do una variodad deMentes pare Heger a conclusions. Data Run Date: 0570312004 NT=Nist Tested. NR•No4 Reported, NF'Not Found EFTA01710239 Spring 2004 NAME: Florida Comprehensive Assessment Test (FCAT) ID: SSS Mathematics Student and Parent Report SCHOOL: 1691-CRESTWOOD MIDDLE Grade 08 DISTRICT: 50-PALM BEACH High Your Mathematics FCAT Score History 5 Year 2001 2002 2003 2004 4 Grade Tested 3 Achievement Level 44 1 Low 'These scores show your achievement on the day you were tested. If you were to take this same test again, it is likely that your 2004 FCAT Mathematics scae would be between 1776 and 1862. 3000 2b00 2C00- 0 0 co E- 1500- Your 2004 Mathematics Content Scores LL PointS Pods Compared to other students Content Areas Percent 1000 Earned Possitto Number Sense 500 Measurement Geometry 7 10 Algebraic Thinking Grade Tostod Data Analysis ■ Your Score i] On Grade Level (Acteevemem Øb 3 ond above are considered on or above grade level.) Chad of FCAT Achievement Levels and FCATScores La tabla de la deecha meets Table ki adwat la montre film Mathematics bs niveles de renditriento del Rannman nan FCAT a ak Nedhit FCAT y los ranges de calificacta Nett FCAT a you chak Nivo. Grad* Lovell Level 2 .:14,401.8 1: Level 4 Level 5 del FCAT pare cede robed. 3 375-1078 1079.1268 1269‘',1605;: 1509-1749 1760-2225 Nivo rannrnan 3 repramme El nivel do renclimiento 3 Um•ay 'flan Mine Hass la. 4 681-1226 1277.1443 :;144444ti. 18584862 1883-2330 representa el kabaleal elver. 5 569.1451 1452-1631 ii.193.2;1,85f: 1769-1956 19574458 Anvan 2002, yo te regale yon Antes de 2002, a los estudentes noshed net ki gen hva chit laden 8 770.1553 1554-1691 1 .42-i'18W.: 1860-2018 2019.2492 se lea otorgaba Lena ca.:Lac:4n pau elev yo. 7 958-1860 1661.1765 .i1/66€1 ::. 1939-2079 2080-2572 qua segula ma escalade 8 10254732 17334850 t71,`.1:1Sk".. 1998-2091 2092-2605 tres dines. 9 123$4781 1782-1900 ..11#1:12S22:. 2023-2141 2142-2596 10 1068-1831 1832-1948 1)94:7p2§1W.- 2050-2192 2193-2709 On gratte4evel Prier to 2002. a throe-04R scale score was reported for students. Mathematics Content -Content scores give moro Callficaciones de contentdo do matemåticas Net Kontnl pou Matematik spec:fie information about the tiara on tho FCAT. Grade Las callicaciones do corticoid° proporebnan NM pou kontni yo bay enfamasyon Id pi egzak sou level expectations for students Include: Informacia ma especifica solre las hat:Made, en el konpetans elev la nan FCAT a. Mon sa yo atann de FCAT. Las expeciativas al nivel del gratlo pars los elev la dapre ohm Ides la: • Number sense —uses number concepts and estudiantes incluyen: computation skills. • Chlf/Sans — Kittle konSePsyon chit ak abilile pou lb • Measurement — sofas problems involving • Nermero/Sentido — usa ccnceptos num4ricos y katteli. measurements. e.g.. limo. weight, length, area. habidades de cemputo. • Meal — rozoud pwoblern ki gen mod laden, pa • Geometry — analyzes and combines shapes to solve • Medida — resuelve problemas quo incluyen egzanp, tan, pwa, longb, seas. problems. modifies. per Memplo. tiempo. peso, longilud, area. • Jewometd — andze eft konbinen fryl leworcetnk • Algebraic Thinking — analyzes papems and uses • Geometria — antra y combine formes pare pou rezoud pwoblirm. equations and Inagua! Iles. resolver problems,. • Rezonman skebrak- enlire model opl Maze • Data Analysis and Probability — uses dale analysis • Pensamlento algebraic*— anain patrons, y usa ekwasyon ak Megatao. tools to display Information, make ~Wiens and ecuadonos y desigualdades. • Melia Done ak Pwobabilite — Mize mud pou (6 make inferences. • Anållsis do dales y probabilidad — usa anallz done pou prozante entemasycn. fb herranientas de el aneksis do dittos pare meeker prediksyco ak dedatsyon. Data Run Date: 05703/2004 insormecien, hater preclicciones e inkranies. NTeNot Tested, NR•Not Reported, NF•lifet Found EFTA01710240 Spring 2003 Florida Comprehensive Assessment Test (FCAT Vi . ,\V ir • --"i NORM-REFERENCED TEST c• • if GRADE 07 Student Report lee. le SO - PALM BEACH CEICEMTC1==1 This report shows your results from the FCAT National Norm-Referenced Test. to a The FCAT Norm•Referenced Test measures your achievement on a test that was given sample of students. Your norm-referen ced scores in Reading Comprehens ion and in national Mathematics Problem Solving describe your performance In relation to the performance of students throughout the nation. Your scores are shown below. SUBJECT SCORES National Scale Percentile Score Rank Stanine Reading Comprehension Mathematics Problem Solving to year. The Scale Score expresses your performance on the test and allows for comparisons from year Reading Comprehension Scale Scores range from 490 to 819. Mathematics Problem Solving Scale Scores range from 517 to 830. national reference The National Percentile Rank and Stanine indicate your relative standing in comparison to the group. National Percentile Ranks range from 1 to 99. Stanines range from 1 to 9. stated here. If you took the test again, your National Percentile Rank might be slightly higher or lower than However, your National Percentile Rank would probably fall within a certain range. For Reading Comprehension, your National Percentile Rank should be between 54 and 76. For Mathematics Problem Solving, your National Percentile Rank should be between 43 and 66. CONTENT SCORES Number of Number of Number of Questions Correct Questions on Test Responses Attempted Reading Comprehension Initial Understanding Interpretation Critical Analysis Strategies Mathematics Problem Solving Measurement Estimation Problem Solving Number Relationships Number Systems Patterns & Functions Algebra Statistics 0154130 Data Run Date: 04/30/2003 L EFTA01710241 Spring 2003 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Grade 07 Student Report 5O-PALM BEACH Ikeda cemprebaisive ASSOIMeel Test student has the earn and succeed. The purposeof the FcAT 13 to ensure that The Flori Deprtmentot Education believes that on possible, and preparing students to succeed In the competitive 21St century lob market. Florida'spublics chools are pr0viding the best uca system that allows you to track a student's academic achievement from year to Working with teachers, the State has developed a measurement In a years time. Tilt system also allows you to compare a student's score to a year and determine If a years worth of learning has occurred level' score, then they are performing at a level above score that represents 'grade level' achievement. If a student's score is above the 'gradeScores,' you are able to identity any Specific academic their current grade. If it is below, they are in need of improvement. Using the tomcat skills needing Improvement. Below you will find your 2OO3 FCAT Reading and Mathematics scores,grade as well as your scores from previous years. The chart on the right side of the page shows yo(r score compared to the score that represents level achievement. Reading 2500- 2OO3 Reading Content Scores Points Points Content Areas Possible Earned 2000- Words/Phrases Main Idea/Purpose I 1500- Comparisons LL 1000- Reference/Research I Year 2001 2002 2003 500- Grade Tested Achievement Level Grades' Gre • 4 re de t Grads 9 Grid+ 10 11+ FCAT Store • ■ Your Score 0 On Grade Level Mathematics 2003 Mathematics Content Scores Points ERN Content Areas Possible Number Sense I I FCAT Score Measurement I I Geometry I Algebraic Thinking Data Analysis I • Your Score U On Grade Level this test numerous times, it Is likely that all of your scores Would • TheSe scores show your achievement on the day you were tested. If you had taken have been within a certain range. Your 2003 FCAT Reading scores probably would have boon between 1648 and 1782. Your 2003 FCAT Mathematics scores probably would have been between 1639 and 1769. NT= Not Tested NR =Not Reported NA= Data Not Available 0175242 Data Run Date: 05/09/2003 EFTA01710242 FCAT Reports Informes FCAT (Spanish) Rapò FCAT (Rafflat) Creole) aparate reports are produced for the Sunshine State Se preparan Informes separados para los examens del FCAT Yo prepare rapò apa pou egzamen lekti ak matematik, syans :andards tests in FCAT Reading and Mathematics, de lectura y matemåticas, ciencias y redacción según las ak redaksyon FCAT bay swivan prensip Sunshine State since, and Writing. A separate report is also printed normas estatales Sunshine State Standards. También se Standards yo. Yo ekri yon rap& apa tou pou lekti ak matematik r the norm-referenced tests in Reading and imprime otro informe por separado para los exémenes de lectura pou "modél egzamen ofisyél FCAT itilize pou fé evalyasyon" athematics. y matemåticas de acuerdo a las normas de aplicacIón nacional. an. Informe sobre el FCAT milda a normas de aplIcaclon Norm-Referenced Test (NRT) Report The FCAT nacional (NRT) El informe del FCAT NRT presenta los Rapò egzamen ofisyél FCAT hilka pou fè evalyasyon RT report shows reading and mathematits scores on resultados de lectura y matemåticas en una version del estado (NRT) Rapò FCAT NRT a montre nät lekti ak matematik nan Florida version of the SAT9 (published by Harcourt de Florida del SAT9 (publicada por Harcourt Educational vésyon Florida genyen pou SAT9 la (Se Harcourt Educational iucational Measurement). Student scores are Measurement). Los resultados obtenidos por los estudiantes se Measurement ki pibiliye li.) Yo konpare nät elév la ak yon ›mpared to a national 'norms' group, where a percentile comparan con el grupo modelo o "norma", en el que la gwoup nöt yo konsidere kärr' "modél pou egzamen ofIsyét" la, nk store of 50 is average. clasIficación es de un 50% del promedio. kote swivan klasman pa pousantaj la, nöt mwayén nan se 50. inshIne State Standards (SSS) Reports The FCAT Informes según las normas estatales Sunshine State Rapò Sunshine State Standards (SSS) Rapò FCAT SSS iS Reading, Mathematics, and Science reports show Standards (SSS) Los informes según las normas estatales pou lekt', matematik ak syans lan montre nät elev yo fé nan st scores from Florida's tests of academic standards. SSS del FCAT presentan las calificaciones de los exåmenes de egzamen Florida bay sou prensip akademik yo. Rapò sa yo rese reports contain subject scores and content lectura, matemåticas y ciencias de las normas académicas de gen nät pou matyé ak nöt pou kontni ladan yo. Nät pou matyé :ores. Subject scores describe the overall Florida. Estos informes contienen calificaciones por materias y yo dekri tout sa ek» la reyalize anJeneral epl nät pou kontni yo calificaciones por :hievement, and content scores give the number of proporcionan un contenido. Las calificaciones por materia bay kantite pwen elév la få nan yon matyé byen detémine. Ou resumen general del rendimiento y las ka konprann kisa elev la reyalize nan egzamen lekti ak tints earned in specific skill areas. Success on the calificaciones por contenido que proveen el número de puntos aading and Mathematits tests can be best understood obtenidos en åreas de habilidades especfficas. El éxito de los matematik la pi byen si w itilize yon nivo siksé kote 3 oswa plis using the achievement levels where a 3 or higher Is exåmenes de lectura y matematicas puede entenderse mejor se yon nät ki nan nivo klas la oswa yon nät kl pi wo pase nivo i or above grade lavel. utilizando los niveles de rendimiento en Ios que una calificacion klas la. ;hievement Levels Five categories of achievement de 3 o superior estå al nivel del grado o por encima. Nivo siksé elév yo Gen senk kategori siksé ki dekri nivo ›scribe the success students have with the content Niveles de rendimlento El éxito que un estudiante ha lo9rado siksé elév yo pote nan kontni yo teste nan egzamen lekti ak sted on the FCAT Reading and Mathematics. Level 5 en el contenido examinado en el FCAT de lectura y matematicas matematik FCAT la. Pi gwo nivo a se nivo 5 epi pi piti nivo a the highest and Level 1 is the lowest. Since science se describe por medio de tinto categorfas. El nivel 5 es el mås se nivo 1. Piske yo poko detéminen nivo siksé nan egzamenn :hievement levels have not been determined, science alto y el nivel 1 es el més baja Como los niveles de rendimiento syans Ian, yo klase nät pou syans Ian swivan si Ii tonbe pi ba, ores are ranked as to whether they fall in the lowest, en ciencias no se han determinado, las calificaciones de nan tuttan oswa pi wo yon tyé pétbmans elév toupatou nan eta ciencias se clasifican con respecto a si entran dentro del tercio a. iddle, or highest third of statewide student inferior, medio o superior del rendimiento estudiantil a nivel Mormance. estatal. 5 Elev sa a gen siksè nan matyé kl te gen pi plis difikilte ladan This student has success with the most challenging content 5 Este estudiante tiene éxito con el contenido mås dit fdl de las yo nan egzamen Sunshine State Standards la. Yon elev ki of the Sunshine State Standards. A student scoring in Level nan 5yém Nivo reponn pile) kesyon egzamen yo normas Sunshine State Standards. Un estudiante del Nivel 5 körékteman, elév la menm reponn kesyon ki gen pi plis 5 answers most of the test questions correctly, including the responde a la mayorfa de las preguntas del examen difikilte ladan yo. most challenging questions. correctamente, incluyendo las preguntas mås dit folies. This student has success with the challenging content of the 4 Este estudiante tiene éxito con el contenido difícil de las 4 Elev sa a gen siksé nan matyé ki te gen difikilte ladan yo Sunshine State Standards. A student scoring in Level 4 normas Sunshine State Standards. Un estudiante del Nivel 4 nan egzamen Sunshlne State Standards la. Yon elév ki nan responde a la mayorfa de las preguntas correctamente, pero 4yém Nlvo reponn pitt) kesyon egzamen yo körékteman, answers most of the test questions correctly, but may have es posible que solo tenga cierto éxito con las preguntan que men li ka gen kék siksé selman nan kesyon ki sanble yo gen only some success with questions that reflect the most reflejan el contenido mås dif fot pi plis difikilte ladan yo. challenging content. 3 Este estudiante fien un éxito parcial con el contenido difícil 3 Elév sa a gen enpe siksé nan matyé ki gen difikilte ladan yo This student has partial success with the challenging de las formas Sunshine State Standards, pero su rendimiento nan egzamen Sunshine State Standards la, men péfämans content of the Sunshine State Standards, but performance es inconsistente. Un estudiante del Nivel 3 responde muchas Ian pa rete estab. Yon elév kl nan 3yém Nivo reponn anpil is inconsIstent. A student scoring in Level 3 answers many de las preguntas del examen correctamente, pero por lo nan kesyon egzamen yo Ithrékteman, men anjeneral Ii gen of the test questions correctly, but Is generally less general tiene menas éxito con las preguntas que son mås mwens siksé ak kesyon ki sanble yo gen pi plis difikilte ladan successtul with questions that are the most challenging. dif fciles. yo. This student has limited success with the challenging 2 Este estudiante tiene éxito limitado con el contenido dilla de 2 Elév sa a gen siksé limita nan matyé ki gen difikilte ladan yo content of the Sunshine State Standards. las normas Sunshine State Standards. nan egzamen Sunshine State Standards la. This student has little success with the challenging content 1 Este estudiante tiene poco éxito con el contenido difícil de las 1 Elév sa a gen yon ti siksé tou piti nan matyé kl gen difikilte of the Sunshine State Standards. normas Sunshine State Standards. ladan yo nan egzamen Sunshine State Standards la. :AT Certificates Students who earn Level 5 scores or Certificados del FCAT Los estudiantes que se clasifiquen en Sétifika FCAT Elev ki fe nät 5yem Nivo oswa elev ki fè gwo iose science scale scores are greater than 400 receive el Nivel 5 o cuyos resultados de ciencias sean superiores a 400, nät ki pi plis pase 400 nan syans ap resevwa Sétifika pou redben Certificados de rendimiento. En redacción, los •rtificates of Achlevement. For writing, certificates are given certificados se otorgan a lodos los estudiantes que han obtenido Siksé. Yo bay tout elév ki fé nät 5.5 oswa 6 ak elév klas all students with scores of 5.5 or 6 and to fourth graders with calificaciones de 5.5 y 6, y a los estudiantes de cuarto grado que katriyém ki fé nät 5, 5.5, ak 6 yon shtifika pou redaksyon. Yo res of 5, 5.5, and 6. Certificates are not awarded based on han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados pa bay sétifika swivan nät elev fé nan egzamen ki baze sou FCAT Norm-Referenced Test scores. en los resultados del FCAT cefiido a normas de aplicación "modél egzamen ofisyél FCAT itilize pou ffi evalyasyon" (NRT) nacional. an. EFTA01710243 Page 24 Test Record Report STAR Reading 7 Tuesday. 05101101. 11:37 AM Date Range : Al! • , StudentNettle.: • Student ID MM. Test Grade Teacher SS GE PR NCE IRL ZPD Date Placement Class 11/14/2000 5.24 5Th Grade Read 5l1 001 5.80 5Th Grade Read Number of Tests : 2 Historical Data : Included EFTA01710244 NAME: Spring 2004 ID: Florida Comprehensive Assessment Test (FCAT) SCHOOL: NORM-REFERENCED TEST DISTRICT: SO -PALM BEACH Grade 08 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 throughout the Problem Solving describe your performance in relation to the performance of students nation. Your scores are shown below. SUBJECT SCORES National Scale Percentile Starling Score Rank Reading Comprehension I Mathematics Problem Solving I Tho Scale Score describes your performance on the test and allows for comparisons from year to year. Reading Comprehension Scale Scores range from 510 to 820. Mathematics Problem Solving Scabs Scorn range from 627 to 836. The National Percentile Rank (NPR) and Shining indicate your relative standing In comparison to the national students in reference group. National Percentile Ranks range from 1 to 99. Tho NPR score indicates the percent of and 9 is the national sample who scored equal to or below your score. Slanines range from Ito 9 where 1 is low high. Stanines In the range of 46 are considered average scores. your If you were to lake the lest again, your National Percentile Rank might be slightly higher or lower. However, National Percentile Rank would probably fall within a certain range. For Reading Comprehension, your National Percentile Rank should be between 55 and 79. For Mathematics Problem Solving, your National Percentile Rank should be between 61 and 77. CONTENT SCORES Number of Number of Number of Questions Questions Correct on Test Attempted Responses Readln Corn rehension Initial Understanding Interpretation Critical Analysis Strategies Mathematics Problem Solving Measurement Estimation Problem Solving Number Relationships Number Systems Patterns & Functions Algebra Statistics Probability Geometry 0077570 Data Run Cato: 04/16/2004 a EFTA01710245 Spring 2004 Florida Comprehensive Assessment Test (FCAT) FEAT Florida Comprelignsive Assessnrit Test SUNSHINE STATE STANDARDS Reading Performance Task Student Report Grade 8 This report provides your results on the FCAT 2004 Reading FCAT 2004 performance testa. 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 extended-response tasks are scored on a 4-point rubric. Student Number School Name One of the short-response tasks is shown below with a copy of your answer. The number of points you earned for your answer is shown School Number in the box to the right. District Name PALM BEACH District Number 50 This task required you to read an article about ancient and modern paper making. All Routing This Performance Rerlormance Task Task: If you were going to meet Soichiro Sakamoto in person, what Iasi< Response Responses would you already know about him from reading this article? Use details and information from the article to support your answer. Points Possible I Points Earned Iq 1 Wert io meek 901,:n NnICIJI(5, 0 4/1 -0jad,‘\ \perm tica-\htg hasce Ott ett(;otned by thjoh %ruin rea.sem% And 4rOA iak. 23 tot, a wort/drop.Pitt In -APQ\ ntrt- is WOCtsci. ‘re. rnrateb pactr. vie ca up -to*5tax) tx-ck(c vrxxl C' /Cc:tr. n 00%0 C9SCAlel. gra -111;* ha It a ‘nsrm cot%N\ ed crirtonep in vcire mat. tre• 0038487 741400507 Data Run Date: 05/04/2004 EFTA01710246 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Mathematics Performance Task Student Report Grade 8 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 either a short response or a bnger, more detailed response. Short-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 answer. The number of points you earned for your answer is shown School Number in the box to the right. District Name PALM BEACH District Number 50 This Performance Al Mathematic* Task Response Performance Task Responses Points Possibto Points Earned Thomas works 4 hours after school, five days a week, at the Auto Lube Shop for $6 per hour. Sometimes, the shop gets busy and he works extra hours after school and on Saturday for S8 per hour. Part A Write an equation that can be used to calculate Thomas' total weekly earnings. Let I represent Thomas' total weekly earnings, and it represent the extra hours he works during any week. rquationqh.(iiit t±,), Part B Use your equation to determine how many extra hours Thomas must work in one week to earn 4200. Show your work. Work Spare 4 are -i-w6 &L-k j r 5 D1/4 tklp Number of extra hours 2 Data Run Date: 05/04/2004 0038488 736800336 EFTA01710247 NAME: Spring 2004 ID: Florida Comprehensive Assessment Test (FCAT) SCHOOL: DISTRICT: iggi Writing Grade 08 Student Report Florida Comprehensive Assessment Test Writing to Explain 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 (I) 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 an invention and explain the capitalization, and spelling and use a variety of sentence structures to present importance of that invention. ideas. Data Run Date: 04/07/04 50-1691 EFTA01710248 Description of Grade 4 Writing Scores Description of Grade 8 Writing Scores Description of Grade 10 Writing Scores 6.0: The writing focuses on the topic, is logically organized, and 6.0: The writing focuses on the topic, is logically organized, and 6.0:The writing focuses on the topic, is logically organized, and includes ample development of supporting ideas or examples. includes substantial development of supporting ideas or includes substantial development of supporting ideas or It demonstrates a mature command of language. including examples. It demonstrates a mature command of language, examples. It demonstrates a mature command of language with precision in word choice. Sentences vary in structure. including precision in word choice. Sentences vary in freshness of expression. Sentences vary in structure. There arc Punctuation, capitalization, and spelling are generally correct. structure. There are few, if any, usage, punctuation, or spelling few, if any, usage, punctuation, or spelling errors. errors. 5.5: The writing was given a 5 by one reader and a 6 by the other 5.5: The writing was given a 5 by one reader and a 6 by the other reader. 5.5: The writing was given a 5 by one reader and a 6 by the other reader. reader. 5.0: The writing focuses on the topic with adequate development of 5.0: The writing focuses on the topic, is logically organized, and supporting ideas or examples. It has an organizational pattern, 5.0: The writing focuses on the topic with ample development of includes ample development of supporting ideas or examples. though lapses may occur. Word choice is adequate. Sentences supporting ideas or examples. It has an organizational pattern, It demonstrates a mature command of language. Sentences vary in structure. Punctuation, capitalization, and spelling are though lapses may occur. It demonstrates a mature command vary in structure. Usage, punctuation, and spelling arc generally correct. of language. Sentences vary in structure. Punctuation, generally correct. capitalization, and spelling are generally correct. 4.5: The writing was given a 4 by one reader and a 5 by the other 4.5: The writing was given a 4 by one reader and a 5 by the other reader. 4.5:The writing was given a 4 by one reader and a 5 by the other reader. reader. 4.0: The writing generally focuses on the topic, though it may 4.0: The writing focuses on the topic, though it may contain loosely contain extraneous information. An organizational pattern is 4.0:The writing generally focuses on the topic, though it may related information. 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 specifics and details, but 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, correct. spelling are usually correct. though many are simple. Punctuation, capitalization, and spelling are usually correct. 3.5: The writing was given a 3 by one reader and a 4 by the other 3.5: The writing was given a 3 by one reader and a 4 by the other reader. reader. 3.5: The writing was given a 3 by one reader and a 4 by the other reader. 3.0: The writing generally focuses on the topic, though it may 3.0: The writing generally focuses on the topic, though it may contain loosely related information. An organizational pattern contain extraneous information. An organizational pattern has 3.0:The writing generally focuses on the topic, though it may is demonstrated. Development of the supporting ideas may be been attempted, but lapses may occur. Some of the supporting contain extraneous information. An organizational pattern has uneven. Word choice is adequate. There is some variation in ideas or examples may not be developed. Word choice is been attempted, but lapses may occur. Some of the supporting sentence structure. Usage, punctuation, and spelling arc adequate. Sentences vary somewhat in structure, though many ideas or examples may not be developed. Word choice is generally correct. are simple. Punctuation and capitalization are sometimes adequate. Sentences vary somewhat in structure, though many incorrect, but most commonly used words are spelled correctly. are simple. Punctuation and capitalization are sometimes 2.5: The writing was given a 2 by one reader and a 3 by the other incorrect, but most commonly used words are spelled correctly. reader. 2.5: The writing was given a 2 by one reader and a 3 by the other reader. 2.5:The writing was given a 2 by one reader and a 3 by the other 2,0:The writing addresses the topic, though it may lose focus by reader. including extraneous information. An organizational pattern is 2.0: The writing may be slightly related to the topic or offer little demonstrated. Development of the supporting ideas may be relevant information and few supporting ideas or examples. 2.0: The writing may be slightly related to the topic or offer little nonspecific. Word choice may be limited. Frequent errors may There is little evidence of an organizational pattern. Word choice relevant information and few supporting ideas or examples. occur in sentence construction, usage, punctuation, and spelling. may be limited or immature. Sentences may be limited to simple There is little evidence of an organizational pattern. Word constructions. Frequent errors may occur in punctuation. choice may be limited or immature. Sentences may be limited 1.5: The writing was given a I by one reader and a 2 by the other capitalization, and spelling. to simple constructions. Frequent errors may occur in reader. punctuation, capitalization, and spelling. 1.5: The writing was given a 1 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 1 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 writing may only minimally address the topic because there is sentence construction, usage, punctuation, and spelling. organizational pattern is evident. Ideas are 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 waiting 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, capitalization, and spelling may impede communication. U: The writing is unrelated to the assigned topic or cannot be read. U: The writing is unrelated to the assigned topic or cannot be read. 1601409 EFTA01710249 Spring 2004 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Science Performance Task Student Report Grade Oa MS 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. Shod-response tasks are scored on a 2-point iubnc and Student Name extended-response tasks are scored on a 4-poInt rubric. Student Number School Name One of the short-response tasks is shown below with a copy of your answer. The number of points you earned for your answer Is shown School Number in the box to the right. District Name PALM BEACH District Number 50 PerfAll &ciente This Performance ormance Task Task Response Responses Points Possible I Points Earned Joe dropped his book behind the dresser. He tried to move the draw but it would not we. He asked his sin to help and they wereable to move the draw mush tor Joe to get his book. Part A Wanly the tome that kept toe from moving Ike dresser himself. ice rActcol. %nab %not. (vv) =lore 6a) x ditneters CM> vv.4ci Part Et Eattein why Joe and hie sister went able to move the dresser when they worked together. lrey were at:At-to econ. -Cre Ch-votar bteate atrel ceikn r ta-co. at Arty ban nag cbitracrn -to more 4Tr arc. nrd, %rim -trey cmi had Gra do:Es-Noma. w -vo, Al; \rem Quirt wort. Azrs-tfitr -4O ritlia -tom ate 0030088 683500424 Data Run Date: 04/30/2004 EFTA01710250 Spring 2004 NAME: ID: Florida Comprehensive Asscssmcnt Test (FCAT) SCHOOL: SSS Science Student and Parent Report DISTRICT: 504%W BEACH Grade 08 The Florida Department ol Education beteves that El Florida Depanment of Education (Departamento Depatman Edkasyon nan Florida kwé chak °metro every student has the abilty to team and succeed. de Educación del estado de Florida) eec que todos gen kapasite pou °brann epi gen sksé. Objektil The purpose of the FCAT is to ensure that Florida's los estucfrantes benen la capacidad de aprender y FCAT la se pou yo ka sten tekel 'oblik nan Florida public sdwols are providing the best education tener exil*. El propósito del FCAT os asegurar que ap bay pi bon edkasyon ki pearl, la epi yap prepare possble and preparing students to succeed for the las escuelas ablicas de Florida proporcionen la olév yo par yo ka gen sksé nan lavel. futura. mejor educación posble y preparen a los estudiantes para tener éxito en el futuro. Yo idantilye yon nivo konesans id elve nan syans se A high lova of science knowledge has been identihed yon bagay ki esansyél pou yon mun ka gen she as critica) for success in the contetitive 21s1 cenlury Se ha demostrado que. para el éxito en el nan konpetisyon Id genyen nan mache travay la nan job märket. Working with Florida educators. the state competitivo mercado laboral del siglo )O3. es crucial 21yårn syék la. Eta Florida a travay ansanm åk has devetoped a test b measwe a students poseer un allo nivel de aincidmientos de ciencias avolest yo pou yo devlope yon egazamen ki pérnél achievement of the imposant science slöks in the Trabajando con educadores de Florida. el estado ha yo multe rannrnan yon elév nan egzamen syans ki Sunshine State Standards. This report pro/ides your desarriseado un examen para mear los logros de un «pölen nan SunshNe State Standards la. Rapó sa students 2004 Science Score which alkorvs you to estudiante en materia de ciencias de acuerdo a tas a bay Nöt elév få nan Syans pou Ane 2004 ta epi sa contare your students performance to the normas Sunshine State Standards. Este informe pémét ou konpare oktanens elév ou yo ak pelbmans perfamance of other students in the state. In proporciona a su estudiante la calificación de Eit olév nan Eta a Anplis. nót yo kl nan repe a ode addition. the content stores hela you to identity Cencias de 2004. b que k permite comparar el ou Idantlye nan ki matye akademk elév la bezwen få acadomic skals that may need introvement rendimiento do su estudiante con la de otros amelyorasyon. estudiantes en el estado. Adeboalmente. tas calificaciones de contenido le ayudan a bankar las habildades académicas on tes que puede ser necesario mejorar. Your 2004 FCAT Science Score Compared to Other Students Store ' Low ~die High 500 Your 2004 Science Content Scores ROMS Poinls Compared to Other Students 400 Content Areas Eamed Possible Percent Low Middle High Physical and Chemical 300 : 1 Earth and Spana 200 I l Ute and Environmental 100 Il l Sdentific Thinking Stue.** Som Ute hymner) This acore shows your achlevement ort the day you were tested. It you were to lake this test again, it is likety that your 2004 FCAT Science store would be between 288 and 318. Science Content Contenido de ciencias Kisa kl gen nan egzamen syans lan e Physlcal and Chemical Science emlains • Ciencias listats y químicas explican la • Syans Ila& fl ohimik- esplike matyl, maner, motion, force, and energy Induding materia, el movimiento, la fuerza y la energía, mouvman, ids, sk enen', sa vie dl pwopriyete their propenies and interactions; also identifies incluyendo sus propiedades e interacciones; yo ak fason youn reyaji ak km; epi bu dantilye atoms, elements, compounds, and mixtures. también identifican los atomos, eiementos, atom, eleman, konpoze chimik ak melanj. compuestos y mezclas. • Earth and Space Science- explalns Eanh's • Syans laté ak capes- esplike dtanjman ki lét changes over time IncludIng geologin patterns, • Ciencias de la Tierre y el espacio explican sou Laté ano apve ana, sa viedi aktivite the rock cycle, minerals and weather systems; los cambios de la Tierra a través del tiempo, jewolojk, taz wöch, Sistém mineral ak sistöm atso describes the solar system and universo. incluyendo los patrones geológicos, el ciclo de ameleyo a, epi It dekrt sistöm solé a ak inivé a. las rocas, minerales y sistemas • Lite and Environmentat Science identifies meteorológicos; también describen el sistema Syans biyolojik ek anviwonman- idantilye and expains plants, animals, and the solar y el universo. • epi esplike plant, bét, ak anviwonman an, sa environment, inctuding Gle pocesses, vie di pwosesis blyolojk, konsövasyon resous conservation of resources, and the • Ciencias de la vida y el medio eminente yo, ak entédepandans ögat aksistém yo. interdependence ol organisms and systems. identifican y explican las plantas, animales y el medio ambiente, incluyendo los procesos Rezonman syantitik- itNize p•rosede syantitik • Scienttlic ThInking- appfies scientNic vitales, la conservación de recursos y la • pou rezoud pwoblém, rekonét regliarite ak prccesses to problem solving, recognizes interdependenica de organismos y sistemas. sisttim, epi korgrann enpak teknolog sou paneras and systems, and understands the lasosyete. lindad of technology on society. • Pensamiento dentalens• aplica procesos dentilicos a la resolución de problemas, reconoce patrones y sistemas, y comprende el impado de la tecnología en la soesedad. Data Run Date: 04129(2004 0032556 EFTA01710251 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2002 NORM-REFERENCED TEST • Student Report GRADE 06 istnicIt Name an 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 Stanine Possible Earned Attempted Readin t Com • rehension 52 Reading Initial Understanding 15 Comprehension interpretation 21 Critical Analysis 9 Mathematics Problem Solving Strategies 7 Mathematics Problem Solving 48 The Scale Score expresses your performance and allows comparisons from year to year. Measurement 6 Reading Comprehension Scale Scores range from 492 to 800. Mathematics Problem Solving Scale Scores range from 500 to 813. Estimation 4 Problem Solving 5 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. Stanines range from 1 to 9. Number Systems 5 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 3 For Reading Comprehension, your National Percentile Rank should be between 36 and 60. For Statistics 6 Mathematics Problem Solving, your National Percentile Rank should be between 58 and 79. Probability 3 I Geometry 7 Each question was worth 1 point. 05/11/2002 0961160 EFTA01710252 FCAT Reports Informes del FCAT (Spanish) Rapó FCAT (Haitian Creole) The FCAT Reading and Mathematics test results are provided Los resultados de los exámenes de lectura y matemáticas del FCAT Yo bay de (2) rapo apa pou rezilta egzamen lekti ak matemat In two separate reports, one for the "Sunshine State se proporcionan en dos informes por separado, uno para los FCAT la, youn se pou egzamen "Sunshlne Siete Standard Standards" (SSS) tests and one for the "Norm-Referenced exámenes según las normas estatales "Sunshine State Standard? (SSS) yo, epl Itit la se pou egzamen ki be sou -modål egzame Test' (NRT) tests. At grades 4, 8, and 10, a thlrd report (SSS, por sus siglas en inglés) y uno para los exámenes ceñidos a ofisyål FCAT itilize pou fé evalyasyon" az (NRT) yo. Nan klas 4Yér contains the FCAT Writing results. normas de aplicación nacional (NRT, por sus siglas en inglés). Un 8Yére ak 101", yo bay yon twazyém rapo kl gen rezilta egzame tercer informe contiene los resultados del examen de redacción del redaksyon FCAT la. The FCAT "Sunshine State Standards" report presents test FCAT de los grados Oto, 8Y0, 10mo. stores from Florida's test of academic standards. Success on Rape) *Sunshine State Standard? pou FCAT la prezante nät ele this test can be best understood by usIng the achlevement El Informe según las normas estatales "Sunshine State Standard? yo få nan egzamen Florida bay sou prensip akademik yo. Pou levels where a 3 or higher is preferred. This report contains del FCAT presenta las calificaciones del examen de las normas ka konprann ki kantite siksé yon elév pote nan egzamen sa a, c Subject Scores and Content Scores. Subject scores provide académicas de Florida. El éxito de este examen puede entenderse ka itilize tablo nivo siksé elév la. Nan tablo sa a, yo pretere lé yc mejor utilizando los niveles de rendimiento en los que se prefiere an overall summary of achlevement, and content scores give elév få yon nöt 3 oswa yon nät ki pi wo. Rapo a gen kit pou sfj una calificación de 3 o superior. Este informe contiene dos tipos de the number of points earned in specific skill areas. ak nät pou kontni ladann. Nät pou sijé a bay yon rezime jenen calificaciones (calificaciones por materia y calificaciones por The "Norm-Referenced Test" report presents Reading and contenido). Las calificaciones por materia proporcionan un resumen sou tout sa elév la reyalize nan egzamen an, epi nöt pou kontni a Mathematics scores on a Florida version of the SAT9 general del rendimiento y las calificaciones por contenido proveen el bay kantite pwen elév la få nan yon matyé byen detémine. published by Harcourt Educational Measurement. Student número de puntos ganados en áreas de habilidades específicas. Rapé sou egzamen ki baze sou "modél egzamen ofisyél FC,2 scores are compared to a national 'norm' group, where a El informe del examen ceñido a normas de aplicación nacional itilize pou få evalyasyon' yo prezante nät pou lektl ak maternal percentile rank score of 50 is average. (Norm-Referenced Test) presenta los resultados de Lectura y nan vésyon SAT9 Florida bay la. Se Harcourt Education Achievement Levels The achievement level is one of the Matemáticas en una versión de Florida del SAT9 publicado por Measurement ki te pibliye vésyon sa a. Yo konpare nät elév yo a subject scores on the FCAT 'Sunshine State Standards' test. (Harcourt Educational Measurement). Los resultados obtenidos por yon gwoup nät yo konsidere kbm "modål pou egzamen ofisyét I These leveis describe the success a student has achieved on los estudiantes se comparan oon el grupo modelo o 'norma", en el nan nivo nasyonal, kote suivan klasman pa pousantaj la, ni que la clasificación percentil de 50 es el promedio. mwayén nan se 50. the Florida Sunshine State Standards tested on FCAT. Level 5 is the highest and Level 1 is the lowest. Niveles de rendimiento: El nivel de rendimiento es uno de los Nivo siksé elév yo - Nivo siksé eltiv yo se nät pou youn na temas evaluados en el examen Sunshine State Standards del FCAT. matyé ki genyen nan egzamen sou "Sunshine State Standard 5 Performance at this tevel bacetas that the student has success Estos niveles describen el éxito que un estudiante ha logrado en las pou FCAT la. Nivo sa yo dekri siksé yon elév reyalize lé ele« I with the most chatlenaina content of the Sunshine State Standards. normas estatales Sunshine State Standards que se prueban en el pran egzamen "Sunshine State Standard? pou FCAT la. Pi gw A level 5 student answers most of the test auestions correctly. FCAT. El nivel 5 es el más alto y el nivel 1 es el más bajo. nivo a se Nivo 5, pi piti nivo a se Nivo 1. including the most challenging questions. 4 Performance at this level indicates that the student has suersiss 5 El rendimiento a este nivel indica que el estudiante tiene éxito con el 5 Pélibmans nan nlvo sa a demontre elév la te gen siksé nan maly with the challenging centen( of the Sunshine State Standards. A contenido más difícil del examen Sunshine State Standards. Un ki ttgen oi pes difikilte ladan vo nan egzamen 'Sunshine Sta; level 4 student answers most of the test questions correctly, latt estudiante del nivel 5 sr soonde la mayoría de las preguntas del Standard? la. Yon elév kl nan 5Vérn nlvo reponn cito kesvQ rnav have ()n'y sonve success with questions that rattett the most examen correctamente incluyendo las preguntas más difíciles. egzamen yo körékteman elby la menm reponn kesyon ki gen pi pl 4 El rendimiento a este nivel indica que el estudiante gane éxitn con el difikilte ladan yo. challenging content. contenido difícil del examen Sunshine State Standards. Un estudiante 4 Pélbmans nan nivo sa a demontre elev la te gen siksé nan maty 3 Performance at this level indicates that the student haaGadieti del nivel 4 responde la mayoría de las preguntas correctamente, geig success with the challenging content of the Sunshine State ki gen difikilte ladan yg nan egzamen 'Sunshine State Standarck gs °risible Que set() tenga atarle éxito en preguntas que reflejan el la. Yon elév ki nan 4Yére nivo reponn kesyon egzamen y Standards, but performance is inconsistent. A level 3 student contenido más dificil. answers many of the test questions correct4y, but is neneraliv less körékteman, men li aen kék siksé selman nan kesyon ki parét ge 3 El rendimiento a este nivel indica que el estudiante tiene éxito cardal pi plis difikilte ladan yo. successful with questions that are the most challenging. con el contenido difícil del examen Sunshine State Standards pero el 3 Péltimans nan nivo sa a demontre elév la cien 2 Performance at this level indicates that the student has linled rendimiento no es uniforme. Un estudiante de nivel 3 responde enoe Ore). na success with the challenging content of the Sunshine State matyb kl gen difikilte ladan yo nan egzamen "Sunshine Sta, muchas de las preguntas del examen correctamente pero oor lo Standards. general tiene menoCexitq con las preguntas quo son más difíciles. Standards"la, men példmans tan pa rete stab. Yon elåv 3Yém niv 1 Performance at this level indicates that the student has little 2 El rendimiento a este nivel indica que el estudiante tiene éxito limitado reponn anpil nan kesyon egzamen yo körékteman, men anieneral. success with the challenging content of the Sunshine State en el examen Sunshine State Standards. aen mwens siksé ak kesyon kl parét gen pi plis difikilte ladan yo. Standards. 1 El rendimiento a este nivel indica que el estudiante gene poco éxito 2 Péltimans nan nivo sa a demontre siksé elév la limite nan matyé con el contenido difícil del examen Sunshine State Standards gen difikille ladan yo nan egzamen "Sunshine State Standards' It Year-to-Year Growth The FCAT "Sunshine State Standards' 1 Påfbmans nan nivo sa a demontre elöv la aen von ti siksé tou OÍ tests in Reading and Malhematk:s are given In grades 3-10. Evolución de un año al otro: Los exámenes Sunshine State nan matyö kl gen dillkilte ludan yo nan egzamen 'Sunshine Star Therefore, achievement across two years can be compared for Standards del FCAT en lectura y matemáticas se administran desde Standard?. grades 4-10. These comparisons are made based on changos in 3er a 101 ° grados. Por lo tanto, el logro en dos años puede the students achievement leve' from one year to the next. compararse con los grados desde 4i0 hasta 10110. Estas Pwogré de ane an ane - Yo bay egzamen lekti ak matemati comparaciones se hacen basadas en los cambios en el nivel de 'Sunshine State Standard? pou FCAT la depi nan klas 30/11 jisk Certificates Scores on the "Sunshine State Standards" part of rendimiento del estudiante de un año a otro. klas Konsa, ou ka konpare sa elév yo reyalize panda FCAT are used to award students with certificates of dezan (2 an) depi nan klas 4Yére jiska klas 10Y". Yo baz accompllshment. For Reading and Mathematics, students who Certificados: Las calificaciones de la parte Sunshine State score in Achievement Level 5 receive certificates. For Writing, Standards del FCAT se utilizan para otorgar certificados de logros a konparezon yo sou nivo siksé elév la de ane an ane. certificates are given to all students with scores of 5.5 and 6 and los estudiantes. Para lectura y matemáticas, los estudiantes que Sétifika - Dapré nöt olé,/ yo té nan "Sunshtne Siete Standard logran un nivel de rendimiento 5 reciben certificados. Para pou FCAT la, yo ka bay yo sétifika pou sa yo akonpli. Pou lekti a to fourth graders with scores of 5, 5.5 and 6. Certillcates are not redacción, los certificados se otorgan a todos los estudiantes que Matematik, elév ki lb gwo nöt ki klase pélémans yo nan 55" nita awarded based on the Norm-Referenced Test scores. han obtenido 5.5 y 6 puntos y a los estudiantes de ctiarto grado que resevwa sétifika. Pou redaksyon, tout elév ki té nöt 5.5 ak 6 ak tot han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados en elév klas 4)." kl fé nöt 5, 5.5, ak 6 resevwa yon sétifika. Yo ba los resultados de los exámenes ceñidos a normas de aplicación sétifika yo swivan not elév yo fé nan egzamen kl baze sou "modi nacional. egzamen ofisyål FCAT itilize pou få evalyasyon' yo. EFTA01710253 Spring 2002 Florida Comprehensive Assessment Test (FCAT) Sunshine State Standards - Grade 06 S.tudent Report 50 - 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 Scores•" Your FCAT score Is reported In several ways. The This section of the report shows the scale scores Grade 06 Scale Score Is a score between 100 and 500. The Grade 05 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 anges for the test you took last year. Reading Mathematics Reading Mathematics Level 5: 387-500 391-500 Level 5: 384-500 395.500 Level 4: 339-386 354.390 Level 4: 331.383 355.394 Level 3: 296-338 315.353 Level 3: 286.330 326-354 Level 2: 265-295 283.314 Level 2: 266-285 288-325 Level 1: 100.264 100.282 Level 1: 100-255 100-287 Your test scores showhow 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 between two scores. Your FCAT Reading scores might have been between 287 and 319. Your FCAT Mathematics scores might have been between 298 and 328. 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 specula Words/Phrases areas of the Reading and Main Idea/Pur •ose Mathematics tests Comparisons aeterenceisesearch Mathematics Learning Gains: The table shows the number Mathematics Your FCAT Mathematics achievement level score improved over of points possible and the Number Sense last year's score, and you have made progress. number you earned for each category. Questions on this Measurement test were worth 1 point each. Geometry Algebraic Thinking "k 2001 scores and learning gains are reported if matching records were found Data Analysis on the computer file. Data Rio Date: 03/1t/20C2 0339932 EFTA01710254 FCAT Reports Informes del FCAT (Spanish) Rapo FCAT (Haitian Crcole) The FCAT Reading and Mathematits test resuits are provided Los resultados de los exámenes de lectura y matemáticas del FCAT Yo bay de (2) rapé apa pou rezilta egzamen lekti ak matemz In two separata reports, one for the 'Sunshine State se proporcionan en dos informes por separado, uno para los FCAT la, youn se pou egzamen 'Sunshine State Standan Standard? (SSS) tests and one for the "Norm-Referenced exámenes según las normas estatales "Sunshine State Standard? (SSS) yo, epi lät la se pou egzamen ki baze sou "modél egzam Tests (NRT) tests. At grades 4, 8, and 10, a third report (SSS, por sus siglas en inglés) y uno para los exámenes ceñidos a ofisyél FCAT itilize pou fé evalyasyon' (NRT) yo. Nan klas 4v1 contains the FCAT Writing resulta. normas de aplicación nacional (NRT, por sus siglas en inglés). Un 8vém ak 10~, yo bay yon hvazyém rapé ki gen rezilta egzam tercer Informe contiene los resultados del examen de redacción del redaksyon FCAT la. The FCAT 'Sunshine State Standards' report presents test FCAT de los grados ‘90, 8vo, 10mo. stores from Florida's test of academle standards. Success on Rapé 'Sunshine State Standard? pou FCAT la prezante nät el this test can be best understood by using the achievement El Informe según las normas estatales "Sunshine State Standard? yo fé nan egzamen Florida bay sou prensip akademik yo. levels where a 3 or higher is preferred. This report contains del FCAT presenta las calificaciones del examen de las normas ka konprann kl kantite siksé yon elév pote nan egzamen sa a, académicas de Florida. El éxito de este examen puede entenderse ka itilize tabla nivo siksé elév la. Nan tablo sa a, yo prefere lé y Subject Stores and Content Scores. Subject stores provide mejor utilizando los niveles de rendimiento en los que se prefiere elév få yon nät 3 oswa yon nät kl pi wo. Rapo a gen nät pou e an overall summary of achievement, and content stores give una calificación de 3 o superior. Este informe contiene dos tipos de the number of points earned in specific skill areas. ak nät pou kontni ladann. Nät pou sfié a bay yon rezime jene calificaciones (calificaciones por materia y calificaciones por sou tout sa elév la reyalize nan egzamen an, epi nät pou kontni The "Norm-Referenced Test' report presents Reading and contenido). Las calificaciones por materia proporcionan un resumen general del rendimiento y las calificaciones por contenido proveen el bay kantite pwen elév la té nan yon matyé byen detémine. Mathematics stores on a Florida version of the SAT9 published by Harcourt Educational Measurement. Student número de puntos ganados en áreas de habilidades especificas. Rape sou egzamen ki baze sou "modél egzamen ofisyél FC stores are compared to a national "norm" group, where a El informe del examen ceñido a normas de aplicación nacional itilize pou té evalyasyon' yo prezante nät pou lekti ak matema percentile rank store of 50 is average. (Norm-Referenced Test) presenta los resultados de Lectura y nan vésyon SAT9 Florida bay la. Se Harcourt Educatiot Matemáticas en una versión de Florida del SAT9 publicado por Measurement Id te pibliye vésyon sa a. Yo konpare nät elév yo Achlevement Levels The achievement level is one of the yon gwoup nät yo konsidere köm "modél pou egzamen ofisyél" (Harcourt Educational Measurement). Los resultados obtenidos por subject stores on the FCAT "Sunshine State Standard? test. nan nivo nasyonal, kote suivan klasman pa pousantaj la, los estudiantes se comparan con el grupo modelo o 'norme, en el These levels describe the success a student has achieved on mwayén nan se 50. que la clasificación percentil de 50 es el promedio. the Florida Sunshine State Standards tested on FCAT. Level 5 is the highest and Level 1 is the lowest. Niveles de rendimiento: El nivel de rendimiento es uno de los Nivo siksé elév yo - Nivo siksé elév yo se nät pou youn n temas evaluados en el examen Sunshine State Standards del FCAT. matyé ki genyen nan egzamen sou *Sunshine State Standan 5 Performance at this leve! indicates that the student has stams; Estos niveles describen el éxito que un estudiante ha logrado en las pou FCAT la. Nivo sa yo dekri siksé yon elév reyalize lå elév with the most challenaina content of the Sunshine State Standards. normas estatales Sunshine State Standards que se prueban en el pran egzamen 'Sunshine State Standard? pou FCAT la. Pi g, A leve, 5 student answers most of the test ouestions correctly FCAT. El nivel 5 es el más alto y el nivel 1 es el más bajo. nivo a se Nivo 5, pi phi nivo a se Nivo 1. including the most challenging questions. 4 Performance at this leve: indicates that the student has success 5 El rendimiento a este nivel indica que el estudiante tiene éxito con el 5 Pélgmans nan nivo sa a demontre elév la te aen siksé nan mal with the challennina tonfem of the Sunshine State Standards. A contenido más dificil del examen Sunshine State Standards. Un id te gen pi olis difikilte ladan vo nan egzamen "Sunshine St. level 4 student answers most of the test questions correctly, byt estudiante del nivel 5 responde la mavoria de las preguntas del Standards' la. Yon elév kl nan 5vém nivo ;vapor -, pifia kesy examen correctameate incluyendo las preguntas más difíciles. aganertygisgalgemen, elév la menm reponn kesyon ki gen pi g may have oniv some success with questions that rediga' the most 4 El rendimiento a este nivel indica que el estudiante tiene éxito con el challenging content. difikilte ladan yo. contenido difícil del examen Sunshine State Standards. Un estudiante 4 Infamas nan nivo sa a demontre elév la te aen siksé nan mal 3 Performance at this level indicates that the student has oxmini del nivel 4 responde la mayoria de las preguntas correctamente, 0002 success with the challenging content ol the Sunshine State kl gen difikilte ladan VQ nan egzamen "Sunshine State Standan es posible Que sólo tenga algún axil en preguntas que reflejan el la. Yon elév kl nan 4yém nivo reponn kesyon egzamen Standards, but performance is Inconsistent. A leve) 3 student contenido más difícil. answers many of the test questions correctly, but is generaliv less körekteman, men li gen kék seise selman nan kesyon ki parét g 3 El rendimiento a este nivel indica que el estudiante tiene éxito parcial pi gis difikilte ladan yo. successful with questions that are the most challenging. con el contenido difícil del examen Sunshine State Standards pero el 2 Performance at this level indicates that the student has limitad 3 PtiMmans nan nivo sa a demontre elév la pea enne siketit n rendimiento no es uniforme. Un estudiante de nivel 3 responde matyé ki gen difikilte ladan yo nan egzamen "Sunshine St sur ts with the challenging content of the Sunshine State muchas de las preguntas del examen correctamente pero por lo Standards. Standards" la. men påfamans lan pa rete estab. Yon elév 314" n. generaUiene menos éxito con las preguntas que son más difíciles. 1 Performance at this level indicates that the student has little reponn anpil nan kesyon egzamen yo körékteman, men anjeneg 2 El rendimiento a este nivel indica que el estudiante tiene éxito limitado so= with the challenging content of the Sunshine State aen mwens siksé ak kesyon ki paret gen pi plis difikilte ladan yo. en el examen Sunshine State Standards. Standards. 1 El rendimiento a este nivel indica que el estudiante gene poco exile 2 Peförnans nan nivo sa a demontre siksé elev la limite nan matyt con el contenido difícil del examen Sunshine State Standards. gen difikilte ladan yo nan egzamen 'Sunshine State Standard.? Year4o-Year Growth The FCAT 'Sunshine State Standard? 1 Pélémans nan nivo sa a demontre elév la •en vnn ti siksé tou tests in Reading and Mathematits are given in grades 3-10. Evolución de un año al otro: Los exámenes Sumidas State nan malyé kl gen difikille ladan yo nan egzamen "Sunshine Sti Therefore, achievement across two years can be compared for Standards del FCAT en lectura y matemáticas se administran desde Standards". grades 4-10. These comparisons are made based on changas in 341' a 10" grados. Por lo tanto, el logro en dos años puede compararse con los grados desde 410 hasta 10Te. Estas Pwogré de ane an ane - Yo bay egzamen lekti ak materna the students achievement leve) from one year to the next. comparaciones se hacen basadas en los cambios en el nivel de 'Sunshine State Standard? pou FCAT la depi nan klas 3röfll jis Certificates Scores on the 'Sunshine State Standard? part of rendimiento del estudiante de un año a otro. klas 10rém. Konsa, ou ka konpare sa elév yo reyalize pand FCAT are used to award students with certificates of dezan (2 an) depl nan idas 40m »le klas 100m. Yo ba accompilshment. For Reading and Mathematits, students who Certificados: Las calificaciones de la parte Sunshine State Standards del FCAT se utilizan para otorgar certificados de logros a konparezon yo sou nivo siksé elév la de ane an ane. store in Achievement Level 5 receive certificates. For Writing, los estudiantes. Para lectura y matemáticas, los estudiantes que Sötifika • Dapré nät elév yo fé nan "Sunshine State Standar certificates are given to all students with stores of 5.5 and 6 and logran un nivel de rendimiento 5 reciben certificados. Para pou FCAT la, yo ka bay yo sétifika pou sa yo akonpll. Pou lekti to fourth graders with stores of 5, 5.5 and 6. Certificates are not redacción, los certificados se otorgan a todos los estudiantes que Matematik, elév ki fé gwo nät ki klase pélibmans yo nan 5véril nis awarded basad on the Norm-Referenced Test stores. han obtenido 5.5 y 6 puntos y a los estudiantes de cuarto grado que resevwa sétifika. Pou redaksyon, tout elév ki fe not 5.5 ak 6 ak tc han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados en elév klas 41"" ki fé nät 5, 5.5, ak 6 resevwa yon sétifika. Yo b los resultados de los exámenes ceñidos a normas de aplicación sétifika yo swivan nät elév yo té nan egzamen ki baze sou "moc nacional. egzamen ofisyél FCAT itilize pou få evalyasyon" yo. EFTA01710255 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 NORM-REFERENCED TEST :t Student Report Grade 05 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! Com•rehension 54 Reading Initial Understanding 12 Comprehension Interpretation 24 Critical Anilysis 9 Mathematics Problem Solving Strategies 9 Mathematics Problem Solving 48 The Scale Score expresses your performance and allows comparisons from year to year. Measurement 6 Reading Comprehension Scale Scores range from 481 to 802. Mathematics Problem Solving Estimation 4 Scale Scores range from 467 to 781. Problem Solving 5 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 tog. Number Systems 5 Patterns & Functions 3 If you took the test again, your National Percentile Rank might be slightly higher or lower than Algebra 3 stated here. However, your National Percentile Rank would probably tall within a certain range. For Reading Comprehension, your National Percentile Rank should be between 28 and 43. For Statistics 6 Mathematics Problem Solving, your National Percentile Rank should be between 55 and 79. Probability 3 Geometry 7 Each question was worth 1 point Run Date: 04/28/2001 0301319 EFTA01710256 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 SUNSHINE STATE STANDARDS Student Report Grade 05 District Name and Number Florida Comprehensive Assessment Test SO - 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 the reading portion of FCAT have not yet been determined. The table below shows the scale score ranges for each Achievement Level for the mathematics test. Student Achievement Level Descriptions FCAT Student LEVEL 5: Performance at this level Indicates that the student has success with the most challenging content of the Sunshine State Standards. A Level 5 . Achievement Levels student answers most of the test questions correctly, including the most challenging questions. Scale Score Ranges LEVEL 4: Performance at this level Indicates that the student has success with the challenging content of the Sunshine State Standards. A Level 4 student Reading Mathematics answers most of the questions correctly but may have only some success with questions that reflect the most challenging content. Level 5: • 395-500 LEVEL 3: Performance at this level Indicates that the student has partial success with the challenging content of the Sunshine State Standards, but Level 4: wz 355-394 performance is Inconsistent. A Level 3 student answers many of the questions correctly but Is generally less successful with questions that are co2 Level 3: off, 326-354 most challenging. Level 2: 288.325 LEVEL 2: Performance at this level indicates that the student has limited success with the challenging content of the Sunshine State Standards. Level 1: O 100-287 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 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 tall within a certain range. For reading, your scale score should be between 260 and 296. For mathematics, your scale score should Mathematics be between 225 and 267. Number Sense Measurement The check marks ( .1) show If you scored in the lowest, middle, or highest third of grade 05 Geometry Florida students who took this test. Algebraic Thinking Data Analysis The Content chart shows the number of points possible and the number of points earned for each category. Each question on this portion of the test was worth one point. The "TBD: To Be Determined results on your performance items will be reported Separately. Run Date: 04/26/2001 0299051 EFTA01710257 1169-J3-H1R3 DATE: 02/09/99 MIAMI-DADE COUNTY PUBLIC SCHOOLS STUDENT PERFORMANCE PLAN srum:a. ID:a.LA. ID: Ui4E: ESTATUS: A SEX: F ETHNIC: H BIRTHRATE: ADDRESS: CITY: M KIP: 33178 PHONE: LUNCH: F DROPOUT PREVENT PGMS: ATHLETIC ELIGIBILITY: N CCP: TRANSFER CRSE INFO: NO WEIGHTED GPA: WEIGHTED GPA: RANK: COHMUNITY SERVICE HOURS: 000 COMPLETED ON: / / ESOL: LEVEL 5 EXIT DATE 06/11/97 MOST RECENT PSYCHOLOGICAL CASE OPEN: SCRS REFERRALS: STANDARD DIPLCMA: TOTAL ABSENCES: 4 TOTAL TARRIES: 15 TOT DAYS SUSPEN: INDOOR: 0 OUTDOOR: 0 TOTAL ABS PREVIOUS YEAR: 7 PARENT/GUARDIAN: LAST NAME FIRST RAKE REL MIPLOYMENT PRONE PRIMARY HONE LANGUAGE TESTING INFORMATION: • 0 MN SPANISH COUNTYWIDE TEST SCORES TEST DATE: 03/98 TEST GRADE: 02 TEST DATE: 03/97 TEST GRADE: 01 STANINE PERCENTILE STANINE PERCENTILE READING READING MATH COMP MATH COMP MATH APPL MATH APPL SAT TEST SCORES ACT TEST SCORES HIGH SCHOOL COMPETENCY TEST SCORE SCORE COMMUNICATION SKILLS/SCORE VERBAL ENGLISH MATHEMATICS SKILLS/SCORE MATH MATH TSWE READING SCHOLASTIC READING INVENTORY SCIENCE REASONING DATE: 1997-98/MAY 1998-99/SEPT LEVEL: SCORE: REPORTING CYCLE: 981 CURRENT SCHOOL: IMODUREVIT GRADE: 03 SCHL TRH COURSE TITLE SP EP ROOM 1 2 3 4 FGECAB SCHL TRH COURSE TITLE SP BP ROAN 1 2 3 4 FGEC AB 5101 A LANG ARTS 0051 5101 A READING 0051 5101 A MATHMATIC 0051 5101 A SCIENCE 0051 5101 A SOC STUDY 0051 5101 A ART 51 5101 A MUSIC 51 5101 A PHIS ED 51 5101 A SPANISH-S 0051 * DENOTES INACTIVE COURSE 4 DENOTES BELOW GRADE LEVEL EXCEPTIONAL CHILD PROGRAM: PRIMARY EXCEPTIONALITY: IEP DATE: EVALUATION DATE: BARN'S SIGNATURE DATE Chi/ O 2 EFTA01710258 Attachment C DADE COUNTY PUOLIC SCHOOLS OFFICE OF EXCEPTIONAL STUDENT EDUC ATION ALTERNATIVE STRATEGIES AND FOLLOW-UP FORM e e (2ells air . Student's Name Date and Type` of Conferences: (a? )( )( School: Grade:3 DOB l CST Chairperson: Student ID. Problem Area (Objective, Specific and Quantifiable): S faAl I el on 3r as Replacement Behavior cc" SAY on Attskc. Alternative(s) to be tried at Grade/Sehool Level (Plan) (Please note: These alternatives may be helpful Date of Person(s) with other students in the class as well). Initiation 1. Responsible r%kkAA enA- Go; 11. near +Fe Cache)' 10)/ f et 8 2. Sktider1;-* t\ have tt:‘ ,crE'llna f# r: =Cc ed 3. -1--AO C.a Lrcf ve Ea;*tve ret (I-G./ten...GA • 4..SAuden\-- worts L,0;11-% oc peer to 5. ,54-ua0\ V- 15 ,Ca lavelN e>1ra "Me tol2 FOLLOW-UP QUESTION: pasBM -I n ...pc-wed 0.l s k-al , 45 on Problem Area (Objective, Specific and Quantifiable): 0..e,‘ e o) ?-si 1q nrent yliS LP-N., 11 Co..--plc'-e. 0. SS 10 n Alternative(s) to be ttied at Grade/School Level (Plan) (Please note: These alternatives may be helpful with other Date of Persona) students in the class as well). Initiation Responsible 1. 9k-aeA\ - Ircks ,skr.)c-k-w-ed ht tart c q(f1(13 . 2' TeaCke.i, -e rkS asS\greas kel- t nA‘,,i, llJokk y 1 1 I CI 3. 4..-O,zzi A S i; kg-1 a peter V11 1ge 4:1)v.€ Dorle3 fo aisio nr-neA -1-,s are Pas-N's -In 41-go chary, 5. \mos act co_vate 1-; rat 4-° co FOLLOW-UP QUESTION: p roS n-frovect on con-, \e-Ilyi ass )5),--,e4 • Type of Conferences: CST. LEP, ESE, and 504 (Over) rm.5139 Ito-9-41 Child Study Team Procedures 23 EFTA01710259 DADE C6UNTY PUBLIC SCHOOLS ;HOOL NO. F C I c 40 STUDENT CASE MANAGEMENT REFERRAL FORM SCM tl Mo. Day Yr. *UDENT NAME STUDENT ID HOME GRADE ROOM ?im LEVEL PERIOD OF DAY INCIDENT DATE 2. I0 cri TIME •• fMr7hery) PARENT CONTACT: (Gide Yes of No) FERRED BY REFERRED TO 1. For This Behavior YES NO 2. For Other Misbehavior YES NO 1RRATIVE: (CLEARLY STATE WHY THE STUDENT IS BEING REFERRED) 3. Contact Attempted NO 4. Contact Made: 4A. Verbal NO e4uaer.)-1- 'Per Pc:ir yy-Nance 'Plan 4B. Written YES NO ' Read lre and IA NTER REASON FOR REFERRAL CODES BELOW: ENTER NO MORE THAN 4 CODES) ENTER STUDENT SERVICE INFORMATION BELOW: COMPUTER COMPUTER R q RECORDED RECORDED OTHER INCIDENT INFO = LOCATION: .NTER REFERRAL ACTION INFORMATION BELOW U CONTEXT: REFERRAL STUDENT ACTION SERV,ICE DATE TIME EMPLOYEE NO. INITIALS CODE DATE TIME EMPOWER NC, INiTIALS CODE. /Military) (MihAdt y) Mo. Day Yr. DV Yr. r)--ito -7/ ci / :nr R_ 1 C 2- NUM :omments: 1 Ccn1 rut I inn t Lgency/Case Number (If Applicable) 178-2016 FM-2981 Rev. (05-95) FOR DATA ENTRY (ATTENDANCE),THEN FILE IN STUDENT CUMULATIVE FOLDER. EFTA01710260 T EDUCATION OFFICE OF EXCEPTIONAL. STUDEN . . / DADE COUNTY PUBLIC SCIR/OLS FOLLOW-UP FORT[ ALTERNATIVE STRATEGIES AND C11)1 fcri es ee2W. c'./ 5 1( Date and Type' of Conferences: Student's Name:. indent ID. # DOB CST Chairperson. ble): Problem Area (Objective, Specific and Quantifia Replacement Behavior. Date of Person (s) hool Level (Plan) Responsible Alternative(s) to be tried at Grade/Sc Initiation (news note: These alternatives may be helpf ul with other students in the class as welt) 2. )..c.(:• /'LC - 7/ 3. 4. 5. FOLLOW-UP QUESTION: ere Aa- dr i iwe .Spe a Quantifiable): / Problem Area (Obj a , r a-trt„ &Int. - t4A-.1.9/1 262---fe— °Ca Replacement Behavior An A-014-4-cet-I GE/ ,...gAst. /lead Date of Persouls) bool Level (Plan) Responsible Alternative(s) to be tried at Grade/Sc ul with other students !he e.bIsAlapelb. Initiation be helpf Olean note: These alternatives may ( 'tat/ elA e&a /61.-- - btleri-. ka ..iii - /01 - 1 I. MLfre /44:, .1 ir a(c& 2. o ra rorrnn at t‘c6o. v e,nttn‘ Inaa vileati, 7i) 64,.2 /01 _ cif --4 4 Ole. _ ilif in t Wrirda? - eitt t'C'' d .1. Chat _i(e4c.t-\_ Lti-eceed /01 - (11 ..t Z ie tSier a fr d 47S FOLLOW-UP 21JESTPIN:4:4 /A/O ''-1- AMA 1>t, , F.4.n.11/ 026441 (Over) CST, LEP, ESE, and 504 23 • Type of Conferences: res • Child Siudy Team Procedu 12/07 eeaAS-t ‘0441-1,- Gadeffotte anfilinal EFTA01710261 Attachment E OFFICE OF EXCEPTIONAL STUDENT Ei)UCATION DADE COUNTY PeBUC SCHOOLS CST STUDENT INVENT ORY (Elementary Level) by R.1.IR Ceasehums) .(Adspeal trot CISktfillk devslopeet Doc Type: 4096 a 'h. .• • ART • I • Date (talIDDIYY): Student ID. N =rim D.O.B. Teacher(s) lerbrammiciwyvaltil!mmailall ESOL Lcvetcr School: 11102212 Math Levet t •• • • 0 Weakness in regular class settings treng :• I• INFORMATION OUTPUT. INFORMATION INPUT (14en Sauciest Respoods) (Ho. Stticieot Inns) Essay Textbook Written Reports Worksheet/Workbooks Short Answer Oral Presentations Creative Weida", Discussion Worloheetsigrorkbooks AN Materials Hand-On Experience Multiple Choice/Matching Observation True/False Boudwork Math Word Problems Reference Material Computation Computers Derno/Lab Projects. Art or Media Projects Teacher-Directed Activity Maps, Charts or Graphs Peer Tutors Oral Responses Independent Work Group Discussion With An Adult Boardwork fr In A Small Group Oral Reports With The Whole Class Other Other LEARNING AND BEHAVIOR PROBLEMS , • (Check only items or the hishest priority. 61 93 iquistom or S"). . Aemembering (general ' g Questions in Class . Seeing. Relationships tegori iing 96 11, 49 26 35 Staying on Task lass DiSCUS Sit3tt Study Skills dc Ittpleting Assignments- 25 23, 57 106 Learni ng Strategies ollowing Directions Taking Notes letting Started 44 108 47, 109 Taking Tens adependent Work Skills 18 92 Thinki ng Skills anting from Demo nstrati ons 102 Transferring earning from Oral Presentations 29 Information or Skills arising from Tape Recordings 46 17 Understanding • Letting 31, 56 34 55, 64, 75 Conte nt Vocabulary Mathematic Worki ng in Groups Oral Expression 42 28 51, 103 Writing Organ zation 38 8 Oilier Paying Attention Reading Conte nt Materi al 44) Other 16 Pus • sasat.ors rdar a eisma Intn• Swes44 ••• Reading Specific Information FM-4ft. EFTA01710262 rk - t Attachment E DADE COUNTY PUBLIC SCHOOLS 57\ CE OF EXCEPTIONAL STUDENT EDUCATION )14-7l fatAbl " 'IT? - CST STUDENT INVENTORY (Elementary Level) (MAPcsd from esiscriak liCY•k•ptd by RUE Coesestimi) Dee Type: 4496 Date (MM/DD Student's Name: Student ID. N Age: Antiwar:TA temirgari ESOL Level:( Reading Levet Math Levet • + Strengths (commensurate with peers) (7 Weakness in regular class settings INFORMATION INPUT INFORMATION OUTPUT, (Hoer Studeat Leered) (How Stucker Responds) Textbook • Essay Worksheet/Workbooks Written Reports Oral Presentations Short Answer Discussion Creative Writing A-V Materials Worksheets/Workbooks Hand-On Experience Observation Multiple Choice/Matching Boardwork True/False Reference Material . Math Word Problems Computers Computation Demo./Lab Project_ Teacher-Directed Activity Art or Media Projects Peer Tutors Maps, Charts o r Graphs Independent Work Oral Responses With An Adult Group Discussion In A Small Group Boardwork fr With The Whole Class Report Oral Repo Other Other •. LEARNING AND BEHAVIOR PROBLEMS a (Check only hems or the highest priority. Marina of 5). Asking Questions in pass • 61 93 .Remembering (general skills) Categorizing 96 11, 49 Seeing Relationships Class Discussion 26 35 Staying on Task Completing Assigamentr 25 Study Skills & Following Directions 23, 57 106 Learning Strategies Getting Started 44 108 , Taking Notes Independent Work Skills 18 47, 109 Taking Testa Learning from Demonstrations 102 92 Thinking Skills Learning from Oral Presentations 29 Transferring Learning from Tape Recordings 46 17 Information or Skills Listening 31, 56 Understanding Mathematics 34 55, 64, 75 Content Vocabulary Oral Expression 42 28 Working in Groups Organization 38 51, 103 Writing Paying Attention 8 Oilier Reading Content Material 4O Other Reading Specific Information 16 Nip I diodes it w tesarddl Ildrood M.T.Y. ad FM-4n d (ID-ti) EFTA01710263 5008 33 -R2G' net ICD ENGL i'MCY COIR1S.c.t; 02/03/13 11...!2.1•2 StUDENT ID FI A CM ID SIAI tr. A SIX f ITEN1C H LEGAL NAM:: LAS rIRS 14100LE R IIICACC CURREN' SSIIDUI GRAM' 02 Ilk STGI 20I DA1I. Ern EPTD 04/4,!/42 SURVEY: DAIE 11 '13 Y T Y f•ARENf/GUAfdllON LANG SP IfU LANG 1' ASSFCSMFM1: PAU 11 / 0-; / 45 OLPS Saki 13 lfF (TAO N f SCI 1.1W! YE fRONLEf AN: GRADE RAW SCORE: RDG LAE NERCr.Nr (LE: ROC LW COPY DM. 1: / Oi i 9t, RACIC Of FN1RY A ILIOI GINICUR 9:: HU SfRV1fxS If EXIT DACE 06 / 11 / 97 3ASLS ur EXIf A ALPS ::CURE 1? IITTROPOI IlArn MADE PAR SCOPE: roc I A% PERE!. ILE RDG AVG REC.LISSIRICALION DA / SEW ERSE DIP IIRS/IE M1M/1411 DEIII CPS! UV 114/14I1 11111/191 HUM NUM NUN NUii Lai FRANC Dor 04/12"7.7 ;IF* PI AN DA1F 06/12/9? (SUIuva Ul 06/12/47 EFTA01710264 COHNIYLEIDI I r SI SCOUf 5 02/02/90 14,24 SO 5 OJOEN S112- r n) C2-R2111111111 CIA f £0 5 f A fUS A 5J.X C:r11NCC H t rwA. NAME I ASI ftS1 not r Mrzer PI r APP COP2EN r scHOOL CRAHC O. CN f2Y OA(C 09/02/9/ ei eR runn fCST YCAR (52A0::) 9/ 01 ) ) I ) ) i C.5•1 OPTION 4 •• •• SIM' ie:. CDL: 15Iári 7 COg !CAM' 7 CO% I Cl A9 7 Cl.* IS]A9 7 CE»! 12C(U) COMP I I i MAI H COMP I I I MA ril APP i MA nl i 1 I i ANG mr CH / r Ntd. 1SH I I I NO20 :5 r MOY I I I WORD Pt AO I or no voc i i I CONC NáR I I I SOTENLV I I I SOC SCI 1 : I -- .__-.. - __ T OPTION5- 0) HOF ni:1mph Of nc2 (l) MOF l";, .3 ra) 2CCAU5C C5.5 S) CXFCNOCO F[MC • Sc.0 1 ) I Liflt D PO: i St 4) NOI 11SI f D ni cAuta 1 L P CUM( F ol Dr k r OP K pora Z) rt, ....uen :Alf t.CP ) {cri iTn áLi f .:5C ANI) I_CP Li fl) : APst Ntripts czut At: CODE v, C ai u / . .1)1 )1/4/(1 EFTA01710265 Attachment E OFFICE OF EXCEPTIONAL STUDENT EDUCATION DADE COUNTY PUBUC SCHOOLS CST STUDENT INVENTORY (Elementary Level) Commtuuue) (A4apue4 trout Catiak devolopa4 by MR Doc Type: 4996 Demographic Information Date (A4iLfIDDIYY): Student. ID. N Print Stu. Age: Teacher( Class/Course: Grade: ESOL Level:(5 -- Reading Level: Math Level- /12- School: en 0 Weakness in regular class settings INFORMATION INPUT INFORMATION OUTPUT, (How Siidect Lzaros) (How Stu:Scat Rr.spoods) Essay Textbook Worksheet/Workbooks Written Reports. Oral Presentations Short. Answer Discussion Creative Writint A-V Materials Worksheets/Workbooks Hand-Oa Experience Observation Multiple Choice/Matching True/False Boardwork Reference Material Math Word Problems Computers Computation Demo./Lab Projects. Teacher-Directed Activity Art or Media Projects Peer Tutors Maps, Charts or Graphs Independent Work Oral Responses Group Discussion With An Adult Boardwork In A Small Group Oral Report _EL With The Whole Class Ocher Other LEARNING AND BEHAVIOR PROBLEMS (Cheri only items of the highest priority. Madman or 5). • • • Asking Questions in Clam • 61 93.4 itemembering (general skills) tegorizing 96 11, 49 Seeing. Relationships 26 35 • Staying on Task C ass Discussion Completing Assignmentr 25 Study Skills & 23, 57 106 Learning Strategies F°Bowing Directions Notes 44 108 Taking Getting Started Tests 18 47. 109 Taking Independent Work Skills 102 92 Thinking Skills Learning front Demonstrations 29 Transferring Learning from Oral Presentations 46 17 Information or Skills Learning from Tape Recordings 31, 56 Understanding Listening Vocabulary 34 55, 64, 75 Content Mathematics 42 28 Working in Groups Oral Expression Writin Organization 38 51, 103 Paying Attention 8 Other Reading Content Material 40 Other ••••-•• ,at 14 tlaAl ten" Mat. 16 rm. • Reading Specific Information P74-41/4 (10-r1) EFTA01710266 DADE COUNTY PUBLIC SCHOOLS OFFICE OF EXCEPTIONAL STUDENT EDUCATION ALTERNATIVE STRATEGIES AND FOLLOW-UP FORM Student's Nam 4 01 Date and Types of Conferences: ( (1 t 9 (//g/I)1 ) ( 2 Grade: DOB CST Chairperson: Student ID. . PM/ Objective, SpiecifIc and Quant4Ible): N t L. On-- reiCtjA, trathcii ail° tej - 1-ALF r Replacement Itehavioni se 11110 $0h 6115 i thivol41--- Alternative(s) to be tried at Grade/School Level (Plan) ' Date of Person(s) (Please note: These alternatives may be he • I with other students in the class as well). Initiation 1. t , • 3. , Ma fuMW) 'Wtt, (,) yn ,p ° 'L i r( l' ry 1( 5 it . et ,900iltor asrt viten Itil3ifi . 5. FOLLOW-U R ,QUESTION: WI th,Lilitiaiii 020% 0 iiijeci-InufAI-4/16‘514- 47151C antirmitne, a $ 4 qies In silbree a keel? P blem Area (Obi dive, c and Qua tifiable R acentent Behaviol Via/Lae, ekt litA l etiAd dial) n et 'el .22,0DA Alternative(s) to be tried at Grade/School Level (Plan) Date of Person(s) (Please note: These ternatives may be helpful with other students in the class as well). Initiation 1. 5hTh e Al id a1/2'/N9nrytp..yrk—leae avaG cgolfer i t t/t tk_s t, If . t i,t critto,id e 1 de vi es 41)195 . ,,. P Ore • FOLLOW-UP impavtivten,* *trio Aay) QUESTI0W: am y-ti5ektri6miei tes Wit( Mei ene-q k cid i cil 4 514. el rr-4.S. • Type of Conferences: CST, LEP, ESE, and 504 (Over) dfrAptiv e FM -5239 M6-94) vaete gag' )(AM- ' EFTA01710267 cp) vi Vv Lej STUDENT CASE MANAGEMENT COMPUTER SCHOOL NO. STUDENT S RECORDED EMPLOYEE NO. EMPLOYEE NAME STUDENT NAME GR/SECT SCM# DATE SERVICE STUDENT ID TIME CODE Mo. Cray Yr. /Military) 3 /01 08' It rev COMMENTS: ill 02- IV 70-e) 111 /2- iqf 11,00 3 1/1/9 98 /Lap 3 eat- — 747 /2403 I9Sk liao 3 624 O/ ITS/ /70o 1_ /0(- *olte4 t // I 02_19/ 2(30 4- REFERRED BY: s f • /1 I omf 19"8 r:00 // 12.3 19g VI 878.2164 WHITE - For Data Entry (Attendance), Then Student Cum Folder; YELLOW • To Administrator GREEN • To Relaying Party; PINK • To Servke Provider FM-3673 REV. (04-87) COMMENTS. /5 _c -G _ cs,ocesi ) H/02_ henc-e,2"te eallc-Q4nA? f1/43 erer"7 03 - WHITE - For Data Entry (Attendance), Then Student Cum Folder; YELLOW - To Administrator 878-2164 GREEN • To Referring Party; PINK - To Service Provider FM-3873 REV. (0487) EFTA01710268 4-31-R2G DENT RECORD/SUBJECTS 12/03/98 11.15.55 WIT ID SCHOOL In GRADE 03 HR 38L PRO ST SCHL CD iE SEX F EFH H ADDSCH.CD 2THDATE iT SUS UPDT 09/23/98 RECORD UFOT 11/08/98 LAST GRD UPDT 09/23/98 REPORTING CYCLE 981 GRADING PERIOD CYCLE TOTAL ABSENCES 002 CYCLE TOTAL TARRIES 009 PROGRAM NO. 05 2DE 03 HR 3BL / 1 F W-DISEC CRS M MULE ROOM TEACHER 1234 G 1 A04 01 510009032 ALANC ARTS 1 E03 01 510009021 A READING 1 GO3 01 510009007 A.MATHMATIC 1 H04 01 510009063 ASCIENDE 1 I04 01 510009012 A SOC STUDY 1 J04 01 510009015 A ART P3 1 KO4 01 510009016 A MUSIC P3 1 LO4 01 510009017 A PHYS ED P3 1 N0401510009020 A SPN1ISH-S KEY DESIRED GRADING PER EFTA01710269 8-33-R254 LIMITED Y COURSES 12/03/98 12.12.01 DENT MIMI FLA STU ID STATUS A SEX F EGAL WM! LAST MEN KIDDIE ■ BIRMATE SENT WWII. GRADE 03 HR SECT 3EL DATE WSW VEY: DATE 1 /-07 / 95 RESPONSESYYYPARNT/GUARDIAM LANG SP STU LANG SP ESSEN!: DATE 11 / 07 / 95 OLPS SCORE 13 LB, (Y/NU H ESQ. LEVEL 5 ROPOLITNN GRADE RAN SCORE! RD5 LANG PERCENTILE: ROE LANG RY DATE 11 / 07 / 95 BASIS OF ENTRY A ESCL SEMESTER 03 LEP SERVICESLE T DATE 06 / 11 / 97 BASIS OF EXITA OLFS SCORE 19 ROPOLITAN: GRACE RAW SCORE! ROG LANG PERCENTILE! ROE LANG lASSIFICATION DATE / / SCHL CRSE EMP 111S/ITY, MIN/WK SEAL ERSE EMT HRSAC MINAE IRRI NUM NUM NUM I' TRANS DATE 06/12/97 LEP PLAN DATE 06/12/97 ESOLLEVELUPDATE 06/12/97 EFTA01710270 S169-f-H1R3 DATE:02;09/99 es' MIAMI-DADE COUNTY PUBLIC SCHOOLS STUDENTPERKRHANCEPLAN MID:ISA. ID: =INANE: STATUS:A SEX: F ETHNIC:H BIRTHDATE: ADDRESS: CITY: H ZIP: 33176 PHONE: LUNCH:F DROPOUTPREVENTN-HS: ATHLETICELIGIBILITY: H CCP: TRANSFERCRSEINFO: NO INWEIGHTEDGPA: WEIGHTEDGPA: RANK: 'OM/UNITYSERVICEHOURS: 000 COMPLETED ON: / ESOL:LEVEL5 EXIT DATE06/11/97 MOSTRECENTPSYCHOLOGICAL CASEOPEN: SCHSREFERRALS: STANDARDDIPLOMA: TOTALABSENCES: 4 TOTALTARDIES: 15 TOTDAYSUSPEN:INDOOR: 0 OUTDOOR: 0 TOTALABSPREVIOUSYEAR: 7 PARENT/GUARDIAN:LASTNAME FIRSTNAME REL DIPLOYMERT PHONE PRIMARYHOMELANGUAGE SPANISH TESTINGINFORMATION: E SCORES COUNTYWIDTEST TESTDATE:03/96 TESTGRADE:02 TESTDATE:03/91 TESTGRADE:01 STANINE PERCENTILE STANINEPERCENTILE READING 5 48 READING MATH COMP 7 77 MATHCOMP MATHAPPL MATHAPPL SATTESTSCORES ACTTESTSCORES HIGHSCHOOLCOMPETENCY TEST SCORE SCORE COMMUNICATIONSKILLS/SCORE VERBAL EtQLISH MATHEMATI SKILLS/SCO CS RE MATH MATH READINGINVENTORY TSNE READING SCHOLASTIC SCIENCEREASONING DATE: 1997-98/MAY 1998-99/SEPT LEVEL: SCORE: REPORTINGCYCLE:981 CURREN? SCHOOL:IN CURRENT GRADE:03 SCHLTRHCOURSETITLE SP EP RON 1 2 3 4 FGEC163 SCHLTRHCOURSETITLE S? EP ROOK 1 2 3 4 FGEC AB 5101 A LANGEaS 0051 5101 A READING 0051 5101 A MATH TIC 0051 5101 A SCIENCE 0051 5101 A SOC STUDY 0051 5101 A ART 51 5101 A MUSIC 51 5101 A PHYS ED 51 5101 A SPANISH-S 0051 DENOTESINACTIVECOURSE i DENOTESBELOWGRADELEVEL 2CEPTIOHALCW2:5EOGRAM: PRIMARYEXCETIONALITY: IE? DATE: EVALUATIONDATE: ?ARENT'SIGUA12: DATE 600 y EFTA01710271 /ADE COUNTY PUBLIC SCHOOLS OFFICE OT EXCEITIONAL STUDENT EDUCATION ALTERNATIVE STRATEGIES AND FOLLOW-UP FORM (1$j etv Olvitsuit Date and Ty e• of Conferences: 07 ( )( CST Chairperson: r, on *cksV-• !roblem Area (Objective, Specific and Quantifiable): SA —0. ,A) I Replacement Behavio Lom s\-oot e\--as1C. Person(s) Alternative(s) to be tried at Grade/School Level (Plan) onsible (Please note: Thcsc alternatives may be helpful with other students in the daze as awn). Sena-- tA; I.\ A--near -ti-e +-eacker Limr!Cctsg‘agect SALkienVuA;t1 have wt; nn -n-e Men 0viCs ea;Ative rein-eiften--4244 eat readel 4- Skuclor\- worts isdim cc peer SAQC\CR,- \S gi ,Jen e Ara cline FOLLOW-UP QUESTION: ' 1e-primed aft A...1 on Ao-s Y-- IACLS Problem Area (Objective, Specific and Quantifiable): ao r ,—,to \ e c, en Ass; 0 n nneri4S Replacement Behavio `‘‘ Conp\C \-e, o. Ss le ni—cfrks Date of Person(s) Alternative(s) to be tried at Grade/School Level (Plan) Responsible (Please note: These alternatives may be helpful with other students in the class as well). Initiation I. hOne L.trt Ck61+ q I I [ CO -+' 9 1-)C.Ve)r - if - t.5 a\ ,S*TtiCAO red 2. Te ac k ej-,v,z, ns a s_s ‘ 43 ,-,..e,,A, .4„, key _to if to t i i ci 3 I nA,,,, (Lemlly 1 SALACAA- ,,D, A La; A-1,Th & ()eer tot, 148 4. D kbe D a4C S fot- _0.3‘.6tru--,04 .4 of-C cilia ke ea.s-kca v-, 4-1-,& (-Dorn 5. .S. \--t-Ci eA+ \mos acteifra+e ft, ,, A-O cil ia lie COn3o\tk a331fi nanonA-.S FOLLOW-UP QUESTION: n-feWeCt on • Cont1E -Lin ass )ore.44. t S FM-$1}v (Ill.-941 • Type of Conferences: CST, LEP, ESE, sod 50.4 (Over) 23 Child Study Team Procedures EFTA01710272 Student's Name: 1 School ID# FOLLOW-UP FOLLOW-UP OUTCOMES AND COMMENTS (Schedul DATES e next follow-up in• (Note ate es: Alternatives, Date or initi ation or Person(s) Rap Ohl i IS) 1'415 rie# in-graved on .5 +ay t k, has ricDV Pisa (nora veal on COnyoie CtSS N4jnr-•faitS / " ir ..) et /tut t IceN ( it : ,.c t.( j. reit, ,tt • 5c. .7.1 (-OP- • ta r ( — ',.. • • ' Date Eualpati•a Assistance Requested: n Alfter alternatives arc found to be ineffectiv 24 i le q& handicapping condition is present e orobvious _ 1 I:M-5239 (116.91) Child Study Team Pro cedures EFTA01710273 SCCHOOLS PUBLI JUNTY C DADE IOONOL . STUDENT CASE MANAGEMENT REFERRAL FORM scm # 01 Mo. Day Yr. GRADE PERIOD INCIDENT DATE 2. 10 HOME TIME DENT ROOM .3D3 LEVEL OF DAY STUDENT ID rmitinwn JAME PARENT CONTACT: (Circle Yes or No) 1. For This Behavior YES NO REFERRED TO 2. For Other Misbehavior YES NO ERRED BY 3. Contact Attempted ta NO UDENT IS BEING REFERRED) 4. Contact Made: RATIVE: i(C 4k Verbal (2' NO e4ucAer4 Per QDr yy\ance 'Plan 48. Written NO 'Read Ins 0r13 \\A aA-In N TER REASON FOR REFERRAL CODES BELOW: ENTER STUDENT SERVICE INgOViMATIO RER NO MORE THAN 4 CODES) COMPUTER RECORDED OTHER INCIDENT INFO = LOCATION: CONTEXT: : REFERRAL /TER REFERRAL ACTION INFORMATION BELOW ACTION CODE r ATF. TIME TIME EMPLOYEE NO. INITIALS (tiblitisy) DATE (Military) Mj. Dm; Yr. o. Day te R_ / iJ I I MIME I MOO MUNI In'.. J- CP4,.,41,11 RAY. 105.951 EFTA01710274 AE COUNTY rInst.tC sainot.S OFFICE. OF EXCEPTIONAL STUDENT EDUCATION ALTERNATIVE STRATEGIES AND FOLLOW-UP FORM es 7 eerg,4) (0).. fic i Name: Date and Type of Conferences: (;) 3 )( )( )( Grade: DOI CST Chairperson: *Went (D. A' objem Area (Objective, Specific and Qumitifiabler . Replacement Behavior: Alternativefs) to be tried at Grade/School Level (Plan) Date of Person(s) (Please note: These alternatives may be helpful wilt outlet students in the elms as welly Initiation Responsible I. 2. , . -CC.% I ' LCXl . . — - vs • 5. FOLLOW-UP QUESTION: • Problem Areat (O2tive Spec* a Quantifiable): _.- egre i t t" Ce i Replacement B5havior: /7zeic pt...-Ole $ OC 'Cc cz--te__- _ 4.54,--tcepr AI4"4-Ayeaci Allernative(s) to be ttied at Grade/School Level (Plan) Date of Person(s) (Please note: These alternatives may be belga' with other students)'p the iilassAewell). Initiation Responsible I. Mite 744.4•1 /764.--• letron4-- kl:1as al/ t -ea&70_7 _ 6/ r Jena.dote/ „mi. ,n4A4-eir 2. am kviA erne - a( rgv-)-( adtf, 69 . Ir-eat4 sAcegi4-74 79 6(4-eI i na?" 74 4. Chat - AterMC' dastit - I" /9-/ - (if /Pack." 5. ari/Zettm,a-L-7Ctii-e-et 0-/-91 Xeici, ., Fou_ow.uf2turzTA 4A4_, ei oae/, p ,....e win A...eetaeme-t, • Type of Conferences: CST. LEP. ESE, and 504 Myer/ FM-5239 «i/.Vs) fluid Study Team Procedures 23 &Oa, '2W-t oadi rat° 4/;71,11-enkenne/a - /Q/ 3 /97 EFTA01710275 ,..77A.:F m tN7 DADE COC NTY PCB LIC SC Oral Langua HOOLS ge Proficien cy Scale Inte rview with Guidelines SCORING S HEET S---E NT's EXAMIN SCUOOL :,?at:- RAW SCC RE SS0L LEV EL RES PONSES C 1,11 I O T 0 !R? X R P 0 A 0 R C la laM S T 0. 7 1.4 I C t R A l t N t R : A S Y • 1: Lt 0 i I C 2 3 S IS I it b 1 EFTA01710276 :a '1 12 13a b e d l • C 4 a t i k N / 4 14 1S 16 17 1$ 194 b e 20a b C d • Subtotal Individual Lanquaq• Skill IDOL L•v•1 RAW SCORES ESOL LEVEL 04 - OS 06 - oa !Sot ISM 10 - 13 14 - 17 16 - 20 RAN SO713 EFTA01710277 77AC7`4 FNT D /UDE COUNTY PUBLIC SCH OOLS Oral Language Proficiency Scale Intervie w with Guidelines ScOFtLNG SHEET S:'-=ENT' S EXAMINER .1,AL'E RAW SCORE K. . SCHOOL ESOL LEVEL Q cr C RESPONSES O S X I R O N N I O 3 4 I s I ' 7 a b C d I • I . EFTA01710278 rbr MThtota 1 Individual La nguag, Ski 11 ISOL Laval RAW SCORES Ego; LiVIL 04 OS 04 - 0, la !SOL LIVIL 14 - 17 I4 - 20 RAN 3COu 14 EFTA01710279 D&DE COUNTY PUBLIC SCHOOLS Interview with Guidelines Oral Language Proficiency Scale SCORLNG SHEET I j; - - --, 5A (- 02/41.L1- ;')(1 t. /41. G 7 $ . I a I b i C I a I e 1, 1 r O. t'i i) r I - f,4/1 CA KO I-Or i c i be 36- EFTA01710280 DADE COUNTTPUBLIC SCHOOL FULL SERVICE SCHOOLS • 1500 BISCAYNE BOULEVARD, SUITE 128 • MIAMI, FLORIDA 33132 MR. ROGER C. CUEVAS DADE COUNTY SCHOOL BO SUPERINTENDENT OF SCHOOLS DR. SOLOMON C. STINSON, C MR. DEMETRIO PEREZ, JR.. VICE.0 MR. JOSEPH H. MATHOS MR. G. HOLMES BRADS CEPUTY SUPERINTENDENT MR. RENTER DIAZ DE LA PORT DR. FRED C. RODGERS MS. BETSY H. KAI DISTRICT DIRECTOR OR. MICHAEL M. I MS. MANTY SABATES M' HEARING SCREENING REFERRAL LETTER MS. TABARES-HANT MS. FREDERICA S. Wit Dear Parent(s): The hearing scree School indical that your child, in need of further evaluation. This does r necessarily mean th t your c ild has a anng pro em, ut It does mean that he/she should have an examinati by an ear specialist. Hearing disorders can often be corrected, or at least be prevented from progressii Therefore, we urge you to give this your immediate attention. If you do not have an ear specialist, your child may be examined at the ENT Conservation of Fleecing Clinic Jackson Memorial Hospital. Should you choose to have your child examined at the clinic, you must complete I attached postage paid card and mail it. You will then be contacted for an appointment. All of the appointments on Wednesday, and there is a minimum charge of $75. If you have any questions, or need additional information, please contact the Speech-Language Pathologist at y( child's school. Pl EASE HAVE YOUR DOCTOR COMPLETE THE INFORMATION BELOW, AND. RETURN THIS FORM TO TH SPEECH-LANGUAGE PATHOLOGIST AT YOUR CHILD'S SCHOOL. Dear Doctor: LEFT RIGHT Comments: 500 Hz 500 • Hz 1000 Hz 1000 Hz 2000 Hz 2000 Hz 4000 Hz 4000 Hz Please note your findings and recommendations: Signature of Ear Specialist Date FM-4196 Rev. 108 EFTA01710281 ESCUELA PUBLICAS DEL CONDADO DE DADE DOC OFICINA DE EDUCACION DE ESTUDIANTES EXCEPCIONALES TYPE 4960S hoidi ~din de tindilded• 0.490ITY) dimwd _7.4 diond/boodc:n aV Eitud•d. NOTIFICACION INFORMATIVA DE LA ELEGIBILIDAD PARA PROGRAMAS DE EDUCACIOM nr-reli"A'uTt^ EXCEPCIONALES AL LOS PADRES O EL GUARDIAN DE El Convite de Elegibilidad para la Educación de Estudiantes Excepcionales (ESE) se reunió el 7% 3/ff y reviso los resultados del rendimiento de u hipl I lo si i tes i strum tos de evaluad 'n y los reportes de laevaluacion. I SC PYT (JO Basado en la información previa y después de revisar las opciones y servicios ofrecidos en el programa ESE, el Comité de Elegibilidad determinó que su hijo (a): no satisface el criterio de elegibilidad para el programa ESE. CI si satisface el criterio de elegibilidad del (de los) siguiente (S) Programals) especial(es): Las demas opciones fueron recharadas porque su hijo (a) si satisface el criterio de un programa de ESE. no satisface el criterio de elegibilidad de un programa de ESE. Si otros factores que pudieron ser pertinentes en la determinación de este comité, se relacionaban con: resultados de una audiencia administrativa U determinaciones previas de elegibilidad O datos de una agencia comunitaria ti revisión de los resultados disciplinarios U Otro (D'Indique con una IV) si el estudiante fue encontrado elegible para ubicación en un programa de estudiantes excepcionales atreves de procedimientos de Asignación Temporal para Estudantes Excepcionales, transferidos a este condado. (Vombrelfiducsonl !Nombee/PoicionI Si usted tiene alguna pregunta relacionada con esta decisión o con sus derechos, como estan especificados en las Protecciones de los Procedimientos Disponibles a los P . s a esta noti ntacto con: (Nonti 878-1125 Copia Blanca : Director, despues Archivo Cumulativo FM-49808 (09-951 Copia Amarilla: Padres EFTA01710282 DADE COUNTY PUBLIC SCHOOLS GARANTIAS PROCESALES A LA DISPOSICION DE LOS PADRES DE LOS ESTUDIANTES EXCEPCIONALES . NOTICIA Si no están de acuerdo con la evaluación • mantener un registro dele; personas • sets, Komp••••40 y •••••••do per el proporcionada por te escuela •-• o sea, si que obtienen acceso el expediente * tordo Y Pon ~ambas con be, coreCseminlo Coma padres. Ustedes tienen derecho a: no piensan que se han *l'herido las educacional (excepto • los padres del repare' W es probiema• de bs erba • Cure ee les n'ebeje. en un lapso de pruebas adecuadas o que se he Negado e menee y • hm empleado* Con mirribrab004 tiempo razonable antes de que l• escuela' la conduelan correcta -- ustedes tienen autorización de las agencias • prii•enta. evidentes. inlarropm y tercer • la/ identifique. evalúe o *digno • su Mota) derecho • solicitar una evaluación participantes) incluyendo el nombre, la in tangos • que anoten e le *Sane. • vn program de educación pera educacional independiente costeada por fecha de acceso y al propósito. • preht.• le grikentecen da cadencias ea estudiantes excepcionales; MI cambie una fondos públicos Une "evaluación no hayan arde da rdeedrir • isitielia• e id dismto identificación. °n'yacen c signan& educacional independiente" significa que Le escuela debe prestan,' que ustedes • "f ree como ti,ss Imite de la audieMia. que ya se hoye regirse° o (cl rehuse su las pruebes de su beata' las realizará une tienen sialcirlded para inspeccionar Y • teCitior, ecu incito o en pescan. w pe tición pase que se tomar dichas persona caMicisda que no sea revisar for emelqntes de su Micra] 'aireen literal Matad poi cintra) de la medidas empleado« da le junta escolar del Manos quia se lea baya mamado que no • rectir por inatto loe inewoir distrito. El tilittrtte pegará l• evaluación time deseche debido. pot ejemplo, • • recibir Une relación por escoto da las pertinentes en el lenguaje que hablen y privada o Ami los arreglos pennentes d'e...cree legelea coma le paz initpanonst y de las ~senas tomad.. sn re Comprenden mejor. Si hey padres cuyo pare proporcionarte una fin costo alguno pctested letztonciad que. según reirkm,. •derse. Ustedes ternbin terrecer ~Pene de - modo primario de corremicaca6n nc es el pare sartedee. Sin embargo, el distrito /e• padre* tienen sobre tus hijos • as la amuela e el date lee Mimen lenguaje eterno. los funcionarios también tiene derecho e una audiencia menores de edad' donde se rueda menee atinaras Ispd lintre escolares deberán peeigurared de que: (al pera demostrai que su °veludo:6n es • necee batos. La secsine e el aneto debe st les ~lema el aviso verbMmente o en adecuada. SI al oficial a cargo de le La audiencia no necesandiriente sigue al onspercemile eer. insernmedn en «saque une forme de cumurececión pub elloe me:beocio dee2e Ti. 5 proceso descrito en la sección titulada momento •• que la sol c • e curdo ea baya • puedan comprender, lb) que comprenden escinde •s adecuada, iarT tendrán al 'tes Audiencias' de esta explicación de esebrar sine asdenca la información que es lee ha deriati ieVididiCall- lbeluCeCi0044 demohos. La audiencia puede ser • que su honi asiste • re admita, a asile proporcionado que se •videncle por .inñappeen pero no cateada poi conducida poi cualquier oficial del deba. escrito que este requinto ha sido fondos_puMmen. detrito que no tonga intereses directos • qua le ~enea se leve • cabo din 5.-4 raen cumplido. en el resultado de la misma • lugar que les asan nuonittdement • que se les notifique en cuento e cada 'Cateada per fondo* publica' significa uno de los procedimientos de evaluación, que el distrito escolar o pega el coro Si le derriben tonudo en le audiencia les pilabas, expedientes o informes que la total de la evaluación o garantiza que le favorece. los funcionarios escolares fe ue taps de 45 des • Pan. dol recree de su escuela Utolv•fla corno base pera tomar evaluación se lleve • cabo ion costo deben cambiar le información • *04404 de *.reno* en W ~lamen cualquier decisión sobre su hijo(*) alguno para los padres intOrtnarle del cambio debei4 llapa, • une bocee* delatora y enviarl•il • una descripción de cualquier opción • cepa de ie mema por corre*. en cuanto a programes que hayan El detrito deben informarles donde se Si se encuentra que le inlonnación de le " o considerados por la escuela y del porqué pueden obtener les evatuciones escuela es <bada y se toma la decisión ti &cal de audiencia podrá otorgar Un* Preireni dichas opciones fueron descartadas educacionales independientes, si ustedes de no cambiar le información. ustedes de seis museo de ir encauf ee • se les informe de cualquiera otros ad lo solicitan. tienen el derecho da añadir su propia cusiennir de In da s ~tes la monde ee factores apropiado* que loe funcionarios declaración al expediente Su eche Mesa de ~nos •••• domine • menos escolares consideraron para tomar su Si procuran una evaluación educacional declaración debe ser mantenida en el pus tensen e el dimde deciden Pele. dilución de recomendar o (echase,. pagada por ustedes los resultados de expediente todo el trompo que la pene • une notificación que incluya una dicha evaluación- en cuestión se mantenga en el -ni, pudor. atarear, reme arte da les E: n.o explicación completa de todas las • deben ser tornados en consideración expediente general. Su decir/mida gestee iariannes, ei ato de honorares rredbo• garantir.s procesales a la disposición de poi el distrito el tomar cualquier decisión deben ser incluida s. se muestra e de .atea • b• mar•• o tutoras da urda! los padres según estipula le Ley de concerniente a la educación de so alguien dicho expediente ansia, mineviiiderel 0.• haya gamas si pinto Educación de Individuos Disahabildedes. heolal • deben ser presentados como LAS AUDIENCIAS EL CONSENTIMIENTO evidencia en la audiencia formal (véase APELACIONES la sección sobre 'La Audiencias"). Si en cualquier momento no pueden Si su buchete II. Pavada • cebo por al estado Es (donan° que ustedes den su llegar a un acuerdo con la escuela en mgao ~armar', b• ...ramos minen y consentimiento por escoto antes de que cuanto a le educación de su Njo(a), urdathe re talán satisfechos con la decisión. Si el oficial a cargo de la audiencia la escuela pueda tienen el derecho de solicitar una pueden ese T muna 4e ~ea del • someter individualmente a su N'ola) soleas una evaluación educacional audiencia imparcial Se podrá celebrar Dirimo y/o osen interne w acodn aalces( pruebes a las que generalment no se independiente corno parte del "proceso legal debido'. dicha evaluación deberá una audiencia aobre cualquier asunto Civa en los tribunales ;*;teles e barril**. somete a le ntayorfa de los otro. relacionado con la identificación, ser costeada por fondos públicos estudiantes antes de que se e asigne al evaluación o asignación de su tejerla) y el Derrota al lempo en el que •• desarrolle L• programe de educación para estudiantes aseguramiento de una "educación audiencia y se lleve • cabo el proceso de Las evaluaciones educacionales excepcionales pública adecuada gratis'. apelación. su he01•1 piemnsniecná ' en su independientes deberán ajustarle • las • asignar • su (estola) a un programa de asignación educacional aterró. Sita que Intede• educación exceponnal por pnmera vez. mismas normas len cuanto • las crilificsaones del •xeminisdor) que les La audiencia deberá ser conducida por e et distrito muerden ie centrare. realizadas por la escuela. una agencia educacional estatal en Antes de que ustedes den su concordancia con los estatutos del 5. le diana se ~ene con el normo ami consentimiento la escuela debe explicarles LOS EXPEDIENTES estado y los reglamentos de la Junte su bel*, • Lana amura pera. entonces. con su lo que han aprobado en al idioma u otro Escolar consentimiento. se ie maznará en un Inquina d. modo de comunicación que ustedes Usted tiene el derecho de las momea Miela. hasta qua es teme. si utilizan generalment y deben asegurarse • recibir, cuando oil lo soliciten, una Para lograr una audiencia, deben lista de los tipos de expedientes orases,. de que han comprendido. presentar una solicitud escrita al Clerk educacionales que se mantienen sobre LOSIASI PADRES/MADRES of the School Board ISecretanolal de la El formulan d lineal d be h 01 1 donde se archivan, y de como Junta Escolar), Dada County Public SUSTITUTOS(ASI descnbir lo que ustedes han aprobado. pueden lograr acceso a los mismos Schoot; (Escuelas Pütikcist del Condado Cada una de las escuelas debe garantizar detallar cuates de los expedientes de su • inspeccionar y vindicar cualquiera de de Dadel. 1450 N E Second Avenue, que los derechos de los niños sean N'oral *oren —*rodee • e01100e. y los expedientes de su hpoIal. Miami, Ronda 33132. protegidos cuando: espe cificar quienes los recibirán. • no se pueda identificar • los padres La escuela deberá responder • su LOS OFICIALES DE AUDIENCIAS • 'no se conozca el paradero de uno de Si ustedes no dan su consentimiento, su solicitud al respecto. los padres. negativa no afectará • los derechos • sin demoras innecesarias Se asignará a un oficial de audiencias • entes de una reunión o audiencia • cuando el niño está bajo la tutela del básicos da su Sola) en cuanto • asistir a imparcial para que presida dichas estado. cines y participar en- los actividades sobré el Plan Educacional Individual IIEP) audiencias y eme que tome una decisión escolares. ' • • • anal fórmelo de 45 ollas. len cuanto si caso) Para garantizar la Es el deber del distnto escolar el nombrar • impercialided, al oficial de audiencias no • unta) representante o • unlal Si usted retiene o rehusa dar su La escuela no podrá cobrar por procurar debe ser. Padre/madre sustituto(a) o procurar que consentimiento para la evaluación o le o recopilar la información a empleado de ama nena., pública se nombre. Su distrito escolar deberá asignación, las agendas pueden utilizar • •' &reme escotar, institución. etc 1 que tener un método para deternenar si 011a) procedimientos informales patri obtener Usted tiene derecho a. participe en la educación o cuidado de niñeta) necesita • que alguien en le escuela de su unlal Padrelmsdre consentimiento escrito. Si los su sustitutolal y un método para asignar a procedimiento, informales no resultan en hii0M) lea esplique o les interprete • cualquiera que tenga un interés dichos pailrearmsdres sustitutoslas) el conerentirmento y pueden pedir una cualquier detalle que conste en el personal e profesional Que pudiere estar audiencia imparcial pare resolver la expediente de *u Nota) en conflicto con la °Convidad de la la escuela deberá seleccionar a unid/ manido. audiencia sustauto(el en cualquiera de los modos • rscitir copies del expediente si ese permitidos por las leyes °Mieles. pero Si la orden del oficial de le auckncia ea • es el único modo de garantizar que Une persone que de otro modo retina fas deben ~guiarse de que la persona favor ck la escuela, la escuela puede puedan recitarlo e inspeccionarte le calificaciones para conducir una seleccionada. actuar ein el consentimiento. Usted escuela podrá cobiaries por las copies, si 'audiencia en Concordancia con las • no tenga un conflicto de n'ateces puede moler la decisión del oficial de el hacerlo no les impide inspeccionado o directrices previamente consignadas no revisarlo. • esté calificadolal pare representar audiencia será considerada empleada de la agencie ella IN ninolal simplemente porque la agencia le paga • no sea empleadola) de une agencia Usted debe dai su consentimiento • que una persona los represente, POr actuar como ohcial de audiencias Inspeccione y revise el expediente pública involucrada en la educación o el libremente. y en cualquier niornento tuededo dellde tal niñolit) Iflo *e debe puede retirarlo pero el Colegio puede Cada una de las actor rice deben La escuela tiene la responsabilidad de considerar conto empkadola) a una pedir uno reunión para ~mar su retiro mantener una lista de les personas que del consentimiento y las necesidades proteger e! carácter confidencial de los persone solarnente porque sirve como sirven como oficiales de audiencias, y sualdutola).1 educacionales de su herblal. Si la expedienteo educacionales de su /mol& sus calificaciones Cuestión no se puede resolver por medios del siguiente modo infoimales, una audiencia imparcial se • permitiéndole* vos solamente lo LOS DERECHOS RELACIONADOS CON Fiad) cuetituto(e) podrá representar ella información relacionad', con su Renta) la) rigola! en asuntos relacionados con puede resolver LAS AUDIENCIAS identificación, Id evaluación. la cuando los expedientes contienen la LAS EVALUACIONES EDUCACIONALES información relacionada con mas de Loe derechos que. tanto ustedes corno el asignación y la provisión de una unid] ~letal distrito, tienen, incluyen el derecho de. educación pública adecuada gratuita INDEPENOIENTES EFTA01710283 TYPE 5522S DADE COUNTY PUBLIC SCHOOLS DATE (EALVDD/YY) OFFICF OF EXCFPTIONAL STUOENT EDUCATION I Pn/DT LTUOCNT STUODIT D.NO. NOTIFICACION DE REUNI N (NOTIFICATION OF MEETING) L1 personal dc la acuda debe usar esta planilla para infamar • In< padres de la reunión del Fio;po Profesion A LOS PADRES O TUTORES DE 'he la *ion Cle•hs Les informamos de una reunión relacionada coa c .1, -- Tfi —~w23 (Fecha) Se invitaron a asistir a las siguientes personas: (Si cs necesario, favor de adjuntar otra hoja.) (NOMBRE/PUESTO) (NOMBRE/PUESTO) Ps cit.0-€0kta- Marque con una palomita ( 1 ) todos los cuadritos necesarios pan indicar el propósito de esta planilla. D revisar cl progreso de conducta y/o el académico de su hijo. O considerar revisiones a las estrategias previamente desarrolladas para ayudar a su hijo. 7 discutir los resultados de la evaluación y considerar la calificación para cl Programa de Educación para Estudiantes 1 --3/4 NOTA: 1. Si se determina que su hijo califica para el Program de Educación para Estudiantes Excepcionales, se Plan Educativo Individualizado (IEP), y los Procedimient os para Padres de Estudiantes Excepcionales. Excepcionale s tenga desarrollan un se 16 revisará y una años de edad extendeta una invitación a dicha reunión siempre y cuando copia se le proporcionará. A su hijo se le y este ubicado en el octavo grado. Excepcionales, se considerará si es 2. Si se determina que su hijo no es elegible para el Program de Educacion pan Estudiantes usted de los Procedimiento s Debidos que le corresponden bajo dicha sección. elegible bajo la Swelon SO4, y se le informará a O otro: ES DE SUMA IMPORTANCIA QUE UD. ASISTA A LA REUNIÓN. Si no ;cede asistir a la reunión en la fecha indicada, tiene la opción de cambiar dicha fecha. Al terminar de llenar la sección de los padrea Iver la copia rosada a: (Pasma ale muno rrcmawr Favor de retener la copia amarilla para sus archivos. ESTA SECCIÓN ES PARA LOS PADRES O TUTORES espacio. INSTRUCCIONES: Favor dc indicar ceo una palomita ( 1 ) los cuadritos apropiados. firme* y escriba la facha en el O Participaré en la reunión señalada. : O Necesitaré los servicios de un intérprete o traductor. Especifique el bloom o método de comunicación N Yo deseo fijar la reunión para otra fecha. Por favor póngase en contacto conmigo llamando al teléfono Educación o Necesito cambiar la fecha de la reunión. No obstante, si se determina que mi hijo es elegible para el Programa de para Estudiantes Excepcionales, por favor pónganse en contacto conmigo al teléfono para señalar una reunión del EE. • Firma del padre o tutor Fecha india copy: Cumulativa Record Pi* CaVY: Cautive Record (Mach se 'Ad< copy if parcattauudiati rebana vid. a sigan:un) Yelkiw Copy: Parem FM-6522S (10-96) 878-2717 EFTA01710284 MIAMI-DADE COUNTY PUBLIC SCHOOLS DIVISION OF STUDENT SERVICES CASE MULTI-DISCIPLINARY TEAM REPORT Initial Evaluation STUDENT'S NAME SEX: female GRADE: 3rd DATE OF BIRTH: SCHOOL: ADDRESS: ETHNIC ORIGIN: H STUDENT ID NUMBER: HOME PHONE: PARENT/GUARDIAN: DATE OF CURRENT EVALUATION: 5-26-99 DATE ASSESSMENT AREAS EXAMINER- COMPLETED ADAPTIVE BEHAVIOR/SOCIAL HISTORY 11-24-98 PSYCHO-EDUCATIONAL 5-26-99 VISION 11-23-98 6-4-99 HEARING 2-9-99 SPEECH/LANGUAGE 2-9-99 OBSERVATIONS 12-3-98 11-2-98 REFERRAL INFORMATION REFERRAL FORM/STRATEGIES CST 11-6-98 ATTACHMENTS PERMISSION TO CONDUCT AN EVALUATION 11-6-98 EFTA01710285 Miami-Dade County Public Schools - Division of Student Services PSYCHOLOGICAL EVALUATION DATA SUMMARY Student's Name: Case #.al C.A.: 8-11 Grade: 3rd Schoo Elementary Language Assessed in: English INTELLECTUAL: ACADEMIC: Kaufman Test ofEducational Achievement (2-9-99) Wechsler Intelligence Scale for Children-Third Edition Subtest (VVISC-Ill) Mathematics Applications Mean = 100; Standard Deviation = 15 Reading Decoding Scale Scores: Mean = 10; Standard Deviation =3 Spelling Reading Comprehension Verbal IQ: Mathematics Computation Performance IQ: Full Scale 10: PROCESS: Verbal Comprehension: Perceptual Organization: Peabody Picture Vocabulary Test-Ill Freedom from Distractibility: SS: 75 Processing Speed: AE: 6-1 Verbal Subtests Expressive Vocabulary Test Information: SS: 86 Similarities: Arithmetic: PERSONALITY: Vocabulary: Anecdotal Records Comprehension: Behavior Assessment System for Children (Digit Span): House-Tree-Person (HTP) Kinetic Family Drawing (KFD) Performance Subtests Post Drawing Interrogation Picture Completion: Coding: Picture Arrangement: Block Design: Object Assembly: (Symbol Search): EFTA01710286 1 CASE #11M Psychological Evaluation REASON FOR EVALUATION REQUEST was demonstrating behavioralproblems in the classroom. Her teacher requested this psychoeducational evaluation for in order to determine any intellectual, processing, academic, and/or emotional factors that could be interfering with her progress. SOCIO-DEVELOPMENTAL HISTORY A Socio-developmental history was obtained on November 24, 1998. For more detailed information please see attached report compiled by BACKGROUND INFORMATION EFTA01710287 CASE PSYCHOEDUCATIONAL EVALUATION TESTS ADMINISTERED Weschler Intelligence Scale for Children-Third Edition Bender Visual Motor Gestalt Test House-Tree-Person Technique Kinetic Family Drawing EFTA01710288 3 CASEEIM Anecdotal Records Incomplete Sentence Behavior Assessment System for Children BEHAVIORAL OBSERVATIONS TEST INTERPRETATIONS t Intellectual EFTA01710289 4 CAS' EFTA01710290 5 CASE a EFTA01710291 6 CASE #: ) PSYCHOLOGICAL EVALUATION BY: Licensed School Psychologist Region Ill EFTA01710292 MIAMI-DADE COUNTY PUBLIC SCHOOLS DIVISION OF EXCEPTIONAL STUDENT EDUCATION BILINGUAL/ESOL ESE PROGRAM LANGUAGE PROFICIENCY/DOMINANCE ASSESSMENT REPORT . STUDENT: CHRONOLOGICAL AGE: 8-8 STUDENT SCHOOL: GRADE: 3rd DATE OF LANGUAGE PROFICIENCY/DOMINANCE ASSESSMENT INSTRUMENTS ADMINISTERED: oOral Language Proficiency Scale-Elementary Level (OLPS) °Narrative Development Assessment oBrigance Diagnostic Assessment of Basic Skills-Spanish Edition °Kaufman Test of Educational Achievement-Comprehensive Form REASON FOR REFERRAL: BACKGROUND INFORMATION: BEHAVIORAL OBSERVATIONS: EFTA01710293 TESTS RESULTS: Analysis of=erformance profile reflected the following findings: INSTRUCTIONAL/LANGUAGE DOMINANCE ASSESSMENT INTERPRETATION: Social Language EFTA01710294 ivision oExceptional Student Education EFTA01710295 fiLe 4witeAdv -€AAP bi; tc, Alas- A.17; Developmental History Name Sex : Female File Name Age Interviewed : 11/24/98 Date of Report : 12/02/98 Prepared for : Region III Completed by Presenting Problem Personal Information and Family Background Early Developmental History EFTA01710296 PAGE 2 Educational History Medical History and Health Status an an EFTA01710297 PAGE 3 Family History Current Behavior and Relationships EFTA01710298 PAGE 4 EFTA01710299 Dade County Public Schools ENT PLAN INDIVIDUAL LEP STUD ARY I.D. Number Name (Last First) (Middle) rn tut Entry Date DCPS ///07/97 Date of Birth lace of Birth itt Parent/Guardian Language Studerittanguage Minimum Instructional Year Time Requirements School --ESOL Level I 2 hrs. daily 7 ESOL Levels II - IV 1 hr. daily 9J-i9 9,6 9‘_19 CCHL Levels I/II 45 rain. daily CCE/ESOL Levels 111/IV as appropriate -19 tH Home Language Arts Levels I - IV 150 min. weekly 14-1991 Entry Date 0 7- fir Initial Placement Information: •AurallOral OLPS Score ESOL Level Assessment Date /1— 07 — 9cr DC •Reading/VVriting (Grades 4-5/6) t Metropolitan Achievement Tes Stanford Achievement Test %ile %ile Reading Subtest Reading Subtest %ile %ile Writing Subtest Writing Subtest enda tion ESOL Teacher(s) Recommendation ESQL.Zeacher(s) Recommendation ESOL Teacher(s) R Continue Exit Continue ✓• Exit fr"- Continue Exit Teacher's Signature School 6/ 7 7 Date Date 67 q/6 Date 41 EM-4649 Rev. (09-9 ri^14-,14', Kr. .1 tak<i EFTA01710300 unci upoate Date Grade Ilevel Instrument 7—o7- 41- oc f'S en_ (5 at' I Program Participation (Completed at entry into program and updated yearly or upon transferring) Basic ESOL I99rI99k ESOL ai na Materials Grade K I4:1932 EVIL Instructipl Materials n VP% 0.14 ' ii:S4 Grade I Vida DI CV 19 -I9 ESOL Instructional Materials Grade Book Level 19 -I9 ESOL Instructional Materials Book Level Grade Alternative/Home Language Arts (i.e., Spanish-S and Haitian -Creo le) I 9SCI94 HLA Inst ctional Matekts _,, , Book/g el 629— anbe2,47, /asap Grade // car t9gh -1952 HLA Instructi7I Materials Grade / st: O,t / d .1 a i t-/-; //aim: Book Level *cid 4 n /// -yr ^ i lb -19 i ti fl az g riovpiateii/ls A s 1 Cti Boo Level Grade ItaclUY Igistrua ortal A. wrists Bor . C2-0-C-read.4-51....ren.4 Grade ' ' ;-. y .1-4-0271, r Basic Subject Areas Identify with an X the strategies used for program.delivery: Home Language Strategies (CCHL) or ESOL S rategies (CCE/ESOL) Basic Subjects Grads/ Grade: Grade: 19 96 19 /7 19 - 19_ 19 - 19_ CCHL CC& CCHL CCE/ CCHL CCE/ CCHL CCE/ ESOL ESOL ESOL ESOL Science Mathematics Social Studies Computer Literacy FM-4649 Row. 109.94) EFTA01710301 reriormance Standards* U Level I or HAM! 12:(Not Met* LESS than two (refer to the attached Student Q Met years trl an Performance Plan) approved program Intervention required ______ Promoted Retained "' Teachers Signature 1.101. _ Grade g Date LW___1 7 O Level I or II AND CI Not Met* LESS than two (refer to the attached Student Perform Q Met'. years in an ' anc e Plan) approved program Intervention required Promoted Retained " Teacher's Signature Grade Date O Level I or Il AND 0 Not Met* LESS than two (refer to the attached Studen Q Met years in art t Performance Plan) approved program Intervention required Promoted Retained ** Teacher's Signature Grade Date CI Level I or II AND ED Not Met* LESS than two (refer to the attached Studen Q Met -:ears in an t Performance Plan) approved program Intervention required Promoted Retained " Teacher's Signature Grade Date EtIrient Performance Plan is to be ompleted for all ESOL Lev icz performance standard els IA and IV studer.:s who s for Language Ans/ Rea arc not meeting the established arsrn participation. ding/Writing and/or Mathem atics regardless of number of yea rs of &fttir two full years of program pa cipation. Stud !!) who are not ent Performance Plan is to be cc meeting the establish npleted for all students (inc ed district performance standard luding Levels s for 1.1..5uage Ans/ Reading /Writing and/or teased on district-establ . .. • Studeitt ferie::-.srtan Standard in an ESOL s is only at; :231.t students who have com pleted no.anan EFTA01710302 tlit; claw'. v :1,111•Wi... OW-UP FORM ALTERNATIVE STRATEGIES AND FOLL C (fora). cep frt er )( )( )( N sow Date and Type' of Conferences: (a ) Student II). # Grade: DOII: CST Chairperson: . ohlem Area (Objective. Specific and Quantifiable) . Replacement Behavior ---.. Date of Person(s) Alternative(s) to be tried at Grade/School Level (Plan) Initiation Responsible as well) mai. note: Th ee alternatives say be helpful with nthcr stacienn in the class I 1 2. (.. '' /1, ( 7 ..)li t i • ' —1:2 ) cc 3. — • vs vc ' 4. -I 5. FOLLOW-UP QUESTION: ifiable): Problem Area (014retive Spec' to a pd Quant t-v a r 4 0 , ; 1 ' 41. 672 Pt-t- Replacement Behavior //e " AA& a„ 4,(041 k... a6e 4 Date of Person(s) (r/ Allernative(s) to be tried at Grade/School Level (Plan) uip the deists nil) Initiation Responsible helpful fl it other staden (Please note: These allernatires may be I.7/044 Alet:V1 /1k-frt.= 141-0 - • is ate& 4.frt reir 2. 441,1 1"O71-vn u /5) to-, eraen 4 3. 7-creac-4 SI'al ccW wv-rda, 4:44,,t) 711-4-t /44 cfi r 71ea c Lt-e-?‘ / FOLLOW-Ur y mc'e& Pc d Cle* - etaa Zlettlell'L ri.b5239 nl ESE, and SO4 (Over) CST. Ltr, • Type of Conferences: .Guth Trim Procedur c.; 'hill ?„.7 /Al 42/3/c/7 bted Lt":-. 1:44-0A-4, EFTA01710303 D(OLPS Score / ESOL Level__ ' (Grao'C'S K-5/6) Stanford Achievement Test (Grades 4-5/6) Metropolitan Achievement Test (Grades 4-5/6) Reading Subtest %Ile Reading Subtest Writing Subtest %ile %Ile Writing Subtest %ile Exit Date_ 0a/g7 Post Program Review f' amf aQ; af Witiere gg Making appropriate Refer to progress/continue Other (specify) LEP Committee in regular program 1 Signa = = = Date 1.1- of -9- 7 ZS End of First Semester after exiting Making appropriate Refer to progresstemainue Other (specify) LEP Committee in regular program I1 I Tale Da:x.0A OP-: V gigscritsarw__ art • .ases& making appropriate Refer to Progress/continue LEP Committee in regular program I I I signs ==== Date 4 / 9 nd f Se03 Making appropriate Refer to progresskontinue Other (specify) LEP Committee in regular program I I I I Signatu -rile igeleilf% === Date ci FM-4649 R•Y. 109-94) EFTA01710304 Dade County Public Schools LEP COMMITTEE Grade: 62J Date: ii-m- 97 Grade: Date; Grade: Date: me;rbers: Members: Members: Admin,:strator Administrator Administrator ESOL Te:cicher ESOL Teacher ESOL Teacher •BSHL TeaLher •BSHL Teacher * BSI IL Tcachcr Teacher _1 Teacher Teacher Counselor Counselor Counselor Parent Parent Parent Other Other Other Recommendations: Recommendations: Recommendations: Continue [ 1 Exit Continue [1 Exit II Continue [ Exit I Request for Assistance CST** Request for Assistance CST** Request for Assistance CST** Reclassified as ESOL Level IV M[ I Reclassified as ESOL Level IV [ Reclassified as ESOL Level IV [ ) 1 BasicSkills in the Home Language **thili Study—Team FM•4649 Rev. I09.' EFTA01710305 Roger C. Cuevas, Superint dent M-DCPS -.Robert L. entornas, Superintendent, Region III .1(ü bie 3fin l'cclia Estimados padres Con el (in de cubrir todas las nensidades linguitic as de sus hijos y acorde con estatales de la Florida. se ha crea las disposiciones do un comitéescolar Com mitt ee). objetivo fundamental analizar el El mis mo tiene como desarrollo del aprendizaje del ingles com los alumnos, y a su vez desatollar o segunda lengua de planes de estudio y estrategias educacionales asno requieran. en los casos que Cl Comité' de L.L'-.P. se reu nida dia b a las de nuestra escuela para analizar el caso de •u len la. oficina invitación a dicha reunion. hijo /a. Por este medio e bacanos form al Ate " Por favor. fume esta carta y devuélvala a la maestra de su hijola si decide asistir. S, No 11111111111111 / 3 /ff fecha EFTA01710306 SEMINOLE ELEMENTARY - LEP COMMITTEE Date: 11 — 1 3 - 77. Child's Nam, Dear Mr./Mrs. This is to inform you that we are monitoring your child's academic progress and wish to invite you to participate in a meeting geared towards this progress. Thank you for your cooperation, fRirgiii-enikketet o'n person', ) lea •••••••• Fecha. Nombre del Estudiante: Estimados Sr./Sra. Por este medio, le invitamos a formar parte de un comite con el proposito de estudiar el progreso academico de su hijo/a. Gracias por su cooperacion, Administrador Maestra de ESOL (ESOL.LET) EFTA01710307 FOR REGION USE ONLY: TO: DADE COUNTY PUBLIC SCHOOLS DATE OPENED: OFFICE OF EXCEPTIONAL STUDENT EDUCATION DATE CLOSED: CASE NO.: REQUEST FOR EVALUATION (Documentation of Screening and Prereferral Activities) DOC TYPE 2561 DEMOGRAPHIC INFORMATION DATE (PAIWDDTYY) / qS PRINT STUD (RIO 71 PALI STUDENT D. MO. ADDRESS: 0IQ1-1_ILIN, e SEX: Fr - SCHOOL: GRADE: ETHNIC ORIGIN (circle one): W 8 I AC M PARENT OR GUARDIA WORK PHONE: Requir activities for la}11la Study Team meetingls) were conducted. Parents were invited to attend. Student Inventory/Cooperative Consultation Concerns/Information and Alternative Strategies and Follow-Up forms wen completed. (Attached) Social History attached. (Previous psychological, medical, and/or other evaluative data reviewed, if available.) O Two Observation of Student Behaviors forms or two anecdotal records were completed. At least one must be from professional other than the referring source. Anecdotal records are directly related to the reasons for the request and mus• id,......jlen e d over a minimum of two weeks. (Attached) Attendance records were reviewed. (Excessive absenteeism was investigated, if needed.) O Se sorb, functions were screened when required. Request for further sensory evaluation, if needed, has occurred. (Attached) Procedural Safeguards Available to Parents of Exceptional Students have been received and were explained to the parent(s) or av y a rdian(s) of the student. g A Notice of Intent and Parental/Guardian Consent to Conduct on Evaluation form has been reviewed and signed. (Attached) O Teacher Nomination Form, Gifted Programs - Rating Scale is attached, if needed. For limited English proficient students, only: The CST has reviewed the Individual LEP Student Plan including the ESOL level The Home Language Screening Questionnaire form was completed prior to CST. 0 Section IX of the Observation of Student Behaviors form was complete. (Attached) ❑ Bilingual testing: Yes o Language(s; to be use o CST Members: Ongens: cumulative Record Copy Region Office a r ne a e/1 4:2 A zzd ei 8781516 FM-2561 Rev. (09-95) EFTA01710308 ESCUELAS PUBUCAS DEL CONDADO DE DADE DOC OFICINA DE EDUCACION DE ESTUDIANTES EXCEPCIONALES TYPE 4961$ LØ.cs FECHA CFAHIADO/YY1 // -97 Istullorrt• En La* OF ~4 I i Mime* de LAHHI &salda ar IFFEFEHHE NOTIFICACIÓN DEL PROPOSITO Y CONSENTIMIENTO DE PADRES/GUARDIÁN PARA LLEVAR A CABO UNA EVALUACION A LOS PADRES O EL GUARDIÁN DE Después de una idadosa revisión del expediente ucacional de su hijo(a) de poner en prrategias para ayudar a su hijo(c para repasar I información previa tal como, Observasiones del Aura LJ Anccdotales Exámenes Basados en el Programo Estudios Exámenes hechos por cilla) Maestro(a) ❑ Otro(s): , el Estudio del Nino(a) de la escuela su hijo(a) ha recomendado que se administren exámenes adicionales que contribuyan a conocer las necesidades de su hijo(a determinar la posible necesidad de servicios educacionales especiales. Otros factores pertinentes a este informe, pueden ser: Opciones educacionales que fueron consideradas y rechazadas por ser insuficientes al presente o fueron utilizadas previamente coi hijo(a incluyen: U Control de conducta Cambio en nivel de ensenanca El Prevención de u Remisión a Agencia Comunitaria deserción escolar O Consejería WCambios en metodos de u Tutoría 1:1 Otro(s): ensenanca Con su consentimiento, un grupo de profesionales, incluyendo una evaluación especialista (e.j., sicólogo escolar, patólogo del habla) seleccionara examenes específicos y otros instrumentos de evaluación en las siguientes areas: ❑Asesoramiento del desarollo: La comunicación, la inteligencia, y las destrezas sociales. ¡'Asesoramiento sito educacionales: Destrezas academices, de percepción, de comportamiento, social o de lenguaje. ErrAsesoramiento de la vista: Asesoramiento de la habiridada visual. sesoramnto ie Audiológico: Asesoramiento de la habilidad auditiva Ertksesoramiento de destrezas del habla y lenguaje: Destrezas de comunicación, habilidad del habla, destrezas de articulacidir P/I2 lidad de la voz. sesoramiento Social: destrezas sociales y de comportamiento a Asesoramiento Motórico/Fisico: destrezas rnotericas finas y gruesas. ❑ Asesoramiento Médico: status físico que pudiera influenciar el aprendizaje y pudiera incluir una evaluación pediatra, siquiatrica, física o neurológica jj neCe.SicirP/ d , 4)0,7 all/E irt"“--e— te Un repone sera escoto que contenga los resultados de estas evaluaciones y otra información educacional. Usted sera invitadolal asistir a una reunión para revisar este reporte y ayudar el desarrollo de un program educacional apropiado para su hijo(a). Usted tier derechos específicos ccn relación a este informe que se encuentra descritos en las Protecciones de los Procedimientos Disponibles Padres de Estudiantes Excepcionales, que están adjunta a esta notificación. Porf v antes de devolver la planilla marque todas las respuestas que le apliquen. Si No Yo/nosotros comprendolemosl las razones de esta evaluación. Si No Yo/nosotros solicitolamos) una reunión para discutir la propuesta evaluación / N, n CONSENTIMIENTO: / 06 Af 9 (Fecha) Por favor devuelva la copia blanca de este tormurano y ruja c u nfarme o sobre las Protecciones d, los Procedimientos a: ti A (Posición/ c".67 -?0 97, a tescuelauireccion ow abajo) (Teléfono) 878-1150 Copia Blanca: Archivo Cumulativo FM-49615 (09-9 Copia Amarilla: Padres EFTA01710309 ce,LX/47' . DADE COUNTY PUBLIC SCHOOLS EXCEPTIONAL STUDENT EDUCATION ()641-2 14-'4 _12 VISION SCREENING tCre-ck..1 s -Ot M-TEAM REFERRAL REPORT VISION SCREENING RE RT NAME OF STUDENT _ BIRTHDATE ADDRESS City State Zip Code TELEPHON SEX /:=7 ETHNICITY SCHOOL GRADE 3 TEACHER PARENT/GMIRITAll Reason for referral: Visual Acuity without glasses: Visual Acuity with present glasses: Visual Acuity with prescription recommended: Title Form f 878-1273 MIS-12125 (08-78) EFTA01710310 MIAMI, FLORIDA 33144 Phone: Fax: Supairdenient ThIncbal 0•01MOtrity Mtge 5:11cob 95' P )1(lf pet i evz Acz ccit. en) ft 114 e: .4 1 l• ei i fl).-C jaa ift-et k. P- / 7 '! e if A— 17 c"--1 et6: t eeni A11 iza- -14 et- ; 4Aj ef ,149 c p II ji,7 t 1-1 1, s- en; ern 741ttif hilw4 s AC t vP et h it( 11.e (66:.; AVI C1 ( 7 44 Ilse et. 49.69 / 711 vie...a-Le. 6 EFTA01710311 DADE COUNTY PUBLIC SCHOOLS giving our students the world EXCEPTIONAL STUDENT EDUCATION ge-Hearing Re ort/M-Team Referral Name . D.O.B. Age F Grade/ESE 3 Student's Native Language/Dialect Evaluation Date Examiner Verbal IO 0evelop./Perform. Score Evaluation Conducted in (language) MEMO TO: FROM: u ent Services DATE: /O7 -3 - ir SUBJECT: is- e-cci elvv‘ 7 6, / egg, 444/ O9 6=4,7-- Fe °a,"y '7, woo -enNet, 212) d, 1404 K O d NM/ C 57- - is L it ji 11ji 1 I •0 tf0 -ID II MI *20 de u0 -t aininieol•C Recommendations: O Refer for eligibility staffing: (circle ) Articulation Fluency Voice Language O Additional testing needed: (circle) Bilingual ESOL Psychometric o No further testing needed Comments: Whit. SPOICh Flit Yellow - Referred Pink — Corn Folder 878.1397 FM.1544 Rev. 110-891 EFTA01710312 DADE COUNTY PUBLIC SCHOOLS EXCEPTIONAL STUDENT EDUCATION giving our students the world -Hearing Report/M-Team Referral NarncS D.O.B I. Ag2 -11 Grade/ESE!...3 C• • • uA • r i.lecl-ice... (r . Evaluation Dated. .1 9..(1tviahtli Examine Verbal 'Din prOctSS Develop./Perform. scorelto ?co CC'S Evaluation Conducted in Etril (language) Audiometric Screening atca5..dB. PASS O FAIL Threshold Testing Results: R L Referred: (Agency or Private) Articulation/Phonology (Severity Rating): WNL MILD MODERATE SEVERE Test call" k -tzt r" .phe. Results.noimita.ctc...s..Q9÷,-- - 4 t I • Test Results Intelligibility (Connected Speech): t WNL GOOD FAIR POOR Fluency (Severity Rating): WNL .......MILD MODE AT SEVERE, Test iftettki..7.O..a.irolit Results..{M:f.A Supportive Data: r'ttlEd- YES ...... Voice (Sovority Rating) .. Wt& MILD MODERATE SEVEFIE Medical Clearance YES to PENANG Supportive Data: YES tO Diagnosis: Language (Severity Rating): WNL Receptive WNL MILD MODERATE SEVERE Expressive WNL MILD MODERATE SEVERE Pragmatics Wit MILD MODERATE SEVERE ••••4001 be01•11•4 1—7 ?, Son I vp 1.dithtula4 —1— 410 LI I -10 •IA 4I 010 alt halms I 111111h4j61001•r i Recommendations: O Refer for eligibility staffing: (circle) Articulation Fluenc Language E —Additional testing needed: (circle) Bilingual ESOL O No further testing needed Comments: 'R /toll Aitct-ia - /2.-t714.4..) Speech rile V ellcreV— Referral ✓ Pink --turn Folder 878•1307 FM•1544 Rev. (10-89) EFTA01710313 Dade County Public Schools - Miami. Florida Office of Exceptional Student Education OBSERVATION OF STUDENT BEHAVIORS Students/ am Birtlidate: School: / Grade 3 Obse/er: Sub Date of Completion• 1/ - Z- 8 0% 1-10% 11.30% 31-50% Over 50% ATTENDING BEHAVIORS Never Seldom Sometimes Often Exceeelvel Seems to have difficulty staying in seal Does not correlate tasks. Has shod attention span. Is easily distracted. Appears to daydream. Exhbits impulsive behavior (blurts out. etc.). Appears h eractivs/overactive II. INTERPERSONAL BEHAVIORS Never Seldom Sometimes Tries to dominate others Is easily led, influenced by others. Prefers solitary activity. Avoids competitive activities Avoids verbal communication. Does not participate in class activities. Is ridiculed by peers. Is ignored by peers. Sexually aggressive toward sther students. Physically aggressive. hitsiocks/biles/etc. Threatens teachers/students with bodily harm. Prefers activities with opposite sex. COMMENTS: • er_50% DISRUPTIVE/INAPPROPRIATE BEHAVIORS Seldom Often Excessively Exhbits perseveratincirrepetitNe behaviors TAT (roadng, tapping. etc.). Has temper tantrums. Exhbits self-injurious behavior (specify below). ter Uses profane language. -- Lacks self-control (specify below). Cries inappropriately. Demonstrates moods. Takes things belonging to others. Makes untrue statements. Imitates site sex. is is . COMMENT Ma692 Rev for 94) EFTA01710314 Dade County Public Schools - Miami, Florida Office of Exceptional Student Education OBSERVATION OF STUDENT BEHAVIORS Pg. 2 Student's Na mel School. 0% 1-10% 11.30% 31.50% Over 50% IV. INDICATORS OF ANXIETY . ..... ,r rffr Mill i MIMI M:4 ;I'S: Appears nervous. jurrpy. '. ' Seems to worry. ' Seems unhappy. ...-.. Appears to stutter. .:..z. •••,, Reluctant to speak in group situations. Seems tense, unable to relax. Seems easily frustrated and confused. i-..:,-; "? Appears self-conscious, easily turbarrassed. shy. •astts:II: •S'eftstxt' Manifests fear of school (specify below). . Bites fingernails, sucks thumb/lingers. ..o. Compu - • COMMENTS: 0% 1.10% 11-30% 31-50% Over 50% V. COGNITIVE SKILLS/PERCEPTUAL MOTOR Never Seldom Sometimes Often Excessivel _ e '' \- Has efifficulty copying from chalkboard. 1, Has difficulty reproducing dravkigs,lonem. . numbers or written words. . Exhbits •oor.rose motor skills (. oc" below). I -4,.. Seems to have difficulty with visual tracking: slaps foes, words, word endi .s. etc. s. ' below . Exhbits poor perception of spatial relationships ,:1,5iry..,.;,,r. (letter/number reversals. spacing). " i - Has deist remembering (speciy below). I -- 0% 1-10% 11-30% 11.50%, Over 50% VI. PSYCHO-PHYSIOLOGICAL Never Seldom Sometimes Often Excessively ',....:4. Has need to use bathroom excessively, As Speaks unsteady in native language. Exaggerates physical complaints (headaches, stomach ashes, etc.). Rubs eyes. eyelids/eyes inflamed. Holds material close to lace. Tums head to one side listeningiworking. Wets clothes. Exhibits muscle spasms (hvitchesrlicks) Becomes ill when upset or frustrated. COMMENTS: rOU‘Sri onlanCIEUMO PM 1692 Rev (01.911 EFTA01710315