EFTA01710316

-Mlami.Flolids . Office of Exceptional Student Education btliVA I PUN CM I uutra f BEHAVIORS Pet Student's Name School>, In 1-10, il-SOY, _31-50% Over 50 . VII. EARLY SEIZURE IDENTIFICATION Never Seldom Sometimes Often Excessive It . Periods of -day dreaming', dazed behavior or blank stann.. Picking of clothes, mumbling. chewing of random movements what) acting dazed. Head nodding. I sr. .....- jy s. Memory gaps. I •-•;71.7/ Sudden fear. onset or • • nic. I Muscle jerks or sudden falls. , I ;,, Inability to communicate for a short time. I •V I COMMENTS: A Additional Information: 0%. 1.10% 11-30% 31-50% Over 5o% I VIII. SELF-CONCEPT Never Seldom Sometimes Often Excessive! Appears to lack sett-confidence. I ....- Exhbits feelings of inferiority. Exhbits leek • s of superiority. I .i....1-, Appears to lack motivation. Needs praise and encouragement. -."1",-:----.---j- Demands attention from teacher. I ,„ Demands attention from peers. I Demonstrates • °evasive e — °elation of failure. rdcY '2. Prefers tasks considerably below instnictional level. Selects overly difficult classroom tasks. COMMENTS: Addl.:anal inlormation in. P55 rake/4,...,1.4u° M.1692 Pay. (01.941 EFTA01710316 - Miami, Florida Office of Exceptional Student Education BEHAVIORS Student's Name School: IX. SPEAKER OF LANGUAGE(S) OTHER 0% 1.10% 1 I -30% 31.50% Over S0% THAN ENGLISH Never Seldom Sometimes Often Excessively A. SOCIAL LANGUAGE :•:-.? y.: Points to classroom items upon command. 1 Follows classroom directions. :.,i Exchanges cannon greetings. e.e. 1 Initiatesand maintains a social conversation. e.;(1 Gives classroom commands to peers. a Orally participates in group activities. Appears self-conscious about his/her speaking skits. "?.1 .1 U363 VOICO intonation. 3110331614 • 86303 . :,•C • • rWO COMMENTS: 0% 1-10% 11-30% 31.50% Over S0% B. ACADEMIC LANGUAGE Never Seldom Sometimes Often Excessively •:, Follows specific directions for academic tasks. •Y: Understands vocabulary for academic tasks. ‘;'. Understands teacher's tiscussion. relatedto topics. -:::::. Asks/answers specific questions about the topic t'..' being discussed. :'f Asks for clarification. 2 Volunteerstoanswerquestionsrefatedto thesubject. '1 Follows along during oral reading activities.. '...i Understands reading as a process; is able to :.A integrate words into meaningful sentences. `;.:;.::,: Experiments with writing by drawing, copying a and inventing own spelling. i t...4 Is able to convey information through written v.;:::";... expression, using the correct mechanisms of writing. COMMENTS: X. ACADEMIC PERFORMANCE Grade Level* Instrument Date Based upon your experiences with this pupil, do you Reading: believes significant discrepancy exists between this Decoding pupil's ability and his achievement? Comprehension Arithmetic: Computation Application Language Ability: Verbal ' -I Written Recent Home/Environmental Change•• Teacher's Signature ate. If 3 — `I • Teachers, please provide the best estimate of academic achievement in the student's native language, and in English. FOR ALL LEP STUDENTS. rotIlS1S neaarasAiuo FM -1692 ACV lot -9it EFTA01710317 EXCEPTIONAL STUDENT EDUCATION giving our students the world Speech-Language-Hearing Report/M-Team Referral Name. D.O.B.. Age Grade/ESE 3 School. Student's Native Language/Dialect P Evaluation Date Examiner Verbal IO Develop./Perform. Score Evaluation Conducted in (language) MEMO A TO: FROM: , Student Services DATE: SUBJECT: A, U 49.,. /way (5 7 - ' k eta_e_fif sic, tn.° PFed I I 1440 vtli N EN ( S7 - I I I f 0 I lAi3101 ji 40 1 IM I I ic iI •11 1 I wa -.G 411 I .10 11,111.1 4 i.our , Recommendations: O Refer for eligibility stalling: (circle) Articulation Fluency Voice Language O Additional testing needed: (circle) Bilingual ESC/ Psychometric O No further testing needed Comments: While — Speech File Yellow — Referral Pink — Cum Folder 878-1397 FM-1544 Rev. 110-891 EFTA01710318 EXCEPTIONAL STUDENT EDUCATION giving our students the world Speech-Lan wage-Hearing Report/M-Team Referral Nam D.0.BIEME Agee- 1 Grade/ESE. School Student's Native Language/Dialectiat t Evaluation Date2-5:.... .aw1.9? Examiner Verbal 10 16 proles Develop./Perform. Scorein Fro tres s Evaluation Conducted in (Sin. (language) Audiometric Screening ato1.5..dB. PASS El FAIL Threshold Testing Results: R L Referred: (Agency or Private) Articulation/Phonology (Severity Rating): WNL MILD .....MODERATE SEVERE Test c-pgr.tik ra She. Resultsnosnila.ctr...i.fr.v4-• ts...t.ritre:t • Test Results Intelligibility (Connected Speech): L7 WNL GOOD FAIR POOR Fluency (Severity Rating): WNL MILD MODERAT SEVERE Test -attChl..F...O..os.91-C Results le.)05:4:.1(.11:Cl.10.al. G eat r "17 a l" Supportive Data: ..... YES to Voice (Severity Rating) WM_ MILD MODERATE SB/EFE Medical Clearance ..... YES tO PENANG Supportive Data: ..... YES fa Diagnosis: Language (Severity Rating): WNL Receptive WNL ......MILD . .........MODERATE SEVERE Expressive WNL MILD MODERATE SEVERE Pragmatics WNL MILD MODERATE SEVERE I [Hilt 111111 S aeeneereorteeei ee -40 - Sp RA •I • !...! 430 1 lel31•I III lei Recommendations: 0 Refer for eligibility staffing: (circle) Articulation Fluenc Language r eAdditional testing needed: (circle) Bilingual Esa Psychometric 0 No further testing needed Afi g.t( .e. i. 1244,fe,Afga Comments: 7c/ iOWA44-zelteititi-ihi-cp tieti217,4,tg LAx-.)f Azw. eta White - Speech File v eilnvi/- Referral Pink - rn Folder 878-1397 FM.1544 Rev. 110-891 EFTA01710319 - Miami, Florida Unice of txcep ont Education OBSERVATION OF STUDENT BEHAVIORS irthdate: Grade: Date of Completion' 0% 1.109. 11-30% 31-50% Ovor 50% I. ATTENDING BEHAVIORS Never 1 Seldom Sometimes Often I Evereelvelo Seems to have difficulty staying in seat. Does not complete tasks. Has short attention span. Is easily distracted. Appears to daydream. Exhbits impulsive behavior (blurts out. etc.). Appears hyperactive/overacave. COMMENTS: 0% 1.10% 11-30% 31-50% Overt0% II. INTERPERSONAL BEHAVIORS Never Seldom I Sometimes I Often_ I Excessively Tries to dominate others. Is easily led, influenced by others. Prefers soitary activity. Avoids competitive activities. Avoids verbal communication. Does not participate in class activities. Is ridiculed by peers. Is ignored by peers. Sexually aggressive toward miter students. Physically aggressive. hits/kicks/bites/etc. Threatens teachers/students with body harm. Prefers activities with opposite sex. COMMENTS- 0% 1.10% 1130% 31-50% Over 50% III DISRUPTIVE/INAPPROPRIATE BEHAVIORS Never I Seldom I Sometimes Often I Excessively I Exhbrts perseverating/repetitive behaviors Fi (rocking, tapping, etc.). Has temper tantrums. Exhbits sell-injurious behavior (specify below). ,,..., ..i. Uses profane language. t ••;tl Lacks self-control (specify below). .7 r :?: .I- %Lc coos inappropnatety. .. 0::,-.- -,1;71; Demonstrates moods. ..;-S g •-• 'A Takes things belonging to others. :•-- ‘••;421 Makes untrue statements. Pc• 'T : -.Z:-: ',:7 Imitates opposite sex. : •:1"„:4,...-aii Is destructive (speedy below) COMMENTS: rm•Ise2 Rev 10$ 94) EFTA01710320 - Miami, Florida (Alice of Exceptional Student Education O ttiVA I kJ uu BEHAVIORS Pg. 2 Students Name' School. 0% 1-10% t 1.30% 31.50% Over SO% IV. INDICATORS OF ANXIETY Never Seldom Sometime. Often 11222=a Appears nervous. jumpy. Seems to worry. Seems unhappy. Appears to stutter. Reluctant to speak in group situations. SOOTS tense, unable 40 relax- Seems easily frustrated and confused. • -• .. .. ,,s.:, Manifests fear al school (specify below): '' - . Bites fingernails, sucks thurrbilingers. Er Compulsive talker. COMMENTS: 0% 1.10% 11-30% 31-50% OM 50% V. COGNITIVE SKILLS/PERCEPTUAL MOTOR Never Seldom Sometimes "Often Excessively 1- --cc.3. Has df1c • • • from chalkboard. yr- Has difficulty reproducing drawin'gs.letters. , .14 nun-bets o' written words. ,.4- Exhbits poor gross motor skills (specify below). Seems to have difficulty with visual backing: skips 4' t).,.): „.. Ines words Word andel.- , etc. std3 below. -,- Exhbits poor perception of spatial relationships ..": (letter/number reversals, spacing). ‘.:- Has cfrfficulty remembering (specify below). COMMENTS: 0% 1-10% 14-307. ' 31rSO% Over 50% VI PSYCHO-PHYSIOLOGICAL Never Seldom Sometime. Often Excessively 4.-", Has need to use bathroom excessive . . Speaks unsteady in native language. k~x Exaggerates physical complaints (headadhes. stomach aches. etc.). Rubs eyes. eyelids/eyes inflamed. Holds material close to fate. Turns head to ono side listening/working. Web clothes. Exhibits muscle spasms (IsslcheSAiCkSI trX:,"aY'.0 Becomes ill when upset or frustrated. COMMENTS: 1'OLP" cnietvoisxmo FM•i692 Are (01441 EFTA01710321 - Miami, Florida Office of Exceptional Student Education OBSERVATION OF bit UULNi BEHAVIORS Student's Name- Sc 07. 1-10% 1_1 -3_424 3_12_5T% OteLS0% VII. EARLY SEIZURE IDENTIFICATION Never I Seldom I Sometimes I Often I Excessively Rapid blinking or rolling of eyes. Periods of 'day dreaming*. dazed behavior or blank staring. Picking of clothes. mumbling. clewing or random movements whits acting dazed. Head nodding. Memory gaps. Sudden fear, anger or panic. Muscle jerks or sudden fats. Inability to communicate for a short time. Repeated movements that look unnatural. COMMENTS: Additional Information: 0%. 1-10% 11-30% 31-50% Over 50% VIII. SELF-CONCEPT Never Seldom Sometimes Often Excessive! .. Appears to lack self-confidence. Exhibits feelings of inferiority. Exhibits feelings of superiority. Appears to lack motivation. Needs praise and encouragement. - ---- Demands attention from teacher. .......r . 352 Demands attention from peers. . Demonstrates • -Nasty° a.... ation of faucet. .., ...-:. Prefers tasks considerably below instructional level. ... Selects overly ditficuk classroom tasks. COMMENTS • -I A.Idnoonal information: A * vensis c....rose•4•140 FM•1692 Rov. 10194) EFTA01710322 uppipipplimpr- Miami. Florida Office of Exceptional Student Education BEHAVIORS P •. 4 Student's Name: School: . SPEAKER OF LANGUAGE(S) OTHER o% 1.10% 11-30% 31-50% Over 50% THAN ENGLISH Novae Seldom Sometimes Often Excessively A. SOCIAL LANGUAGE :.:1 Points to classroom items upon command. ..4 Follows classroom directions. : 4 Exchanges common greetings. Initiates and maintains a social conversation. ‘.`;:4 Gives classroom commands to peers. l: .3 Orally panicipates in group activities. r :;:c Appears self-conscious about his/her speaking soils. ... Uses voice Intonation, stress and pauses appropriately. COMMENTS: 0% 1-10% 11.30% 31:50% Over SO% 8. ACADEMIC LANGUAGE . a . .. ....., • L. irnes Often Excessive 1'9 ' Follows specific directions for academic tasks. X .' 1:4 Understands vocabulary for academic tasks. i Understands teachersdscussion.retatedto topics. 4 Askdanswers specrlic questions aboul the topic -.1 being discussed. '4 Asks for clarification. I 1 4 Volunteerstoanswerguestions related to thesubject. 1 Follows along during oral reading activities. :-.i Understands reading as a process: is able to 4 integrate words into meaningful sentences. .. Experiments with writing by drawing. copying ..;..i and inventing own spelling. v.4 is able to convey information through wntten :-..: expression. using the correct mechanisms of writing. COMMENTS: X. ACADEMIC PERFORMANCE r Grade Lever Instrument Date Based upon your experiences with this pupil, do you Reading: Decoding fi r 1.res.4. believe a significant discrepancy exists between this pupil's abikty and his achievement? Comprehension Circle One: Yes No Arithmetic: II yes. please explain: Computation Application Language t Verbal Written event tiomerEnviionmentat Chanties Teacher's Signature Date. • Teacher.. Pleas timate of a• emit achievement e student's native language, and in English, ron ALL LEP STUDENTS. rot t o acw4.- ttUu0 FM -1697 Rev 101 -$31 EFTA01710323 TO: FROM: Keut,-ov Student Services DATE: /- 7 -99 EFTA01710324 DEPARTMENT OF EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD Teacher's Student's Narmz chool Si Directions: This form is to be utilized by the teacher in consult psychologist. During a three week period, certain maladaptive behaviors will be targeted and recorded below. Date/Time Antecedent Behavior Consequence Iriclude State what happened State observed behaviors State what happened duration before behavior, following the behav- of behav- including setting ior, such as the ior, if and/or posiible immediate response applicable. cause. of teacher, student, others. 11-cl -gig ft-ID-Ta .\-11.-418 1-12-T8 il-tS-(11? ►1-1b-cO3 Form # 878-15 EFTA01710325 DEPARTMENT OF EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD Teacher's Student's NamallilliMa School Signature Directions: This form is to be utilized by the teacher in consultation with a school psychologist. During a three week period, certain maladaptive behaviors will be targeted and recorded below. Date/Time Antecedent Behavior Consequence Include State what happened State observed behaviors State what happened duration before behavior, following the behav- of behav- including setting ior, such as the ior, if and/or posiible immediate response applicable. cause. of teacher, student, others. : 1- 2i)--qg 11 —7X-St Form if 878-1 EFTA01710326 ce-44.-ee, -1. 22 Request Assistance Form - Child Study Team Please submit this to Mr. ES after two parent conferences and some classroom strategies have been documented. Student Name Date 0 —l q ID dob Teacher q. to—t-c13 Parent Conferences: 1. Date q -2--q8 Outcome 2. Date q-}s—qg Outcome 3. r>t4-e 4-10-48 cthc Classroom Strategies: Strate ssis an EFTA01710327 MEMO TO: MEM Assistant Principal, Counselor, CST Chairperson FROM: , Bilingual Assessor Bilingual/ESOL ESE Program Division ofExceptional Student Education RE ID DATE: 3 /3 /II Enclosed is the report for the above named student. Should you have any questions, please call meat - Thank you. EFTA01710328 DIVISION OF EXCEPTIONAL STUDENT EDUCATION BILINGUAL/ESOL ESE PROGRAM LANGUAGE PROFICIENCY/DOMINANCE ASSESSMENT REPORT STUDENT: CHRONOLOGICAL AGE STUDENT !DM SCHOOL GRADE: 3rd DATE OF ASSESSMENT: 2-9-99 LANGUAGE PROFICIENCY/DOMINANCE ASSESSMENT INSTRUMENTS ADMINISTERED: °Oral Language Proficiency Scale-Elementary Level (OLPS) °Narrative Development Assessment OBrigance Diagnostic Assessment of Basic Skills-Spanish Edition oKaufrnan Test of Educational Achievement-Comprehensive Form REASON FOR REFERRAL: BACKGROUND INFORMATION: BEHAVIORAL OBSERVATIONS: EFTA01710329 TESTS RESULTS: Analysis oes performance profile reflected the following findings: INSTRUCTIONAL/LANGUAGE DOMINANCE ASSESSMENT INTERPRETATION: Social Language EFTA01710330 EFTA01710331 SUMMARY/CONCLUSION: RECOMMENDATIONS: essor Division of Exceptional Student Education EFTA01710332 EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD Teacher's Student' Name School Signature Firs+cickVo 1.1 11 11 , Directions: This form is to be utilized by the teacher in consultation with a school psychologist. During a three week period, certain maladaptive behaviors will be targeted and recorded below. Date/Time Antecedent Behavior Consequence Include State what happened State observed behaviors State what happened duration before behavior, following the behav- of behav- including setting ior, such as the ior, if and/or possible immediate response applicable. cause. of teacher, student, others. --t 4-qc‘ I— Form 0 878-1559 MIS-22480 (01-81) EFTA01710333 EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD Teacher's Student's Name School Signature Directions: This form is to be utilized by the teacher in consultation with a school psychologist. During a three week period, certain maladaptive behaviors will be targeted and recorded below. Date/Time Antecedent Behavior Consequence Iriclude State what happened State observed behaviors State what happened duration before behavior, following the behav- of behav- including setting ior, such as the ior, if and/or posiible immediate response applicable. cause. of teacher, student, others. Form # 878-1559 MIS-22480 (01-81) EFTA01710334 DADE COUNTY PUBLIC SCHOOLS EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD Teacher's Student's Name Schoo Signature Directions: This form is to be utilized by the teacher in consultation with a school psychologist. During a three week period, certain maladaptive behaviors will be targeted and recorded below. Date/Time Antecedent Behavior Consequence Idclude State what happened State observed behaviors State what happened duration before behavior, following the behav- of behav- including setting ior, such as the ior, if and/or posSible immediate response applicable. cause. of teacher, student, others. form # 878-1559 MIS-22480 (01-81) EFTA01710335 EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD Teacher's Student's Name School Signature Directions: This form is to be utilized by the teacher in consultation with a school psychologist. During a three week period, certain maladaptive behaviors will be targeted and recorded below. Date/Time Antecedent Behavior Consequence Include State what happened State observed behaviors State what happened duration before behavior, following the behav- of behav- including setting ior, such as the ior, if and/or posSible immediate response applicable. cause. of teacher, student, others. Form # 878-1559 MIS-22480 (01-81) EFTA01710336 EXCEPTIONAL STUDENT EDUCATION ANECDOTAL RECORD Teacher's Student's Name School Signature Directions: This form is to be utilized by the teacher in consultation with a school psychologist. During a three week period, certain maladaptive behaviors will be targeted and recorded below. Date/Time Antecedent Behavior Consequence hiclude State what happened State observed behaviors State what happeneA duration before behavior, following the behav- of behav- including setting ior, such as the ior, if and/or possible immediate response applicable. cause. of teacher, student, others. Form # 878-1559 MIS-22480 (01-81) EFTA01710337 ZMLVNUAKT blUUtNI WIIHUKAWAL FIJKM School Year 03/04 This is NOT an official transcript. Please send WEST PALM BEACH FL 33411 request to school center for an official transcript. Race HISPANIC Grade Sex Birthdate withdrawal Date Code Reason 08 FEMALE /.£/y EACH TEACHER: Mark grades to present date. Record number of unexcused absences in upper left half of absence box; record total absences in lower right half of absence box. Collect book(s) and note return. Do all work in ink. Prds Course sec 1st Abs 2nd Abs Ex 3rd Abs 4th Abs Book Bldg-rm Title Gr Ex/un Gr Ex/un Gr Gr Ex/un Gr Ex/U Rt'd 01 1205070 01 m/3 MATH 3 IC 02-P-13 Signature of c_-3 / 02 2002100 02 M/!IIII1 SCI 3 IB 01-147 Signature of va N/ A _ 03 2100010 01 M/J us HISTORY IA .02-P-8 Signature of 04 1303020 01 M/J CHORUS 3 IC 01-155 Signature of YIN 05 1501040 11 M/J STRIKING OBJE Is 42-C 02-201 Signature of 06 1001070 06 M/3 LANG ARTS 3 I 01-168 Signature of 07 1204000 01 M/J INTENS MATH ( 02-P-1 Signature of Title of books not returned Book# condition Price Other Outstanding Obligations Media specialist: Assistant Principal: Occupational Spc: Counselor/Stdt Serv: Data Processor/Dat -Lag,l'2:3 Parent Form# PBSD 0756 (Rev. EFTA01710338 BELL' SOUTH Page 2 of 9 ccot e... er Your Current Regulate° charges are the minimum you must pay in order to maintain Charges total is your local telephone seethe. II you do not pay this amount: $90.73 *your local service may be disconnected, and •you may need to pay a charge or deposh to have your service reconnected. The amount °I Regulated Charges may be attained by calling 1 888 7576500. If you do not pay the rest of your bill, whica includes unregulated charges:- all of vAtich are Identrted by " on your di: Late Charge Reminder: A $1.95 •yout local phone service will not be disconnected, and Late Payme.it Charge and a.0% •you ate sell responsible for paying these charges. !Merest charge may apply to an utp•id balance as of Ocl 11. BellSouth _A neworeSM I- 00 ELO 6 0 0 0 0 0 00 0 0 BO 00140 BOO AadricovamosPlIwd% clad • Z9ZT—TOZ8Z -ssappe m ut . astrapuodsenoo 'or uodnao b06L-TT4E£ to aaS • 401°S1108 q spun) rn tit apeAed 09VZOI I CAMS BLZ'O AV I 5096£OX Maul Maid • 11"11"1111 1' 1'1"""II"I'Il'"Ill"11"11"I"II"'l 4unoto £f06S :c Jaqopco )(a an° H111OS77313 S pasopu3 ninthly WImord Aei(micia:ineoseavvai Rialto 'fed nieuded nob tom wood Still UAW pue ayes) EFTA01710339 A :R:CH STONE Apartment Lease Agreement Replacement Lease Re ident Address: OR H FL 33411 Resident Name(s): Resident ame : occ. only) (occ. only) Lease Term 12 Refundable Deposit 0.00 Lease Begin Date 03/01/2003 Applicable Fees 200.00 Lease End Date 02/29/2004 Pro-rated Rent 0.00 4:P3 WtlitiggegNiSit VaidigigrigsrA algUttf4i*':, ./ Mkit(PY: t- ' ' Electricity RESIDENT Water/Sewer RESIDENT Gas N/A Trash RESIDENT Agreement and Acceptance This is a Lease besweer. the above named Resident(s) and the Below-named Management for the a artment dwelling described above. It (and any contemporaneo usly executed additional agreements) is the entire agreement between Resident(s) and Management and be modified only in writing. As used in this lease, "you" means the resident (tenant) or residents whose names appear above. If there is more than one resident, you are jointly and severally liable for any payments due to us. "We," "our," or "us" means the apartment community. UPON EXECUTION OF THIS LEASE, YOU AC OWLEDGE THAT YOU HAVE READ AGREE TO AND ALL OF ITS PROVISIONS. It was executed by the Resident(s) and Management on the above . Date." In consideration of the mutS eements and covenants contained herein, Reside and Management agree as follows: Page IA EFTA01710340 YEAR 13CI1/F1 Cciej Pei/VI CAISIS ROM Pln WORK MONTI Social Steam) and rip to • (Lamgane Arta, Math, Comprebenutve Seleace, ad Wilt traders will have FOUR aradsslaic subjeds ELEC'ITVES. Cher one of the following dective options: WEIKEL ((9wases will randy each 9 weeks.) 10000704 READING 8200210 COMPUTER APPLICATIONS PITIRCAL EDUCATION 8600110 5001' OR Exception: Students who at twt below grade level wilt not be cam Students may select one of the folberbag full year electives. al /awn s a they we be resound front the readin g. They wi l be given the option cd taking man( In the after snood tutori from year lank elective to take nine wedot cf raking, L UIKE TENCEIERJADMINTSTRATIVR APPROVA ALL OF Tr:a FOLLOWING RIE;Q 1302000 SAND I (Grades 6 - 8) _07083408 SPAM:MICR& CREDIT) - A's & Ws be L.A.) 1302010 LAND DI (Grades 6 - 8) 1302030 BAND IV (Grades 7 - 8) _1400000 OFFICE AIDE (Reecendstkia required) 1303010 CHORUS 11 (Grades 7 - 1363030 CHORUS IR (Grades 7 - 8) 82090218 COMPUTERS R.S. omen) 1302110 HANDBELLS I (Grades 6 - 1302120 1ANEDBELLS 11 (Grades 7 - 8) y. Unit. lyni VI:ks, Ave tatmid% r e subject to administrative douse based ea &th -:! Rif`,-' ' u feint retur:ed, e will select the student's electives . • -"it :Zie,...Var: Student' glut= EFTA01710341 FY2004 Mt GRADE THIS SIDE FOR SCHOOL USE ONLY LANGUAGE ARTS MAMILMATICS SCIENCE SOCIAL STUMM 1001070 Regular 1M5070 Math 8 21)02100 CompSci 8 _2100010 Regular 1001080 Advanced 12003108 ALgl R 7820010L Gifted 78210101. Gifted 7810010L Gifted 12003208 Algl H 78200101 Ell 78210101 EH 78100101 EH 12063208 Gem. H 7163010T Unique Skills _78630101' Unique Skills 7810010E MB 7812010.1 EH 7820010K SLD/FT 7821010K SLD/FT 7863010T Unique Skills 78630100 Unique Skill's 7820010Q SED 7812010Q SED _7810010K SLD/FT _7812010K SLD/F0 7820010E EMIL 7821010t3 E2.03 7810010Q SED 78175310Q SW _7810010G ALP/Lime 7812010E EMH _78100100 ALP/Acad. 7866030F Speech Therapy SOC/PERS READING 78630001 VE 7810320K YE 7810020E EMH mui UNIQUE SKILLS OCCUPATIONAL 'HERAPY PHYSICAL, THERAPY 7815010E Adaptive PE 786310H HI 7866070 7866070 _ Reading EFTA01710342 SECONDARY STUDENT WITHDRAWAL FORM School Year 03/04 This is NOT an official transcript. Please send WEST PALM BEACH. FL 33411 request to school center for an official transcript. Race HISPANIC Grade sex Birthdate withdrawal Date code Reason 08 FEMALE AL/JCALS/ EACH TEACHER: mark grades to present date. Record number of unexcused absences in upper left half of absence box; record total absences'in lower right half of absence box. Collect book(s) and note return. Do all work in ink. Prds course Sec 1st Abs 2nd Abs Ex 3rd Abs 4th Abs Book Bldg-rm Title Gr Ex/Un Gr Ex/un Gr Gr Ex/Un Gr Ex/U Rt'd 01 1205070 01 m/) MATH 3 IC I/ 2 A/ 1 I 02-P-13 Signature of C-3 ye 02 2002100 02 MO COMP SCI 3 B -i/ 7/ 1 01-147 la N/A 03 signature of 2100010 01 t4/TITTISTORY -2 A 02-P-8 04 Signature of 'I'll 1303020 01 MO CHORUS 3 • 3 4'4?-dt OS 01-155 signature of 1501040 11 M/) STRIKING OB)E C 3Y/ CZ 02-201 Signature of 06 1001070 06 M/) LANG ARTS 3 01-168 Signature of 07 1204000 01 MO INTENS MATH 02-P-1 i tid it74 Signature of , 7) Ye Title of books not returned Book# Condition Price Other Outstanding Obligations Media Specialist: sistant Principal: Occupational Spc: unselor/Stdt Serv: Data Processor/pat - /___/___ Parent: Form. PBSD 0756 (Rev. 9/90) EFTA01710343 blaring nub NAME: Florida Comprehensive Assessment Test (FCAT) ID: SSS Reading Student and Parent Report SCHOOL: fIrrldo Cenerrhiniirr airtime:It Tea Grade 09 DISTRICT: Your 2005 Reading Results rch Your Reading FCAT Score History 5 Year 2001 2002 2003 2004 2005 Your Reading score is on grade level. You answered 4 many of the questions on FCAT correctly. Grade Tested Achievement Level 2 I Low Tu calificacidn de Lectura este al rivet. Rospondiste a muchas de las pregunlas del FCAT correctamente. These scores show your achievement on the day you were tested. II you were to take this same test again, it is likely that your 2005 FCAT Reading score would be between 1949 and 2091. Xi00 Not Lekti Ou nan nivo klas la. Ou reponn anpil nan kesyon FCAT yo kothkteman. 25C0- 2X0 1500 - Your 2005 Reading Content Scorn Points LL Points Compared to other students Content Areas 1CCO - Earned Possible OMNI= IN Won/Phrases 5C3 Main IdeaPurpose Comparisons 0 10 Reference/Research Grade Tested I L=Low, /4=Middle, !PHIgh II Your Score O On Grade Level (Achievement levels 3 and above are considered on or above grade level.) Chart of FCAT Achievement Levels and FCAT Scores La table do 4 &realm mcestra Table ki adwat :a montro Nivo Reading los &vein do rendimbrit° del Rannman nan FCAT a ak Neat el FCAT y los ranges de <ratification Net FCAT a you chak Nivo. Grade Levert Level 2 iC,:ii. .p . Level 4 Leval 5 del FCAT para sada nivel. .3 86-1045 104134197 <::1189I748ei 1489-1885 1868-2514 El nVol de mndimlento 3 Nivo lannman 3 reprozante travay "nan nlvo klas` la. 4 295-1314 1315-1455 ;:.4.,Aailac 1890-1984 1965-2638 roprosonta el nab* -al nWo7. 6 474.1341 1342-1509 maxim 1782.2058 2059-2713 Anvan 2002, yo to rant° yon Antes de 2032 a los estudiantes nochel not Id gen twa chit laden 6 539-1449 1450-1621 MW0ite 1860-2125 2126-2758 se les otorgaba una callicacion pou elev yo. 7 671-1541 1542.1714 ..ntaiitki. 19454180 2181-2787 qio segula una escala do fres clIghos. 8 888-1695 1696-1881 Liggin 2073-2281 2282-2790 9 772-1771 1772-1971 atitalW 2148.2297 2298-2943 10 814-1851 1852-2007 3108M.31::: 22194310 2311.1008 On grade-level Reading Content --Content scores give more CalilleaCIOneS de contenido de lecture NOt Kontni pou Lela' specific information about the skills on the FCAT. Grade Las calificacbnos do contenklo proporcionan Net ono kontniyo bay entemasyon kl pl egzak sou town expectations for students Include: informacion mss ospecnica sobre as habildades en el konpelans eAv la nan FCAT a Mon sa yo atann de FCAT. Las expectatins al ravel del grado pare cos elk la dapre nivo klas a: • Words/Phrases — uses skills to determine word ostudianles Induyon: meaning. including word pans and relationships . MolFraz — alliZ0 apeld pou dettiminen slyifkasyon between words. • Palabras/Frasos —OSA la habliidad pare diatombar mo ye. sa Nadi chak pati nan no yo opt rektsyon Id • Main Woo/Purpose -- determines a stated or el signiloado do una palabra, incluyendo las partes genyen ant mo yo. Implied essential message, details, authors de palabras y las relations entre palabras. • Ido Pronslpal/Objekttf —deteminott yon mosaj purpose. or plot. • Idea principal/Proprasko --determine un mesa's esansyel ki doklare oswa syere, bay delay sou • Comparisons — knows similar and ddi'rent, cause esencial manes, o implicit°, detallos del propOsito 01:401(1110SW3 plan eta a. and oiled, and contrast del autor o el argument°. • Konparozon — Kennon monm ak 'Moran. kez ak ofe, • Roloronce/Research -- uses information from a • Co mparaclones -- conoco 51111461 y diligent& cause °pi kontras. variety of sources to reach conclusions. y efecto y contrast°. • Roforans/Rechech — Mize enfomasyon kl soli nan • Referertelannvostlgacion -- usa ta inlormackm do plizye sous pou dcthvikonklityon. una varledad de fuentes pare Ilegar a COMIJS-10110S. 0130807 NT=Not Tested. NR•Not Reported. NF=Not Found EFTA01710344 Spring 2005 NAME: Florida Comprehensive Assessment Test (FCAT) ID: SSS Mathematics Student and Parent Report SCHOOL: Grade 09 DISTRICT: Your 2005 Mathematics Results High Your Mathematics FCAT Score History 5 Year 2001 2002 2003 2004 2005 Your Mathematics score is above grade level. You 'er: n .Itir answered most of the questions on FCAT Grade Tested corredly. 3 I Achievement Level 2 1 Low Tu calificacién de Mateméticas està per enclin del n val Respondiste correctamente a la mayoria de *These scores show your achievement on the day you were tested. II las preguntas del FCAT. you were to take tits same test again, it is likely that your 2005 FCAT Mathematics score would be between 2022 and 2090. 3000 Net Matematik ou depase nivo klas la. Ou reponn pile nan kesyon FCAT yo korektemen. 2500 0, 2000 É 1500 Your 2005 Mathematics Content Scores Points Compared to other students se. Points Content Areas Earned 1000 Possible fl M22MMIIIM Number Sense 500 Measurement Geometry 0 Algebraic Thinking Grade Tested Data Analysis ■ Your Score O On Grade Level L•Low.1.1.1dIddlo. H-HIgh (Achievement levels 3 and above am considered on or above grade level.) Chart of FCAT Achievement Levels and FCAT Scores La tabla do la doredm muestra Table ici adwat la montre Nivo Mathematics lei revers do roadimionto del Rannman nan FCAT a ais Weenie FCAT y los ranges do calificaclon Not FCAT a pou chais Nivo. Gus Level 1 Level 2 ;,.-.1LeVel-3....j? Level 4 Level 6 dol FCAT para coda rvel. 3 375-1078 1079-1268 E:(2994S095:": 1509-1749 1750-2225 Nero mailman 3 reprezanio El nival de rendmiento 3 travay 'nan Moo Mae la. 4 581.1276 1277-1443 :"(4.44.15.67:d: .. 1658-1892 1863-2330 represonta el trabajo 'al niver. 6 569-1451 1452-1631 ::191r ›.17.90!d.. 1768-1956 19572456 Moan 2002, yo to raptdo yon Antes de 2001, a lee estudlantes nacho' not le gen twa cell laden 9 770-1553 1554.1691 .:IG.:92.-as.e. 1860.2018 2019.2492 se les otorgaba una caldicacién pou aide yo. 7 958-1660 1661.1785 :t.-71s.-163.8.: 1939.2079 2080-2572 quo ;enure una oecala do 1733-1850 ..11.51.-1917- 1998.2091 2092-2605 CMS «OilOS. 8 1025-1732 9 1238-1781 1782-1900 :1901:2022' 2023-2141 2142.2596 10 1068-1831 1812-1946 '1,947.20491 2050.2192 21934709 On grado-kw I Mathematics Content -Content scores Oro more Calitleaciones de centered° de maternetteas Not Kontni pou Matematik specific information about the skins on the FCAT. Grade Las califcaciones de contondo propercionan Net pou konini yo bay enlômasyon XI pl egzak sou level expectations for students include: Informachn mas ospocilica sobre las habdidados on el konpotans Ay le nan FCAT a Mon sa yo atann de FCAT. Las expedauvas al Sol dol grade para los elèv a dapro Nye Mas la: • Number sense - uses number concepts and estudlantos iricluyen: computation skills. I chit/Sans - Ulm konsepsyon chit ak abilite pou tb • Measuremom-- solves probtent involving .ttilmerofSemido - usa conceplos numérises y tall measurements, e.g., time, weight, length, area. habilidados de compute. a Meal — rezoud pwoblem ki gen meal laden, pa • Geometry — analyzes and combines shapes to solve . Mediae -- resuelve problemas quo Incluyen egzanp, tan, awe lone!, alias problems. modidas, par ehn-ple. Memo°, peso, ongitud. area. • Jewometrl — analize epl konbinen figl jewomatik • Algebraic Thinking —analyzes patterns and uses . Geo movie — analiza y combina tonnes para pou rezoud pwoblem. equations and inctuaides. resolver probtamas. oRezonman allobrik — analize model epl Nee • Data Analysis and Probability —uses data analysts • Ponsamlonto algebraic.— analiza pationes yusa ckwasyon ak inegatle. tools to display information, make predictions and ecuachnes y dosigualdados. • Maltz Done ak Pwobabliito —Mite zoutl pou lb make Inferences. • Amide's do dates y probabilidad --usa anallz done pou pezante enlemasyon, le horramlentas de 01 analisis do dates para masher modesyon ak deeksyon. leformaci6n, haver prodicclones o inforanclas 0130808 NT.Not Tested, NR•Not Reported, NF•Not Found EFTA01710345 t. FLAT SSS READING/55S MATHEMATICS • SPRING 2006 EFTA01710346 Special Health CUMULATIVE SCHOOL HEALTH RECORD Problems - See (This form Is not Intended for physician's use) Narrative_ Na Race ex School Address Fathers Nam J 3 321-70 Mother's Name Date of Birth 40 / 7 l fb Place of rth Birth Recorded: Yes 0 No El Immunization Certification: Yes LSd Special Immunization Programs A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES K 1 2 3 Screening and Screening Screening co Outcome Assessment Outcome co Outcome Outcome To' -15 c Referral t 'E tie Ws Grades te B 'E 0 t0 B 'E Date K-3 Date as ?. 01 0 0 E0 cc 0 cc cc o o) co [ Vision Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Physical Assessment .1 Other Other 4 5 6 7 8 Screening and Screening c Screening Assessment oo Referral Outcome Outcome Outcome co Outcome E S 0 TS. c • Grades E 0 — r .a 'E 1p co 75 75 8 ec. ti m ho co ro B Date 4-8 co Dale 0 s ga m 0 2! 0 0 cs CC • rr cc cc • Vision Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Physical Assessment Scoliosis . Other - Other --, ti 3H 3041, 9/98 (Replaces HRS-H Form 3041 which may 80 ono° EFTA01710347 SEX: RACIAL/ETHNIC GROUP: STUDENT NtRiABER: STUDENT NAME: gitiC 0 White Not Hispanic LI American Indian/Native Alaskan Legal 0 Black Not Hispanic. ❑ Asiar/Pacilic islander 0 Mull Racial ADDRESS: use once in thiss ace until final BIRTHDATE: Vetlfied by Birth Certificate: 0 Yes 0 No If No, What Type Verification? ? P G OA NAME OF PARENT(S) OR LEGAL GUABDIAN OR OTHEI2 RESPONSIBLE ADULT At HOME: CURR Name Street City Date First Entered This District 'T Ca L.J School: I Grade: School: Grady School: -Oto: School: Grade: School Grade: School Year: School Year. Schad Year. School Year. School Year. Days Present: Days Absent Days Present Days Absent Days Present Days Meant Days Present Days Precast. Days Absent: Teacher Name: Teacher Name: Teacher Name: Teacher Norm: Teacher Name: COPY OF COPY OF COPY OF COPY OF COPY OF FINAL REPORT CARD FINAL REPORT CARD FINAL REPORT CARD FINAL REPORT CARD FINAL REPORT CARD MUST BE INCLUDED MUST BE INCLUDED MUST BE INCLUDED MUST BE INCLUDED MUST BE INCLUDED DE:CATE N0ICATE INDICATE INDICATE MCKIE P • Purcao P- Prwrola Prwrow P• Prance P -Parra* R • FWati R • ROM R• Ranh - Rd& R•Re.sh PAW • Pwrole MAP PAIP• Proncle WAIF PAW • Piccolo WAIF PAP Pica& WAP PAP • Praia WAIP SS •Sanwer Y-Scol SS - Sumter &Mot SS •StrrewSdowl SS •SanweScIdol SS •Suranix Sdirad EST • &Andel Sol Vat. ESE EST Ederded SDI War ESE ESY Undo:ISA NAME EST Warded Sae Year ESE EV-Eno:IS Set Year ESE School: Grade: Schwa I Grade: Schott &oda School: Grade: Smoot Grads School Vaal School Year. School Year. School Year School Yew: Days Presoni: Days Abut* Days Newt on Absent Days Present Days Absent Days Present Days Absent Days Present: Days AbSer2.: Tumor Name: Teacher Name: loather NaTIK Teacher Nam Teacher Na,,: COPY OF COPY OF COPY OF COPY OF COPY OF FINAL REPORT CARD FINAL REPORT CARD FINAL REPORT CARD FINAL REPORT CARD FINAL REPORT CARD MUST BE INCLUDED MUST BE INCLUDED MUST BE INCLUDED MUST BE INCLUDED MUST BE INCLUDED INDICATE N0ICATE INDICATE INDICATE INCICATE P. Roacce P.Prom:6o P Pond° P • Pronnor R • Nasal A -Pail R • Patin R • Roth R Raub PAW • Ptorrole WAP PAP •PioantesiNP PNP •P000sto WAR PAW •Noirolo v•WO PAP: PioneirerA? SS • Sires ss • Saone Sava: - . Sch:d SS- SorrterSctool EFTA01710348 r 0 W/RETURNING STUDENTS REGISTRATION BACK snow twes WITH Iota( ono (13 r BOTH PARENTS El MOTHER j FATHER 0 SHARED CUSTODY OTHER t. ON TRANSPORTED BY: SWUM wi be IrmsperNd Wins school by (morn eI M ar Dan patent) (33) IS INLRE A COURT ORDER BARRING EITHER PARENT FROM REMOVNG —11 CONTACTING THE STUDENT DURING THE SCHOOL DAY? a'.YES 4O O IF YES, PLEASE PROVIDE THE SCHOOL WITH A_ČOPY OF (34) FATHER/GUARDWE DOES FATHER HAVE CUSTODY? DYES NO 35) MOTHER/GUARDIAN: DOES MOTHER HAVE CUSTODY? S Omo POST NAM( I at IAtT ICI2OLL LAST MSC ADOSISS CITY WW .IIIIII I IIII L Kiska(dye f7-939ik STFIt St COOS ManbT . / /LS ryie C r nA.G OP tA410.0•Lam7 Platt 0' Illt0VMSO latME mom metiats Piet LOW' roCILS MINUS WPC (3d) RICHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) 1371 HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) .t,, . 11011INTART SCLIC.CK WA= B O 0.;is 0-IIII c O. SCICOOL LIMADUATO AO it"*-7:1';,"' BO (10....: sw.:4..recL C Al ."" ,,, W4" »,;t3 E N TIONitLawalcri D El SONS POST•SIMONOMY E umw.atotuct D O sc'-`7.'"`Usr. * et ASOVO ONACOATI • t:oLLOVATS LA ..STD 3P) LEGAL GUARDIAN IIF AHNI DOES LEGAL GUARDIAN HAVE CUSTODY? O YES El NO Ilµi N41{ Pat LAST " G" Acaa s A v TbM stnanc.c met iWgPP‘JPX;;,1E4.I".t.:e. r'0.1,70fPn.'2 3 i • na PAK, I: PERSONIS) OTHER THAN PARENT AUTHORIZED TO NCR UP STUDENT . MI PASSWORD (LIMIT 10 CHARACTERS) IAN M1,01/1210 roc tianClAty ct.„ . .. • PHONE RELATIONSHIP ( YES . Fevo - A7444e..,- O NO LATIONSHIP n ( U YES D NO 143) NAME ADDRESS PHONE RELATIONSHIP li YES D NO 144) NAME ADDRESS PHONE RELATIONSHIP r u YES D NO (45) NAME ADDRESS PHOTE. RELATIONSHIP n U YES D NO (48) PART IE M SCHOOL PERSONNEL ARE UNABLE TO CONTACT YOU 94 CASE OF ILLNESS OR ACCIDENT, MAY WE HAVE YOUR PERMISSION TO CALL YOUR DOCTOR OR EMERGENCY SERVICES 4911) FOR TRANSPORT TO THE HOSPITAL? D YES O NO (47) FAMAY DOCTOR (45) PHONE NUMBER (49) HOSPITAL PREFERENCE (Si) DOES YOUR CHILD CURRENRY HAVE HEALTH INSURANCE? C YES .t NO MC LIST YOUR CHILD'S ILLINESSES, BEHAVIORAL HEALTH ISSUES, ALLERGIES. II yes, Moan IndIcam--..— MEDICATIONS TAKEN, OR OTHER PHYSICAL MUTATIONS: 1:7 ModirAd 1=I Heahhy Kids/KM Cu. 'I=1 Privo• ai Imetwed In ?stela., H emotion teNo.r .saN?:9Š 444 44s -444, '4' .4 YOUR CHILDREN IN OTHER PALM BEACH),, šp.:„.4041 :. . 352, NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) CRAZE BIRTH DATE (53) NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) GRADE BIRTH DATE (54) NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) GRACE BIRTH DATE (ES) NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) GRACE BIRTH DATE (563 NAME OF CHILD SCHOOL ATTENDING . STUDENT NO. normatau GRACE BIRTH DATE (57) I VERIFY THAT THE INFORMATION GIVEN IS TRUE AND ACCURATE TO THE BEST OF IA? KNOWLEDGE. 0 Q.as .OO DATE FOR OFFICE USE ONLY: i ,,'• I • Ca 4 ENTRY LOA •iS INTEL LIS a 33: I• SSS :CSE EN E01 OS/15/00 058C i I3t) CT AN (foil (34: :SLINIA•3 i T343PL; NS. ai l EN US 05 01 514 ,A. i /3 333 37t, 13 ,% FidCW1l MN •L ' /CS/ I1 fi II •::: • ES 373I OCCOMILL- AT IS:. 3/ E., U. 7 i113C• SIN ' )I • Or R‘q,P,En, ON.PIP:1 DE0E ri-it, 9 i Z Eric D E-ESCL O ..-P17, , /3 i D AT, '' ,. / ::: 4' 4 w;'; 043 O:.TA ID TNT COW/WILL 3 , 3 J;.1t PDSLI U635 (NU. 43133/1 EFTA01710349 STUDENT NUMBER: VERIFICATION FOR NEW/RETURNING STUDENTS: TO THE PARENTS OR GUARDIANS: NEW/RETURNING STUDENTS NEW STUDENTS: Complete all non- shaded areas on both sides of form REGISTRATION RETURNING STUDENTS: Please review both sides for correctness of typed information. If the information printed is into rect. please correct it by carefully )ISTR: 2141 TCHR TNBR: 514STOT il l and lightly crossing out the incorrect information and 08/12/0 6 HMRM: 514 writing the correct information above it. KM DAM II) STUDENT'S LEGAL NAME (2) ALSO KNOWN AS Sante> /All •A I ""'"' (3) LOCAL ADDRESS (4) MAILING ADDRESS (AML NA MAW mood is: MAIL . API. MO. LOXAHATCHEE FL 33470 Los4p,heiChea_ et 3 5 4-7 e.. .. SIAM 2rctO PIY STAY& zo COM MI STUDENT'S SOCIAL SECURITY NO. 161 HOME PHONE NO. 7) SEX F (B) RACE H (OPTIONAL) rrrXXXIII I d A rE AL ATr AN INOIA AN FEMALE 14 TAM I A PA SICAACISLAADER I W NON-HISPANIC MALE I B NON HISPANIC rA H HISPANIC I M MULTIRACIAL IS) DATE Of BIRTH 00/ PLACE OF BIRTH DADE COUNTY FL US FLORIDA maim riAY VIM OW sr/Ai ODUiRtY (I11 RESIDENT STATUS 3 (12) ENTRY DATE INTO USA . . D. FOREIGN EXCHANGE STUDENT 2. OUT-Of-STATE RESIDENT ll El I. OUT-OF-COUNTY RESIDENT I 3. IN-COUNTY RESIDENT (13) FEDERAL IMPACT AID SURVEY . DYES NO A. THE STUDENT RESIDES ON FEDERAL PROPERTY. I YES RI NO B. THE STUDENT RESIDES IN LOW RENT HOUSING. I YES 0 NO C. THE PARENT IS EMPLOYED ON FEDERAL PROPERTY LOCATED IN PALM BEACH COUNTY. I YES Ei NO D. THE PARENT IS MAKI:in° ON LOW RENT HOUSING LOCATED IN PALIA BEACH COUNTY. I YES Ei NO E. THE PARENT IS IN TIE UNIFORMED SERVICES OF THE UNITED STATES. IF YES, IS TIE PARENT ON ACTIVE DUTY? I YES I NO I AIR FORCE I ARMY I COAST GUARD I MARINES I NATIONAL GUARD I NAVY (Ill (AS THIS CHILD BEEN ENROLLED IN ANY PRESCHOOL? (PLEASE PLACE A CHECKNIMIX I sdir BY EACH PROGRAM ATTENDED. ALSO, INDICATE WITH AN ASTERISK i *). ME PROGRAM YOUR Cilit0 WAS IN THE LONGEST.( 0 C. CHAPTER I I H. NEAOSTART I O. OTHER I D. PO-ii DISABILITIES I M. MIGRANT PRE-K I S. SUBSIDIZED CHILD CARE I I. PRE-K EARLY INTERVENTION 0 N. NON-SUBSIDIZED CHILD CARE (151 IS THE STUDENT A SINGLE PARENT? (IS) CURRENT GRADE LEVEL NO I YES I NO OS TROOF.ECKIR1140,4100. .,.d II? OM DATE OF LAST ATTENDANCE 3-t4,0/2- tto100 (20) GRADE LEVEL (2 I) LAST PUBLIC SCHOOL ATTENDED IN PALM BEACH COUNTY (22) DATE ATTENDED 444A NfflggicTIARRPPPEP:getilP..,44:Mco. . . ..:NPktiMititi(tliNFORW09,0127,4, - i ,-. 123) NAVE YOU FILLED OUT AN APPLICATION FOR FREE ON REDUCED LUNCH? (APPLICATION IS PROVIDED WITH THIS REGISTRATION FORM) Er YES I NO (24) HEALTH SCREENINGS: I GISE PERMISSION FOR MY CHILD TO BE GIVEN NON-INVASITE HEALTH SCREENINGS. THESE TESTS MAY BE GIVEN INDIVIDUALLY OR III GROUPS. FON EXAMPLE: VISION, HEARING, SCOLIOSIS, HEIGHT & WEIGHT YES gi YES I NO (25) SODIUM FLUORIDE: I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE IN THE SODIUM FLUORIDE PROGRAM YES TO PREVENT DENTAL DECAY. PERMISSION IS VALID MAOISM( GRADE SIX. Igi YES I No • ,.014, 44 -WiaaViseta .1 4 3 /4 .Pa.04 4teOg COSPOiO.Itt!telf00.0*§i400.0,41 1*E4ra ciAft41aSIMI MIN NOME LANGUAGE SURVEY Ws 26-23) I. IS A LANGUAGE OTHER THAN ENGLISH USED IN THE NOME? ri YES I ND II yµ Mile loaguagel Span ts h 2. DOES ME STUDENT HAVE A FIRST LANGUAGE OTHER THAN ENGLISH? I YES I NO I.I YE; wbM beguile? 3. DOES THE STUDENT MOST FREQUENTLY SPEAK A LANGUAGE OTHER THAN ENGLISH? El YES 0 NO II yes. whet leaguer? (271 WHAT LANGUAGE IS SPOKEN IN THE MST WHAT LANGUAGE IS 7HE (29) BATE OF ENTRY 130) DISCLOSURES FOR ENTRY late thle School District HOME BY THE PARENT or GUARDIAN? STUDENT'S FIRST flu) INTO AN LANGUAGE? ESOL PROGRAM HAS THE STUDENT EVER: (I I. Been expelled Item school? I TES gii. gni a / 5°Pa") 44 CeCiat L-S tt 2. Ned as mai resulting IR a charge/ ,YES NO 3. Ned soy Oriel,. Janice edifies? I Yrs tem P850 0636 (Rev 4/00) EFTA01710350 THE SCHOOL DISTRICT OF 678 Academic Improvemen an ) Student Name / Student ID # Iasi MI FNRT A H: School Name FCAT — READ: MATH: evel School Year HSCT — COMM: MATH: Student's Previous Pr HAP: AIP: R-ZZ 14-ZZ M-F previous AIP (AIP): PRIMARY EXCP: LEP: N A R W i R W T 1 R II 1 R II Diagnostic Assessments 5 Instructional Intervention Strategies A I ! A 0 I T u 0 i T i M Chock (V) all that apply. i I A . Check (V) all that apply. N N A T N N T 0 0 I 0 0 i C e _ s Classniom/Schoolwido Assessments Tutoring " • Gass Performance During School Day . I Student Portfolio AfterschooVSaturday Program Teacher Assessments Enrollment in Intensive Course Tod PlacemonViests Classroom Organization 7,5 Systemwide Assessments Small Group instruction Norm Referenced Test (NRT) Cooperative Learning Groups State Assessment(s) Guided Reading/ Writing Groups Other Standardized Assessments Alternative Reading Program Diagnostic Software Technology/Computer-Assisted Instruction Other (Soo attached.) Other. Instructional Alternatives After completing diagnostic assessments, Suspension of Curriculum I check (14 all that apply. Variety of Teaching Tochnlques i \.," READING - Focus for remediatlon: Varied Pacing L., Reading Clues: I 0 Graphophonlcs 0 Structure E Context Assignment Alternatives -Adaptations In: Reading Strategies Time O Sampling/Searching 0 Predicting Quantity O Cross-Checking 0 Confirming Product Requirements l.--- Reading Behaviors ESE Referral O Rate 0 Self-correcting 0 Self-monitoring Other (See attached.) Comprehensive Strategies Parent/Guardian Contact - Commitment/Contribution 0 Fiction 0 Nonfiction Specific Sidls Reading Skills O Vocabulary ❑ Word Recognition 0 Word Patterns Specific Skirls Specific Skills Specific Skills WRITING - Focus for remedlation: 0 Sentence Writing 0 Paragraph Writing 0 Composition Writing Date Types of Writing: 0 Expository 0 Persuasive Awareness/Application of Florida Writes Rubric Data O Focus 0 Organization 0 Support O Conventions of Writing (Grammar/Mechanics) Other: • CI MATHEMATICS - Focus for remedlatIon: 14 A R W T Student Performs co Review f A II P -Cmber Sense, Concepts, and Operations A I t 0 T IA Specific Concept(s) Date(s) I A ‘ //oZ N N T 0.-demosuroment 0 0 C I 3 Specific Concept(s) O Geometry and Spatial Sense Outcome (indicate Yes or No as appropriate) S,tufelfic Concept(s) Successfully Remodiatod ir Algebraic Thinking Requires New AIP next school year Specific Concept(s) Retention O Data Analysis and Probabfilly Special Serv.ces/Placement Specific Concepts) Other (See attached.) FWD 1686 FY 00 (REV.81=000) ORIGINAL • Curnelaftes Feder COPY- School COPY• Parent/Guardian EFTA01710351