EFTA01710352

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HEALTH EXAMINATION He lit Blood Pre-sure (I) Normal-It Abnormal =A N ty COMMENT: Abnormal Findings, by number ( 1. Appearance 2. Skin/Nose 2 Head/Scalo 4 Eyes E. Visual Acuity IR 8 L) E Ears i Auditory Acuity IR 8 LI E Nose / Throat 9. Mouth. Teeth and Gums 10. Clital / Lungs 11 Heart 12. Abdomen 13. Borstals and Anus 14 Musculo-Skeletal 15. NetstilOgiCal 16 Alertness 17. Emotional Mental/ Behavior Rub) 18 Handicap. physical/ other (Speedy) 19. Activity Restrictions ISPecifyl 20. Abuse. substance/ physical / emotional 21. Nutrition 22 Other B. HEALTH HISTORY tsercvs I blesses triunes: exerainl /1/ (attach narrative if additional space needed) C. LABORATORY (as indicated) HemoglebintHematoent Stool 10 & -uberculin te8 Load Sickle Cell NAME: ADDRESS: (Please Print) Authorized Signature ate DM 3040. 1046 (Rap-aces HRS-H Form 3010 wh c.h may be us•O) (Sto4.4 N4mOar. 5744.003.3040-2) EFTA01710353 NARRATIVE RECORD Notations by educators, nurses and other designated personnel should be dated and signed. Narration section should include information concerning referrals, follow-up and special consideration to be given students in classroom as a result of screening, as well as teachers' observations, parent conferences, home visitations and services rendered. Educators need only record information concerning teacher observation and educational decisions made for stucents in the classroom as a result of screening and other health information. DATE aitLacai Ail/14_, ‘---Le attic_ c HRS-H Form 3041, MAY 80 (3) EFTA01710354 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES Special Health CUMULATIVE SCHOOL HEALTH RECORD Problems - See (This form is not intended for physician's use) Narrative Name _ Race L) Sex F School Address, Father's Name Mother's Name Date of Birth Place of Birth CO (Sri- ?Dial BPGehr Fl Birth Recorded: Yes El— No O Immunization Certification: Yes Ear No O Special Immunization Prcgrams A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES K 1 2 3 Screening and Screening Screening sio=utcome Outcome Outcome Outcome Assessment 13. aC 16 a) C 7.! Grades •E a) .. *E m i ii, CD A ZS 8 8 Date Date K-3 0 ft CD O CD ? 8 G so cc 33 cc 8 Vision Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Physical Assessment Other Other 4 5 6 7 8 Screening and ci, ci) ai ci, Screening 4. Outcome Outcome Outcome Outcome Assessment c o Ts c To C TO Grades 'E CD t - C 0 •-• t •E a) t '2 m 't 13' in 0 0 to 0 e to 0 0 to 0 ZI:, g o eo 0 e. 0 15 • Date 4-8 II Es 0 1S I' 0 115 5 cc o CC o cc m , CC CC 0 Vision cn I co I cn i Hearing Height, Weight & Graphing .., Nutrition Dental Health Mental Health Communicable Disease Records Review Physical Assessment Scoliosis Other _ . Other _._ , EFTA01710355 • atuan Lae e, % , each,jr 3"`t- r hipzienrlifie ,avaderenview AgjAri.XaytelaZ atria Aiapi %%BanosBlurtofAgrAWAV aledetatafeilelata4 Atredhteied Awid ' , re/meads EFTA01710356 V., 09 FLORIDA CERTIFICATE OF IMMUNIZATION (HRS 680 - PART A) flutida Statutes 232.032) OF MALIII PAO FOR CHILDREN WHO HAVE COMPLETED ALL REQUIRED IMMUNIZATIONS FOR SCHOOL ATTENDANCE 0.1 RATE OF R'RTH CHILD'S NAME MO DA YR PARENT OR GUARDIAN DETOP: PART A OF THIS FORM IS USED ONLY IF THE CHILD HAS MERE() ALL REQUIRED INMUNIZATIOAS LISTED BELOW. IF NOT. SEE REVERSE SIDE. CTP - 5 DOSES REQUIRED • IF THE FOURTH PR MARY DOSE OF CTP IS ADMINISTERED ON OR AFTER THE FOURTH BIRTHDAY, A FIFTH DOSE IS NOT REQUIRED. CT (PEDIATRIC) VACCINE IS ACCEPTABLE IF PERTUSSIS VACCINE IS MEDICALLY CENTRAINDICATEO (COMPLETE PART C FOR PERTUSSIS CONTRAINDICATION.) ii (ADULT) VACCINE (A SERIES OF 3 DOSES) IS ACCEPTABLE AND RECOMMENDED FOR CHILDREN 7 YEARS OF AGE OR OLDER. POLIO (TCPV) - 4 DOSES REQUIRED MO DA YR MO DA YR MO OA YR MO DA YR IF THE THIRD ETIIMARY DOSE OF TO'V S ADMINISTERED ON OR AFTER THE FOURTH BIRTHDAY, A FOURTH DOSE IS NOT REQUIRED. FOLD VACCINE IS OMITTED FROM THE REQUIRED MMUNIZATIONS OF CHILDREN 18 YEARS OF AGE OR OLDER MEASLES. MUMPS. AND RUBELLA - I DOSE REQUIRED MMP COMBINED - 1 DOSE AT 12 MONTHS OF AGE OR OLDER AND IN 1968 OR LATER (FECOMMENDED AT 15 MONTHS) -OR- MEASLES SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER AND IN 1968 OR LATER (RECOMMENDED AT 15 MONTHS MUMPS SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLO?(/1, RUBELLA SINGLE - 1 DOSE AT 12 MONTHS OF AGE OR OLDER THE CHILDREN'. ALL AI-VHOPHIVE Dirt TNGL DING BIRTHIDATE MUST BE ENTERED. AND THE CERTIFICATE SIGNED BELOW BY A PHYSICIAN OR AUTHORIZED PERSON ANA FOR THE CHILD TO ATTEND SCHOOL ist D I HAVE REV AVAILABLE AND TO THE BEST OF MY KNOWLEDGE THE ABOVE NAMED CHILD HAS BEEN ADEQUATELY IMMUNIZED AGAINST DIPHTH R _ APOLIO. MEASLES, MUMPS. AND RUBELLA AS REQUIRED BY FLORIDA LAW FOR SCHOOL ATTENDANCE. SUITE 201 ROYAL PALM BEACH, FL 33411 PHONE Q,0 9 a PHYSICIAN OR CLINIC NAME 'PLEASE PRINT) R AUTHIRIZED NATURE DATE EFTA01710357 STATE OF FLORIDA DEPARTMENT OF HEALTH If REHABILITATIVE SERVICES STUDENT HEALTH EXAMINATIONS 7- ao Lj sex rh N A JSe zadi Scalp /4 Eyes 5. Visua Acuity I 4-I! t s 1--- G Ears 7.luditorett Latty & 8. Ncse / Throat 9. Mouth. Teeth and Gums 10. Chest / Lungs II. Heart 12 Abdomen 13. Genitals and Alus 14. Muoculo SkcIval 15. Neurological 16. Alertness 17 Emotional / Mental/ Behavior Prob.) 18. Handicap, physical/ cthec (Specify) 19. Activity Rostricaans ISOM( r) 20. Abuse. substance physical / emcoonal 21. Nutrition 22. Other B. HEALTH HISTORY Serious Illnesses Injules explain) (attach rarrative if adclutianal space needed) C. LABORATORY Hemoak>bin/Flematccse Stool (O PI 1 I-17: I:2 DitIthrei -. .. Tuberculin Sickle Cell ctri.,L.O5.; NAMI: TITLE ADD (PiirsiiA'0t(m) PALM BEACH BLVD. 30 . 9 L SUITE 201 Date ROYAL PALM sena'. FL 33411 F. Obsolete. previous 'dittos.) (Stock Nunber: 5744-000-3040-2) EFTA01710358 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES Special Health CUMULATIVE SCHOOL HEALTH RECORD Problems • See (This form is not intended for physician's use) Narrative__ Name Race Lc) Sex F School Address Father's Name fi r. Mother's Name Date of Birth Al/. / El ■ Place of Birth (4 es4 -Palo .3eGeh F1 Birth Recorded. Yes El— No 0 Immunization Certification: Yes Er No 0 Special Immunization Programs A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES K 1 2 3 Screening and Screening Screening Screening Outcome Outcome Outcome Outcome Assessment cn Referral Referral Referral c O IL3 Grades m ,,, IS K-3 00 Date Date Date Z.5 0 tr (I) Vision Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health I Communicable Disease Records Review Physical Assessment Other Other 4 5 6 7 8 Screening and a crooning creening Screening CD 'Outcome Outcome Outcome Outcome Assessment Referral Referral 1. 4. E c To c To Grades O c2 '- "E 0 r, O co €3) 4-8 Date Date O , Et, 0 0 cr Date s a ILI:, t.) Vision I I u) Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Physical Assessment Scoliosis Other Other L EFTA01710359 1 cTI inENT HEALTH EXAMINATIONS 7/‘/T3 Date Students Full Name Phone Age Race Sex Address Girth ate Nans of P e 1 or ds A. HEALTH EXAMINATION Hear Pressure (/) Normal-N. Abnormal-A comment I: Aoriormai rindings, Dy numoer 1 Appearance 2 SiuniNose 3 Head/Scalp 4 Eyes 5. Visual Acuity IF & LI 6. Ears 7 Auditory Acuity (R & 8 Nose / Throat 9 Mount Teeth and Gums 10. Chest r Lunos 11. Heart 12 Abdomen 13. Genitals and Anus 14. Mu5W10•Skelelal 15. Neurological 16. Alertness 17. Emotional Mental/ Behavior Prob1 18 NandCall,DblyS/cal/ other ISPeCI1Y) 19. Actsfity Restrictions iSpeciry) 20. Abuse. substance/ Physical / emotional 21. Nutrition 22. Other B. HEALTH HISTORY sv,..us (Messes Injuries: explain) (attach narrative d additional space needed) C. LABORATORY (as indicated) t- rnoglcbin/Hemafocrit Stool (O & d Tuberculin test: LP 1C1 Sickle Cell NAME: TITLE: ADDRESS: (Please Print) Authorized Signature 7A /7 5 Date OH 3040. 10/16 (Rapacas HRS-ef Form 3040 when may 0* oseie) (Stock Nwnbsr 57444430 JU0 2) EFTA01710360 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES Special Health CUMULATIVE SCHOOL HEALTH RECORD Problems - See Narrative (This form is not intended for physician's use) Name. Race th Sex F School eatewnese 77(.1 45 1 Adore Father's Name Mother's Narre MalL Date of Birth Place of Birth CO e54 Fl Birth Recorded: Yes 9 No ❑ Immunization Certification: Yes a' No D Special Immunization Programs A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES K I 2 3 Screening and Screening Screening Screening Screening Outcome Outcome Outcome Outcome Assessment To -5 7! 1.a. Grades 0 IS O To Date Date Date Date K-3 t:i co 71) 0 .......— CC cc cc cc Vision Hearing Height, Weight & Graphing Nutrition Dental Health at r - Mental Health Ccmmunicable Disease Records Review Physical Assessment Other Other 4 5 6 7 8 Screening and cr) a, 3creening 3creening Outcome — a) Outcome Outcome Assessment a) c — — c — c E e .E 0 'E E Grades O tor co 45 B co to. w e 8 O Date 4-8 eO 0 TD Date CD 0) O -0- '5 en cc en cc:: cr EFTA01710361 THE SCHOOL DISTRICT OF PALM BEACH COUNTY $Y: 04 4• -"-° -1°°AIN F 0 a 9-12 Academic 1,k--74 O, Improvement Plan (AIP) DC6: ABS: 3 TH:RET: FISRT: : MA Marking Period Monitoring Dates: FCAT: READ: MATH: wAP: 4.0 . —FZ W—ZZ FIR I S —FL First /D' Second / / PRIM: LEP: 504: Third / / Fourth / / Et READING D WRITING 0 MATHEMATIC 014extbook Assessments O Palm Beach Wrtes ❑ Textbook Assessments Textbook Assessments YED. O Portfolio 0 Pored 0 El Portioiio [( CAT Diagnostic I Practice 0 Performance Assessments 0 Performance Assessment Performance Assessments Tests ❑ FCAT DagnostdPract ce Tess ❑ FCAT Diagnostic/Practice Tests FCAT Dagrostc/Prachce Tests orb S iagncstic Soltwae O Diagnostic Software 0 Diagnostic Schware O Diagnostic Software D Otter (see attached) ❑ Other (see *Midler!) 0 Other (see attached) ad) 0 Other (see attached) ❑ Phonemic Awareness Types of Writing Number Sense, Concepts andNU The Nature of Matter M i il etter Recognition O Word/Sentence wiring Operations O Energy O Paragraph Writng ❑ Measurement O Force and Motion WV -Phonies: Sound /Symbol Ccrrespondence ❑ Georretry ❑ Processes that Shape the Earth O Composition Writing ❑ Al)ebraic Thrikirg ❑ Earth and Space Decoding/Encoding Awareness /Application of O Data Analysis and ProbabiTityNa LWMeaning 0 Structure Processes of Lie FCAT Writing Rubric O Readhg n Content Area Visual (Phonics) How Living Things Intend with Flue c), El FOCUS ❑ Support Specific Concepts Mel Environment Prevent Words El Organization 0 Conventions ❑ The Nature of Science concepts N zo 0 Rafe Compositions Reading it Content Area ing ❑ Narrative Specific Concepts v cabulary ❑ Expository N art Comprehension ❑ Persuasive O a N gI wing Tutoring Tutoring Tutoring ng Schad Day ❑ During School Day D During School Day 0 Outing Sd000l Day After/Before School /Saturday ID After/Before Schod I Saturday O After/Before School; Saturday AfterlB9tora ehcol / Saturday instructional Artematives Instructional Alternatives Instructional Alternatives Instruction itemativee O Temporary Skill Groups O Temporary Skit Groups 0 Temporary Skil Groups ❑ Temperay Skip Groups ----N D. O Cooperative Learning Groups O Cooperative Learning Groups Cooperative Learning Groups o cooperative Learning Groups O Guided Reading/Writing Groups ❑ Technology Uri dsd Readng/Nriling Groups D Gutted ReacfinghWiting Groups Technology O Technology O Technology ID Other (see earned/ Fe d O Other (see attached) 0, Other (see attached) O Other (see attached) Assignment Alternative Assignment Alternative Assignment Alternative Assignment Alternative O Time O Time O Time Time O Quantity ❑ Quantity ❑ Quantity U Quantity O Product Requirements O Product Requirements El Product Requirements ❑ Produd Requirements p Child Study Referals O child Study Referrals El Child Study Referrals O Child Study Referrals rW Instmotional Reading 0 Instructional Language Arts ❑ Irstrudicnal Mathematics ❑ Instrudinnal Reaeing Student progress will be monitored throughout the school year, and student progress will be reflected on the report card. ❑ Suxessfttly Remediated ❑ Sumessfully Remediated ❑ Successfilly Rertoedated ❑ Successtufy Remediated 0 Requires New AID Next School 0 Requires New AIP Next School ❑ Requires New AIP Next Soled 0 Requires New AIP Next School Year Year Year Year ED Special Services! Placemert ❑ Special Services / Placement 0 Special Services / Placement 0 Special Services I Placement 0 Other (see enacted) 0 Other (see attached) 0 Other (see attached) ❑ Other (see attached) [1] Deficiencies due to non-attendance (refer to Attendance Specialist) Number of Days Absent GNATCR£ OF PARENT/ GUARDIAN DATE ParentlGuardlan Contact Commitment/Contribution Check as that appiy D Monitor Attendance / 'rarefies O Check Homework Pµ EI Read with Child Every Night O Reinforce Skills O Attend Parent Conferences O Sign Daily/Weekly Notes O Attend Parent Curriculum/ Information Meetings SIGNATLPE OF PEIS0 1697 (REV. 9/11/20021 ORIGINAL - Cumulative Folder COPY Teacher COPY • Parent/Guardian EFTA01710362 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW/RETURNING STUDENTS REGISTRATION BACK DI STUDENT (CHECKOK) S Wilt DOT) PATIENTS ❑ MOTHER ❑ FA HER . SHAREDCUSODT P OTHER I (32) TRANSPORTEDIV( Stpoiem .44 44 i ..... 4/I44 'SR.', by Wm. .1 •04. thew ...twill IS THEREA COURTORDERBARRINGEITHERPARENTFROMREITOViNSOI (III CONTACTINGTHESTUDENTDURINGTHE SCHCOLDAM n YES n NO IF YES, PLEASE PROVIDE THE SCHOOL WITH A COPY OF THE COURT ORI1PR I 4 FAT R/ AR IAN DOES FATHERHAVE CUSTODY> OYES 0 NO T ' r DIAN MOTHER DOES 0 HAVE CUSTOOW YES 0 NC YES YES .mm. bay,. kat IIIII I t A" illillill.MM ROYAL PALM BEACH FL 33411 ROYAL PALM BEACH FL 33411 .TA• 4 E4:Ep OKTATTIlai 016.0A .04 RACE Of DIATOIAT011 RAM 0/ DMIODANT NOTTS •TOAI INMAN ATOM nom TRAI RASTAS ...ow OM RICHESTLEVELOF EDUCATIONCOMMTED *PT ONAL) (37) H CHESTLEVELOr EDUCATIONCOMPETED(OPTIONA.1 A • "'"""` CITA011 KAI ' a B 0 WWII t. TA w-2O, C 0 .0........ TWOUATO 0 ❑COADD ''" I•O 0 ❑ISTAOlt AID 30/00.. C 0 "4" SCCC4 .......,../DamouTr D 0 TITOSICADCOLDTAI E 0 ",„„uw, `"""):;, 17.„„ D M ITTOIMICALKOLLIGO ' "" """" E0 c ".`,,,,,"'„ „ A.,„," (39) LEGALGUARDIANOF Ala) COESLEGALGUARDIANNAVECUSTODY? riEc 0 NC IAO TAM SA Inc As MAMtaltiltC- -Tr VOMCASEICS lilt WTATE R. C6R em.L•ATRA Rya CA /MAO/ WC Ai Mutratt ream EMERGENCY HEALTH AND SAFETY INFORMATION PARTI PERSONIS)OTHER THANPARENT AUTHORIZEDTO PICK UP STLOENT • I35) PASSWORD (LIMIT 10 CHARACTER&HA AATTTARIDO Ace 0021ACTI WNW 1411NAME ADDRESS PHONE RELATIONSHIPU rn YES 0 NO (42) NAME ADDRESS PHONE RELATIONSHIP(U -4 YES 0 NO (43) NAME ADDRESS PHONE RELATIONSHIPrl U YES 0 NO (44) NAME ADDRESS PHONE RELATIONSHIPu I-1 YES 17 Dan (45) NAME ADDRESS PHONE RELATIONSHIP0 YES El NO (46) PARTII IF SCHOOLPERSONNELAREUNABLETO CONTACTYOUII CASEOF ILLNESSOR ACCIDENT,MAT WE HAVE YOURPERMISSIONTO CALLYOLR 0 YES UOC7O14OR EMERGENCYSERVICESSlit PON TRANSPORT7O THEHOSPII44( . NO (411)FAMAYDOCTOR 48) PHONENUM3ER 491 HOSPITALPREFERENCE (50) LIST YOURCHAPS ILLNESSES.ALLERGIESOR OTHERPHTSICALLIMITATIONS YOUR CHILDREN IN OTHER PALM BEACH COUNTY SCHOOLS! ISO NAMEOF CHLD SCHOCLATTENDING STUCENTNO (OPTIONAL) GRACE 8)1414DATE (511 NAMEOF CH40 ACTIOCI.ATTENDING STUCENTNO (OPTIONAL) GRACE SLATSDATE (53) NAMEOF CHAO SCHOCLATTENDING STUCENTNO (OPTIONAL) GRACE BIRTHDATE 154) NAMEOF GILD SCHOOLATTENDING STUCENTNO (OPTIONAL) GRACE BIRTHDATE (55) NAMEOF CHID SCHOOLATHEADING STUCENTNO. (OPTIONAL) GRACE SIRENDATE ISO) I VERIFYTHAT THE INFORMATIONGIVENIS TRUE AND ACCURATETO THE BEST CF MT KNOWLEDGE. SIGNATUREOF PARENTOR AGE( GjAROIAPT WTI FOR OFFICE USE ONLY: 19) SEMI WO ISA: Sliin(NT ARMOR (5§; stinitt I ANctiaci FA COPT 0:l 0 ENTRYTOM i TM 'MEV DATE 'hi) SAE tOif EN E01 08/19/98 106D (641 PARENT/GLARDIANLANGUAGE tiEP)GRACELtd; IFS) CALENDAR .e7) TEACH!A NO. 1091 EN US Oa 01 1681 REASSIGNMENTCODE RS) TRANSPORTATION (70) VERIFICATIONW BIRTH On RAS MI DOCUMENTATION (*CRUST CHECKAND DATE WHEN EaDED) OA/ AGM OE•FSE 0 YES El Ng CAEC IMMLNIZATIONS 0 OAT( VERIFICATIONOP OlKles RECORDS 1 z O SODIAk,SECURITY n OB4ES4k 0M/MAG 0 1 2 3 4 t) 6 I 3 4 5 6 7 8 9 T 4 B t Doan NO DPT OTIAL g..4 OAT{ PHPSOCAL IIXMAS (73) DATA ENTRYCOMPLETEDBY: GATE' P650 0636 (REV.3/58) EFTA01710363 THE SCHOOL DISTRICT OF STUDENT NUMBER: ily10OLO4sTh a\ PALM BEACH COUNTY X 5 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 STLOENTS: Please review both sdes for correctness of typed information. If the information printed is incorrect, please correct it by carefully 1STR : 1891 TCHR : ThER: 021STDT • and lightly crossing out the incorrect information and .-.. writing the correct information above it. Lar. 8/05/9 8 TIN. P. 17 ID STUDENT'S LEGAL •I ID ALSO KNOWN AS 21 LOCAL ADORE55 m MAI. ING AGGRESS r nuny ...my ir. e6 KJRM ir root 2ir, 15) 3TM/a S SOCIAL SECURITY NO. IM In ME PHDNE No SEX ICI RAC IIIPTI3NAJ I (1" 141 I F AVGAlcAs onotAv OR ALASKAN NAIVE I A PICIAINFIC,ISLANDER I W „VON-HISPANIC .4i$PANIC U MAA I B ivltoArtc-4mISPANK 0 H HISPANIC 0 MMIATiRAGIAt (9) OATS OF BIRTH 1'O1 MALE Of B RTH WEST PA1.,01 BEACH R. U A„ FLORID(,,,,,,, ma/ow OD RESIDENT STATUS II2) ENTRY DATE INTO USA 0. FOREIGN EXCHANGE STUDENT 2. OUT -CFI -STATE RESIDENT I I. OUT-01-COUITT RESIDENT 3. IN-COUNTY RESILIENT I ll FIJI FEDERAL IMPACT AID Mality A. THE STUDENT RESIDES ON MERAL PROPERTY. O YES ND _ B. THE STUDENT RESIDES IN LOW RENT HOUSING. NO S 0 I as TES I ywa C THE PARENT IS MAPIOTED ON MOM PROPERTY LOCATED IN PAINE REACH COUNTY THE PARENT IS EmPtOTEC ON LOW RENT ROSSINI. (CENTER IN PALM BEACH COMM TES 0 E. THE PARENT IS IN THE UNIFORMED SERVICES Of THE UNITED STATES. IF YES, IS THE PARENT ON ACEliE CUM 0 TES I NO AIR FORCE I ARMY I COAST cum 0 ITARINIS I NATMNII GUARS 0 NAVY II4 AS THIS CHILD BEEN ENROLLED IS ANT PRESCHOOL? Err 0 (PLEASE PEACE A CHECAMARK I ye BY EACH PROGRAM ATTENDED. ALSO. INDICATE WITH AN ASTERI5A I *I Tilt PROGRAM TOUR CHILD WAS IN THE MINGEST.I C. CHAPTER I I H HEA)START I 0 OTHER 0 0 PRE-K DISABILITIES I M. MIGRANT PRE-H 0 S. SUBSIDIZED CHILD CARE 0 E PRE-A EARLY INTERIENTION I N. NON-SUBSIDIZED CH LO CARE 1I S) IS THE STUDENT A SINGLE PARENT? ill M.T. (IS) CURRENT GRADE LEVEL NC Oa TRANSFER INFORMATION: IIII NAME Of SCHOOL TRANSTERRIMG IRON lie) CII) OR LOCATION OW CATE Of EAST ATTENDANCE 120) GRADE LEvEl al/ LAST PUBIC SCHOOL ATTENDED IN PAM BEACH COUNTY (I2) CATE ATTENDED FREE OR REDUCED PRICE LUNCH AND HEALTH INFORMATION: 123) HAZE YOU FILLED OUT AN APPLICATION FOR FREE OR REOUCEO LUNCH* (APPLICATION IS PROVIDED WITH THIS REGISTRATION FORK* TPL iii E , NO UM HEALTH sCREENiiics, I GIVE PERMISSION FOR MY CHILD TO BE GIVEN MALIN SCREENINGS. THESE TESTS NAY BE GIVEN INDIMULIALLT OR IN GROUPS. YES E - 0 NO (21 4 SODIUM FLUORIDE. I GIVE PERMISSION FOR MY CRIED TO PARTICIPATE IN THE S)DIUM FLUORIDE PROGRAM NO 0 YES I TO PREVENT DENTAL DECAY PERMISSION IS VALID THROUGH GRADE SIX. YES NEW STUDENTS TO PALM BEACH COUNTY: HOME LANGUAGE SURVEY 1261 WHAT ANGUAGF It SPOKEN IA THE HOME 071 WHAT LANCIIACE IS SPOKEN 128) DATE OF ENTRY ID THE PARENT or GUNMAN IN THE HOME 3Y THE STUDENT' INTO THE ESOL PROMIAM 129) LANGUAGE SURiET 130/ DISC OSURES IM liftl ten) int; I. IS A IINGUAGI OTHER THAN ENGLISH USE) IN THE HOME? 0115 I NO this SCRUM. DISTRICT 2. 00(5 THE sTUCENT HALE A EMT LANGUAGE OTHER THAN ENGLISH? I YES I NO HAS THE STUDENT EVER 3. DUES THE slUEEN1 MOST FREQUENTLY SPEAK A LANGUAGE OTHER THAN ENGLISH? Olf 5 0 NO T. KEEN EXPELLED FROM SCHOOL? ,YES I No 2. HAD AN ARTIST RESULTING IN A CHARGE? OTES I NO 3. HAD ANT JUVENILE JUSTICE ACTIONS? ,TES Ill NO EFTA01710364 THE SCHOOL DISTRICT OF STUDENT NUMBER: 4HOOLD4s 7A PALM BEACH COUNTY ail Q 1 li l VERIFICATION FOR NEW/RETURNING STUDENTS: .! ../. TO THE PARENTS OR GUARDIANS: s..;<.,,,-„,..4-./.;;,,,,, NEW/RETURNING STUDENTS NEW STUDENTS: Complete all non-shaced areas on both Sides of form REGISTRATION RETURNiNG STUDENTS. Pease review both sides for correctness of typed information. If tho information printed s inco rect. please correct it l:N carefully D [STR: 1891 TCHR: TNBR:055STOT: and lightly crossing Out the nCOrrect information and 08/05/99 writing the correct information above it. .,...,, FRE, 1001040 EEC t 04 BLDG 00 AMe F4 il SIUCENT S its:, NAM W ALSO KNOWN AS ... .3) LOCAL ADDRESS 14/ MAILING ADDRESS .C, -sa .0 MIMI Wilt APT IN PLAT! In COGS IS/ STUDENT'S SOCIAL SECURITY NO 161 HOME PHONE RO. IT/ SEX 18/ R CE (OPTIONAL) 0 „,,„ F 0 01 ASCR.CAN INDIAN ALASKAN NAT« 0 A ASIAN OR • w voon ...,..wc 0 B MALI 0 .NDANC-tiSPANiC 0 H HISPANC 0 M muLTRAGIAL (9) DATE Of BIRTH 110 PLACE OF BIRTH „ O ., u n WEST PALM BEACH FL U%.„ FLORID(,„„„, II) RESIDENT STATUS 1121 ENTRY CATE INTO EGA 3 0. IOREIGN EXCHANGE STUDENT 2. OUT -01-STATE RESIDENT 1 I I nin-OF-pueirr RESIDENT 3 IM-rnuerf mrsnrra I 13/ FEDERAL IMPACT AID SURVEY MS V NU A. THE SWUM U RESIDES UN IWIRAL PROPERTY. IIILLLIII ES B. THE STUDENT RESIDES IN LOW RENT HOUSING. C. THE PARENT IS EMPLOYED ON FEDERAL PROPERTY LOCATED IN PAIN BEACH COUNTY. S 1ES D. THE PARENT IS EMPLOYED ON LOW RENT MOUSING LOCATE) IN PALM BEACH COUNTY. ' ICS NO E. THE PARENT IS IN TNT UMTOPME0 SEA/ICES OF THE .0111(0 STATES. IF TES IS THE PARENT ON ACTIVE DUTY? 0 TES 0 NO I AIR FORCE 0 ARMY 0 COAST GUARD 0 MARINES 0 NATIONAL GUARD I NAVY 1141 HAS IRIS CHILD BIEN ENROLLED IN ANT PRESCHOOL? t v ... (PLEASE PLACE A thitEGMARK IfrIBY EACH PROGRAM ATIENOCLI AISO, INDKATE V WITH AN ASTIRISI I Lk 1 THE PROGRAM LOUR CHID SAS IN THE IONCEST / I C. CHAPTER I i H. NEADSTART 0 0. OTHER p U. Plit-1( DISABILITIES p M MIGRANT PM -il 0 S. SUBSIDIZED WILD LAM F ARE•K FARM INTER:411MM I N NON-SURSIOI7F0 CIIIITI CARE (ESN IS THE STUDENT A SINGLE PARENT? NO 0 TES NO (161 UNREST GRADE EMT 07 TRANSFER INFORMATION: 1171 NAME OF SCHOOL TRANSFERRING FROM LIED CITY OR LOCATION 119/ DATE OF EAST ATTENDANCE 1201 GRADE LEVEL NI/ LAST PURL MIMI. ATIMIDEU IN PALM BEACH COUNTY 1221 DATE At ENLEU FREE OR REDUCED PRICE LUNCH AND HEALTH INFORMATION: 123) HAZE YOU FILLED CUT AN APPLICATION FOR FREE OR REDUCED LUNCH? 0 TES Er .:Eu .---- APPLICATION IS PROVIDED WITH THIS REGISTRATION FORM) LIE) HEALTH SCREENINGS: I GIVE PERMISSION FOR MY CRIED TO BE GIVEN IRALTH SCIREFNIES. THESE TESTS MAY BE GIVEN INDIVIDUALLY OR IN :ROMPS 0 NS p NO YES 12E4 SODIUM FIUORIDF: I GIVE PERMISSION FOR MI [SILO TO PARTICIPATE IN TIE SODIUM FEMME PROGRAM Ill YES NO YES 0 TO PREVENT DENTAL DECAY. PERMISS ON IS VALID TIROLGH GRADE SIX. NEW STUDENTS TO PALM BEACH COUNTY: HOME LANGUAGE SURVEY (26) WHAT LANGUAGE IS SPOKEN II IMO HOME WI WHAT ,ANWACE is STOLEN 1211 DATE OF ENTRY BY THE DAEMON or GUARDIAN: IN THE HOME BY THE STUMNI? NTO THE (SOL MOEN" r,..,,,\,4t/1 s P hIA5 ' \ 1 e.-...,\Isk 1231 UNGVAGL SURTET 1301 ousao>om, IM in. ...! 40.0 L. Ii A LANGUAGE OTHER THAN !MAISIE USED IN TEE ROME? Ei NO On SCHOOL DISTRICT 2. GOES IRE STUDENT HAVE A 'IRS! LANGUAGE OTIIR THAN ENGLISH? AS THE STUDENT EVER: 3. DOES THE STUDENT MOST TRECIUENTlf SPEAK A LANGUAGE OTHER THAN ENGLISH? I MEN EXPELLED /NOM SCAM? VOW 2 hAD AN ARREST MSATERG IN A ACTIGNIT 3 PAO ANT ,NPRIIII1 ADM( O EFTA01710365 HE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEM/RETURNING STUDENTS REGISTRATION BACK STUDENT S WI 'N (CHECK ONE) OTN PARENTS 0 MOTHER n FATHER ll SEARED CUSTODY U OTHER UV NSIOR'ED BY Shady., .. mud Harm. MM. by Guam e non *rot) (33) IS THERE A COUR' ORDER BARRING EITHER PARENT FROM REARITHAL OR CONTACTiN3 THE STIJOENT DURING THE SCHOOL CA.?) M YES :HO IF YES. PLEASE PROVIDE THE SCHOOL WITH A COPY OF THE COURT nixnnt I F T / i DOES f ATIER NAVE CUSTODY, OYES 0 NO IDS) MG ' N DOES MOTHER NAVE CUSTODY, D YES 0 NO YES YES max. lAS4 vat, wet sADOL1 LAST MM.. ROYAL PALM BEACH FL 33411 ROYAL PALM BEACH FL 33411 t SA 1651 240 4004 OLOSATai &WARD. ALAS Oi sm4404•4444 nam ore 4.mnvmma m0m4 nal .n.ns now m0441 ROW PA4414 Mat -UM rii4HrsrisvEr OTTCLICITR511 COMPLETED (OPTIONAL) IlT) HIGHEST Weft OF EDJCATIDN COMPLETED (0, TiONAL) AD n" en4•" -s ic"'“ B 0 '''''':I n scca c n , soma — KADOSCI AO "P4Tay,."°°' B D a— .0Am— ORAIN4 c • .4. "" M4APA4IP D MI • ....., POST -144044•Jv AtteammAtoste.c )g) LEGAL GUARDIAN (IC APO) E 0 ..0.41444.1COullit caA4mAn .. Arm. DOES LEGAL GUARDIAN HAVE CuSTOEY) n 0 RA❑ aLlcaktal E0 SW 4011.50:00, 44 OYES El 11154•CALCOu404 IIAACUAR 04 wow R est eAs NO w,(ai LAST PC.it ACcilsi CITY ITA/1 2d COpI A .,. ,A ...,,,..... a Atm,. Arndt EMERGENCY HEALTH AND SAFETY INFORMATION PAnT I FERSOND) CINER THAN PARENT AUTHORISED TO KS UP STUDENT 1341 PASSWORD (Lim I ID CHARACTERS( my 4,44mm$200 004 14400PC• 4.44-44 '41 ADDRESS PHONE RELATIONSHIP rii s S;i4e, 4 L ko I42) ADDRESS RELATIONS-OP r .....e IC TES le ".'. 1, 4 i' 0 NO 43 MANE ADDRESS PMCNE RE,ATONS4IP • YES gmai pc s NO 1441 NAME ADDRESS PHONE RELATIONSHIP 0 YES G$ 421 04 In NO A NAM ADDRESS /NONE RELATIONSHIP 0 YES 0 ta NID: PART II IF 50.001 PERSONNEL APE INIAERE TO ONTACT YOU IN CASE OF ((NESS OR ACCIDENT, MAY WE .445E VDUR PERMISSION TO CALL YOUR DOCTOR OR EMERGENCY SERVICES (SI ll FOR TRANSPORT TO THE HOSPITAL' 0 yes 0 No (471 faun DOCTOR 14G) THOSE Num(hR 141) HOSPITAL PREFERENCE (so: LIST YOUR CHAD'S ILLNESSES. ALLERG£S OR OTHER PHYSICA. LIMITATIONS YOUR CHILDREN IN OTHER PALM BEACH COUNTY SCHOOLS: OH NAME OF CtiRLD SCHOOL ATTENDING STUDENT •10. (01-10NALI GRADE MTH DATE (52) NAME OF CHID SCHOOL ATTENDING STUDENT NO. lOrIONALI GRADE BIRTH DATE (53) MAME OF CHILD SCHOOL ATTENDING STUDENT •10. (OPTIONAL) GRADE BIRTH DATE ISA) NAME Of CHILD SCHOOL ATTENDING STUDENT NO. IOPIONALI GRADE BIRTH DA•E (55) NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) GRADE BIRTH DAVI ISM I VERIFY THAT THE INFORMATION GIVEN IS TRUE MID ACCURATE T3 THE REST Of MY KNOWLEDGE. SIGNATURE UI PARENT OR LEGAL GUARDIAN DATE FOR OFFICE USE ONLY: On 5 MLR NU. 1541 SI VAN' NLAU31N (SD) STUDENT LANGUAGE SD) CUR iblI MITI LUCIE (biT LATE, URft MO) SM. LODE EN E01 08/16/99 1060 (441 PAREMMUAROIAN LANGUAGE IDS) GLADE EMI. (65) CAlt743AR 16T1 TEACHER NO. 1691 EN US 07 01 EOM REASSIGNMENT CODE ISO. TRANSPORTATION NI VliutiCATTON OF DIRER (III WS 17.1/ COCIALEMEAT ON EHE:IAIST CHM AND DATE WIEN RECOY£T 00ATE 0 iPALAJMEATiONS 11IlisiCATION of DA•ADM DE•Ea Ei vis 0 Ng, i z DATE 'NTH RECORDS OD-ISOL OM -NAG C I 2 ;‘. 4 5 0 I D 4 6 0 7 IS S T Sor ou. TISPC,UR A D t °GATT h0 LOPOVAD TY 0 OATt. fARY51CAL EXAMS OW DATA ENTRY (OWIETIO BY: DAM PESO 06M1 (At,. EFTA01710366 .STUDE. SEX RACIAL/ETHNIC GROUP O Hispanic STUDENT NUMBER arNhite. Not Hispanic O American Indian/Native Alaskan Legal F O Black, Not Hispanic O Asian/Pacific Islander • n " ' ' ace, until final.) , BIRTHDATE: Verified by Birth Certificate: Y Yes If Not, Whet Type Verification? caw In, eack Fi I NAME OF PARENT(S) OR LEGAL GUARDIAN OR OTHER RESPONSIBLE ADULT AT HOME BIRTHPLACE: P G OA Wes-i- - Pain, -Paeaell ci C--•••-" CURRE T SCH OL: enCil in this space, until final.) Name Street City .1kr..,, a I --P. h-r, 'lead, i F I Da e First Entered This District Withdrawal Date Withdrawal Date Withdrawal Date 9 - P-5.- 9g. Grade: Grade Grade: - •• Grade- -h., Grad@: i School Year: 19- c) a •19 9t School Year 19 4'3 -19 95/ School Tear 19 al •19 School Vac 19 aSchoolYear ;19 4.P___. s..9_7_ Days Present: Days Absent Days Present: Days AD flu Days Present Days Absent: Days e Data.nnt Days Present Days Absent: /7/ 1% le ubject Teacher 7r— —i Teacher Mark f i-r,ct Subject Subject Subject Subject Teacher i. u. LOS in. ", Eu. rtim ,t 4 t. ‘ I ,4.: I. 14 A i , e- ; g I 17nraIMMIS N li2trorraM READING .:, A E rMa Illl liriratt IlrirdEX II NGUAGE Mlitial ill IFTOTET IMI ria"741.91 1FM I SPELLING .A. • A4; it :EL'1•]47;DIG3. I IIMAMaAliAllila. n HANDWRITING •E Tirign I Itzi•Di it:WM[4c= IdelridelEdLUBIOr= SOCIAL STUDIES SCIENCE and CIENCE and SCIENCE and SCIENCE and HEALTH EALTH H A TN RM.. HEALTH BEHAVIOR CODE EHAVIOR CODE BEHAVIOR CODE BEHAVIOR CODE BEHAVIOR CODE AVERAGE VERAGE AVERAGE AVERAGE AVERAGE Indicate: Indicate: Indicate: Indicate: Indicate: Promote (P) Promote (P) Promote (El Promote (P) Promote (P) FLORIQPi PERMANENT RECORD CARD Retain (R) Retain (R) Retain VD Retain (RI Retain (R) Summer School (SS) Summer School (Ss) SS Summer School (SS) I Summer School (SS Summer School (SS S I rat School: Grade: School: Grade: School: Grade: Sctmot Grade I C School Year: 19- -19 ril School Year: 19 -19 School Year: 19x•18__ School Year: 19_-19_ School Year 19 -19 Days Presentr Days Absent Days Present Days Absent: Days Present: Days Absent: Days Present Days Absent: Dam Present: Days Absent: CATEGORY A - Education Records Subject arbor Subject Teacher Mark Subject Teacher Mark Subject Teacher Mark Subject Teacher Mark MATHEMATICS MATHEMATICS MATHEMATICS MATHEMATICS READING READING READING READING READING LANGUAGE ANGUAGF LANGUAGE i ANGUACE LANGUAGE SPELLING SPEI LING SPELLING SPELLING SPELLING HANDWRITING HANDWRITING HANDWRITING HANDWRITING HANDWRITING SOCIAL STUDIES SOCIAL STUDIES SOCIAL STUDIES SOCIALSTUDIES SOCIAL STUDIES GRADES K-5 SCIENCE and SCIENCE end SCIENCE end SCIENCE and SCIENCE and HEALTH HEALTH HEALTH HEALTH HEALTH BEHAVIOR CODE BEHAVIOR CODE BEHAVIOR CODE BEHAVIOR CODE BEHAVIOR CODE AVERAGE AVERAGE AVERAGE AVERAGE AVERAGE Indicate: Indicate: Indicate: Indicate: Indicate: Promote 01 Promote (P) Promote (P) Promote (P) PromoteIP/ Retain (R) Retain IR) Retain IRE Retain (R) Retain(R) Summer SeenolISSI Summer School (SS) Summer School fESI Summer School ISSL Summer SchgoUSSI PB5D0932 01.9340 EFTA01710367 THE SCHOOL DISTRICT OeldiLNI BE71eI1320 ELEMENTARY REPORT CARD tt . Student School Teacher Principal MARKING CODES - ACADEMIC SUBJECTS SOCIAL DEVELOPMENT/CLASSROOM STUDY HABITS GRADES 1 and 2 Please work on the area(s) that have a check (✓) E - Excellent S - Satisfactory V - Very Satisfactory N - Needs Improvement tit 2nd 3rd , Overall effort GRADES 3-5 Works cooperatively A - Outstanding (94% - 100%) B - Above Average (85% - 93%) Works independently C - Average (75% - 84%) Completes classwork on time D - Below Average (65% - 74%) F - Failing (0% - 64%) Completes homework on time 1 - Incomplete . Follows classroom rules and routines Uses time wisely ACADEMIC SUBJECTS Follows directions Accepts responsibility for own actions •~. Comes to class prepared with materials r; Pi."' • 4 .. .irate ALTERNATE ASSESSMENTS Marking Period Indicate those used with a check (.1"). 1•t 2nd and oh Composition Skills Checklist(s) Language Portfolio Spellin. Audio Cassette Recording Video Recording Handwriting/Penmanship Computer Program Social Studies Standardized Test(s) Science/Health Observations/Written Comments • Grades not given this nine w Other ATTENDANCE Marking Period Regular attendance and punctuality are essential for quality education. Days Present FINE ARTS REPORT Marking Period Days Absent Days Tardy Art. Information Included Music Physical Education PLACEMENT • PARENT/GUARDIAN/TEACHER Marking Period Grade Special Session CONFERENCE . 1•t 2nd an, placement WA if Special ssion program is indicated, grade I Conference conducted (Indicate"dato be determined by the home scribal. PBSD 0700 (Rev. 7/94) Goldenrod/1st Period PInkft eceBerJO:• .::;,Denaryard Period Green/4th Period wotworna, copy , EFTA01710368 TlaHOOL DISTRICT OF PALM BEACH COUNTY rc l 1997-1998 END-OF-YEAR REPORT CARD INSERT for GRADES 1-5 Grade Dear Parent(s)/Guardian(s), In a continuing effort to keep you informed, this report card insert is being provided to notify you of your child's progress toward meeting the school district's desired levels of performance In reading, writing, and mathematics. Your child's end-of-year performance level in reading, writing, and mathematics is identified beloyi. READING YeING (COMPOSITION) MATHEMATICS id At or above grade level At or above grade level IlAt or above grade level O Below grade level* O Below grade level* O Below grade level* *If Below grade level has been indicated for reading, writing, and/or mathematics, you will 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 1998-1999 school year. Sincerely, e PBSD 1674 (NEW 5/15/98) White/Cumulative Folder Yellow/Report Card EFTA01710369 `STUDE • SEX RACIAL/ETHNIC GROUP 0 Hispanic STUDENT NUMBER • Le<thite, Not Hispanic 0 American Indian/Native Alaskan Legal El Black, Not Hispanic 0 Asian/Pacific Islander al.) BIRTHDATE: Verified by Birth Cenificate: i!E Yes If Not, Whet Type Verification? , NAME OF PARENT(S) OR LEGAL GUARDIAN OR OTHER RESPONSIBLE-ADULT AT HOME P G OA BIRTHPLACE: Wes-l- —Poin-, - P-eciej, RI , CURRENT SCH 01.: use encil in thi til final.) Name Street City Iker I 11/4 Irn -"Sec ch it I Date First Entered This District Withdrawal Date Withdrawal Date Withdrawal Date 8 -as- 9a Grade: School: Grade ride: Gredo3 ' Greg : K ( School Year: 19- 4:1 a . • 41S -19 Scheel Year: 19 93 -19 65/ School Year 19 -19.fiL. School Year: 19 -19 act, School Year -19 -.gO. 9 -S-2— Days Present: Days Absent: Days Present: Days Ab nt: Days Present Days Abair, Days present Days A• Days Present Days Absent 17/ Subject , Teacher 1% Subject „ 172 bject Teacher /7Subject Teacher M rk ,q Subject Teacher Mark ... _., • t I ATHEMATICS MATHEMATICS MATHEMATICS MATHEMATICS • I A. READ( G 1 • : . _. 1 I /1/4219 'te MI aUITOMIIII I IlltucoLuilIMINII = Mia/IMPailill I / UITITIT IMI IN Irrfifla I Cal Mr Ear' I .. L , Aj; ii I 1 !tuiesclaitua M B.m...m.inta l I Ell.ma•thatimcS E MEILINsIWIUIRIc I .., IAL T DIE I Icyltalcipm.4-MI U LY$Ie1M II Illk•folat it:201•1 :*, IM a'i . L 1St • LA-'-= I SCIENCE and IENC 1.E and SCIENCE and SCIENCE and .- • I . • Mira I H II I BEHAVIOR CODE I .EHAVIOR CODE BEHAVIOR CODE BEHAVIOR CODE BEHAVIOR CODE ‘ A :; VERA AVERA E AVERAGE AVERAGE Indicate: cam Indicate: Indicate: Indicate: Promote IP) emote (E) Promote (P) Promote (P) Promote IP) MI FLORIDA PERMANENT RECORD CARD Retain (R) ' mein IR) Retain IR) Retain (R) Retain IR) Summer School (SS) ummer School (SS) ‘'S 3 Summer School (S$) Summer School 1551 Summer School 1551 Gra hoot (Grade: School: a• School: G School: Grade: • I School Year 18- 19 School Year: 19_-19_ School sear 19_-19_ School Year: 19_-19— School Year: 19 •19 — CATEGORY A • Education Records Days Present:i Days Absent: Days Present: Days Absent: Days Present: Days Absent Days Present: Days Absent: Days Present: Days Absent: Subject • Subject Teacher Mark Subject Teacher Mark Subject • Teacher Mart Stabled Teacher Mark MATHEMATICS MATHEMATICS MATHEMATICS MATHEMATICS MATHEMATIOI READING READING • READING READING READING LANGUAGE LANGUAGE LANGUAGE LANGUAGE LANGUAGE SPFI I ING SPELLING SPELT ING SPELLING SPELL ING HANDWRITING HANDWRITING HANDWRITING HANDWRITING HANDWRITING SOCIAL STUDIES SOCIAL STUDIES SOCIAL STUDIES SOCIAL STUDIES SOCIAL STUDIES GRADES K-5 • SCIENCE and SCIENCE and SCIENCE and SCIENCE and SCIENCE and HEALTH HEALTH HEALTH HEALTH HEALTH BEHAVIOR CODE BEHAVIOR CODE BEHAVIOR CODE BEHAVIOR CODE BEHAVIOR CODE AVERAGE AVERAGE AVERAGE AVERAGE AVERAGE Indicate: Indicate: Indicate: Indicate: Indicate: Promote (P) Promote (P) Promote IP) Promote (P) Promote IP) Retain (R) Retain (RI Retain (R) Retain (R) Retain (RI • Summer School ($5) Summer School 1551 Summer School (SS) Summer School MS) Summer School (55) EFTA01710370 THE SCHOOL DISTRICT OF STUDENT NUMBER: 4 BOOL PALM BEACH COUNTY VERIFICATION FOR NEW/RETURNING STUDENTS: TO THE PARENTS OR GUARDIANS: NEW STUDENTS: Complete all non—shaded areas on both sides of form ~ ~NREGISTRATIONS RETURNING STUDENTS: Please review both sides for correctness of typed information. If the information printed is Moo rect. please correct it by carefully DISTR: 1691 TCHR AIM TNBR:O59STDT and lightly crossing out the incorrect information and 08/09/00 CRS:2002100 SEC:06 BLDG:00 RM:801 writing the correct information above it. rur (I) STUDENT'S LEGAL NAME (2) ALSO KNOWN AS mat litSI «r .• (3) LOCAL ADDRESS (4) MAILING ADDRESS cv 4C(.4160. ST4IIT NAM, one HMI 2, LCDZ L,,, HtA? 1,0 coat (5) STUDENT'S SOCIAL SECURITY NO. BB HOME PHONE NO. (7) SEX p 18) RACE W I FEMALE I I Otatt.:smi:Atig=lvE i A gr:Flinsuoven i w :e,,74,s,..i. I MALE II B ileL0f-KHISPANIC I H HISPANIC I M MULTIRACIAL IS/ DATE OF BIRTH OM PLACE OF BIRTH WEST PALM BEACH FL US FLORIDA mcqui DAY IVO anr . . tot.rinv (I I) RESIDENT STATUS . (12) ENTRY DATE INTO USA 3 • 0. FOREIGN EXCHANGE STUDENT 2. OUT-Of-STATE RESIDENT I I. OUT-OF-COUNTY RESIDENT 3. IN-COUNTY RESIDENT I I (13) FEDERAL IMPACT AID SURVEY. YES I NO A. THE STUDENT RESIDES ON FEDERAL PROPERTY. I YES I NO B. THE STUDENT RESIDES IN LOW RENT HOUSING. I YES I NO C. THE PARENT IS EMPLOYED ON FEDERAL PROPERTY LOCATED IN PALM BEACH COUNTY. I YES I NO D. THE PARENT IS EMPLOYED ON LOW RENT HOUSING LOCATED IN PALM BEACH COUNTY. YES I NO E. THE PARENT IS IN THE UNIFORMED SERVICES OF THE UNITED STATES. IF YES. IS THE PARENT ON ACTIVE DUTY? I YES I NO I AIR FORCE I ARMY I COAST GUARD I MARINES I NATIONAL GUARD I NAVE (MI HAS THIS CHILD BEEN ENROLLED IN ANT PRESCHOOL? PLEASE -PLACE A CXECKMARK (1.1BY EACH PROGRAM ATTEN3EO. ALSO, INDICATE WITH AN ASTERISK ( */ THE PROGRAM TOUR CHILD WAS IN THE LONGEST.) 0 C. CHAPTER I I H. HEADSTART I 0. OTHER I 0. PRE-K DISABILITIES I IA. MIGRANT PRF-K I S. SUBSIDIZED CHILD CARE I I. PRE-K EARLY INTERVENTION 0 N. NON-SUBSIDIZED CHILD CARE (16) IS THE STUDENT A SINGLE PARENT/ (OS) CURRENT GRADE LEVEL NO I YES I NO 08 TRANBFERLINFORMATASNI Ill) NAME OF SCHOOL TRANSFERRING FROM WO CITY OR LOCATION (ID) DATE OF LAST ATTENDANCE IRO) GRADE ;FILL UN LAST PUBLIC SCHOOL ATTENDED IN PALM BEACH COUNTY (22) DATE ATTENDED FREE OR REDlyggpfPRiggIMOGOVIDAFAISitairsgStigN: 123) HAVE YOU FILLED OUT AN APPLICATION FOR FREE OR REDUCED LUNCH? (APPLICATION IS PROVIDED WITH THIS REGISTRATION FORM/ I ITS 9 NO 12e) HEALTH SCREENINGS: I GIVE PERMISSION FOR MY CHILD TO BE GIVEN NON-INVASIVE HEALTH SCREENINGS. THESE TESTS MAY BE GIVEN INDIVIDUALLY OR IN CROUPS. FOR EXAMPLE: VISION, HEARING, SCOUOSIS, HEIGHT A WEIGHT YES I IFS S nn 125) SODIUM FLUORIDE: I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE IN THE SODIUM FLUORIDE PROGRAM TO PREVENT DENTAL DECAY. PERMISSION IS VALID THROUGH GRADE SIX. YES E 'as i NO NMS.XleMgtittSITO PALM. BEACA,POUNTY;;;;;;Ppinplgte the 1909W,ipaus.eclictris UM HOME LANGUAGE SURVEY (a's 26.20) I YES I NO II ye; what loacrege? I. IS A LANGUAGE OTHER THAN ENGLISH USED IN THE HOME? 2. DOES THE STUDENT HAVE A FIRST LANGUAGE OTHER THAN ENGLISH? I YES I NO II yes. YAM langasof? 3. DOES THE STUDENT MOST FREQUENTLY SPEAK A LANGUAGE OTHER THAN ENGLISH? I YES I NO II yes, wk.' luggage? 117) WHAT LANGUAGE IS SPLICER IN THE (281 WHAT LANGUAGE IS THE UM DATE OF ENTRY (30) DISCLOSURES FOR ENTRY lato this School Olorld HOME BY THE PARENT ee GUARDIAN? STUDENT'S FIRST (151) INTO AN LANGUAGE? ESOL PROGRAM HAS THE STUDENT EVER: I. Been expelled from scbool? I ES I NO 2. Had are arrest reselling In a charge? IIES ono 3. Had my Ovalle justice actions? ,YES ONO • PBSO 0030 Mee 4/00) EFTA01710371 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW/RETURNING STUDENTS REGISTRATION BACK fr , (31) STUDENT LIVES WITH (CHECK ONE) 0 BOTH PARENTS 0 MOTHER li FATHER 0 SHARED CUSTODY i OTHER ,. i .(32) TRANSPORTED BY: SloeIsm will two tionsportod to/Itow school lirldimo if oilier ihsa Parsed WIS 0 G El CONTACTING THE STUDENT DURING THE SCHOOL DAY] 0 YES 0 NO - •• IF YES, PLEASE PROVIDE THE SCHOOL WITH A COPY OF THE MART ORDER . 4 FATHER/ DOES FATHER HAVE CUSTODY? OYES ONO (3:51 MO DOES MOTHER HAVE OUSTCOTT AYES 0 NO YES YES Mint Off MOM WI FliiiiiIIIIIIIIIII alli ROYAL PALM BEACH FL 33411 ROYAL PALM BEACH FL 33411 • Ml[ nCC0( CCCOATOr occwavon • • RALF OF WP101.1440 Heal OF DiPiontrriT NOM /One MS= NIOVt HOW Mai MUMS. 1.40/4 (361 HIGHEST LEVEL OF EOUCATKAN COMPLETED (OPTIONAL) (37) HIGHEST LEVEL Of LDUCATION COMPLETED (OPT L1 CM SCSOOL Bn SOW /OW SO•1001. AO unitsar "°°1 B 0 CS " 6"to"";.,sr, C 0 latra•ATO AO il"UnsIA •Ral 11 °.31 '6-1 MANS 9-1.1 C El'=„4 ": D 0 esr.2,":7,:"" E 0 71""r4".?:,,vo D D f,0:4( 10ST•SICOODAAV E n Tiornsucousix 1-J IGRAZUMS w. MOM (381 LEGAL GUARDIAN (IF ANT) DOES LEGAL GUARDIAN HAVE CUSTODY? 0 YES ❑ NO ,as. 1.44 WOOL( IAD .064g ^Witt, WV fTAfs. it coot . FM S 0,0.4VF S PART I: PERSONS) OTHER THAN PARENT AUTHORIZED TO PICK UP STUDENT . (39) PASSWORD: ROM 10 CHARACTERS) W. 0#1,0:02/0 Ng C.MOKOICY MCP/ ADDRESS RCLATIONSITP • YES SOTHER itr El NO 1421 ADDRESS PHONE RELATIONSHIP • YES A h 0 NO (43) ADDRESS PHONE RELATIONSHIP n U YES 0 NO (44) NAME ADDRESS PHONE RELATIONSHIP n LJ YES (3 N° (45) NAVE ADDRESS PHONE FtELATIONSTOP n u YES 0 NO (46) PART IL IF SCHOOL PERSONNEL ARE UNABLE TO CONTACT YOU IN CASE OF ILLNESS OR ACCIDENT. MAY WE HAVE YOUR PERMISSION TO CALL YOUR DOCTOR OR EMERGENCY SERVICES (911) FOR TRANSPORT TO THE HOSPITAL? n YES 0 NO (47( FAMILY DOCTOR (48) PHONE HAWED 491 HOSPITAL PREFERENCE (50) LIST YOUR CHAD'S ILLINESSES, BEHAVORAT HEALTH ISSUES, ALLERGIES. (59 DOES YOUR CHILD CURRENTLY HAVE HEALTH INSDRANCE? OYES 0 NO II hiss, Oman isdkato--... MEDICATIONS TAKEN, OR OTHER PHYSICAL LIMITATIONS: 0 Mmlinid CI Flabby Kids/KM Cue 0 Pthesto 0 Lowdoss4 a witoiving Ommokis fit) OM : raWIFOA. 13 PH ' "'"".''' (62) NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) GRADE BIRTH DATE Si ' (531 NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL] GRADE BIRTH DATE • 4. (541 NAME Of CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) GRADE BIRTH DATE , ' '..:. 455) NAME OF CHILD SCHOOL ATTENDING STUDENTNO. (OPTIONAL) CR.40€ BMW DATE . . •• • (56) NAME OF CHILD SCHOOL ATTENDING STUD-TIT NO. (OPT.ONAL) GRADE BIRTH DATE *1 I . . (57) I VERIFY THAT THE INFORMATION GIVEN IS TRUE AND ACCURATE TO THE BEST DE MT KNOWLEDGE. 5?L. (,- 6) a NA U E 9F F EIPL GUARDIAN DATE FOR OFFICE USE ONLY: (:. ,cii.:LL ..0. ,,, STL'EliNT !.L'I.',3fil . .,61: II 7.1.1" I. UACL ' 71; CU.; .: i ;41.‘ BILE I EN E01 08/16/00 1060 t6b,„.PAH NT,/ kaint;i : r,,:,..,cu,Lci I (C ': CHt.1 IL/I LAiCIJ1H 1'HI TrAC,grt 210. . ., 1091). ..; EN . US j OF. 01 t. 1 r /;•-. PF.Y.SICNWP,- C •3( lt:SSVcW,U,Vt:•, 11 NN i : I II ()•2! , •-•'. ' UK ;!.,Ps1A - :,: .. vli. r to Li> r•C'.• DC,•(5C 11,1 dS "a N ) al.}SU: 0.•.1.•'S ! : I f„ E ? 3 : f, , • ' • - in. 0 1, 1:".1.: ciur CL!...?“7ED Bu P650 0636 (REV. 4/001 EFTA01710372 i..lai., .thil.ctativt . THE SCHOOL DISTRICT OF. STUDENT NUMBER: • , 1 4 PALM BEACH COUNTY • N VERIFICATION FOR NEW/RETURNING STUDENTS: TO THE PARENTS OR GUARDIANS: A e,,,ccdpNEW/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 Moo rect. please correct it by carefully IISTR:1761 TCHR: TNBR:504STDT: and lightly crossing out the incorrect Information and MAY PATA HaIRM: 504 writing the correct information above it (I) STUDENT'S LEGAL NAME 121 ALSO KNOWN AS LAST THSI MOM CT) LOCAL ADDRESS (4) MAILING ADDRESS ..rer ica. ... SiPiif PAM " m 1FlIIi1m API. t STATL sr iWI (6) STUDENT'S SOCIAL SECURITY NO. 16) HOME PHONE NO. (7) SEX F (8) RACE W (OPTIONAL) I UNaL5 f4MALE I MA ALASKAN OR ALASKAN101 NATTVE i A II C PACIFIC AACDR ISLANDER ISLANCIER I W WHITE NON-HISPANVC I MALE I B r/LOAc ti-KmiSPANIC I H HISPANIC I NI ImATIRACIAL (9) DATE Of BIRTH (ID) PLACE OF BIRTH WEST PALM BEACH FL US FLORIDA MONTI MY VIM CITY STATE CMYTAY (II) RESIDENT STATUS (IV ENTRY DATE INTO USA 3 D. FOREIGN EXCHANGE STUDENT 2. OUT-OF-STATE RESIDENT I I I. 01/7-0E-COUNTY RESIDENT 3. IN-COUNTY RESIDENT I (13) FEDERAL IMPACT AID SURVEY I YES i NO A. THE STUDENT RESIDES ON FEDERAL PROPERTY. YES NO B. THE STUDENT RESIDES IN LOW RENT ROUSING. 0 YES cla NO YES NO C. THE PARENT IS EMPLOYED ON FEDERAL PROPERTY LOCATED IN PALM BEACH COUNTY. D. THE PARENT IS EMPLOYED ON LOW RENT HOUSING LOCATED IN PALM BEACH COUNTY. 0 Yu NO E. THE PARENT IS IN THE UNIFORMED SERVICES OF THE UNITED STATES. IF YES, IS THE PARENT ON ACTIVE DUTY/ I TES I NO AIR FORCE I ARMY I COAST GUARD I MARINES I NATIONAL GUARD I NAVY (141 HAS THIS CHILD BEEN ENROLLED III ANY PRESCHOOL.? (PLEASE PLACE A ONEXMARK 10/BY EACH PROGRAM ATTENDED. ALSO. INDICATE p0 WITH AN ASTERISK ( * I THE PROGRAM YOUR CHILD WAS IN THE LONGEST.) C. CHAPTER I I N. NEADSTART I D. OTHER D. PRE-K DISABILITIES I M. MIGRANT PRE-K I S. SUBSIDIZED CHILD CARE E. PRE-X EARLY INTERVENTION I N. NON-SUBSIDIZED CHILD CARE (IS) IS THE STUDENT A SINGWAREMT? I YES . I ND Ile CURRENT GRACE LEVEL 05 mlow-steterfatimmitaa. (I7) NAME OF SCHOOL TRANSFERRING FROM (181 CITY OR LOCATION OM DATE OF LAST ATTENDANCE (20) GRADE LEVEL ao LAST PUBLIC SCHOOL ATTENDED IN PALM BEACH COUNTY (221 DATE ATTENDED Vifft,E,POIVIREDUCED PRICE LUNCH ANO-HEALTH •INFDSMATIONL ,, - (23) NAVE YOU FILLED OUT AN APPLICATION FOR FREE OR REDUCED LUNCH? I YES . NO (APPLICATION IS PROVIDED WITH THIS REGISTRATION FORM) P° ig (24) HEALTH SCREENINGS: I GIVE PERMISSION FOR MY CHILD 70 BE GIVEN HEALTH SCREENINGS. THESE TESTS MAY BE GIVEN INOIWDUALLT OR IN GROUPS. YES I YES I NO (25) SODIUM FLUORIDE: I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE. IN THE SODIUM FLUORIDE PROGRAM YES I YES I NO TO PREVENT DENTAL DECAY. PERMISSION IS VALID THROUGH GRADE SIX. ;4:NEW STUDENTS.0 PALM BEACH COUNTY: HOME LANGUAGE SURVEY (26) WHAT LANGUAGE IS SPOKEN IN THE HOME (27) Y/HAT LANGUAGE IS SPOKEN (28) DATE OF ENTRY BT THE PARENT xi GUARDIAN: IN'THE HOME BY THE STUDENT? INTO THE ESOL PROGRAM 129) LANGUAGE SURVEY I. IS A LANGUAGE OTHER THAN ENGLISH USED IN THE HOME? I YES I NO 2. 0014 THE STUDENT RAVE A FIRST LANGUAGE OTHER THAN ENGLISH? I YES I NO 3. DOES THESTMENT MOST FREINANTLY SPEAK A LANGUAGE OTHER THAN ENGLISH? I YES I NO PLOD 0636 (Am 6/97) EFTA01710373 higW/NelUNNINU STUDENTS MEGISTRATION BACK (30) STUDENT LIVES WITH (CHECK ONE) ll BOTH PARENTS II MOTHER D FATHER 0 SHARED CUSTODY P .OTHER 131) S . StoLM will be icansport• to rem It ool by ham it other dr pans) i ) LS THERE A COURT °Ring 8ARRric EITHER PARENT FROM REMOVING OR • CONTACTING THE STUDENT DURING THE SCHOOL DAY) 0 YES 17110 IF YES, PLEASE PROVIDE THE SCHOOL WITH A COPY Of THE COURT ORDER. (3S) FATHER/GUARDIAN DOES FATHER HAVE CUSTODY? OYES 0 NO 134) MOTHER/GUARDIAN DOES MOTHER HAVE CUSTOM? 0 YES 0 NO• YES . YES non MAINZ MORC LAST MST ALMS MOW ROYAL PALM BEACH FL 33411 ROYAL PALM BEACH FL 33411 ACtS ACOALSI STAR br CGt SIC AO MSS 'Tr — HAIL To CAW OLC....A.1.0v ociLTAITAT PIACI CA 001.011eUll RACE co (74ftsvison S'Q ISOM •41041.9 Moon i0Mt Mask loVSNItS3 Mitt (IS) HIGHEST LEVEL OF EDUCATION COMPLETED ,OPTIONALI OM HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) de/410 ratIriA.:".“-3“ SO c El BACA SCHOOL AO fahn'ar.."4-ct Bn :CAC pa :CAM B 0 . 1","•in ScsAWATO , --1 Caseis s M C O WON Taro o I critt PC:T.S/LOroARY E • n4MC mtlx,`"" „ 1 0 O USW POSTISCO.O...tv E M Mt",:tr.., "" wo 1371 LEGAL GUARDIAN DP ANY) DOES LEGAL GUARDIAN HAVE CUSTODY? O yEs O NO tipsy NAME M45 LAST ...CA% ACCUSZ off STATE To COO( 4StP.r.,P),PAYeAP*VDIPA,EETY.m.r.PRDAATIPTOr , , Ilaiela flo „,, CO. (3E0 PART c PERSON'S) OTHER THAN PARENT AUTHORIZED TO PICK UP STUDENT. uoteciac DTI PASSWORD iALLAT (40) NAME ADDRESS PHONE RELATIONSHIP O YES O No (41) NAME ADDRESS PHONE RELATIONS/LP n I--, YES O NO IAD NAME ADDRESS PHONE RHATIONSHP n L-I YES D NO (43) NAME ADDRESS PHONE RELATIONSHIP nt-i YES O NO (44) NAME ADDRESS PHONE RELADOCCR. Ei YES ILIA PART IE f SCHOOL PERSONNEL ARE UNABLE TO CONTACT YOU IN CASE OF ILLNESS OR ACCIDENT. MAY WE HAVE YOUR PERMISSION TO CALL YOUR O Pm DOCTOR OR EMERGENCY SERVICES 1911) FOR TRANSPORT TO THE HOSPITAL) 0 YES 0 NO (47) FAMILY DOCTOR (46) PHONE HUMBER NB) HOSPITAL PREFERENCE (50) IF YOUR CHILD SUFFERS FROM ANY ILLNESS, ALLEGIES OR HAS ANY PHYSICAL teCTATI0NS THAT WE SHOULD BE AWARE Of PLEASE LIST: (611 MAXIS) OF CHILDOIEM (52) SCHOOL ATTENDING 453) STUDENT 110. (OPTIONAL) (54) GRADE (SS BIRTH DATE (SDI I VERIFY THAT THE INFORMATION GIVEN IS TRUE AND ACCURATE TO THE BEST OF MT KNOWLEDGE. SIGNATURE OF PARENT CR LEGAL OLIARDIAN DATE FOR OFFICE USE ONLY: •Ulu Itnthr tELPE;SiK EL SII littEr 1", el t nn COS ILE EI rilri tUL I 2) E. TFI JiUF 1 .e. EN Y.k.t.)E 01 08120/07 • 0 P ullAPUI YE .E./“I.E4'F. 1561 GF,,CE ;fit, IF; CE1IttE049 R 0 1761 EN US OS 01 ' 0 ,...*„..., ,46 , .,. F.L.• t- I I . IE EE III Er ; E. TEE a nt) ALES ; A1 /4effTV/ D9PjtitEKTArrt tStSCHE ° a" " If S' a I n FitEt IXI gi n • Qaaie fl uff TIGN Of II 1 Z , INTO. >, RECMUS 4.,;>, •st. M' . f ,E. 9 ., • .1L) o i 7 . I, I [MA Srxt44.5 (Can A L tOP•VONAL , i.r .-1 U 0...."T _ -- -_ PHYSICALf. EXAMS 2 Ec 1'!,1E EirlEl '1;;;EiTP1 0 is 04't PBS 0(E 6 (REV. Sr 97) EFTA01710374 VERIFICATION FOR NEW/RETURNING STUDENTS: occx_D is›The School District of Palm Beach County TO THE PARENTS OR GUARDIANS: La A NEW/RETURNING STUDENTS NEW STUDENTS: Complete all non- shaded areas. :1 - RETURNING STUDENTS: Please review both sides for \71 REGISTRATION" sile,e2+RIBUTION:1761 TCHR:EICHNER, -t11"N ic TNBR: 402 correctness of typed information shown below and on the other side. If the Information printed is incorrect. please HMRM: 402 correct it by carefully and lightly crossing out the incorrect ex, Oe1,, 8/14/96 STOT : information and writing the correct information above it. ill STUDENT'S LEGAL NAME 121 ALSO KNITNTI AS LAST I T MOOS fu LOCAL ADDRESS (4) MAILING ADDRESS Elan-- Stint wart mt., rmor P.O soar sssr .4.1. Nci City OYU ZAP wit WV SIMI tar osix (El STUDENT'S SOCIAL SECURITY MI (CI HOME PHONE NO. (71 SEX F OD RACE W (OPTIONAL) AMERICAN I !MALI I INDIAN I A tIrCAI7IC SUMMER 0 V iii ‘NVCITIrE —MISPANIC I MACK 0 H MSpµlc 0 M El MALE B NON—HISPANIC mULTI-RACIAL (9) GATE Of BIRTH (10) PLACE Of BIRTH FLORIDA (I I) RESIDENT STATUS 3 (ID ENTRY DATE WEST PALM BEACH FL US 0 0. FOREIGN FRI:MANGE STUDENT INTO USA WNW OAT YEAR CITY new cccinyy rl U I. OUT-OF-COUNTY RESIDENT 03) FEDERAL IMPACT AID SINIT£Y (IF APPLI ABLE) (14) HAS THIS CHILD BEEN ENTERED (CHECK THE LETTER CODE FOR ONE CODE ONLY) IN ANT PRESCHOOL? 0 2. OUT-DF-STATE RESIDENT 0 3. IN-COUNTY RESIDENT D l ipicterctriepareet employed on federal A. Spirtg tyrespidJsinoaa Igiroi:m (Please place a cAralmark ($ by each program emended. Also. indicate (1W IS THE STUOENY D I. Student resides on linholl property, parent not employed on federal with an asterisk ( * ) the program year child was in the longest.) NOA SINGLE PARENT? r 9 J. Modem resides In low rent housing. parent eraemployed on lean) El YES 0 NO prop erty C. CHAPTER I El M. MIGRANT PRE-I( D K. Stvdeit 'nides ode nonle4eral prepay, pant employed on federal property in Palm Beach Canty 13 ❑ 0. PRE-K DISABILITIES 0 ❑0 N. NON-SUBSIDIZED CHILD CARE (ID) GRADE LEVEL 0 0. sari IsiifeersyiN s meafeeeral property, punt on salve duty la 0E. PRE-II EARLY INTERVENTION 1K 0. OTHER Oii. HEADSTART 0 S. SUBSIDIZED CHILD CARE 04 'i (17) NAME OF SCHOOL TRANSFERRING FROM (18) CITY OR LOCATION (ID) DATE Of EAST ATTENDANCE 120) GRADE LEVEL (211 LAST PUBLIC SCHOOL ATTENDED IN PALM BEACH COUNTY (22) DATE ATTENDED t, ...2:i Der 4l2F ? Til p. (231 HAVE YOU FILLED OUT MI APPLICATION FOR FREE or REDUCED LUNCH? (lppikaien is provided with ills animation Form) us SODIUM FLUORIDE: TES a NO Mg HEWN SCREENINGS: YES YES I give permission la ay child to he given health screenings. These tests I give permission (or my child to participate In Ihe Sodium fluoride Program to may be Diva ladivIdally Or In groups. to previa dental decay. EtIMISSICE Is valid through grade six. Et YES NEW; STUDENTS TO PALM BEACH COUNTY: HONIMArgGraStittW:¢ NO YES' NO .; (261 WHAT LANGUAGE IS SPOKEN IN (27) TTHAT LANGUAGE IS SPOKEN (281 DATE Of ENTRY (292 THE NOME BY THE PARENT or GUARDIAN IN THE HOME BY TEE STUDENT? INTO THE 'SOL PROGRAM 1. Is a tanguara other than English used In me home I YES 0 .0 2. Coat the student have a first language othee thin Englitig I yes 0 me 3. Oen me memo malt fretwonlif meek a language other than Englich2 DYES 0 NO .1 . WONLY: C212,'S Ilfice PI yarattmsB , ;€ ita iNri1 CIITI I ITI:; II, TMI TATA A. .. EN E01 I 08/21/96 1060 an I'ApI.: A.- tl.tit :;A It tiI41-C II‘,,.1 GRAIII LEVI. 1 119 CAUNTAR ITT: IITI.c&III. N.. i 1761 I EN US 04 01 402 IIIIIIIII WI At /IITIONIMNT ION 121 TRANPORTATION (l cat TIOA II lit II 11 It 51 OCCI.A.IiSTATICN Ch IF I, ICIIIIIK AM IIAT1. droN It .TO N z 9 ,......ttl OF,,,„ D YiC . li 0 '4 tTt ...11‘.55tAt Ic'ti 0 04Tc I .'.-,v 9 t,,t:,:.. 0 M•IIAT C I 2 4 4 5 G. ; 4 4 AL., 1' : i4t, 11...v. tAIT;./ III.IM, I.IT-O T.!. 641(f . . .. . MI/ I AIR IT "'AT TI E INFORMATION GIVEN IS TRUE AND IRATE TO THE BEST OF MT KNOWLEDGE. 46 citNtaltlif Ile PARENT OR if CAI TIMIlfilell min t; ( `tin; REV. 5/14 FRONT EFTA01710375 The School District of Palm Beach County - NEW/RETURNIMG STUDENTS REGISTRATION TOT • BACK MI STUDENT LIVES WITH (CHECK ONE) BOTH PARENTS 0 MOTHER 0 FATHER 0 SHARED CUSTODY `: , •• OTHER 1491 I NI w.0 be Vaneeeee corn *Mel by Wm. 0 Ns( wee wow) (SW IS THERE A COURT ORDER BARRING EITHER PARENT FROM REMOVING CONTACTING THE STUDENT DUPING THE SCHOOL OAY7 YES 9 NO IF YES. PLEASE PROVIDE THE SCHOOL WITH A COPY Of THE COURT ORDER. bt OYES [Pt 521 MOTEER/GUAROUIN: DOES MOTHER HAYS cumobv? DYES NO 0 YES YES Mil MOM ROYAL PALM BEACH FL 33411 ROYAL PALM BEACH FL 33411 Hoc.; *ram on .c a c 2 0 CON IN 000•6S t. RAn xn MC 6COACTION =VANN Of tioNnnala /WA a InNOVNIO ISE) HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) A n •INCPITAM :6100% B' ri...1nr"' C0 Cl (54) HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) A ill (ISHnITMO seem B 0 r....7.2," C o µ D D SON 00iiiSKNONY Itsainikelity• E Ill .",`7„:,,n.'t,"::: D 0 :7...ante:ea. E0 N.' (651 LEGAL GUARDIAN (IF Ain1 GOES LEGAL GUARDIAN HAVE CUSTODY" 0 YES O NO Last NMI FAST MIX‘t 1401.i • SS OTT :MU SiI OM CCOOATIO01 NAGTAroatormaN NM . in "?‘ IP Ainete ta ?Jiiil (SG) PART I PERSONIS) OTHER THAN PARENT AUTHORIZED Ti) PICK UP STUDENT. (57] PASSWORD: 1k) NAVE TS% AfOIRIS (Si) IN ALITNICISO (SO) PHONE 9 LATIORSHP M MO IIIILKEINI Pall r tli 9 - rn * • rash Er NO h 4 El-ItS istior ■ 0 NO MPS EtIES 0 NO Pis 0 f ats NO (:13) PART It II wheel it sloth w cameo you in tin I Moen Or *abet. ii•I' we lye You( WW1 to cell dieter en ozwIlwoY L• TAT TG 1 II ILTI Lan SPOT' iii OPE NJ P:YESDNO (84) nay (*MN .‘k 1./ I T. ft sk i ,P-1 vvik oh our a r„ti IT Pt .NUMBERzpsik, te, Hospiym PREFERENCE toTer Vies A p e &S I: Si m 1,0C/MORA g 0 6 14h./ GIOLYS/ g itbt 6.1 u S FROM ANY ILLNESS CI HAS ANY PHYSICAL DEFECTS Hal WE SHOULD SE AWARE OF, PLEASE LIST YOUR:.CIELDAENANIOINER latitEACH4gOUNTMSCHOOILSWSVSEKS•M-r: Sig,(4.:?ofp:n:w, ',/4M<Iti .;:fgft.tMita•c)fl. we4 (GM MAYEISI OF OAD0CNI (CS) SCHOOL ATTENDING (7C) STUDENT NO. (OPTIONAL) (711 GRADE O21 BIRTH DATE EFTA01710376 441 Li .14OOL Di's,\ - • r e \ A E, The School District of Palm Beach County VERIFICATION FOR NEW/RETURNING STUDENTS: TO THE PARENTS OR GUARDIANS: 0 ;-I • NEW/RETURNING STUDENTS NEW STUDENTS: Complete all non- shaded areas. RETURNING STUDENTS: Please review both sides for K <,:r.:..-,ict9 ; nSTRIBUTION:1761 TCHR: REGISTRATION! TNBR:304 correctness of aped information shown below and on the other side. If the information printed is incorrect, please HMRM:304 correct it by ca efully and lightly crossing out the incorrect OUT DAM 8/22/95 STDT. information and writing the correct Information above it co swears LEGAL NAME (2) ALSO KNOWN AS (3) LOCAL ADDRESS PP . II/ MAILING ADDRESS ' -.yr, .0 --- blFtt I Kant An. a ant a S MUT had AFT. a C.!, STAY/ U.toot aTr MAI/ 20 on( 151 STUDENT'S SOCIAL SECURITY NO. (5) HOME PHONE NO. 1) SEX F lb RACE W (OPTIONAL/ WHITE I FEMALE I = "N / A PACIFIC ASIAN ISLANDER I W NON-HISPANIC I MALI ii B SLACK NON-HISPANIC I H HISPANIC IS: DATE OF BIRTH :101 PLACE Of BIRTH FLORIDA (II) RESIDENT STATUS 3 dal GRADE i.tvtt. 0 0. FOREIGN EXCHANGE STUDENT 0 1. OUT-OF-COUNTY RESIDENT WEST PALM BEACH FL US 0 2. OUT-OF-STATE RESIDENT 03 SIT/ STAY{ 00011/7 0 3. IN-COUNTY RESIDENT (13) FEDERAL IMPACT AID SURVEY (IF APPLICABLE) 04/ HAS THIS MILO BEEN ENTERED IN ANY PRESCHOOL? IN Is the Medea( a 'single wen? (CHECK THE LETTER CODE FOR ONE CODE ONLY) Please plus a chackmerk 11/5 by each program 'Needed. Also, indicate NO ❑ with an 0SNIIM I * ) Ike program you child was in the longest) A I >,.. ;,, IM Federal Wintry Samna. DC. CHAPTER I O M. MIGRANT PRE-K I in, a civilise *boobs b the annul atuniabinninn and Ihe 0 D. PRE-K DISABILITIES O N. NON-SUBSIDIZED CHILD CARE YES I NO ❑B cell of my child's mItseallon Is provided In part or wholly by Federal **HO. O E. PRE-K EARLY INTERVENTION OH. HEADSTART O 0. OTHER O S. SUBSIDIZED CHILD CARE I K Le a • 2. 5. ..51-) 0 Yak 9 Yr . lf N:., y y .v. a ' `I: er' (IS) NAME OF SCHOOL TRANSFERRING FROM I?) OTT OR LOCATION (IS) DATE Of LAST (191 GRADE LEVEL (20) LAST PUBLIC SCHOOL ATTENDED IN PALM BEACH COUNTY (21) DATE ATTENDED —Mg. 3 eVati.EPUngir .100100411.010,g*TiONEOFIRCAT0Orikaa:mtIt • n'.:, c UV Hare you filled oot an applicetien lei free of Reduced Lunch? (Application is blended will, (Ms Regisitatiot Form) Q TES El NO (23) HEALTH SCREENINGS: YES (24) SODIUM FLUORIDE: YES . I give :remission her my child I be given health ncieenhigs. These lasts I give poraissice for my child to pertIcipate In the Sodium Flaorlde Program to may be gives Ielirliftolly or In groups. to prevent denial deny. Permission Is Mid through glade six. YES a NO TES ONO itg IlalBEACH COUNTY: HOME LANettak-Gea/ li 4: ..). ee v ; ,C i ...: (25) Whet linguine Is spoken in the (26) Whit lesg.rce it :peke° it 2?) Ore c! Enry isle pal home by ibe pun] or mardlen. the home by Me swdeetT VSO' i'r oy :7 I. is a language other than English used in the horn? YES I No 2. Deer th• student have • llmt language ether Thin Fagltsh? OYES II NO 3. Dv : the stoomil east Ham...v , ;rt/I a language ether than Ent, g YES 0 NO FOR OFFICE. USE .ONLY: In>.5:-.3,,.. 41 cq:11 ,7:::!i i ii ii 1,.: H — l;l i"C I:,3 I ,' 34' ifin: OAL EN COI 08/23/95 1060 ‘•7' :./.;"` IICI: 1761 EN US 03 01 3C.1 .:C.Ii hic,-, c.,r;0. ,m N t '.!a ; :I: E,I;,NSF.1,17.t!:-.. .; I ,Ii :, ,TI .W.LMEr 0...: torrICT cv I chi 0,..f .. O 0 A , tPA [H-zsE USES : j 4f, I LI:, U... (1 TA iC16Y CAPS' WI' ' (46) I VERIFY THAT THE INFORMATION GIVEN IS TRUE 11 AND ACCURATE TO THE BEST Of MT KNOWLEDGE. jF ./2S cUO S nart PBSD 0636 REV. 4/95 FRONT EFTA01710377 ono ...girds wtot.rn..t yr room own@ loVulity - mcw/MCIUMNLMU *!MUCtIllb KCOLb1MAIAUN STDT: DATA (n) STUDENT LIVES WITH (CHECK °Hifi V PM TRANSPOO k OTH PARENTS BY: Stuelont willbt . MOTHER aaapenod IA MT se4al by Isame • Hew dan paeasU FATHER 9 SHARED CUSTODY 1 91 M THERE A COURT ORDER BARRING EITHER PARENT FSIOM R5 VI ❑ OR OTHER TACTING THE STUDENT DURING THE SCHOOL OAT? •T D YES NO IF YES. PLEASE PROVIDE THE SCHOOL VAN A COPY O THE COURT ORDER. GUARDIAN: DOES FAT HA CUSTODY? OYES YES 0 NO (50 MOTHER/GUARDIAN. DOES MOTHER HAVE CUSTODY? II£ NO ,,„. ROYAL PALM BEACH FL 33411 ROYAL PALM BEACH FL 33411 CMNo fl Olt k1A.te JD• CC 04 AMU% Co , li *lc QCtw. io n.0 Or Amy wi noa Or 1MilOYMINI • lw.att MO I , si p,,,,,[ NOM[ t (i2r NTORE ci 1 Etter OF MOTOCAriai ZoltR.ETO rOPHOIIALF 153) HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) A 9 Egg— WON SCA001. B0 WI IX,.ilatOOT a aa K.:rya I gt:LTIrl'' C I WON A I t ,t"" wnnigt: 145eu c... C aIt?: Dl ;inct"3"- " El ...A.,.....; nt-..“ ou u"“ta D 9 Are rostrum. E 0 itaP TI°.?"‘ " T.TibT" ': 154) LEGAL GUARDIAN OF ANY) DOES LEGAL GUARDIAN HAVE CUSTODY? Ill YES 0 NO In, iiaiit FbAST PoOtos Uzi. AOwua UTY %TAX 2:9 COX NNAW AI l ' ACI P""n°T^441 await Had tv AkEtigg.K.. tl S4MigIngTTYAOAMOI1. 1 .M :T 4"' 'WTI 155) PART L Parses()) other than parent authorind to pick up slucloat 1161 • •z • tinerimuzo , piorel et 1•10.00•• i ll (Si) NAME ADDRESS Oil MOOS • All} 14.11S D NO -bkboi, EFIES 0 NO RklyES Sm-kr 0 NO 0 YES 0 NO 167) PART '.e U Hltenl Is ebb; to elwatt you in ease el Anew or weLlant, easy Wa have your pormNilon le toll yew doctor el arnotienty winces 191 1) ter Irarttpewl to NH hovel 2 OYES iii NO (63) FAMILY DCCTCR (64) PHONE NUMBER 65) HOSPITAL PREFERENCE (661 2 year thild sellers ham • :Muss el eel way physical delects the ...e gheult1 ba swan of. paaaaa hat pa/As (Ales 1- 10 X011MtiliigiBRATAIKOSVALIVIMACW.couNrametiO,Cis • ' (67) NAMEMI OF CHILD(REM 168) SCHOOL ATTENDING Teel STUDENT NO. (OPTIONAL) I i _. A oi-Ne. __.- EFTA01710378 PICTURE CARD NAME F ll at / Middle School_ Schoo School . Year / Y-2- 13 Year I 99 3-9V Year Grade Crade Schoo I _ School Year 94-11 Year t r ". EFTA01710379 H.L.JOHNSON ELEMENTARY SCHOOL 6, SOBS ge tie 40 4e de le 0 ROYflL PALM BEACH, FLORIDA 33411 PHONE: PA: FAH: Principe* 8- 1/- r Oats Dear Panbrit I This letter is to notify y • ession (summer school) achievement, your child, has been S nts Na promoted to grade 3 You are urged to work cooperatively with your child's teacher during the coniing school year and check on your child's progress often. cc: Student Cumulative Record EFTA01710380 L THE SCHOOL DISTRICT OF PALM BEACH COUNTY Elementary School Special Session Registration Student Number ,e of ParenUGuardian Telephone: Home ame School Home School Teacher Special Session School Assignment Students Date of Birth High Risk Medical Information Legal Information on Recor•: V no yes (Call home school.) Student is on free lunch reduced lunch SPECIAL PROGRAM ASSIGNMENT (Check services needed.) ESOL Intensive ESOL Support ESE (Program) Other TRANSPORTATION Special Session Bus # Needed: no it, yes regular ESE lift) SAC# /06 ID RECOMMENDATION FOR SPECIAL SESSION (Check all that apply.) Students in grades K-5 who are in ESOL (LEP students), Dropout Prevention, and those in ESE whose IEP includes a recommendation for Special Session. _e Students in grades K-twho receive recommendation from the principal may attend for remediation purposes only. Students in grades 2-5 who received a score in quartile 1 in the reading comprehension and/or mathematics concepts and applications on the most recent norm-referenced test. Students in grades 2-5 who received a score in quartile 2 in the reading comprehension and/or mathematics concepts and applications on the most recent norm-referenced test along with the recommendation of the principal. Note: Students retained in their current grade level may be eligible for promotio upon corn letion of Special Session. Sin] ir / -en_r Da re of Principal / Date chifittk"tpititiF?1,41149 Effeu'A In otrillitic ieleYostitionikli0M 4 018,4004re <'-;! eqtreircif$ 16O'j'h9;11 eallikabontforrtn endiffht„., c s.4s4on isumme Arm, :Spectialge ?setionn: .rime v ignature (la n Dettifit Attachments to the registration form sent to the Special Session school: Parent/guardian copy - signed registration form Copy of completed ESE IEP, if appropriate Other information To be completed at the conclusion Special Session: STUDENT ATTENDANCE RECORD: Days Present 0 Days Absent C) Days Tardy Tea t9r comme s: PLACEMENT DECISION Made following Special Session in Promoted O Administrative Placement CI Retained Ziee llja15"fi / P- 54 r Wstrator 1--€7-9-s— I Date Signature of Home ool Principal / Date PBSD 0673 FY 95 Revisio WhitelSpecial Session School om coo ome SchoollOffice PinkfTrensportetion GoltrerentIGueniian then Horne School EFTA01710381 (I) STUDENT NUMBER (2) SAC GIME (3) GRACE LEVEL THE SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) New and Returning Student Registration 1060 12 NEW STUDENTS: Complete all areas on both sides of the form except areas specified. RETURNING STUDENTS: Review both sides. If the pre-printed information Is incorrect, correct the information by carefuly and lightly crossing out the incorrect information and writing the correct information above it. Complete any areas that are blank. DIST:2331 TCHR NBR:O23 STDT: CRS:21O46OO SEC:OO4 BLDG:O2 RM:226 08/11/04 (4) STUDENT LEGAL NAME (last MIL middle) (5) ALSO MOM AS MI CORESS (house no. 4 UrnilfiliM (...no.) (a)0 (ask.) Op code) (7) MAIUNG ADDRESS Poemhe & skeet hene) (pt no) OM (state) OP code/ (8) SOCIAL SECURITY Negooneo (9) HOME TELEPHONE NO. (10) SIECI (11) RACE/EThNIC ORIGIN W 0 I-American Indian/Alaskan Native 0 B-Black, Non-Hispanic 0 H-Hispanic P 0 A-Asian/Pacific Islander 0 W-Whlte, Non-HI panic 0 %Multiracial (12) DATE Of GIRTH (13) PLACE 0 BIRTH 9*. oak cow*y) (14) RESIDENT STATUS (IS) USA ENTRY DATE (M4.41DONYTy) 0 0. Foreign Exchange Student (HAVDDeryn) WEST PALM BEACH FL US FLORIDA 0 1. Out-of-county Resident (Is) FEDERAL IMPACT SURVEY 0 2. Out-of-state Resident YEs NO 0 3. In-county Resident 0 0 A. The student resides on federal property. (17) PRESCHOOL ENROLLMENT INFORMATION Place an X by each program encoded. Also. Indicate with an 0 0 B. The student resides in low rent housing. n asterisk filo program your child was in the longest 0 0 C. The parent is employed on federal property located in PB County. 0 C. Title I Prekindergarten 0 M. Migrant Prekindergarten • • D. The parent is employed on low rent housing located in PB County. 0 D. Pre-l< Disabilities 0 N. None 0 0 E. The parent Is al the uniformed services of the United States. 0 F. Fee for Services 0 P. Private Prekindergarten ❑ H. Head Start 0 0 T. Teenage Parent Program 0 • If E. Is YES, Is the parent on active duty? Cheek service below: III L. Readiness Program 0 Z. Not Applicable 0 Air Force M Army 0 Coast Guard 0 Marines 0 National Guard 0 Nary an Is the student a single parent? N 0 YES 0 NO TRANSFER STUDENT Only students transferring from another school complete this section (19) NAME CF SCHOOL TRANSFERRING FROM (2[9 CITY! STATE /COUNTY COUNTRY . (21) LAST ATTENDANCE DATE (72) LAST GRACE LEVEL (23) Have you ever been enrolled in a Palm Beach County School? • YES 0 NO (24)DATE ATTENDED 94 PSC If yes, what school? All new and returning students compete the remaining form including page 2 p2si Students will receive non-Invasive health screenings pursuant to Florida Statute §381.OO56(7)(d). Non-invasive screenings may include viSlon, hearing, scoliosis, height, and weight. These tests may be ghien individually or In groups. Parents or guardians, however, have the right to request an exemption In writing. If you DO NOT want your child to receive the screenings, write the words "Do not screen" here: (This exemption wit cover at types of screenings) Gar) I give permission for my child to participate in the sodium fluoride program to prevent tooth decay. 0 YES 0 NO (Permission is valid through grade 6) YES pan Does your child currently have health insurance? 0 YES 0 NO P If YES, indicate: • Medicaid II Healthy Kids/Kid Care 0 Private 0 Interested in receiving information (28) HOME LANGUAGE SURVEY (chock WI ghat app.') In A language other than English is used in the home. What language/ 0 The student has a first language other than English. What language? 0 The student most frequently speaks a language other than English. What language/ (29) DISCLOSURES FOR ENTRY INTO PSC SCHOOL DISTRICT (Check ON the! apply) 0 The student has been expelled from school. • The student has had juvenile justice aerials taken against himiher. III The student has arrested resulting In a charge. (30) STUDENT LIVES WITH (check one) (31) CUSTODY STATUS OF STUDENT (check one) 0 Mother 0 Father 0 Both Parents 0 Foster 0 Group Home 0 Mother 0 Father 0 Shared Custody 0 Other 0 Other IMPORTANT INFORMATION - MUST BE COMPLETED (32) Is there a court order barring either parent from removing or contacting the student during the school day? ❑ Yes 0 No If YES, provide the school with a copy of the court order. PBSD 0636 (Rev. 03.117(2004) page I of 2 EFTA01710382 PARENT/LEGAL GUARDIAN INFORMATION (53) FATHER OR LEGAL GUARDIAN (Ns( inidEtInITMI AM(/ (34) DATE OF BIRTH (44)MOTHER OR LEGAL GUARDIAN (MK mild,. n'M4 PM (43) DATE OF BIR I H AC/CRESS (street number; street apartment number) (46) ADDRESS Ettset sumac,. sires; apartment nuiruer) (36) CITY STATE ZIP CODE (47) CITY STATE ZIP CODE ROYAL PALM BEACH FL 33411 ROYAL PALM BEACH FL 33411 (37) OCC(PATON (38) HIGHEST (48) OCCUPATION (49) HONEST ED. LEVEL ED. LEVEL (39) PLACE OF EMPLOYMENT (50) PLACE OF BAPLOYMENT (4)) HOME TELEPHONE (41) BUSINESS TFJ-EPtSDNE (42) CELUPAGER NUMBER (51) HOME TELEPHONE (52)BUSINESS TELEPHONE (33) CELUPAGER NUIABER (43) EMAIL ADDRESS (option ) (54) atm. ADDRESS (optional) EMERGENCY HEALTH AND SAFETY INFORMATION Provide name(s) of person(s), other than parent, allowed to pick up student. (SA PASSWORD ((kilt 10 characters) (58) NAME gat mdelle /MN!, LNG (62)NAME pint mktelle it( last) (57) ADDRESS (street number, steel aPartmenr number) (63) ADDIESS (street number, Ares, apartment number) (55) CITY STATE ZIP CODE (64) CITY STATE ZIP CODE (98) RELATIONSHIP (80) TELEPHONE (61) CS.UPAGER NUMBER (65) RELATIONSHIP (66)1ELEPHDNE (67) CGLUPACIER NUMBER OTHER (86) STUDENTS ALERGES (chick allMel applyand specify) 0 Ncne • Animals 0 Birds 0 Reptiles 0 Amphibians 0 Plants 0 Food 0 Other Specify (88) LIST STUDENTS ILLNESS, BEHAVIOR ISSUES. MEDICATIONS OR PHYSICAL uteri/mom (70) FAMILY PHYSICIAN (71) PHYSICIAN PHOtE NAMES OF PARENT'S/LEGAL GUARDIAN'S OTHER CHILDREN (72) NAME OF CHILD (Rat trick* Waal, libs0 (73) SCHOOL ATTENO1NG (74) STUDENT NO. (option•O (75) GRADE (78) DATE OF BIRTH (77) NAME OF CHILD (Ent /ENS lolls'', ass) (78) SCHOOL ATTENDING (79) STUDENT NO. (optional WO GRADE (81) DATE OF BIRTH (02) NAME OF CHILD (hzt Middle initial, ail) (83) SCHOOL ATTENINNG (84) STUDENT NO. (optional) (65) GRACE (88) DATE CF BIRTH INFORMATION VERIFICATION PARENT/GUARDIAN CONSENT verify that the Information given Is true I understand and agree that all educational records of my child may be shared with the Districts and accurate to the best of my health care partners and other governmental and social agencies jointly seeing the child or having knowledge. a legitimate Interest In the records, as needed to provide and evaluate heath services and government/social services to students. I also understand and agree that my child's medical records or other medical information that I provide to the school, and treatment records or other medical records created by health care personnel at the school will be shared with school officials who have a legitimate educational purpose for accessing such medical records and I IMRE CF IT/LEGAL GL/ FOR OFFICE USE ONLY Documentation Checklist Transportation COB US CAL O1 r No. ❑ Immunizations 0 RC Bus St. Entry Code E01 Reassign. Code 0 Birth Records Verification 0 Palm Iran Enlry Dale 08/11/04 Birth Verification ESOL Entry Date DCF CI Social Security Number 0 Parent/Student Transportation 0 Physical Exam 0 Walk 0 Bke 0 Address Verification PBSD 0636 (REV. 03/17/2004) page 2 of 2 EFTA01710383 Spring 2003 Florida Comprehensive Assessment Test (FCAT) Student Number Sunshine State Standards School Name and Number Florida Comptitens'Are Assessment Test Grade 10 Student Report District Name and Number The Florida Department of Education believes that every student has the ability to learn and succeed. The purpose of the FCAT is to ensure that Florida's public schools are providing the best education possible, and preparing students to succeed in the competitive 21st Century job market. Working with teachers, the State has developed a measurement system that includes reading, writing, mathematics, and science. This report allows you to compare a student's scorelo other students in the state. Using the -Content Scores,' you are able to identify any specific academic skills needing improvement. Below you will find your 2003 FCAT Science scores. The chart on the right side of the page shows your score compared to the average score this year. Science Score 590 State Comparison 450 Lowest Middle Highest 400 350 330 The Score Is a number between 100 and 500. 250 230 150 100 Science Content Scores Points Points State COMpdt SOn Content Areas Possible Earned Middle Highest Physical and Chemical Earth and Space Life and Environmental Scientific Thinking e These scores show your achievement on the day you were tested. If you had taken this test numerous times, It is likely that all of your scores would have been within a certain range. Your 2003 FCAT SSS Science scores probably would have been between 234 and 270. Data Run Date: 05/0W2003 0061004 EFTA01710384 FCAT Reports Informes FCAT (Spanish) Rapò FCAT (Hattian Creole) Separate reports are produced for the Sunshine State Se preparen informes separados para los exåmenes del FCAT Yo prepara rapa apa pou egzamen lekti ak matematik, syans Standards tests in FCAT Reading and Mathematics, de lectura y matemåticas, ciencias y redacción según las ak redaksyon FCAT bay swivan prensip Sunshine State Science, and Writing. A separate report is also printed normas estatales Sunshine State Standards. También se Standards yo. Yo ekri yon rapa apa tou pou lekti ak matematik for the norm-referenced tests in Reading and imprime otro informe por separado para los exåmenes de lectura pou "modél egzamen ofisyél FCAT itilize pou fé evalyasyon" Mathematics. y matemåticas de acuerdo a las normas de aplicación nacional. an. Informe sobre el FCAT cefiido a normas de apficación Rapb egzamen oflsyél FCAT Itillze pou fé evalyasyon FCAT Norm-Referenced Test (NRT) Report The FCAT nacional (NRT) El Informe del FCAT NRT presenta los NRT report shows reading and mathematics scores on resultados de lectura y matemåticas en una varslar' del estado (NRT) Rapa FCAT NRT a montre nöt lekti ak matematik nan a Florida version of the SAT9 (published by Harcourt de Florida del SAT9 (publicada por Harcourt Educational vésyon Florida genyen pou SAT9 la (Se Harcourt Educational Educational Measurement). Student scores are Measurement). Los resultados obtenidos por los estudiantes se Measurement kl plbillye li.) Yo konpare nät elév la ak yon compared to a national "norm" group, where a percentile comparan con el grupo modelo o norma", en el que la gwoup nät yo konsidere kam "mod& pou egzamen ofisyér la, rank score of 50 is average. clasificación es de un 50% del promedio. kote swivan klasman pa pousantaj la, nöt mwayén nan se 50. Sunshine State Standards (SSS) Reports The FCAT Informes según las normas estatales Sunshine State Rapö Sunshine State Standards (SSS) Rapö FCAT SSS SSS Reading, Mathematics, and Science reports show Standards (SSS) Los informes según las normas estatales pou lekti, matematik ak syans lan montre nät elév yo fé nan test stores from Florida's tests of academic standards. SSS del FCAT presentan las calificaciones de los exåmenes de egzamen Florida bay sou prensip akademik yo. Rapa sa yo These reports contain subject scores and content lectura, matemåticas y ciencias de las normas académlcas de gen nät pou matyé ak nöt pou kantni ladan yo. Nöt pou matyé stores. Subject scores describe the overall Florida. Estos informes contienen calificaciones por materias y yo dekri tout sa elev la reyalize anjeneral epi nöt pou kontnl yo calificaciones por contenido. Las calificaciones por materia bay kantite pwen elév la fé nan yon matyé byen detémine. Ou achievement, and content scores giva the number of proporcionan un resumen general del rendimiento y las points earned in specific skill areas. Success on the calificaciones por contenido que proveen el numera de puntos ka konprann kisa elév la reyalize nan egzamen lekti ak Reading and Mathematics tests can be best understood obtenidos en åreas de habilldades especfficas. El éxito de los matematik la pi byen si w itilize yon nivo siksé kote 3 oswa plis by using the achievement levels where a 3 or higher is exåmenes de lectura y matematicas puede entenderse meder se yon nät kl nan nivo klas la oswa yon nät kl pi wo pase nivo on or above grade level. utilizando los niveles de rendimiento en los que una callficacIón klas la. Achievement Levels Five categories of achievement de 3 o superior estå al nivel del grado o por encima. Nivo siksé elév yo Gen sank kategori siksé ki dekri nivo describe the success students have with the content Niveles de rendimiento El éxito que un estudiante ha lo9rado siksé elev yo pote nan kontnl yo teste nan egzamen lekti ak tested on the FCAT Reading and Mathematics. Level 5 en el contenido examinado en el FCAT de lectura y matematicas matematik FCAT la. PI gwo nivo a se nivo 5 epi pi pitt nivo a is the highest and Level 1 is the lowest. Since science se describe por medio de cinco categorias. El nivel 5 es el mås se nivo 1. Fiske yo poko detéminen nivo siksé nan egzamenn achievement levels have not been determined, science alto y el nivel 1 es el mås bajo. Como los niveles de rendimiento syans lan, yo klase nåt pou syans lan swivan si Ii tonbe pi ba, stores are ranked as to whether they fall in the lowest, en ciencias no se han determinado, las calificaciones de nan mitan oswa pi wo yon tyé péfamans elév toupatou nan eta ciencias se clasifican con respecto a si entran dentro del tertio a. middle, or highest third of statewide student inferior, medio o superior del rencfimlento estudiantil a 'livet performance. estatal. 5 Elév sa a gen alltså nan matyé ki te gen pi plis difikille ladan yo nan egzamen Sunshine State Standards la. Von elév ki 5 This student has success with the most challenging content 5 Este estudiante tiene éxito con el contenido mås dit fall de las nan syém Nivo reponn pitt, kesyon egzamen yo of the Sunshine State Standards. A student scoring in Level normas Sunshine State Standards. Un estudiante del Nivel 5 körékteman, elév la menm reponn kesyon kl gen pi plis 5 answers most of the test questions correctly, inciuding the responde a la mayoria de las preguntas del examen difikilte ladan yo. most challenging questions. correctamente, incluyendo las preguntas mås diffciles. 4 Elév sa a gen siksé nan matyé ki te gen difikilte ladan yo 4 This student has success with the challenging content of the 4 Este estudiante tiene éxito con el contenido difícil de las nan egzamen Sunshine State Standards la. Yon elév ki nan Sunshine State Standards. A student scoring in Level 4 normas Sunshine State Standards. Un estudfante del Nivel 4 responde a la mayorfa de las preguntas correctamente, pero 4yém Nivo reponn pitt' kesyon egzamen yo körékteman, answers most of the test questions correctly, but may have men li ka gen kék siksé sélman nan kesyon ki sanble yo gen oniy some success with questions that reflect the most es posible que säl° tenga alerta éxito con las preguntan que reflejan el contenido mås difícil. pi plis difikilte ladan yo. challenging content. 3 Este estudiante bitne un éxito parcial con el contenido difícil 3 Elév sa a gen enpe siksé nan matyé ki gen difikilte ladan yo 3 This student has partial success with the challenging de las normas Sunshine State Standards, pero su rendimiento nan egzamen Sunshine State Standards la, men péfömans content of the Sunshine State Standards, but performance es inconsistente. Un estudiante del Nivel 3 responde muchas lan pa rete estab. Yon elév ki nan 3yém Nivo reponn analt is Inconsistent. A student scoring in Level 3 answers many de las preguntas del examen correctamente, pero por lo nan kesyon egzamen yo körékternan, men anjeneral li gen of the test questions correctly, but is generally less general tiene menos éxito con las preguntas que son mås mwens siksé ak kesyon ki sanble yo gen pi plis difikilte ladan successful with questions that are the most challenging. ditides. yo• 2 This student has limited success with the challenging 2 Este estudiante tiene éxito limitado con el contenido ditkil de 2 Elév sa a gen siksé limite nan matyé ki gen difikilte ladan yo content of the Sunshine State Standards. las normas Sunshine State Standards. nan egzamen Sunshine State Standards la. 1 This student has little success with the challenging content 1 Este estudiante tiene poco éxito con el contenido difícil de las 1 Elév sa a gen yon ti siksé tou piti nan matyé ki gen difikilte of the Sunshine State Standards. normas Sunshine State Standards. ladan yo nan egzamen Sunshine State Standards la. FCAT Certificates Students who earn Level 5 scores or Certificados del FCAT Los estudiantes que se claslfiquen en Shtifika FCAT Elév ki fé nät 5yém Nivo oswa elév ki fé gwo el Nivel 5 o cuyos resultados de dendas seen superiores a 400, whose science state scores are greater than 400 receive recIben Certificados de rendimiento. En redaccian, los nöt kl pi plis pase 400 nan syans ap resevwa Sétifika pou Certificates of Achievement. For writing, certificales are given certificados se otorgan a todos los estudiantes que han obtenido Siksé. Yo bay tout elév kl fé nät 5.5 oswa 6 ak elév klas to all students with scores of 5.5 or 6 and to fourth graders with calificaciones de 5.5 y 6, y a los estudiantes de cuarto grado que katriyém ki fé nöt 5, 5.5, ak 6 yon sétifika pou redaksyon. Yo scores of 5, 5.5, and 6. Certificates are not awarded based on han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados pa bay sétifika swivan nöt elév fé nan egzamen kl baze sou the FCAT Norm-Referenced Test scores. en los resultados del FCAT cefiido a normas de .aplicación "mod& egzamen oflsyél FCAT itilize pou fé evalyasyon" (NRT) nacional. an. EFTA01710385 Spring 2003 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Grade 10 Student Report The Florida Departmentof Education believes that PVPN student has the ability.to learn and succeed. The purposeot the FCAT is to ensurethat Honda's public schools are providing the best education possible, and preparing students to succeed in the competitive 21st Century Job market. Working with teachers, the State has developed a measurement system that allows you to track a student's academic achievement from year to year and determine If a years worth of learning has occurred In a years time. This system also allows you to compare a student's score to a score that represents 'grade level' achievement. It a student's score is above the 'grade level' score, then they are performing at a level above their current grade. It it Is below, they are in need of Improvement. Using the 'Content Scores; you are able to identify any specific academic skills needing improvement. Below you will find your 2003 FCAT Reading and Mathematics scores, as well as your scores from previous years. The chart on the right side of the page shows your score compared to the score that represents -grade level achievement. You did not score well enough to pass the Grade 10 FCAT Reading test. Reading Your Reading score needs improvement. Tak to your teacher or guidance counselor about classes you can take that will help you improve your score. 2003 Reading Content Scores Content Areas Points Points Possible Earned FCAT Score 2000 Words/Phrases Main Idea/Purpose Comparisons Reference/Research 500 Grade 3 Grade 4 Grelp 5 Orede e 0 • Your Score O On Grade Level Congratulations! You have passed the Mathematics test and your score is on grade level. You have answered many of the questions on FCAT correctly. Mathematics 4000 2003 Mathematics Content Scores Points Points 2500- Content Areas Possible Earned Number Sense 2000- FCAT Score Measurement I Geometry 1500- I Algebraic Thinking I Data Analysis 1000- Year 2001 2002 2003 Grade Tested Achievement Level Grok 3 GM* 4 Grade Grade t FCAT Score • Your Score 0 On Grade Level These scores show your achievement on the day you were tested. If you had taken this test numerous times, it Is likely that all of your scores would have been within a certain range. Your 2003 FCAT Reading scores probably would have been between 1764 and 1926. Your 2003 FCAT Mathematics scores probably would have been between 1934 and 2008. NT= Not Tested NR = Not Reported NA = Data Not Available Data Run Date: 05/09/2003 0165653 EFTA01710386 FCAT Reports Informes FCAT (SpanIsh) Rapti FCAT (Haitian Creole) Separate reports are produced for the Sunshine State Se preparan informes separados para los exåmenes del FCAT Yo prepare repe apa pou egzamen lekti ak matematik, syans Standards tests in FCAT Reading and Mathematics, de lectura y matemåticas, ciencias y redaccIón segön las ak redaksyon FCAT bay swivan prensip Sunshine State Science, and Writing. A separate report Is also priMed normas estatales Sunshine State Standards. También se Standards yo. Yo ekrl yon rap?) apa tou pou lekti ak matematik for the norm-referenced tests in Reading and imprime otro informe por separado para los exåmenes de lectura pou "model egzamen ofisyél FCAT itilize pou fé evalyasyon" Mathematics. y matemåticas de acuerdo a las normas de aptit:eden nacional. an. Informe sobre el FCAT cehldo a normas de aplicación Rapti egzamen ofisyél FCAT Rilke pou fe evalyasyon FCAT Norm-Referenced Test (NRT) Report The FCAT nacional (NRT) El informe del FCAT NRT presenta los NRT report shows reading and mathematics scores on resultados de lectura y matemåticas en una versiön del estado (NRT) Rapti FCAT NRT a montre nät lekti ak matematik nan a Florida version of the SAT9 (published by Harcourt de Florida del SAT9 (publicada por Harcourt Educational vésyon Florida genyen pou SAT9 la (Se Harcourt Educatlonal Educatlonal Measurement). Student scores are Measurement). Los resultados obtenidos por los estudiantes se Measurement ki pibiliye li.) Yo konpare nöt elev la ak yon compared to a national "norm" group, where a percentile comparan con el grupo modeto o "normen, en el que la gwoup nöt yo konsidere kem "modet pou egzamen ofisyél" la, rank score of 50 is average. clasificación es de un 50% del promedlo. kote swivan klasman pa pousantaj la, nät mwayén nan se 50. Sunshlne State Standards (SSS) Reports The FCAT Informes se un las normas estatales Sunshine State Rap?) Sunshine State Standards (SSS) Rapti FCAT SSS SSS Reading, Mathematics, and Science reports show Standards (SSS) Los informes segön las normas estatales pou lekti, matematik ak syans lan montre nöt elév yo fé nan test scores from Florida's tests of academic standards. SSS del FCAT presentan las calificaciones de los exåmenes de egzamen Florida bay sou prensip akademik yo. Rapti sa yo These reports contain subject scores and content lectura, mateméficas y clencias de las normas académicas de gen nöt pou matyé ak nät pou kontnl ladan yo. Nät pou matyé scores. Florida. Estos informes contienen calificaciones por materias y yo dekri tout sa elév la reyallze anjeneral epi nöt pou kontni yo Subject scores describe the overall calificaciones por contenido. Las calificaciones por materia achievement, and content scores giva the number of proporcionan un resumen general del rendimlento y las bay kantite pwen elev la fé nan yon matyé byen detémine. Cu points eamed in specific skill areas. Success on the calificaciones por contenido que proveen el número de puntos ka konprann kisa elev la reyalize nan egzamen lekti ak Reading and Mathematics tests can be best understood obtenidos en åreas de habilidades especfficas. El éxito de los matematik la pi byen si w itilize yon nivo siksé kote 3 oswa plis by using the achievement levels where a 3 or higher is exåmenes de lectura y matemåticas puede entenderse mejor se yon nät ki nan nivo klas la oswa yon nöt kl pi wo pase nivo on or above firade level. utilizando los niveles de rendimlento en los que una calificación klas la. Achlevement Levels Five categories of achievement de 3 o superior estå al nivel del grado o por encima. Nlvo siksé elév yo Gen sank kategori siksé ki dekri nivo describe the success students have with the content Niveles de rendimlento El éxito que un estudiante ha logrado sikse elev yo pote nan kontni yo teste nan egzamen lekti ak tested on the FCAT Reading and Mathematics. Level 5 en el contenido examlnado en el FCAT de lectura y matemåticas matematik FCAT la. PI gwo nivo a se nivo 5 epi pi pitt nivo a is the highest and Level 1 Is the lowest. Since science se describe por medio de cinco categodas. El nivel 5 es el mås se nivo 1. Fiske yo poko detérninen nlvo siksé nan egzamenn achievement levels have not been determined, science alto y el nivel 1 es el mås bajo. Como los niveles de rendimiento syans lan, yo klase nät pou syans lan swivan si Ii tonbe pi tia, en ciencias no se han determinado, las callficaciones de scores are ranked as to whether they fall in the lowest, ciencias se clasifican con respecto a si entran dentro del tercio nan mitan oswa pi wo yon tyé pefemans elev toupatou nan eta middle, or highest third of statewide student inferior, medio o superior del rendimiento estudiantil a nivel a. performance. estatal. 5 Elév sa a gen siksé nan matyé ki te gen pi plis difikilte ladan yo nan egzamen Sunshine State Standards la. Yon elev ki 5 This student has success with the most challenging content 5 Este estudiante tiene éxito con el contenido mås difícil de las nan 5yém Nivo reponn pleti kesyon egzamen yo of the Sunshine State Standards. A student scoring in Level normas Sunshine State Standards. Un estudiante del Nivel 5 körékteman, elév la menm reponn kesyon kl gen pi plis 5 answers most of the test questions correctly, including the responde a la mayorfa de las preguntas del examen difikilte ladan yo. most challenging questions. correctamente, induyendo las preguntas mås dit folies. 4 Elév sa a gen siksé nan matyé kl te gen difikilte ladan yo 4 This student has success with the challenging content of the 4 Este estudlante tlene éxito con el contenido diffcil de las nan egzamen Sunshine State Standards la. Yon elev ki nan Sunshine State Standards. A student scoring in Level 4 normas Sunshine State Standards. Un estudiante del Nivel 4 responde a la mayorfa de las preguntas correctamente, pero 4yém Nivo reponn pile kesyon egzamen yo kärékteman, answers most of the testquestions correctly, but may have men Ii ka gen kék siksé selman nan kesyon ki sanble yo gen only some success with questions that reflect the most es posible que ebb tonga cierto éxito con las preguntan que refiejan el contenido mås dirka. pi plis difikilte ladan yo. challenging content. 3 Este estudiante tiene un éxito parcial con el contenldo (fiffel! 3 Elév sa a gen enpe siksé nan matyé kl gen difikilte ladan yo 3 This student has partial success with the challenging de las normas Sunshine State Standards, pero su rendimiento nan egzamen Sunshine State Standards la, men pefbmans content of the Sunshine State Standards, but performance es inconsistente. Un estudiante del Nivel 3 responde muchas lan pa rete estab. Yon elév ki nan 3yém Nivo reponn anpil Is inconsistent. A student scoring in Level 3 answers marw de las preguntas del examen correctamente, pero por lo nan kesyon egzamen yo körékteman, men anjeneral Il gen of the test questions correctly, but is generally less general tiene menos éxito con las preguntas que son mås mwens siksé ak kesyon ki sanble yo gen pi plis difikilte ladan successful with questions that are the most challenging. dif fåles. yo• ≥ Thls student has limited success with the challenging 2 Este estudiante tiene éxito limitado con el contenido dirka de 2 Elev sa a gen siksé limite nan matyé ki gen difikilte ladan yo content of the Sunshine State Standards. las normas Sunshine State Standards. nan egzamen Sunshine State Standards la. 1 This student has little success with the challenging content 1 Este estudiante tiene poco éxito con el contenido difícil de las 1 Elév sa a gen yon ti siksé tou pill nan matyé kl gen difikilte oi the Sunshine State Standards. nornas Sunshine State Standards. ladan yo nan egzamen Sunshine State Standards la. rCAT Certificates Students who earn Level 5 scores or Certificados del FCAT Los estudiantes que se claslfiquen en el Nivel 5 o cuyos resultados de clencias sean superiores a 400, %Mike FCAT Elév ki fé nät 5yém Nivo oswa elév ki fé gwo uhose science scale scores are greater than 400 receive reciben Certificados de rendimiento. En redaccien, los nät kf pi plis pase 400 nan syans ap resevwa Sétifika pou Dertificates of Achlevement. For writing, certificates are given certificados se otorgan a todos los estudiantes que han obtenido Siksé. Yo bay tout elev ki fé nät 5.5 oswa 6 ak elév klas o all students with scores of 5.5 or 6 and to fourth graders with calificaciones de 5.5 y 6, y a los estudiantes de cuarto grado que katriyem Id fe nät 5, 5.5, ak 6 yon skinka pou redaksyon. Yo 5cores of 5, 5.5, and 6. Certificates are not awarded based on han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados pa bay sétifika swivan nät elév fé nan egzamen ki baze sou he FCAT Norm-Referenced Test scores. en los resultados del FCAT cehido a normas de aplicación "mode' egzamen ofisyél FCAT itilize pou fé evalyasyon" (NRT) nacional. an. EFTA01710387 THE SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) New and Returning Student Registration NEW STUDENTS: Complete all non-shaded areas on both sides of the form. RETURNING STUDENTS: Review both sides. If the pre-printed information is incorrect, correct the information by carefully and lightly crossing out the incorrect information and writing the correct information above it. DISTRIBUTION: 2331 STD? RUN DATE: 08/07/01 (3) ST CENTS LEGAL NAAE past. Erg miadas) H) AL SO KNOWN AS (5) LOCAL ADDRESS Mousein A UAW Nina) (opt no) (OW (slat) pip code) (6) MNUNG ADDRESS (7/oua• no. 4 OM( AITAW0 Opt no) (c)ly) (state) (slaw:Is) (7) SOCIAL SECURRY NO. Optional) (8)143HE TELEPHONE NO. (0) SEX (10);RACETETHNIC ORIGIN w Di -American Indian/Alaskan Native 0 B-Black, Non-Hispanic • H-Hispanic F 0 A-Asian/Pacific Islander 0 W-White, Non-Hispanic 0 M-Multlraclal Oh DATE OF WM (12)PLACE OF BIRTH (cozy, suit oouncy) 03) RESIDENT STATUS 3 (14) USA ENTRY DATE 00414:0111/0 0 0. Foreign Exchange Student nuAtaavvvv) WEST PALM BEACH FL US FLORIDA 0 1. Out-of-county Resident (15) FEDERAL WACT SURVEY p 2.9ut-of-state Resident USI!.*17 In-county Resident YES NO7 (10 PRESCHOOL ENROLLMENT INFORMATION o p±The student resides on federal property. Place an X by each program attended. Also, indicate with • 20 /6 ." The student resides In low rent housing. an asterisk r ) the program your child was In the longest. 0 ' The parent is employed on federal property located in P.B. County. 0 N. Non-subsicized Child Care 0 M. Migrant Pre-K 0 The parent is employed on low rent housing located in P.B. County. 0 D. Pre-K Disabilities 0 H. Headstart 0 E. The parent Is In the uniformed services of the United States. 0 I. Pre-K Early Intervention 0 C. Chapter 1 0 S. Subsidized Child Care 0 0. Other 0 0 If E. Is YES, Is the parent on active duty? Check service below: (TY) IS THE STUDENT A (18) CURRENT GRADE LEVEL 0 Air Force 0 Army • Coast Guard 0 Marines 0 National Guard 0 Navy SINGLE PARENT? NO 09 0 YES 0 NO italgteXINOSairfettM „,„ \ itn it. ! . jtirla r\Z" (IS) NAME OF SO/OOL TRANSFERRING FROM (20)CRY on Locoman (21) LAST ATTENDANCE DATE (22) LAST GRACE LEVEL (23) LAST PUBIC SCHOOL ATTENDED IN PALM BEACH COUNTY (24) DATE ATTENDED IN PSC ElgattagagNitqlSFORMATIPN , , .. . FREE OR REDUCED REDUCED:- • QS) Students vall receive non-invasive health screenings pursuant to Florida Statute 381.0056(7)(d). Non-invasive PRICE LUNCH screenings may Include vision, hearing, scokosis, height, and weight. These tests may be given individually or (27) Have you fired out an in groups. Parents or guardians, however, have the right to request an exemption in willing. Hyou 00 NOT want your child to receive the screenings, write the words "Do not screen" here: application for free and (This exemption wet cover at types of screenings) reduced lunch? 0 YES 0 NO (26) I give permission for my child to participate In the sodium fluoride program to prevent tooth decay. • YES ONO (Application is provided (permission is veld through 6th grade) YES with this form) 11SEVY:i§IP,Ota",0.1PALAI BEACH COUNTYnal- r * ifia. a P, Mg HOME LANGUAGE SURVEY )L- is a language other than English used in the home? If YES, what language? Op4 4 ICI % 0 217...Does the student have a first language other than English? If YES, what language? pc) 0 er 3. Does the student most frequently speak a language other than English? If YEp, what language? (29) 4. What language Is spoken in the home by the parent or guardiant. IL r• 3\if k CA. A. 5\ VA (30) 5. What language is the students first language? (322e796ff LIVES VW. plink coo) (31) What is the date of entry Into an ESOL program?7 e (33) DISCLOSURES FOR ENTRY INTO PSC SCHOOL CTSTRICT YES 0 L as the student ever been expelled from school? Mother er Father 0 Both Parents 0 Other pe CUSTODY STATUS OF STUDENT (chock one) 0 Mother 0 Father • Shared Custody 0 Has the student ever had an arrest resulting in a charge? 0 3. Has the student over had any juvenile Justice actions? 0 Other (35) Is there a court order barring either parent from removing or contacting the student during the school day? 0 YES 0 If YES, provide the school with a copy of the court order. PBSD 0636 (REV. 5/29/2001) page 1 of 2 EFTA01710388 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION • (30) FATHER OR LEGAL GUARCW OSA snick* Melia( last) (37) MOTHER OR LEGAL GUARDIAN first mickIT•Mac rasp PU: Y • PU: Y ADDRESS MANN~neer, act name. aparlmenf number) ADDRESS (siredmatt sbre: name, apartrwr: number) CITY STATE ZIP CODE CITY STATE ZIP CCOE ROYAL PALM BEACH FL 33411 ROYAL PALM BEACH FL 33411 OCCUPATION OCCUPATION 1ePA Ilk .1 5 vfiforf Compieti PLACE OF EMPLOYMENT NUMBER NOME TELEPHONE SUSNESS TELEPHONE CB. PAGER NUMBER EMAIL ADDRESS (cptional) D AfkrAINEPRINATI0N CS.] SA gt:MENP APifil . . Person(s) other than parent authorized to pick up student (39) NAME Oat mato* inNal, lade (2.3) PASSWORD Ma* 10 characters) (41) NAME (Pat Inkrthe Arbet NV r ADDRESS faIsclnumber. steel name, eparlanzal nuns ADCftESS (etrix4 nombsv, skeet mem Oparthefal nuenbc) CITY STATE. •ZP CODE an STATE ZP CODE TELEPHONE RELAT3I4SHP (40) AUTHORIZED FOR TELEPHONE RELATIONSHIP (42) AUTHORIZEDFOR EMERGENCY PICKUP EMERGENCY P13(UP OTHER D YES O NO V O YES O NO (44) MEDICAL NFORMAT/ON (Nsl sturfesa illnesses. Cohort; heetth (43) If school personnel are unable to contact you In case of illness or accid Mouesalfagies. medications. or other phymcal Artrlaboist) may we have your permission to call your doctor or emergency services (91 ) for transport to the hospital? YES O NO (45) FAMLY PHYSICIAN (40) PHYSICIAN PHONE n ine (KR Does your child currantflve health insurance? OrYES O NO If YES, indicate: (47) HOSPITAL PREFEREIC O Medicaid El rNate e kk •fts teiesA- li dt0 e h O O Healthy Kicks/Kid Care Interested in receiving information itattN.WOO OtAtiLIATifigar Ogg s114 OALIVingairarittiVICti, ,... (49) NAME OF CHILD (190t midite, las° SCHOOL AT/END:NS STUDENT NO. (optional) GRADE DATE Cf BIRTH (50) NAME OF crew rest mdse. bra SCHOOL ATTENONG STUDENT NO. (0042040 GRADE DATE OF BIRTH (51) NAME OF CHLD (first middle. b s0 SCHOOL ATTEND NG STUOENT NO. (op*** GRADE DATE OF BIRTH (52) NAME OF CHILD (lint middle. RN) SCHOOL ATTEND NG STUDENT NO. (optional) GRADE DATE OF BIRTH PARENT/GUARDIAN SIGNATURE jEMO.FFIO.SgcPS)ta ., W ID) SCA W) OS STUDENT NO (55) COB %) ENTRY CO. (57)EWIRY DATE (MGR LY (H)M. I verify that the information given 2331 US E01 08/14/01 08 01 is true and accurate to the best of my knowledge. (50) TEACHER NO (61)REASSION ONE OR TRANSAATA71011 tea NTHMr. (64) HS* O MOOSE O Pain Tran 1 2 3 4 51 A O Parent/Student Trans. O Walk O Bike 6 7 8 9 T B2 (65) 00CULIEMATI011CHECNIStatert al 46 to naiad) O Immunizaborts (date) O Birth Records Verif. (da e) O Soc. Sec. No. (date) O Physical Exams (date) IIIIIII S/ S - /4Q DATE ( (46f DATA ENTRY COMPLETED BY DATE page 2 of 2 PBSD 0636 (REV. 4/6/20015.29/2001) EFTA01710389 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, s. 10D-3.088, F.A.C. and s. 10M-12, F.A.C. LAST NAME MI DOB 111O/DANR PARENT OR GUARDIAN Child's SS# (optional) STATE IMMUNIZATION IDO Directions: • Enter all appropriate doses and dates below. • Sign and date appropriate certificate (A-1, A-2, B, or C) on reverse side of form. • If the child is presenting for the 7th grade requirenientoSif and:has:previously filed a Certificate of Immunization (680A or 680A-I) with their current Florida school; fill in boxed areas below and‘Complete Part A-2 on the reverse side of this form. ,.... • For additional information: See,Arantinrizatiorr:ghidelineS.forghool4nrkChild'eare Facilities for information and instructions on form completion4nd imintriiiilitiaireipiirenients.-!.Guidellires.ait updated annually and are available from the local county health departnientr ' - - :,,. . . ‘' - '- :"... ' • x.. .- .• VACCINE DOE' ''‘, -- - Iowa .1),3?•0 3 'IC\Dose 4 Dose 5 CODE"." 64:Th. A/ l t `M.9.6 4 :Arlz- =map..Ail(R tae PA/YR MO/DA/YR DTaP/DTP2 t Der' Td` Polios Hie MMR (Combined)' (Separate)s Hepatitis B9 The state immunization ID# is an identifieeapplied-bighe statetimiauniptiotikegistry (optional). 2 DTP 5 doses required. If the fourth primary dosectSadininisteredtiroaier the fourth birthday a fifth dose is not required. DTaP is an acceptable alternative for one or more doses of DTP. 3 DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) 4 Td (Adult) Vaccine is recommended for children 7 years of age or older. s Polio 4 doses required. If the third dose is administered on or after the fourth birthday, a fourth dose is not required. WV is an acceptable alternative for one or more doses of OPV. Polio vaccine is not required for children 18 . years of age or older. Hib is required for child care and preschool entry and attendance only. 7 1st dose valid if given on or after 1st birthday. Second dose (measles) valid if given at least 1 month.after 1st dose. A second dose of measles (preferably MMR) is required for students in grades K-4 in the 1997-98 school year, and 7th grade entry and attendance effective with the 1997/98 school year. In each subsequent year thereafter, the next highest grades are included. Includes single measles vaccine (G), single mumps vaccine (H) or single rubella vaccine (I). 9 Hepatitis B vaccine series is required for seventh grade entry and attendance effective with the 1997-98 school year and kindergarten entry and attendance effective with the 1998-99 school year. In each subsequent year thereafter, the next highest grades are included. EFTA01710390 LAST NAME FIRST MI DOB (MOMMYR) Certificate of Immunization for K-I2 Excluding 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 of my knowledge, the above named child has been adequately immunized against diphtheria, tetanus, pertussis, polio, measles, mumps, rubella and hepatitis B (for kindergarten effective with the 1998/99 school year) for school attendance as documented on the reverse side ofthisform. Physician or Clinic Name: Physician or (Print or stamp) Authorized Signature: Address: Date: Certificate of Immunization Supplement for 7th Grade Requirement PART A-2 (Immunizations are complete for students who enter or attend the 7th grade after the beginning of the 1997/98 school year. Each subsequent year thereafter, the next highest grade will be included in the requirement.) DOE Code 8 I have reviewed the records available, and to the best of my knowledge, the above named child has received the following immunizations requiredfor entry and attendance in 7th grade effective with the 1997/98 school year: tetanus-dip ter, hepatitis B vaccine series, and second dose ofmeasles vaccine as documented on the reverse side ofthisform (boxed are Physician or Clinic Name: Physician or (Print or stamp) _Authorized Signatu Address: oyal Palm each, FL 33411 Lie. # Date: 51-/,*-no Temporary Medical Exemption PART B (For preschool children, children in day care and school children who are incomplete for immunizations in Part A-1 or A-2.) Invalid without expiration date. DOE Code 2 I certibi that the above named child has received the immunizations documented on the reverse side of thisform and has commenced a schedule to complete the required immunizations. Additional immunizations are not medically indicated at this time. Physician or Clinic Name: Expiration Date: (Print or stamp) (r9 dart after nest humanization appo 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 certify that the physical condition of this child is such that immunization(s) as indicated in Part C above is medically contraindicated. Physician or Clinic Name: (Print or stamp) Physician Signature: Address: Date: DH 6s0,11/96, °tacker" earlier eclitiorn (Stock[ Number 5740/003-0680-6) EFTA01710391 PANEL: A17. ABSENCE DETAIL YEAR.: 99 Tuesda January 12, 1999 11:22 am --STDT: SCHL: 169 clAig :46'.szt A . CAL: 01 VIPtc. START: 081998 PERIODS A DATE DLY 12345678901234 SCHL CAL FY 082898 1691 01 99 111398 A A006 PieldTwp 1691 01 99 010899 A 1691 01 99 PF1=HELP 3=EXIT 5=REFRESH 6=KEYBOARD 7=BKWD 8=FWD 12=ESCAPE NO ADDITIONAL PAGES...NEXT? TERML: CB1B uniAg eiata /J.& (4 axilti;(5 It24 P03 a4 Avic- uJ ak. A— - rbor „at tr Kit s3-0 maul aieuafr La4Pc A-(4/{-0-1-17 J1,4- ezom. A n. 01-0u- A•ewi 41_,L Wa-0 CAIll "64- 2-4-h` I -a yrac sac7- 4Qt O1a ot- 6Alta Aaa a et,w0 /ea"— /14A kamic- EFTA01710392 4 A10. CURRENT SCHEDULE YEAR; 99 12, 1999 11:21 am STDT: SCHL: 1691 GR: 06 ST: A HMRM: TM: 6A ST: A T: SY: 99 A COURSE SEC DATE SCHL T PRDS DAYS BLD-RM TCHR ST - 1205010 01 081998 3 0101 M/J MATH 1 MTWRF 00P21 2002040 02 081998 3 0202 M/J COMP SCI 1 MTWRF 00P19 2103030 03 081998 0303 M/J GEOG:AS, OC, AF MTWRF 00P20 10080104 14 081998 '404 M/J READ 1 MTWRF 00602 8200110 34 012099 8 0404 BUS KEYBOARDING MTWRF 00824 1001010 04 081998 3 0505 M/J LANG ARTS 1 MTWRF 00P17 PORT: PF1=HELP 3=EXIT 4=PROMPT 5=REFRESH 6=FORCE 7=BKWD 8=FWD 9=NXT 11=PRT 12=ESCAPE NO ADDITIONAL PAGES...NEXT? TERML: CB1B EFTA01710393 Name STUDENT RECORD FOLDER COMPOSITION Grades 3-6 tz-st PALM BEACH COUNTY PUBLIC SCHOOLS GRADE 3 INTEGRATED COMPOSITION F II Test'n Spring Testing School School Teacher Teacher Date • (0 - q5 Rank r--9 Date c / 2) Rank .43 The student needs further work on: The student needs further work on: Response to Prompt Response to Prompt Audience Audience Development Development Organization/Sequence Organization/Sequence Details Details Vocabulary Vocabulary ,entence Structure Sentence Structure <,..Grammar Grammar Mechanics LZMechanics UNIT EVALUATIONS UNIT ONE — Photo Story Date Ran UNIT TWO — Journal Entry Date //- " gc"-- Ran UNIT THREE — How-To Report Date -AA )? r gic7 Ran UNIT FOUR — Friendly Letter Date /a Ran UNIT FIVE — Story Ending Date ~log5 Ran UNIT SIX — News Story Date Rank UNIT SEVEN — Book Report Date Rank UNIT EIGHT — Descriptive Paragraph Date Rank RANK: 4 - Outstanding 3 - Reasonable 2 - Minimal 1 - Insufficient FY 94 PRINTING 3CMPRF EFTA01710394 THE SCHOOL BOARD OF PALM BEACH COUNTY PALM BEACH COUNTY, FLORIDA 6 KINDERGARTEN REPORT CARD KINDERGARTEN CHECKLIST MARKING CODES Student: formal instruction has not yet begun student receiving formal instruction to meet specific needs and ex- Teacher periencing difficulty with skill student receiving formal instruction and making satisfactory progress student consistently performs skill accurately and efficiently The asterisks (*) indicate critical skills.• School: CENTRAL PROCESSING LANGUAGE 24 3rd 4th BODY IMAGE LISTENING Imitates Body Movements I.1 Recalls Information 9.1 Identifies Body Parts 1.2 Predicts Outcome 9.2 Principal: Assembles Body Parts 1.3 'Retells Story 9.3 GROSS MOTOR SPEAKING Creeps 2.1 'States Full Name 10.1 Runs 2.2 Describes Common Objects 10.2 Uses Complete Sentences with The areas listed on the checklist as well as music, Jumps 2.3 Proper Speech Patterns 10.3 art and physical education are included in the MOPS 2.4 PREREADING kindergarten curriculum. The checklist is composed Balances 2.5 Interprets Pictures of skills that are essential for students to master if Gallops 2.6 Recognizes Labels they are to be successful in the primary grades. All Bounces/Catches Ball 2.7 'Recognizes Own Name activities provided in kindergarten lead toward the HAPTIC 'Ilkistrates Story attainment of these skills. The teacher determines the Moves Through Obstacle 'Recognizes Letters appropriate time for the student to begin formal Course 3.1 instruction in each skill. Beginning with the second Follows Commands PREWRITING Using Body 3.2 marking period, the checklist is used to report student 'Demonstrates Mastery of Identities Objects by Touch 3.3 Fine Motor Skills 12.1 progress. Sorts/Matches Objects 'Reproduces First Name 122 by Touch 3.4 FINE MOTOR/EYE HAND NONACADEMIC BEHAVIOR Strings Beads 4.1 GRADES /ft Assembles Puzzle 4.2 This grade reflects the student's overall conduct in Copies Shapes 4.3 ENVIRONMENTAL AWARENESS all school activities. Matches/Pastes Shapes 4.4 Cuts Circle 4.5 2nd 3rd 4th 4 = Very Good Colors Objects 4.6 3 = Good Observes Accurately 13.1 Sequences Fingers 4.7 Makes Comparisons 13.2 2 = Fair Parent conference requested. 1 = Poor VISUAL DISCRIMINATION Predcts Outcomes 13.3 Parent conference requested. Sorts by Color 5.1 Phrases Significant Questions Sorts by Shape 5.2 Stalking Period Sorts by Size 5.3 Matches Pictures 5.4 •Identilks Likenesses/Differ- ences of Numbers 5.5 ' Identifies Objects by Relationships 5.6 MATHEMATICS identifies Likenesses/Differ- ences of Letters 5.7 2nd 3rd 4th NUMERATION Identifies Size Relationships 5.8 'Matches One•t0One 14.1 ATTENDANCE Marking Period VISUAL MEMORY 'Names Numerals 0.10 14.2 Regular attendance and punctuality 'Recalls Colors 6.1 'Matches Sets and 1st 2nd 3rd 4th Numerals to 10 14.3 are essential for quality education. Sequences Shapes 6.2 'Identifies Ordinal Position 14.4 Days Present 'Sequences Numbers 6.3 •0 4 45- ' Sequences Letters 6.4 FRACTIONS Days Absent c2) 6 — I / 'Identifies One-Hall 15.1 AUDITORY Days Tardy 7 sA II DISCRIMINATION Names Sounds 7.1 GEOMETRY 'Identifies Shapes 16.1 INFORMATION INCLUDED 7 1 / 'Identifies Likenesses/Differ- / ences of Words 7.2 MEASUREMENT TEACHER REQUESTS CONFERENCE 1 1 17.1 Identifies Rhyming Words 7.3 Compares Objects wentules Likenesses/Differ- 'Orders Objects 17.2 ences of Sands 7.4 Identifies Use of Measurement Tools 17.3 AUDITORY MEMORY *PLACEMENT Repeats Sound Pattern 8.1 Measures Objects 17.4 Grade —Licy— Summer School Program Repeats Sentence 8.2 SPECIAL TOPICS 'Sequences Numerals 8.3 Identifies coins 18.1 'If summer school program is indicated, grade placement 'Follows Dkections 8.4 States Values of Coins 18.2 will be determined by the home school. "Sequences Letters 8.5 Joins/Separates Sets 18.3 P850 0767 FY 93 Revislei Goldenrod/1st Period Pink/2nd Period Yellow/3rd Period Green/4th Period While/Office Copy CC 6307 EFTA01710395 arc . 200;4 4 thinker* *bole number '„. 1/.1 *delaHIS wl"111" Ins " IL tin ' El 123 to find a missing ning tarn siren a pair degas! `• 83' mortis ?men toe qv both maten are ,;rod;min the odor form 0 'loader whole numbers and decimals 8.6 *change footle;and.reixeintimtert: wMlen,m,betup to 6 12.4 in write a percent as a incites ,r decimal and 1.4 toted and subtract vice vent . ' 0 dm-grab a* *covet* • t• mess 81 to solve related problem in tannic sat _ id round Whale menten and titian 12.5 to find a mare of a numba 126 to write a probability ratio (or a tiniatien 9.1 D unite a lido intim differern.ways , ae toadd ind sitar Orimals through thinwats involving vitally likely events • 9.2 *rite:MiltMick( ittiti nibs are Nu* 7 • to solver WS.4. pisklans Initallofic attlidp ❑ I27 to wive ;elated problems in tealistie whop C 93 (Intl nitsing terms in prop3sions 13.1 tofu* the areas of rectangles ancisquarth 0 9A to kin* die comic tazionica fora gra . 21 Devalune addition and subtraction expiation, • - •• O 132 to identify the number of bases. otha faces. edges. and vertices in prisms and pyramids - 93 to trite the proMbditrntientsirriong 2.2 to (mite aldizion. subtraction. and muhiplica • don thigessint O 13.3 to find the volumes of rectangular plasm' a *Zak y°9103 66 • • 96 to.salve timed problemin realistic Sane 23,.to find tte least common muliipk of MO or ❑ 13.4 to solve related problems in realistic settings ci 10.1 Dre* congruent rote parallel puts grit der Merles figure end in slide or.flip ithage • 24..to find oodlesof 2- and Idige multiplicands Teacher: 10.2 toadennfy . Foilsmen art/parallel tins and I-. 2-. and 3-dtgamuleplies Comments: given a fireless:Air lt71..or I 1 ' 23 to solve related problem in realistic settings ❑ 3:l tocydiwe bale fact expressions ❑ 10.3 to iderxify figures a tidying turn and/or Ith 3.2 to divide by 1.cligit divisors a synametrY C • • ; • 33 •to divide by 2-digit divisors 10.4 to write the caked pair fora given paint o . 3.4 to find the prime famorthadon of a number 0 Level 6 • 33 to find the greatest common factor of two or .. 1.1 to idcmify the value °fa digit by its place a 10.5 to classify pictures of garnet* *lids •• • Three nun s • whok number or decimal 10.6 to solve related problems in realistic wing 3.6 to solve related problems in realistic seamy 0 1.2 to round whole numters and decimals 11.1 to write a german for di shaded•poni0nott 4.1 *fiddle mean. median. arid range of a set of 1.3 to add and interact decimals through ten figure • • • • • • . • , dan 0 thousandths • 0 112 to write fractions and ckeimals as ream' 4.2 to analyze den in Ethe Fern 0 1.4 to write one-variabk addition cc subtraction 11.310 compute a patent of a number ' ' " 43 to analyze an in double-begraphs and ❑ • exptessions involving whole numbers, 11.4 to computtelescke gitql theorigirialpic double-line graphs ' • IS to?wive mined problems in realistic satin, 0 and diswras[}ar!' - 4.4 to analyze dan in cirele rapid using fractions 0 LI to evakiale one-vanabk multiplication • II-Itocarp= tones; given the pricsand ru 4.5 to soke related problems in tali* swings 0 expressions 1 0 rate , • Si to give the Conan ufil obi= . 0 22 tO Wive muPiplication equations 0 11.6 tot:emu" annual inners gnat the rimer 5.2 to find te miners of a Irgobra irregular. 2.3 Druid the leap common multipk of and interes rase OIrE 6 a two numbers 0 11.7 to!dye reined problem iitiealMiesetingt 5.3 to add and subtract unia of time to find elapsed 2.4 to multiply whole numben by 2-digit ' 12.1 io find etc wade manglerMale Mtos . time 0 multipliers • 0 • 5.4 to compare times in dictates 1.13. dine zones. 0 23 *muttply dentists by whole numbers I 0 12.2 to find die arat and przineterbfa trinigle . 0 -5•5 aspire runt! Pithier,* in molar settings 2.6 10 miikiplydecitnals by 6:cirnals . 0 12310 fitd the ales of pattlkloimm •• 6.1 to multiply decithals trough tents by whole 7-7 to solve related problems in realistic settinp 124 to 64 the aplitoxiintfe 664 bilacirck •. •• tai nlbes • 0 3.1 to solve division equatom 123 in raid the volumsofa rectangular.piles: . 6.2 to multi* decimalathrotto thousandths by 12 to simplify numerical expressions mini the 12.6 to solve (eked problems in:realistic ;sittings • Atholentuntat- • 0 °nitro( °pennons • 63 io Multiply decimals by decimals ❑ 13.1 to write new tempaannagiveri tiro ii 3.3 *divide by a 1- or Zdiglt divisor I 3 increases from given tenthearthet • • 6.4 MulliPlY Money intents by :Mule numbers 3.4 to find the prime fanixizatien of a number D 132 to ordir signednumber . and decimals 0 • 3.5 to findfie meat common factor of two 6.5 to Solve related problems in =link stoning? ❑ •- t 13.3 to add two signed numbets:with unlike sign numbers 13.4 to subtract a biter whole number front a 7.I• to divide a &ibnal by a I -dish whole number 16 to solve Maned problems in realistic satiny 2 • with quotient to thousands 0 4.1 winter kne pica • J " 72 to write mot* place holden indarnel ❑ 115 to nitre datzet4 dine 4.2 to find and use meant median. mode. and *nee 13.6 to solve rehied probierniin Slink inings quodent *describe dap -• • • 7.3 to esdnumand . divide a money amount by a • ' • •• . . 4.3 to analyze data in tor graphs Teacher: t .wbole number 0 4.4 to analytic dua in line graphs • . . • 7.4 to Ina:ally 'divide a whole number by a whole 43 to analyze data in circle graphs I Comments: number, with a decimal quotient 0 73. to solve related problems,in realistic seninp 0 Ii *divide a whok number by a smaller or larger_ whole number I • 8.1.6 Classify. quadriLuerals by appearance 0 5.2 *divide a money amount by a whok number : 82 to reompure the congruency of corresponding 5.3 to divide a decimal by a decimal paste of a figure and its slide, flip. - r Level? _ . . .. . • • . . . mein% image ' 0 5.4 to round decimals 53 to estimate unit prices codetermine the bitter - - 1.1 to road whokiitintherun•eldedthaft ; • 83 tojdentifyfiguns andloraurn 1.2 to add and subtrandetinials. 7.. , synergy 0 buy , 5.6 to solve related problems in realistic sating:a Li to write variable expression . 8.4 to Classify thangks asequilatend, isoscelet or 1.4 to write 1-stepadd/donor hibernation • solar 0 6.1' to write equivalent curtailer units — • 6.2 to write equivalent mark win equations for reined problemS, ▪ 8.5 matinee rioted pars of whole mantel with paints on a grid 0 6.3 to classify angles as acute. right, obtuse. or _ 1.5 to solve I -sup *Mort oraubtaiticit a••••. • 8.6 towlve seined pr0blettis in tealisti satiny 0 I equations ;. 9.1 tO ivrite %vivaria crashers and fractions in 4 Stotraigilltbe circtunferate of a cisek lincl 2.1 to solve one-step multiplinticit •Ottfivision Papist form- 0 63 to construct a circle graph and to identify taps _ equations 9.2 to write mixed nurntets and whole manta as related to clicks . — 2.2 to sirtnplify evaluate. Compare:1nd cirri fraction greater than one ad rice versa 6.6 to solve elated problems in realistic sittings Z exponential expression ' 9.3 to Compare and ode &anions and mixed 7.1 to write fractions plater than 1 as mixed _ 23 to find die least comrnorr multipk of 2 Oil numbers 0 • numbers and vice versa I — • 9.4 to salve reined problem in realistic settings 0 7.2 to add and sulanci frardons ard mixed 24 to solve 2-step ethttrions • • I ilt attl or Subtract fractions with like nuristen with like &nominalism 23 us solve related problems by writing linear deranintiors 7.3 to compare and order fractions with like and 491446016 • 102 fo Os or tonna fractions with unlike unlike denominators 3.1 to evaluate simple multiplicationnorm-owe derspninucts 7.4 to mentally add and subtact fractions and with decimal replacements 10.310 adds snort mixed numbers with ei mixed numbers in which ate denominator is a 3.2 to multiply decimals by decinult and by adroit hit or unlike dmorninnos. no regrouping 2 multiple of the other numbers 10.40 subtract ranted nu mten with like or 73 madder subtract customary Measures 3.3 to divide decimals by whole minters.td by 7.6 to add and subtract fractions and mixed 1 (lanais • • urdike denominators, ors. requiring repaying D. MI to solve related in =liege settings Z. • numbers with unlike denominators in which 3.4 to compote picas to deten6ineibe best 64. . :". 11.1 *Multi* fraction by whole numbers neither is a multiple of the other 3,3 to writeand:multiply numbers-in sciaitifiC 112 to mtthiply fraction by fraaions 7.7 to solve related problems in realistic seeing, Z notation ' 8.1 to multiply fraction and whole numbers 3.6 to solvelewd problems in realistic semis • ± EFTA01710396 name and ognasissi 3.4 in caloadise the utida.ui eve!.;rag ovally plebs O likely ' o 73 to mite lantining gad 43 to analyze dies lea wale 133 to determine the pvtehnny Mao flan O die ratio of hin. gain • 5.1 to determine pecitica aradgmatest pang* 13.6 m prolia duepribillslity ofinevert when 76. to solve aged pateemsi i • cent./ a lints Maitinirnall a -1101 aully likely O Al to write and we pruportin t, les multiply rah do* teas adnlarartg lay 13.7 to use a randart manta table to solve whole nurnben O 8-2 to use ratiotot owe/Wen tensa; modems ❑ from ere customary unit to mote I° :53 m irlissify dial:rag .types of stiles eelpia ofO' '• • 8.3 ps fisd percent penzonge or btu Ngles Teacher. 5.4 Loftin trA trait a eitele graph Meatier two are given rented problem in restate wings 0 8.4 to ompute simple and cattpewel • 53 to solve Comments: • O 83 to cempute salts tax, 6.1 tot/nava *via fractions 62 to order fractions from lent to groan O ant narb4. , . 8.6 to use tea apratonet prim indp co esda4e, 63 to add ad maraca fractions with catlike damsel in nix • O 8.7 to solve retard problems in malign solids 6A to solve apntiolls mithfacOre O 9.1 to simplify expressions by conibining like; 63 to add and subtract mixed numbers, Main* Level 8 • • • O it to identify elements of the ccenmuutive. tams a whole numbers O associative. and zero popmies for aderitkel O 9-2 to save muskeg consoling life tents • 64 to solve related problein lit realistic Settings 93 to simplify expressing by using the dismlitnive 7.1 to multiply Mains and mixed mantas O 1.2 to write a variable equation locatable or a ptoblem situation O property 72 to mite and use dre recipmcaLs of fractions and 9.4 to solve equating that apply the disuibutive • whole numbers . O 13 to detennine whether two ante ovarian at equivakni O Pf9FritY 7.3 to divide fractions and mixed numbers' ' O 93 to solve and grar the soling* set for 1- and 7.4 to was a Inane or mixed nominees a 1.4 to solve ore-sap addian and sultan:a . . equations in one variable ❑ 2 istep Spain • - decimal and via van O • IS odetennine wheMer inenstlisy is tree 9.6 to win options.or ineastigies for stated 73 to solve 1, aid 2-sep equation wit fact= re and mixed numbers Q false for given values of die variable O 1.6 to solve related problems in realistic settings O 9.7 to solve related poisons n realistic swings 7.6 tp solve related problems in realistic settnis O • 10.1 to identify ins:fes as trieslationt tellections. 8.1 to add signed numbers O 7..1 to simplify ccenpuuton by using the propenin andraatiors flpan: - 82 to subtract signedmantas • O of multiplication O 2.2 to multiply and divide decimals I O 102 to iderrify cotsgmen sides and *legin a 8.3 to multiply and diode sigried nurntas O figure Ind ilia 8.4 to Waxily equivalent foam of signed numbers O. 23 to evaluate expressions involving ado of • 10.3 to identify angke relMOOOSigya given hues . opetion inchiding examen O 83 toSolve 1— an:12.step musing with sipiech parallel lines and a agOiersal • • Mantas' • • a 2.4 to solve muld photon and division cessations O 10.4 to fmd the length ofintifile philight miemsle 4. 8.6 toverite the inequality (resents graph O 23 to solve two-sepoustion in one rentable O given de lengths of tte other two soles .81 4 min allied problerns in really& sto w a 24 to solve related problems in statistic settinp O 10-5 to apply popatinofinalar figures 9.1 4, use tit wale damp et sea &nog a , 3.1 to interpret data presented in a line pioz O 10.6 03 sole related problems in realistic settings : 91 to find a percent of a number • O 3.2 to inierpret danpresented bi a sem-and-leaf 11.1 to find its atria eta trapezoid ; ! 9.3 M find the patent when the time • Pint O. 11.2 to fmd the so of a cale • . pates tagean given 3Y to interpret data presaged in a fnamencyl a I1.3 to fwd the 'Mace trea of a prism a pyramid : Q , 9:4 to Ad.the base I/tram= of it is Itmown a histogram . a . 4. z.3.4 iii find the upper and Iowa quanties for a uem- 11.4 to fool the surface metaa cylinder t 94 to fed timple interest O 11.5 to find the volume of a psismce cylinder ' - ond•lof pia 9.6 th calculate pavan of increase or decrease • O I find the median tad quartiles (roma ' 11.6 to find the voturtm, again. and mass of wale 9.7 to solve reined-problems in realmic sett ini - O . 3-5 M • box plot O in given is inetriC dimensions 10.1 to recognize transigias. reflection and rum ,• a 3.6 so solve reined problems in realistic settings O 11.7 to solve tonednada= in realistic fl ings - images of figures 4.1 to identify in.a diagrams radius. diamear. 12.1 to give the condi:ran of the vertices of an 10.2 to identify the medians and attiturks in ' semicitsk. nujor arc. and tninor me O Stage:triangle alto a refleetice— or hall(-can Mangles ' O 42 to find distance M nautical milestenvem 122 to give the condenses of the vertices of an. 10.3 to use tatsformadas to identify congruent .1. • nvo locations on earth given their antral angle O image triangle resulting from a translation line segments and angles great in a figure and- 4.3. to find the length of an as of a cafe given the 12.3 to list the Send pairs-Mal belong to 4. given _ ' its turn image O measure of its antral angles and dr radius of reLvicin 10:4 ad idanify the scale factor in rwo similar die cluck ' C I2A to &turning whether a relation is a funcdce Mangles given theirdimensiorg r• 4.4 to recognize lines of symmetry in differmt 12-1 arta a aziphito Wye a syrem of linear 103 to identify perpendicubr. parallel, and skew figures t-i equaling • • • edges of a sight month: prism a 12.6 to solve relied problems in realistic settings _ tasoi solve related problems in mastic settings O., ' 43 m rec9/O24 4964ave• convex' and retiuliar 13.1 a detennine the didactical probability of _ PalYficAls 11.1 to calculate pennon and area of parallel> 44 to solve related problems in realistic soar equally-likely even • grams O I3.2 w deennine she thew:idol notability of the . 5.1 to compare and order tractions and mixed 112 to caloilaie Mignon and area of Ma/4ln O numbers accurate of eider Of two mutually exclusive I I.3 to cakunte penneter and area of trapezoids O 52 to add and subtract fractions and mixed event!' 11.4 toplculate de area of a circle O , . numbers to doennine the ditaetital probability of the I '15 to a volumes of prism cylindas. 5.3 to multiply fractions and mixed numbo4 cccurrace of adi of two incieprocant vacs ' cores. and mond' . O 5.4 to divide rots and mixed numbas OA to determine the theca:tied probobility.dthe 11.6 to catalog the surface area of pins and 53 to solve one- and two-step equations I:incurrence of both oftwe dependent event cylinders 13.5 to ?ermine dr . number °Combinations aid 11.7 to solve rebated problenn in realistic settings O contairing Frieda* permutations possible fog a given set of objects C in to solve one-step inequalities 34 to solve related problems in realistic settings O 13.6 to solveyelased pothlattin Statistic settings O 12.2 to find and graph ordered pairs.. . ... 6.: to compare two signed numbers 1 ❑ 123 tonne the coordinates for a aandation image ^..... 6.2 to add two sired numbers .3 63 to subtraa two signed numbers Teacher. eta given point . ..., 12.4 to •yniteitticoordinnes fors reflection image 6A to multiply two signed numbers Comments. of a given point O 63 to divide nvo signed numbers 12.5 to,write the coordinates for a half-turn image 64 to solve one- and two-step equations involving oft given point 1.... " ; signed numbers 124 to solve reused problems in nialinc settings O 6.7 to solve related problarts in realistic settings 13.1 to calculate the probability eta event smog 7.1 to write expressions using positive exponents equally likely outcomes rt —, with negative exponents. and vice versa I 2 E l i D,C. Heath and Company LexingtonNassatusens / Tonto HEATH • Cepydghtt 1992 D.C.Headt and Company 1415. 9 EFTA01710397 Cumulative Record Folder indicates topic was studied ' 21 indicates topic was mastered Lend IC 1.1 Wady, demote. and pat an object In II.; tell meta the hour ❑ 9.4 to anti= ,]sties and sutencuon (la . a specific kcal= above. below, next 11.4 mach a grainof Cakes *a pnce lamas to. top. Conan cn croft ❑ IS desaike an evert in ants or its chase of 9.5 tO sole relaxed probiom in tali* settings 1.2 Jambe to object a being Wt or tight happening O 10.1 to measat krigths in inches aid centimeters of anodes object ❑ 11.6 discuss the 12 moan of the year 102 to estimate which of two pictured object is 1.3 physkally represent movement along I 1.7 ascribe the weather cacao:auks of ach of heavier even open and dosed parka die fair seasons 10.3 to choose the alleiropine thermometer for 1.4 deseribe an object in a specialc Ication 12.1 identify objects aid flames with equal pads O piaured clothing ot weather usivg parietal arra 2.2 use die attributes of length ad area to divide 10.4 to choose the comet mentoing tool 21 identify an object toe Ls different fan objects and figures into heves. thirds. or 103 attain raced problems in realistic settings *a object, u founds II.lib fad how many in all given several 22 identify and (Mate an objea tha is the 12.3 use the anxibutes of length weight and area to • . equal sets same as a differna torn maker object solve simple grouping problems in one arena ways O 12.4 solve simple problems involving grouping and 112 at find how many sets can be made from . asetofobjecn 23 sort theca into gawps on the tests of cattiConing ❑ their* I!3 tared hone many are in .1. }.a}" 12.5 use a calculator to awe number pine= O of a set 24 eau* and centime Ikea pontos using objects pictwes of atm with 11.4 to separate a group ot objects into coal sets. Teacher: identifyingov many kft hocrv.i many in each set and how • wallahasuses C 2.5 seta a specific object from a given Comments: many left '• gat of object ang de pans of II-5 to solve rased problems in reallsec settings ' climatal and logical dating ' 12.1 to add a I- or 2-digitmonta to a 2-digit 3.1 tae *mac needing to &sonnet if number IWO &TIMM are equal a not equal in '22 subareas l- or 2digit number from a • anger • Level 1 2diga number 34 comma a gnxtp equal in numba to a 1.1 to count 1-20 objects 123 to SOINt maid problems in realistic sentries • &ma flma ❑ 12 to write numerals 1.20 33 use representabons tocompare ard ceder i51 Teacher:J • mom than two gate 1_1 to determine which amber is taiga a smalkr and which a ofobjects ant* more a fewer 05 Comments 3.4 use tally marks to represent symbobally • the number of abject a a group f O 1.4 to count how many objects In a collect* are 4.1 identify ow-dimensional shapes as laces a given aortute 21 a three thmensiong Naas 13 warder numbers 1.6 to solve elated problems in a tealispc; stains 42 cram a single whole goia from Om Palls 2.1 to find how many in all using pawn of Level 2 4.3 ore= pas= of two. and daec-dinunsiong objets toconnote 20 objects in a set , objects using pastoral locations& 2.2 to add zero to a number .2 main de nornaaht 0.20 and dimetionalrobrionshipe a 2,3 to find sums through 6 I.3 to conspire tWO nurnerils nvo sea *fajta:1i 4.4: gasify themad figs= In diffam 2.4 ro find the sum of pennies in two picand IA to aorta a pogrom and condnue Of . orimarions O Ma% ciantlae et • 5.1. Identify a given numerrl (0-5) to reptant 2,5 to write addition number unterces 1.5 *solve as* warns in realistic lacings the quantity of a given gag 2.6 to solve related problems in =Banc settings 2.1 toad tweet dote namkers with 5-2 mite numerals firm 0 to 5 O 3.1 to solve subtraction facts through 6 sums alt 5.3 use ordinal words fire through firth O 3.2 to subtract to compere groups 2-2 to find missing addends 5.4 solve simple vettel problems involving 3.3 to solve related geoblems by writing number 2.3 to solve subtraction facts through 12 subtraction ❑ saunas a subtraction facts 1.4 10 complete addition and subtraction rich 6:1 chafe the long:slasher= object from a 4.1 to write addition facts through ill for pictures a families • of obtaa a 4.2 to find how many ane kft W a group 2-5 to solve related problems m realistic settings by 6.2 bola more than two objects on the basis of 4.3 to write samara facts through 10 for finding how many (evict or length ❑ paw* et tare by subtraction 63 identify. continue and crustaceans with 4.4 fa to complete addition and subtraction fact 11 to coat objects and write tow many tens and tepid to length and one** O milies 6 tea 6.4 pse physical and picurial representations to 4.5 to solve related addition and subtraction fact 3.2 to write a number up to 100 in differtni forms PUMIAlit ind order lengths families 3.3 to compose two numbers up to KO 00000 7.1 dotty synanary 5.1 to count up to 1C0 objects and write the using <>. or a 7.2 cows annex with congruent figures numeral 3.4 to write a sequence of number up to I03 in 7.3 identify and illustrate slides 52 to compare two angers, 0 through 99 circa 7.4 Identify and Warm a* 53 to order nurnbess to S9 3.5 midget& flutdiers as odder even &I Identify a grasp of a given sire with a 5.4 to identify ordinal positions. through tents 34 to identify *eat in a picture by their ordeal 'numeral 640 5.5 to solve related problems In realistic settings names Ll 00000 8.2 identify and contioue a numerical patron 6.1 oidcntify and order the d.ays of die week 3.7 to solve rebned problems in realistic settings 8.3 ortkr two or more natal 62 to read ad write time to the hour a half hout 41 to solve addition facet through 20 8.4 µse ading worth first through tenth 6.3 to count and write the value of a collection 42 to add dace addends with sums so 20 83 equalize groups claim 43 to solve subtraction facts through 20 8.6 solve simple probkms involving addition and 6.4 to den:imam whether there it enough moray 4.4 to complete addition and sutaaction fact Subtraction in a collection of aim families 9.1 tyse physical and pictorial represent:dials to 6S to solve related problems in realistic settings }2 4.5 to solve related problem in realistic servings compare and nets rwo figures on the basis of 7.1 to add three I digit nuts with sums toll 1 5.1 to tell tine from an analog clock area O 72 to write addition saw* for pica* 5.2 to wax MUM in order 9.2 &` cog nut titan= of a figure is the same 31die total and of its componimts ❑ 73 townie salaam sentaices for pictures g lid 5.3 to know de Intledflot the year in sequence 5.4 *count combinations of coins • 7.4 to solve subtraction fact through 12 0. 9.3 pzlentify a pictorial rcpesentation of a weight 7.5 to complete addition and subtraction fact 5.5 to solve raged problems by telling how much comparison 9.4 it TOM than two objects on the basis of ❑ families time has ti46ed 6.1 to add motets of ten to multiples nf five 7.6 co solve relaxed problems in realistic settings S r neighs 9.5 mance and order containers on the basis of FOPElY C 8.1 to draw a figure with a given number of sides or comers aim 6.1 to adds 2-digit number to a k or 2-4 igit number F 8.2 to identify figures that have a line of syromeoy 1 lot Tad and write the numerals 11.20 3 63 to addmoney smart 8.3 to identify firt(04 divided into equal pats X 10.2 *stun a pap of a specified size O 6A to adddaee24igit addends 8.4 to color I. . or deplane 10.33.Plve simple problems involving addition and figure 43 to solve selaid *bans III realistic utungs *aka 0103 o 8.5 to solve related problems in realistic settings 7.1 to recognize solids in pica* 11.14 ante &single event in tams of its 7.2 to manna 'maces of plane figures daytime a nighttime 9.1 to solve addicts faces through 20 ZA ❑ (te.sides sedans) 9.2 to valve subtraction facts through 20 EFTA01710398 7u3Joilt":""" """ 7.6 toMee rehired prookrhs in realistic sating, ,.......,..„ , g in to save related probtans in :Max CIF 6.1 to find missing fat-ors • 6.2 to complete (xi families for mulaplicaion a ❑ 4.4 to know tonic division (acta multiplication'and 4.1. to ,ulerammultiplei. 0 fives and tern from K division se tenon ❑ 43 to solve related emblems in ra 6.3 to solve multiplication and division fatt with bs« km multiples of fives and rem 5.1 to idmnty and Cesaite 8.3 to subtract a hoc 2digit number from, 2<tipC 6. 7. 8. and 9 ❑ angles chareeterisnotof rip number 6.4 to solve related problems in realistic settings CI 5.2 to identify and draw slides 8.4 to subsea a I- or 2-digit numy stmetra gran ir 7.1 co identify examples of slides. flips. and half 5.3 to pkt points ona grid horn 2-digit money amount 83 to solve related problents in teaCc cp 9.1 to measure the length of an object using an p,.. treats by position. shape. and size 7.2 to classify angles as smaller than Equal to.« greaser than a nght angk CI 5.4 to find die asea of a figure «deredpairs 55 to solve related pmblerns in realistic settings 6.1 mamba* 2-digitriumters inch ruler 73 »dam lines of symmetry in a figure 6.2 to multiply 3-digit numbers 9.2 to estimate (be weights of (unitise objects as 12 7.4 to enceinte:solaced pair of kaos and 63 to&Oak 4-digh runben - lat diax or more dun a pared numbers with a specific square on a grid 0 6.4 tqgolve related problems in realistic settings 93 to commie capacities measured in customary 7.5 to solve related problems in realistic sating, a 74 tt; maw 3-digit dividends by I -digit units 8.1 to write franktos for shaded figures ❑ 9.4 w message the length of an object using a 8.2 to write mixed numbers for two a me shaded 71 to Arvide 3- and 4-digit dividen'ds by 1-digit ceninmer tuler 9.5 to estimate capacities of farniliar amain«, at NP- figures divided into copal pans 83 to read an analog clock and write the time using❑ ❑ divisors 73 to divide 3- and 4-digit dividends by I -digit less dun, abort. or mom Measlier .21. a fiction divines with wain the quotient including 9.6 to solve related piobians in realistic settings ..K 8.4 to solve related problems in realistic settings 0 money 10.1 to con*C addition :Mintres for equal sen 9.1 to mescaline segmes to the nearest 7.4 to divide up to adigh matey dividendltibY I. 10.2 to complete muhiplication sentences for inch. half inch. or centimeter C3 digit divisor% C3 • Nitel sets ;5 92 to fuel the perimeter of a polygon 73 to find die whole number ava-age'bfup to.5 103 utisotve multipp anon fax Cough 6 9.3 to choose the berm«tannery or manic unit ~Men - 10.4 trade tolind how many sen of a given size can X horn a pouted set, and how many will fora given measurement 9.4 to compare two mantra in unlike customary ❑ 7.6 to solve related problems in realistic settings : 81 to writ Maims representing shaded parts of . te left over wits ❑ Fraction Bars 103 to solve related problems in realistic settings 93 to read time to die minute famn 82 to write an equivalent fraction with a given' 11.1 to identify die number of ones. tens, and - I f analog clock ❑ dationannix hundreds in p 3-699: comber E3 . 9.6 to solve related problems in realistic scamp C 8.3 to capon ad order up to tow twice* C •112:65;fite In arodard form a 3-cligit manta 10.1 to write tenths decimals for fixtioro. mixed 8.4 to find a fraction of a whole number ' • Moist in eitendedlbrin numbers. and word names ❑ • 83 to represent staled pans of Fraction Bap by • 113 to Tmene 3-digit numbers using < and > t I I IA to conanue a sacra of 3-digit numbers with . a otirnmon difference of 1, 5, IQ 50. or 1DO • e 102 to compare tenths decimals using c, >, and. 0 10.3 at order up to 4 tents decimab 10.4 to add and subtract 2 tendu decimals ❑ CI both fractions and mixed numbers . • 8.6 to solve misted «them% in realistic servings 9.1 to addend sr.ibna like fractions 1130,91m relaxed chime inreds« avian 10.5 to solve related cinema in realistic settings a 9.2 to add two fractions whet ore denominaux is 12.1 to aid two 3-digit numbers with no regronpitsig 12.2 to kids 2- a3-digit number to a 3-dlgit L at to!midi* 2<ligh muldpicands by 1-digit tt midge«the«me multipliers 9.3 to subtract two francs when ore matiber with rellicuttn8 . 1/4-1 Ill to muldplytivee_I digit factors C ' demist is a multiple of the other • 7. 123 to ,abtract two 3-digit numbers with no frefacansing 12.4 to sebran 2-or 3- digit number from e ( 11.3 to multiply 3-digit mutt:lotions« by 1-digit multipliers 11A to multiply 3-digit money smarm by I-digit ❑ 9.4 to add and subtract two lille mixed numbers 2. 93 to solve:MC pcoblerro in realistic serfal85 101 to find the perimeter in customary unitt • 0 3-digit number with rooming numbers ❑ 102 to trout« a line segment to die'neamst 423 co add or subtract 2- cc zit money . testmos 113 to solve related problems in realistic settings ❑ contact or minisatar • C 12.6 to (dive 12.1 to write de fraction of a pictured sa lining a 10.3 to choke de best estinwe for the length. Teacher: specified =but C capacity, weight, or tams of a given object ID 112 to divide 1- and 2-digå dividends by 1-digh 10.4 to compere two measures excised in ditiefera _ Cornmanta: divisors resuking in 1-digii quotients ❑ canary cc mark maces . 2' 113 W divide 24ign dividends by I-digit divisors 10.5 to choose the most appr=edishmaieit or _ resulting in 2digit quotian ❑ Celsius tempera= for condician _ 124 to divide 3-digit dividends by 14igit divisor, 10.6 to determine elapsed tine between two given _ maim in 2.digit quotienn times Level 3 113 to solve related problems in realistic setungs t2 10.7 to solve related problems in realistic menings I.1 so «der nurnIrs — Teacher. 11.1 to smile a decimal grec than one in word 1.2 muse doubles phis and minus one to find sums form to a . Comments: 11.2 to wile the value of an underlined digit in a IS to aid tree or morel digit numbers decimal caw than we IA io Swat -digit number from a number 11.3 corder up to four decimals through to 2g ❑ Inesdredths 1.5 to find missing adiknds a Level 4 11.4 to add up to dime decimals through 44 to iclinify and We addition and subtraction fat hundnalzhs families 0 • I .l to write whole mattes from word namna 115 to tuba= decimals through hundredths C• 1.7 mstilve related problems in realistic seeing, 2 expanded form D alb to solve reined problem in a realistic setting . 21 so reaöre a number expressed in standard . 1.2 to identify die value origins digit ILI to multiply 2- and 3-digit numbers by multiples expanded or word fainin eider of the other 1.3 m round whole numb= • of 10 -1 forne' • • 1.4 to order whole numbers forn least to greatest 122 to multiply two 2-digit numbers using tin any 22 bada whole numbers ni — or Mtn greatest to least ditgrgn 2.3 to write the value of a collection of bills and IS tomtre Cap for amowas up to 320 12.3 to multiply 3-digit numbers by 2-digit numbers coins- 1.6 to solve mined problem,in reallsOe %taints 2 including money — 2.4 to make change for =cures up to 5200 — — .7 2.1 muse properties and rules for addition and II. »multiply dine 1.- or 2-digit numben — 23 to write die timess shown on an analog clock C subtraction 123 to solve related gmbitins in realistic seninp 2 2.6 to solve related problems in realistic settings O 2.2 to add two 2- or 3-digit addends • — 13.1 to divide 2- and 3-digit dividends by /digit — 3.l to ack! 2.- or 3-digit addends ...• 23 to add up to four addends with 2. 3. or 4 digirs divisors muffing in 1<ligit quotients n— — 32 to add up to four 2-a 34igit addends 2.4 to alma numbers with up to 4 digits 13.2 to divide 3-digit dividends by 2digit divisors _ 3.3 to subtract 2. and 346git numbers from 2- and 23 to subtna a 2-. 3-. or 4-digit number from a ' resulting in 2-digir citients 3-diga numtas — _ 3- or 4-digit mantel with zeros 133 to find the average of a set of numbers — 3.4 so subtract 3-digit numbers from 3-digit 2.6 to solve related problems in realistic settings • 2. 13.4 03 solve relaxed problem in realistic 'mines numbers with zeta — — 3.1 to analyze dau in a bar graph 33 to solve related problems in realistic senings 2, - Teacher: 3.2 to analyze data in pictographs 4.1 to reacipinographs 4.2 to read horizontal and vertical bar graphs ' .2 33 to analyze data in line graphs Comments: 43 to solve related problems by reading (tau ina 3A to analyze data in circk graphs • "Z. ruse graph 33 to «press the probablity of an event _— 3.6 to solve related problems by comparing 5.1 to multiply anctor divide with 2 --: 52 to multiply Clot divide with 3 outcomes as more/less likely. most/least C likely EFTA01710399 THE SCHOOL DISTRICT OF PALM BEACH COUNTY Elementary School Special Session Registration Student Student Number ale a. Last nam First name Address ZIP Name of Parent/Guardian Telephone:: Ho mergency Home School Home School Teacher -Special Session School Assignment Student's Date of Birth 6/4/5- igh Risk Medical Information 4517e2 Legal Information on Recor : 1 no yes (Call home school.) Student is on free lunch reduced lunch SPECIAL PROGRAM ASSIGNMENT (Check services needed.) ESOL Intensive ESOL Support ESE (Program) Other TRANSPORTATION Special Session Bus # Needed: no yes regular. ESE lift) SAG,/ /06 D RECOMMENDATION FOR SPECIAL SESSION (Check all that apply.) Students in grades K-5 who are in ESOL (LEP students), Dropout Prevention, and those in ESE whose IEP includes a recommendation for Special Session. Students in grades K-teho receive recommendation from the principal may attend for remediation purp0ses only. . ' Students in grades 2-5 who received a score in. quartile 1 in the leading \comprehension and/or . niathematics concepts and applications on the most recent norm-referenced :test , ...._ Students in grades 2-5 who received a score in quartile 2 in the readpg Abbirnpraans(op and/or mathematics concepts and applibations on the moat recent norm-referenced to t--along with the recommendation of the principal. ,,. •• — Note: Students retained In their current.. grade level may be eligible foi promotion •on completion of Special Session. Si 11)1 c S 9 '6 .-. Signature 0 ea er Dal V ipa PARENT/GUARDIAN NOTIFICATION EA Yes, my &ird will atterut the Special Sessiori(unulier school). The. Information on address and telephone numbers is correct or I have noted changes on my copy of the registration form. [7 No, m 'Id w' ttenci the Special Session (summer school). J Date Attachments to the registration form sent to the Special Session school: Parent/guardian copy - signed registration form Copy of completed ESE IEP, if appropriate Other information To be completed at the conclusion of Special Session: STUDENT ATTENDANCE RECORD: Days Present Days Absent Days Tardy Teacher comments: PLACEMENT DECISION Made following Special Session El Promoted O Administrative Placement O Retained • / Signature of Home School Principal / Date Signature of Special Session Administrator / Date PBSD 0673 FY 95 Revision WhitelSpecial Session School then Home School Yellovolliome Schooll0ffice PinklTransportation GoldlParentlGuardian then Horne School EFTA01710400 A . . ' la.„9-..et. • V- k I ... N" 4" 1 1 -.% • . % •-. -•:•:i•••••••' -•; •• • I- :IN . C.', •;' •2 4. ••ficir. 4 .. t" . • • •••• • • • . le • • .1 • %I .1' r..... w if A . " • r ti . •. Tip4. 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I. • . . .. • . • . • . • • •..E. • ....a. • a moo...mamma • . • • • . • • • . . • • . . • . . . • • • • ; I • • • • . • - .. • • • • . • • ••••.. o.n.o.... .....r•• .• • m. ••• •• .........••• •• as •• • ..•-• . • •• gaga. • a• so am.. •.. ea ........ am •••• • •• • • •• . . • . a.. a :.•• ••••••••• . .1.... • • . . . . • . . . • • • • . . • . . . • • 5. . . . •. . • • • . . • • . ••••••••• . . . . . . • • • • a. . • • a . .•. ... .. . . . . . • . . . . v • . . . . . . . . . . . . . . • • v. •. ••• .. • •.••...•• • • Sm. • •7•.•• • • • • . • • m. • . •• • . • • .. . • • • • . . . . • • • • • r . . - . .- . - . .....• .. . . -....... .. . •..... .. .... • ..... . - ... • ...... a. 1.... - .• ....- . .1 . ........ ....... -.. ....-...-.........-............................ ...... . . . . . . . . . . . . . . . 1 • . ..• EFTA01710402 ., . . .. . . . . • .. . . . es) .e.tilbe,e. • . . .. 6. ..v.0 r k - e_ \ O3 . .. . . . . . . . . •.. . . her_•\--.7.vcv.-. -..e. aywcce-5---------- et . . •. ... . .d.- --: •S e • o7m.:•kit'vE\i‘vt--. • .• . ..____ .........,. .. .. .. - • -(3.kb•e- 'Cxn..6 . .._._ • , • .••.. .. .• _ -• 3.. ..•.. . .- _____. • . . . .. .. . . . . . •• . .• . . . .• • . .• . . • • •• EFTA01710403 y -t-sm VC71.11 37 rn 'far TA77+ rn A Li-Fre-Tr —F---- Tu EH\ ro- irrr - rap - h • VI-P.1s qin+-7.--- rr 4EL k MP --rn -y-- -5-- 73n- IP -(:)+VTer— EFTA01710404 EFTA01710405 . i CIL tt ' . i .• ,. , IA) ,pah, ,A1P_, _1141"-i • --eUrti - J.A_And 61112_56. LiWeir, 1 AS , 4 / „Ai jne}k a 'HAP ,Vnis /21/Z -.I.A.70 2142/ , ,S10, Lbil/492 1 I EFTA01710406 • a -"Mt AA AiIfd ..64.7 La . se4 AtarZit als2djitatite . 4201161-1 /1411 jinn sots,. aalon dzizz 0. it ..t.,Ae teal. ..oat li(); 71 4/ /et .4, Ana's, On trot, EFTA01710407 8-23-9e • tom-. ------aM04). WIII:444 -td beauoacteluaskaaal-- rm.7-17 de, fito4/7) Jtj )ftny° 4n1. tiCA19?1 • %Ali ,.0illy, nh A 4"-0O2 -414, 461 / ae fiumi4 A 6/. Jon. _kees 4.th "Fe 111,9177 ~Y101 mg. _Ai- EFTA01710408 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 NORM-REFERENCED TEST School Name and Number Student Report Grade 08 District Name and Number 60 • 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 Eained Attempted Readlnr Com•rehension I I Reading Initial Understanding I Comprehension interpretation I Critical Analysis I Mathematics Problem Solving. Strategies Mathematics Problem Solving The Scale Score expresses your performance and allows comparisons from year to year. Measurement Reading Comprehension Scale Scores range from 510 to 820. Mathematics Problem Solving Estimation Scale Scores range from 527 to 836. Problem Solving The National Percentile Rank and Stanine Indicate your relative standing In comparison to the Number Relationships national reference group. National Percentile Ranks range from 1 to 99. Stanlnes range from tog. Number Systems Patterns & Functions • If you took the test again, your National Percentile Rank might be slightly higher or lower than Algebra stated here. However, your National Percentile Rank would probably fall within a certain range. For Reading Comprehension, your National Percentile Rank should be between 43 and 67. For Statistics Mathematics Problem Solving, your National Percentile Rank should be between 24 and 44. Probability Geometry Each question was worth 1 point. Run Date: 04/25/2001 0182069 EFTA01710409 Student Name FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 Student Number SUNSHINE STATE STANDARDS School Name and Number Student Report Grade 08 District Name and Number 50 - PALM BEACH This report shows your results from the FCAT Sunshine State Standards Test. The FCAT Sunshine State Standards Test measures your performance on selected benchmarks In reading and mathematics as defined by the Sunshine State Standards. Scores on this test are one indication of your achievement of the challenging content that Florida students are expected to know. On the FCAT, you can attain one of five possible achievement levels. The table below shows the scale score ranges for each Student Achievement Level. Student Achievement Level Descriptions FCAT Student LEVEL 5: Performance at this level indicates that the student has success with the most challenging content of the Sunshine State Standards. A Level 5 Achievement Levels student answers most of the test questions 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: 394-500 371-500 LEVEL 3: Performance at this level Indicates that the student has partial success with the challenging content of the Sunshine State Standards, but Level 4: 350-393 347370 performance is Inconsistent. A Level 3 student answers many of the questions correctly but Is generally less successful with questions that are Level 3: 310-349 310-346 most challenging. Level 2: 271-309 280-309 LEVEL 2: Performance at this level indicates that the student has limited success with the challenging content of the Sunshine State Standards. Level 1: 100-270 100-279 LEVEL 1: Performance at this level indicates that the student has little success with the challenging content of the Sunshine State Standards. Your scores are shown below. SUBJECT SCORES CONTENT SCORES State Comparison: Student Thirds Achievement Scale Level Score Lowest Middle Highest Reading Mathematics If you took the test again, your scores might be slightly higher or lower than the scores on this report. However, your scores would probably fall within a certain range. For reading, your scale score should be between 274 and 310. For mathematics, your scale score should be between 294 and 316. The check marks ( J ) show if you scored in the lowest, middle, or highest third of grade 08 Florida students who took this test. The Content chart shows the number of points possible and the number of points earned for each category. Each question on this portion of the test was worth one point. The results on your performance Items will be reported separately. Run Date: 04/26/2001 0179204 EFTA01710410 arkanamoresa*** 70LENDL- Ilca~~~~ 313~2k DATE FEB-17-2005 WIalc TIME 12:25 tTT***** MODE e TETORY TRANSMISSICN STARTsFEB-17 12:24 END..FEB-17 12:25 FILE mp.-7s5 STN Ø. CKF-TOUCNI STATIC NOMF-ITS_ N3. PncEs 13.ROIT I CN N3 OffiBR NO. eat ac a 47033 3024302 ØØ:Øa:20 -RPENS RECORDS - RECORDS OFFICE - ideas 561 753 4022- aleleaca~ STUDENT SCORE REPORT REPORT DATE: 6117104 Seclit WHAT Dore YOUR SCORE Mat Han war% TIN AVERAGE VERRAL OR MATH Salta NO Engle hunareal scare can exaCy represent au' ror collage-0014 salon In Me Dan of 2003, reacting ant u you ea tar dare% means of la tat ta average verbal score Was 801 are Um ayer~ waln 8 that ~a Of Mat your praffarOe IsOal probably war stue was $19. vary someralf On MO 200 to 803 scale. Vat YOUR SCORES CHOICE HOW DO YOU ~PARE WITH COLLEOECOUSID aillOR37 IF YOU TAKE THE Tat MIMI? Permace In.3~ ~I pereenas Of Wet :akin canal It If you take the 1.91 egam, espeali yas may bell~ Ø. lost dun yours. 1110 raga reran% e br >Ow verbal row ave UVIM. your ~a may go up. scot* el 1.94 It 42. ne «ea am did bear tar 42 % ol the national grwg V ealej•420,w43 ~ors. The ~one Mang Mara with wail scone of 430. 58% sore agar Parana far your no, yen or a* N 27 indatla you skr en a Nand lestIno. $1% sore low, and 0% ~In the beta Dia 27 14 of the ~al group el cedeg•~4 felon lame score. On average, • person WM I Vera wore of WI Islet II pelelt•7 on • name ~la ow YOU DO Inn VI Ill VERRAL OR MATH? Yew ~es Ind eats tat yOJ pa!~ salarly on Among Italha era nab corm Of 4.50, V% score Me ma, I.at 11, 42 MO verbal teal. »Dar 441 • second ~ 112, 30% son loaf, end II% maws ha afro score. On avenge • plena an. mom MOO of 150 00% 17 Puna/ rise:0nd tera. HOW DID YOU DO ON EACH TYPE OF QUESTION? Yaw ro pfireml to ~Ole types of Cueaons an platereed can anar* yaf Deferment to coteaDOVNI argon ninett r,wQ. ono nuYtow ~ad. Raw ~a as who took al teat Ttus anemia n en namste of tar pot- Dated nl a spa IN ~Ion of ter test tat you WOK ocfitsge of carfge«une saner% wee earned • raw sae You amyl ~pare fa stow On efferent atlas of It,. lost of Cwt' tnln yJts en ear tya of 04msc on. serva Glotann lams a ~boa For fah syp. Of Ix -silo^. yo.. SUMMARY OF SCORES Register new for nest når nr rehab; *1 rww cCc;cboard.corn eel I, Re40•ala. Tnt RAT ~~ *Inn Sol s• InIs Ins ~bones ID INFORMATION To take ihelelanal 1~ you can ~Or by Mall or by phone (~ ~la. TO tend f~ etyue Ød yw MIM ~I the ma ~ea. MarnerCatI, Arm/fantasia Vreaser, er 4C9. insatifonlI4rall a ale Oa besk of ea neparl Poi Vaal ~4 We flallatIon number Wart and Naga ~~~ a hew d IS SOW ~Ica EFTA01710411 EFTA01710412 IDREstVE, REMOVE UREA TO EXPOSE ADHESIVE, REMOVE tHEER TO EXPOSE ADHESIVE, REMOVE EIRER TO EXPOSE ADHESIVE, REMOVE URM TO EXPOSE ADHESIVE. REMOVE LINER TO EXPOSE ADHESIVE. 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WINO 0Ct6-W 08ZOGSEld lbSYINALVHd . £6b1AE clxO100428 Iqul 100IPOIAS 0P03 letland0 111N5 64111.% b MMD WIN 30 JA•A Pclim SOU nm 3513 r6 V WHOA 91 13A31 t/SH13 IKILLYMOTiiti2R1.0 SAUVN owvdnd OT—TI 301 =CMI 90 Barn mmm . eu tilie33 WHOA 51 13A31 •"/S813 Z ‚LYN • WY" Hi3w diVUJ UUUMS aygli pNv, 11111 McriMm V WHOA h T 13A31 plana 30,s 3.:Y0 S T-6 Iona arlisprij ststiP.2 V331 HI.VW V301% diP3 CIV313 3tIODS V WHOA ZT 13A31 y/5813 ira NOIMMMI adlvlN eonom OT—L ao WWW VI) HIVW YOUA I dWUD 34.0.1.316305 MW/ .— KLVW HIVIS. 1101 _MM OV311 10'031 cmoaansai SEX: RACIAr DC GROUP: El Hispanic STUDENT NUMBER: White Not Hispanic G American IndiarYNallye AkIskan Le RACE: M SEX: F El Black Not bespeak 13 Asian/Pacific Islander BIRTHDATE: M O Mufti RacIst - 5.5AL BIRTHDATE: I VerTied by Binh Certificate: G Yes G No If No. What Type Verification? BIRTHPLACE: NAME OF EARENT(S) OR LEGAL QVARDIAN OR OTHER RESPONSIBLE ADULT AT HOME: P a OA iez • CURRENT SCHC‘X: (use pencil hi this space until final) Name 0RES11NOOD MIDDLE MiI0Of Street City Date First Entered This patriot School: Grade: School Grade: School: OWE Sena* Gsadox Scher* Breda SehooI Year 19 Scheel: Year 19 School Year 19 Schad Year 19 Sand Year. le Days Present Days Absent Days Present Days Absent Days Present Days Absent Days Present Days Meant Der Present Days Absent COPY OF COPY OF COPY OF COPY OF COPY OF REPORT CARD REPORT CARD REPORT CARD REPORT CARD REPORT CARD INCLUDED INCLUDED INCLUDED INCLUDED INCLUDED INDICATE INDICATE INDICATE INDICATE INDICATE AchninIstraWo Administrant* AcInDlstralhe Adrolnlarathie Admiristmees Placement (ADMP) Placement (ADMP) Recomem (ADMP) Racerrent (AMP) Plammont (ADAM) Premoto (P) Promote (P) Promote (P) Promote (P) Promote (P) Retain (R) Ratan (A) Noah GI) Rath GB Retain (n) Special Session (SS) Special Seeable (SS) Special Session (SS) Special Session (SS) Special Session (SS) Scoot Grade &Moot Gteda School: Grade • School: Gale Grade: School Year 19 Schect Year Is School Year 19 School Year 19 School Year. 19 Days Present: Days Absent Days Present Days Absent Days Present Days Absent Days Present Days Absent Days Present Days Absent: COPY OF COPY OF COPY OF COPY OF COPY OF REPORT CARD REPORT CARD REPORT CARD REPORT CARD REPORT CARD INCLUDED INCLUDED INCLUDED INCLUDED INCLUDED INDICATE INDICATE INDICATE INDICATE INDICATE Adminbuative Admblatrathe Adintrisnathie AdmIrdshaavo Adnirietnelee Plant (ADMP) Piecemeal (ADMP) PLUG/noel (ADMP) Ptacement (ADMP) Plecement (ADMP) Promote (P) Promote (P1 Prattle (P) Promote (P) promote (P) Retain Retain (Ft) Retain (R) Retain(R) Retain ge Special Session (SS) Special Session (SS) Special Session (SS) SpodelSesslon (SS) Special Session (SS1 PSSD 0932 (REV =fan EFTA01710413 For Secondary Cumulative Grades: SEE STUDENT RECORD SCREENS GENERAL QUERIES ATTENDANCE A01 Student Name (District) A15 Daily Summary A02 Student Name (School) A16 Period Summary BASIC RECORD A17 Absence Detail A03 Demographics Al8 Absences (Class Hours) A04 General Assignments A19 Letter Preview (PRD ATD) A05 Contact Information TESTING A06 Health Information A20 Test Score Query A07 Assigdment History A21 Test Score A08 Local Data Elements A2A Test Score Errors COURSES A22 Standard Mastery A09 Course Requests MISCELLANEOUS A10 Current Schedule A23 Special Programs All Interactive Scheduler A24 Discipline • Al2 Current Grades A25 Fees and Fines A13 Academic History A26 Recognition/Achievement A14 Graduation Status A27 Letter History SPECIAL CHARACTERISTIC CARD STUDENT SAL SAL Place a red dot or red check in any area to denote that this student has additional information available ESE ESOL 504 DOP HEALTH MIGRANT OTHER O O See ESE See 504 Confidential Folder Sae ESOL Folder Confidential Folder See DOP Folder See Health Folder See Migrant A23 A23, A03 A23 A23 A06 A23 EFTA01710414 Fax Cover Sheel RECORDS DEPARTMENT Royal Palm Reach, FL 33411 —Records Custodian (phone) IME (fax) TO: J 117 loS DATE: 02-71776T FAX #: PAGES: 4 , including Cover Sheet RE: EFTA01710415 'Par •••• 1 w V les• %sr EFTA01710416 FLAT Reports informes FCAT (Spanish) Rapt) FCAT (Haitian Creole) Separate reports are produced for the Sunshine State Se preparan informes separados pare los examenes del FCAT Yo prepare rape apa pou egzamen lekti ak matematik Standards tests in FCAT Reading and Mathematics. de lectura y matematicas segt las normas estatales FCAT bay swivan prensip Sunshine State Standards yo. Sunshine State Standards. Sunshine State Standards (SSS) Reports The FCAT SSS Informes segtin las normas estatales Sunshine State Rape Sunshine State Standards (SSS) Rape FCAT SSS Reading and Mathematics reports show test scores from Standards (SSS) Los informes segan las normas estatales pou lekti ak matematik Ian montre net elev yo le nan egzamen Florida's tests of academic standards. These reports contain SSS del FCAT presentan las calificaciones de los examenes de Florida bay sou prensip akademik yo. Rape sa yo gen net subject scores and content scores. Subject scores describe lectura y matematicas de las normas academicas de Florida. pou matye ak net pou kontni laden yo. Net pou matye yo the overall achievement, and content scores give the number Estos informes contienen calificaciones por materias y dekri tout sa elev la reyalize anjeneral epi net pou k ontni yo calificaciones por contenido. Las calificaciones por materia bay kantite pwen elev la fe nan yon matye byen detente. Ou of points earned in specific skill areas. Success on the proporcionan un resumen general del rendimiento y las ka konprann kisa el& la reyalize nan egzamen lekti ak Reading and Mathematics tests can be best understood by calificaciones por contenido que proveen el n6mero de puntos matematik la pi byen si w itilize yon nivo sikse kote 3 oswa plis using the achievement levels where a 3 or higher is on or obtenidos en areas de habilidades especificas. El exits de los se yon net ki nan nivo klas la oswa yon not ki pi wo pase nivo above grade level. examenes de lecture y matematicas puede entenderse mejor klas Ia. utilizando los niveles de rendimlento en los que una calificacit Achievement Levels Five categories of achievement de 3 o superior esti al nivel del grado o por encima. Nivo sikse elev yo Gen senk kategori sikse ki dekri nivo describe the success students have with the content tested Niveles de rendimlento El exito que un estudiante ha logrado sikse elev yo pole nan kontni yo teste nan egzamen lekti ak on the FCAT Reading and Mathematics. Level 5 is the en el contenido examinado en el FCAT de lectura y matematicas matematik FCAT Ia. Pi gwo nivo a se nivo 5 epi pi piti nivo a highest and Level 1 is the lowest. se describe por medic) de cinco categories. El nivel 5 es el mas se nivo 1. alto y el nivel 1 es el mas bajo. 5 Elev sa a gen sikse nan matye kite gen pi plis difikilte laden 5 This student has success with the most challenging content 5 Este estudiante tiene exits con el contenido mas dificil de las yo nan egzamen Sunshine State Standards la. Yon elev ki of the Sunshine State Standards. A student scoring in level normas Sunshine State Standards. Un estudiante del Nivel 5 nan 5yem Nivo reponn pito kesyon egzamen yo 5 answers most of the test questions correctly, including responde a la mayoria de las preguntas del examen kereldeman, elev la menm reponn kesyon ki gen pi pits the most challenging questions. oorrectamente, incluyendo las preguntas mas dificiles. difikilte laden yo. 4 This student has success with the challenging content of 4 Este estudiante done exito con el contenido dificil de las 4 El& sa a gen sikse nan matye ki to gen difikilte Iadan yo the Sunshine State Standards. A student scoring in level 4 normas Sunshine State Standards. Un estudiante del Nivel 4 nan egzamen Sunshine State Standards Ia. Yon elev ki nan responde a la mayor(a de las preguntas correctamente, pero 4yem Nivo reponn pife kesyon egzamen yo kerektemen, answers most of the test questions correctly, but may have es posible que solo temp cierto exits con las preguntan que only some success with questions that reflect the most men li ka gen kek sikse selman nan kesyon Id sanble yo gen reftejan el contenido mas dificil. pi plis difikilte laden yo. challenging content. 3 Este estudiante tiene un exito partial con el contenido dif foil de las normas Sunshine State Standards, pero su rendimiento 3 Elev sa a gen enpe sikse nan matye ki gen difikilte laden yo 3 This student has partial success with the challenging nan egzamen Sunshine State Standards Ia, men plfemans content of the Sunshine State Standards, but performance es inconsistente. Un estudiante del Nivel 3 responde muchas de las preguntas del examen correctamente, pero por lo Ian pa rete estab. Yon elev ki nan 3yem Nivo reponn anpil is inconsistent. A student scoring in level 3 answers many general tiene menos kilo con las preguntas que son mas nan kesyon egzamen yo koreldeman, men anjeneral li gen of the test questions correctly, but is generally less diffciles. mwens sikse ak kesyon ki sanble yo gen pi plis difikilte laden successful with questions that are the most challenging. 2 Este estudiante tiene exito limited° con el contenido (Illicit de yo. 2 This student has limited success with the challenging las normas Sunshine State Standards. 2 Eliot sa a gen sikse limite nan matye ki gen difikilte laden yo content of the Sunshine State Standards. 1 Este estudiante tiene poco exito con el contenido (illicit de las nan egzamen Sunshine State Standards Ia. 1 This student has little success with the challenging content normas Sunshine State Standards. 1 Elev sa a gen yon ti siksi3 tou piti nan matye ki gen difikilte of the Sunshine State Standards. Requisitos pare la graduation - Los estudiantes que se laden yo nan egzamen Sunshine State Standards la. gradilan en el 2003 o despues deben obtener una calificacion Graduation Requirements—Students graduating in the year de aprobado lento en el FCAT (SSS) de lectura como en el Egzijans pou dipbme - Elev k ap diploma nan ane 2003 a oswa 2003 and later must receive a passing score on both the FCAT (SSS) de matematicas y asf cumplir con los requisitos apre sa dwe fe yon net pou pase ni egzamen lekti FCAT SSS la FCAT SSS Reading and FCAT SSS Mathematics tests to de graduaci0n. Para los estudiantes que tomaron el examen ni egzamen matematik FCAT SSS la alaiwa pou yo ka ranpli meet graduation requirements. For students that first took the del 10° grado por primera vez en el aim 2001, todavia esti) en kondisyon pou diplome a. Pou elev Id to pran egzamen Ides 1001" 10th grade test in calendar year 2001, an alternative passing vigor una calificacien de aprobado alternative. Para los nan ane 2001 an, gen yon net altenatif pou pase egzamen an ki score is still in effect. For students that first took the 10th estudiantes que tomaron el examen del 10° grado por primera toujou an efe toujou. Pou elev Id to pran egzamen Ides 1Crtim nan grade test in calendar year 2002 or later, higher passing vez en el arm 2002 o despues, puede que le sean aplicadas pou lapremye fwa nan ane 2002 a oswa apre sa, yo mande pi scores apply. calificaciones mas alias que de aprobado. gwo net pou pase. Grade 10 FCAT FCAT pare 10• grads Not pou eery Ides 107emII pou Passing Scores Reading Mathematics Calificaciones de aprobado Lecture Matemetleas pass *stamen FCAT la Laird Maternatik CalltIcachin de aprobado Current Passing Score SS 300 .OSS 1926 SS 300. DSS 1889 actual SS 300. DSS 1926 SS 300. DSS 1889 tibt pou pase koulye a SS 300- DSS 1926 SS 300= DSS 1889 Alternate Passing Score SS 287 . DSS 1858 SS 295 = DSS 1868 Calincacion de aprobado SS 287. DS5 1856 SS 295 = ['SS 1868 NM alienist:II pou pass SS 287 = DSS 1856 SS 295 = DSS 1868 alternative 1504796 EFTA01710417 October 2003 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS cncei numb:rand Name: FEAT 11,;:dc Coripronthe Assewnyntfrsi Grade 11 Student Report District Number and Name: 50-PALM BEACH The Florida Departmentot Education believes that student has the ability to learn and succeed. The purposeof the FCAT is to ensure that Florida's nubile schools are providing the best education possible, and preparing students to succeed in the competitive 21st Century lob market. Working with teachers, the State has developed a measurement system that allows you to track a student's academic achievement from year to year and determine if a year's worth of learning has occurred in a years time. This system also allows you to compare a students score to a score that represents 'grade level' achievement. If a students score Is above the "wade level score, then they are performing at a level above their current grade. If it Is below, they are In need of Improvement. Using the toMent Scores; you are able to Identity any specific academic skills needing Improvement. Below you will find your 2003 FCAT Reading and Mathematics score; as well as your scores from previous years. The chart on the right side of the page shows your score compared to the score that represents grade level achievement. Congratulational You have passed the Reading test; however, your Reading achievement needs improving. Taal to your leacher Or guidance counselor about classes you should take to better prepare you for college or a career. 2003 Reading Content Scores Content Areas Points Points Possible Earned FCAT Score Words/Phrases Main Idea/Purpose Comparisons Reference/Research 1000- Year 2001 2002 2003 Grade Tested NA NA Achievement Level GOO Grab 4 FCAT Score • We were unable to find a Mathematics score that matched your student identification number. If you look the test this year, be sure Mathematics to contact your school about locating your FCAT lest scores. 2003 Mathematics Content Scores Points Points Content Areas Possible Earned Number Sense FCAT Scor Measurement Geometry Algebraic Thinking Data Analysis Year 2001 2002 2003 Grade Tested 10 Achievement Level NT Grade! Grab 1 Grades Credo i Grade? GMAot Grades Grade 10 11+ FCAT Score • NT • Your Sco e 0 On Grade Level _ These scores show your achievement on the day you were tested. If you had taken this test numerous limes, It is likely that all of your scores would have been within a certain range. Your 2003 FCAT Reading scores probably would have been between 1975 and 2127. NTE• Not Tested NR = Not Reported NA = Data Not Available Data Run Date: 11/10/2033 0040567 EFTA01710418 Spring 2003 FCAT FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) MATHEMATICS SUNSHINE STATE STANDARDS PERFORMANCE TASKS Florida fertps eh ersive Ar.sosmr, Te:I Student Report Grade 10 This report provides your results on the FCAT 2003 Mathematics FCAT 2003 performance tasks. Each performance task on FCAT requires you MATHEMATICS PERFORMANCE TASKS to respond with either a short response or a longer,more detailed response. Short-response tasks are scored on a 2-point rubric and extended-response tasks are scored on a 4-point rubric. Student Name One of the short-response tasks is shown below with a copy of Student Number your answer. The number of points you earned for your answer Is School Name shown in the box to the right. School Number IM District Name PALM BEACH District Number 50 This Performance AN Mathematics Task Response Performance Task Responses Points Possible -7 The students in the sailor class at Paradise Island High School have decided to raise money by selling graphing calculators and geometry tool kits. They have set aside 53,000 to purchase the items they need to selL They will spend S75 foreach calculator, and S20 for each tool kit. From past experience, they know that twice as many students will buy the calculators as will buy the tool kits. . •' The inequality" and equation below can be used to determine the number of each item the senior class should have available to sell, where c is the number of calculators and t is the number of tool kit • 7Sc 20t s. 3,000 04•=fit How many tool kits should the senior class puechise? Show your work mon 1- -sr. alai east 2,O ec02 18 +Wt . er %OM 2LZO$ _ l ei St- 40 Number of tool kits ' Data Run Date: 05/07/2003 C085312 851200288 EFTA01710419 Spring 2003 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) READING SUNSHINE STATE STANDARDS PERFORMANCE TASKS Student Report Grade 10 This report provides your results on tile FCAT 2003 Reading FCAT 2003 performance tasks. Each performance task on FCAT requires you READING PERFORMANCE TASKS to respond with either a short response or a longer, more detailed response. Short-response tasks are scored on a 2-point rubric and extended-response tasks are scored on a 4-point rubric. student Name One of the short-response tasks Is shown below with a copy of Student Number your answer. The number of points you earned for your answer Is School Name shown in the box to the right. School Number District Name PALM BEACH This task required you to read a passage about an American District Number 50 zoologist's attempts to rehabilitate two young gorillas in Africa. All Reeding Describe how Coco and Pucker change as a result of their This Performance Performance Task Task Response Responses experience with Dlan Fossey. Use details and Information from the story to explain your answer. Points Possible Points Earned in'int-CCeO Curd. ctfutri e• ortincle tneve!_epevance., LA* In 1'CAV1 FOsSzy (5\kCirW0CAUP CAS torek1 'c'y v5t VICE-V he e rye,/ tAavk,%ct., 4- ©v acccfr rIc.i) 4,\Ai- sorradv..taim iney cl_cceporicpbociL aria_ Waled eggtp1 OW/ fey 4yelckeivcivrto t5Y1C ia3Z 01,10S-CeZe AvYYrnelern wv1cfri Sr 1c car; raCkivrai still iCh-c-thriev ale10 WinetrtaircfccelihtMA ; S Data Run Date: 05/07/2003 0085341 853200161 • EFTA01710420 FCAT WRITING Student Name: Student I.D. No.: STUDENT REPORT School: District: PALM BEACH 2001 Grade 8 soma. Florida Comprehensive Assessment Test WRITING TO CONVINCE How Papers Are Scored Dear Student The student responses are scored by trained readers using the holistic method to evaluate The paper you wrote in February as part of the FCAT has been read a piece of writing for its overall quality. The readers consider four elements: focus, independently by two people trained to score this test. Each reader organization, support, and conventions. In this type of scoring, readers make a judgment judged the paper against a set of standards and gave it an overall about the entire response and do not focus on any one aspect of the writing. score. Your score is the average of the two readers' scores. Focus refers to how clearly the paper presents and maintains a clear main idea, This writing score will help you, your parents or guardians, and your theme, or unifying point. Papers representing the higher end of the point scale teachers understand how well you performed on this statewide writing demonstrate a consistent awareness of the topic and do not contain extraneous test. A description of how papers are scored is printed on the left information. side of this report. A description of each possible score is printed on the back of this report. Organization refers to the structure or plan of development (beginning, middle, and end) and whether the points are logically related to one another. Organization Remember, you were given 45 minutes to read the assigned topic, also refers to (1) the use of transitional devices to relate the supporting ideas to the plan what to write, and then write your response. The conditions main idea, theme, or unifying point and (2) the evidence of a connection between under which you write papers in class or at home may not be the sentences. Papers representing the higher end of the point scale use transitions to same as those for this test; therefore, the writing may not be the signal the plan or text structure and end with summary or concluding statements. same. You and your teachers should consider the score on this test along with all of your other writing when planning activities to Support refers to the quality of the details used to explain, clarify, or define. The continue developing your writing skills. quality of the support depends on word choice, specificity, depth, and thoroughness. Papers representing the higher end of the point scale provide examples and illustrations in which the relationship between the supporting ideas and the topic is clear. Conventions refers to punctuation, capitalization, spelling, and variation in sentence structure used in the paper. The conventions are basic writing skills DESCRIPTION OF THE TOPIC: included in Florida's Sunshine State Standards. Papers representing the higher end of the point scale follow, with few exceptions, the conventions of punctuation, You were asked to convince your friend capitalization, and spelling and use a variety of sentence structures to present to cat at your favorite place. ideas. RUN DATE: 04/16/01 60-1691_ EFTA01710421 Description of Grade 4 Writing Scores Description of Grade 8 Writing Scores Description of Grade 10 Writing Scores 6.0: The writing focuses on the topic, is logically organized, and 6.0: The writing focuses on the topic, is logically organized, and 6.0: The writing focuses on the topic, is logically organized, and includes ample development of supporting ideas or examples. Includes substantial development of supporting ideas or includes substantial development of supporting ideas or It demonstrates a mature command of language, including examples. It demonstrates a mature command of language, examples. It demonstrates a mature command of language with precision in word choice. Sentences vary in structure. including precision in word choice. Sentences vary in freshness of expression. Sentences vary in structure. There are Punctuation, capitalization, and spelling are generally correct. structure. Punctuation, capitalization, and spelling are few, if any, usage, punctuation, or spelling errors. generally correct. 5.5: The writing was given a 5 by one reader and a 6 by the other 5.5: The writing was given a 5 by one reader and a 6 by the other reader. 5.5: The writing was given a 5 by one reader and a 6 by the other reader. reader. 5.0: The writing focuses on the topic with adequate development of 5.0: The writing focuses on the topic, is logically organized, and supporting ideas or examples. It has an organizational pattern. 5.0: The writing focuses on the topic with ample development of includes ample development of supporting ideas or examples. though lapses may occur. Word choice is adequate. Sentences supporting ideas or examples. It has an organizational pattern, It demonstrates a mature command of language. Sentences vary in structure. Punctuation, capitalization, and spelling arc though lapses may occur. Word choice is adequate. Sentences vary in structure. Usage, punctuation, and spelling are generally correct. vary in structure. Punctuation, capitalization, and spelling are generally correct. generally correct. 9.5: The writing was given a 4 by one reader and a 5 by the other 4.5: The writing was given a 4 by one reader and a 5 by the other reader. 4.5: The writing was given a 4 by one reader and a 5 by the other reader. reader. 4.0: The writing focuses on the topic, though it may contain 4.0: The writing focuses on the topic, though it may contain loosely extraneous information. An organizational pattern is evident, 4.0: The writing focuses on the topic, though it may contain ' related information. An organizational pattern is apparent. but lapses may occur. Some supporting ideas contain specifics extraneous information. An organizational pattern is evident, Some of the supporting ideas contain specifics and details, but and details, but others are not developed. Word choice is but lapses may occur. Some supporting ideas contain specifics others do not. Word choice is adequate. Sentences vary in adequate. Sentences vary somewhat in structure, though many and details, but others are not developed. Word choice is structure. Usage, punctuation, and spelling are generally are simple. Punctuation, capitalization, and spelling are usually adequate. Sentences vary somewhat in structure, though many correct COMO. 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 limey 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. 1.0: The writing addresses the topic. though it may lose focus by 1.5: The writing was given a I by one reader and a 2 by the other reader. 1.5: The writing was given a I by one reader and a 2 by the other including extraneous and loosely related ideas. The organizational reader. pattern is weak. Ideas are presented through lists and limited or 1.0: The writing may only minimally address the topic because there is inappropriate word choice. Frequent errors may occur in sentence little or no development of supporting ideas or examples. No 1.0: The writing may only minimally address the topic because them is construction, usage, punctuation, and spelling. organizational pattern is evident. Ideas are provided through lists, little or no development of supporting ideas or examples. No and word choice is limited or immature. Unrelated information organizational pattern is evident. Ideas are provided through lists, U: The writing is unrelated to the assigned topic or cannot be read. may be included. Frequent errors in punctuation, capitalization, and word choice is limited or immature. Unrelated information and spelling may impede communication. may be included. Frequent errors in punctuation, capitalization, and spelling may impede communication. U: The writing is unrelated to the assigned topic or cannot be read. U: The writing is unrelated to the assigned topic or cannot be read. EFTA01710422 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2000 Student Number et FSAT Florida Comprehensive Assessment Test NORM-REFERENCED TEST Student Report Grade 07 School Name and Number District Name and Number 50 - PALM BEACH This report shows your results from the FCAT National Norm-Referenced Test. The FCAT Norm-Referenced Test measures your achievement on a test that was given to a national sample of students. Your norm-referenced scores in Reading Comprehension and in Mathematics Problem Solving describe your performance in relation to the performance of students throughout the nation. Your scores are shown below. SUBJECT SCORES CONTENT SCORES National Number Number Number Scale Percentile of Points of Points of Questions Score Rank Stanine Possible Earned Attempted Readint Com•rehension Reading Initial Understanding Comprehension Interpretation Critical Analysis Mathematics Problem Solving Strategies Mathematics Problem Solving The Scale Score expresses your performance and allows comparisons from year to year. Measurement Reading Comprehension Scale Scores range from 490 to 819. Mathematics Problem Solving Estimation Scale Scores range from 513 to 829. Problem Solving The National Percentile Rank and StanIna Indicate your relative standing In comparison to the Number Relationships national reference group. National Percentile Ranks range from 1 to 99. Stanines range from 1 to 9. Number Systems Patterns & Functions If you took the test again, your National Percentile Rank might be slightly higher or lower than Algebra stated here. However, your National Percentile Rank would probably fall within a certain range. For Reading Comprehension, your National Percentile Rank should be between TO and 89. For Statistics Mathematics Problem Solving, your National Percentile Rank should be between 43 and 66. Probability Geometry The content tested Is described on the back of this report. Each question was worth 1 point. Run Date: 08/21/2000 0142216 EFTA01710423 Grades 5, 6, 7, and 8 Grados 5, 6, 7, y8 The FCAT NRT Reading Comprehension Test assesses La Prueba de Comprensión de Lectura FCAT NRT evalúa the following objectives: los siguientes objetivos: • Initio/ Understanding - Demonstrate the ability to comprehend explicitly • Entendimiento - Demostrar su habilidad para comprender stated relationships in a variety of reading selections. explicitamente el contenido y la relación entre si dentro de una variedad de • Interpnetation Demonstrate the ability to form an interpretation of a variety selecciones de lectura. of reading selections based on explicit and implica information in the • Interpretación - Demostrar su capacidad interpretativa dentro de una selections. variedad de selecciones de lectura, basándose en información explicita e • Criticar Analysis - Demonstrate the ability to synthesize and evaluate implícita en dichas selecciones. explicit and implicit information in a variety of reading selections. • Análisis critico - Demostrar la habilidad para sintetizar y evaluar • Strategies - Demonstrate the ability to recognize and apply text factors and información explícita e implícita en una variedad de selecciones de lectura. reading strategies in a variety of reading selections. • Estrategias - Demostrar habilidad para reconocer y aplicar el contenido del texto y estrategias utilizadas en una variedad de selecciones de lectura. The aboye objectives are measured within the following contexto: Los objetivos anteriores se evalúan en los contextos siguientes: • Recreational - material typically read for enjoyment. • Textual- material typically found in grade-appropriate textbooks and other • Recreativo - material utilizado para entretenimiento. sources of information. • Textual - material utilizado en libros de texto del grado apropiado y en • Functional- material typically encountered in everyday lile situations. otras medios Informativo. • Funcional - material utilizado en la vida diaria. The FCAT NRT Mathematics Problem Solving Test La Prueba para Resolver Problemas de Matemáticas assesses the following objectives: FCAT NRT evalúa los siguientes objetivos: • Measumment - Demonstrate an understanding of the principies of • Medidas - Demostrar sus conocimientos de los principios de medir. measurement. • Estimación - Deteminar cuán razonables son los resultados y aplicar la • Estimation - Determine the reasonableness of resulto and apply estimation estimación en la solución de problemas. in problem solving. • Estrategias para resolver problemas - Demostrar comprensión del • Problem Solving Strategies - Demonstrate an understanding of the procoss proceso de resolver problemas convencionales y fuera de lo común. of solving conventional and non-routine problems. • Números y relaciones entre números - Representar y usar números en • Number end Number Relationships - Represent and use numbers in formas equivalentes en problemas de matemática y de la vida diaria, y equivaient forms in real-world and mathematical problems, and demonstrate demostrar sentido para las fracciones, los decimales y los números enteros, number sense for whole numbers, fractions, decimais, and integers. positivos y negativos. • Number Systems and Number Theory - Demonstrate an understanding of • Sistemas y teoria de los números - Demostrar conocimiento numérico de relationships among arithmetic operations and apply concepto of number las relaciones entre las operaciones de aritmética y aplicar conceptos de la theory such as primes, factors, and multiples in real-world and mathematical teoria de los números tales como números primos, factores y múltiplos en problems. problemas de matemática y de la vida diaria. • Pattems andFunclions - Identity numerical and geometric patterns and • Pautas y funciones - Identificar funciones y pautas numéricas y usarlas functions and use them to solve problems. para resolver problemas. • Algebra - Demonstrate the ability to evaluate expressions and solve linear • Algebra - Demostrar la capacidad para evaluar expresiones algebraicas y equations. resolver ecuaciones lineales. • Statistics - Demonstrate an understanding of the relationships in data sets. • Estadistica - Demostrar conocimiento en procesamiento de data. • Probabilay - Demonstrate an understanding of the laws goveming chance. • Probabilidad - Demostrar conocimiento de las leyes que gobiernan el azar. • Geometry - Demonstrate an understanding of geometric principies. • Geometria - Demostrar conocimiento de los principios de geometría. Soaste: Stanford Adiereenent Test Sedes, Nrth Eciteon: Ceenpen6um of lostrueliceeal 00»ctNes Note: %Hect vdth permiselon [piHarccort Educational Measurement 100 EFTA01710424 . 91 .2:,50rii LEVEL & COURSE PERFORMANCE 11 End of Year Report Total Total Total Corr/Att Percent Enroll IPM Current Course Time Exercises Correct Level Level Level Gain 1477 Enroll Date - 1 26/98) Class MCS 1:39 4.54 4.45 4.63 0.18 PS 0:46 5.11 5.11 5.17 0.06 TRN 0:45 4.00 4.00 4.36 0.36 RA N/A N/A N/A N/A EFTA01710425 6/1/98 11:56am LEVEL 6 COURSE PERFORMANCE End of Year Report Total Total Total Corr/Att Percent Enroll IPM Current Course Time Exercises Correct Level Level Level Gain 1431 (Enroll Date - 8/19/97) Class AW 7:00 4.50 5.18 5.45 0.27 MCS 7:58 4.49 4.50 4.67 0.17 RA N/A N/A N/A N/A WIT 0:00 N/A N/A N/A N/A EFTA01710426 6/5/97 7:51am COURSE PERFORMANCE Page . • • (continued) Total Total Total Cori/Att :%Percent Enroll IPM. Current Course .Time Exercises Correct Level Level Level • Gain ... ' 4231 (Enroll Date - 9/10/96) MCS 4:05 3.49 ' 3.53 3.56 . 0.03 RW : 3:49 3.50 3..80 3.91 0.11 RA N/A 14/A. N/A N/A EFTA01710427 6/6/96 2:07pm COURSE PERFORMANCE Page Total Total Tot Cor/At Per Enr IPM Curr Tot Crs. Time Exer Corr Lvl Lvl Lvl Sess Gain 3330 8/22/95) A N/A N/A N/A 7 N/A WE 2: -- -- -- -- MCS 9: 2.50 2.01 2.26 45 0.25 RW 5: 2.80 2.82 3.12 28 0.30 FAB 2: N/A N/A N/A 13 N/A EFTA01710428 6/1/95 1:03pm COURSE PERFORMANCE Page 2 (continued) Total Total Tot Cor/At Per Enr ' IPM Curr Tot Crs. Time Exer Corr Lvl Lvl Lvl Sess Gain 2125 8/29/94) RR 7:05 0.50 0.43 0.99 61 0.56 MCS 11:35 0.92 0.52 1.48 61 0.96 IR 0:57 1.00 1.57 5 0.00 SD • 0:05 -- ...... __ -- WE 1:44 RW 1:29 2.80 2.80 8 0.00 EFTA01710429 PALM BEACH COUNTY PUBLIC SCHOOLS Elementary Interim Report of Unsatisfactory Progress School: Date: 6 (77 •Grade: To the parent or guardian of This report is to advise you that your child is making unsatisfactory progress in: In order to improve, your child needs to: We need.to work together. Please discuss this report"with your child. eac er c ioo one umber C Please sign and return the portion below the dotted line. P• smcit.q iu Parent's e Parent's Phone Humber(s) tb-1.1O611 (Alt Lys I wish to request a conference with the teacher. y kt (-130 PM Yes N' White/Parent Copy Yellow/Cumulative Folder PBSD 0764 (FY 86 Revision) WN 0179890 EFTA01710430 PALM BEACH COUNTY PUBLIC SCHOOLS Elementary Interim Report of Unsatisfactory Progress School: Date: 6'6 '97 •Grade: Lf To the parent or guardian of This report is to advise you that your child is making unsatisfactory progress in: In order to improve, your child needs to: We need.to work together. Please discuss this report' with your child. Teacher School Phone Number Please sign and return the portion below the dotted line. Student's Signature Date Parent's Signature Parent's Phone Number(s) I wish to request a conference with the teacher. Yes No White/Parent Copy Yellow/Cumulative Folder PBSD 0764 (FY 86 Revision) WN 01-9890 EFTA01710431 ?ALM BEACH COUNTY PUBLIC SCHOOLS Elementary Interim Report of Unsatisfactory Progress School: Date: To the parent or guardian o This report is to advise you that your child is making unsatisfactory progress in: In order to improve, your child needs to: We need to work together. Please discuss this reports with your child. c er School Phone Number Please sign and return the portion below the dotted line. 6-?‘ Stud g ature Date Parent's Signature Parent's Phone Number(s) I wish to request a conference with the teacher. Yes No White/Parent Copy Yellow/Cumulative Folder PBSD 0764 (FY 86 Revision) WN 01-9890 EFTA01710432 EFTA01710433 IIII Oa*. a OP 4s * Cs ROYAL PALM BEACH, FLORIDA 33411 PHONE: PM: FAH: Principal fl747 -)5/ Date Dear In a continuing effort to provide additional educational opportunities and assistance for students to achieve academic success, the School Board of Palm Beach County will offer a twenty ession (summer school) program. will attend the Special Session er sc oo ). A student my be recommended to attend the Summer chool Session (recommended by teacher or parental request to attend) based on the following eligibility: students who require more than the normal 180-day term to complete the expected course of study, for flexibility for students (K-5) to allow for maintenance of skills (at grade level) and /or consideration of special needs students (E.G. ADHD, ADD, ESOL, DOP, ETC.), students being promoted to the next level who need "maintenance" and alternative methods to sustain their continuous progress, or students who receive a score in the first or second quartile in the reading and/or mathematics sections of the CTBS/4 may be recommended, but are not required, to attend Summer School. It is recommended that your child attend the elementary Special Session at H. L. Johnson Elementary School, Monday through Friday, beginning Friday, July 1, 1994 ending Friday, July 29, 1994. Our profession staff considers it essential that your child attend the Special Session (summer school) program on a regular basis with no more than (3) absences if recommended by the teacher to attend. Please sign, date and return this form to your child's school by May 5, 1994. If you have questions or would discuss this recommendation, please contact our school at Parent/Guardian notification: Yes, my child will attend summer school No, m child will NOT attend s cc: Student Cumulative Record EFTA01710434 PALM BRACH COCNTY PUBLIC SCHOOLS Elementary Interim Report of 4 Unsatisfactory Progress School: 2 Crads: 2? To the parent or guardian of This report is to advise you that your child is wilting unsatisfactory progress in: In order to improve, your child needs to: We need to work together. Please discuss this report with your child. School Phone Number Please sign and reEurn Olt por:lon below the dotted line. i/p ure 3-. -9$ Date 043C all ire en e one umber e I wish to request a cc:inference with he teacher. Yesj.L.f:No White/Parent Copy Yellow/Cumulative Folder PBSD 0764 (FY 86 Revision) III ;MOO EFTA01710435 * 44- 485- 1* , * a u.a' 0 a ROYAL PALM BEACH, FLORIDA 33411 PHONF: Pik FAH:. PrISCION u eMs dik Dear In a continuing effort to keep you informed, this letter is to notify you that your child is experiencing difficulty in the area(s) checked below. The, Pupil, Progression, Plan for Palm Beach County- requires that students, demonstrate continuous progress in the academic areas of reading,. valtingi,mathematIcsk science, social•• studies and computer literacy. Classroort performance,. Maturity; and attendance, as well as physical, emotional and social factors are also considered in promotiod docisiont.," It is our judgment that your child may experience difficulty meeting the-mlnImum requirements for promotion. Students who do 'not meet minimum requirements may be:subject to retention: We believe that significant progress can be made if parents, students and teachers work together during the remainder of the school year. ti It is urgent that you arrange a conference with your child's teacher. Please sign the form below- and return it to the school. • Sincerely, leacher • cc: Cumulative Guidance Folder im meeting the I have been advised that IIIII may have difficulty nes Name minimum requirements for promotion. Dee er s re • EFTA01710436 * 44 gie 'OP 911 is to 41 • ROYAL PALM BEACH, FLORIDA 33411 PHONE: FAH: Prtatrlpsl On e Dear In a continuing effort to keep you informed, this letter is to notify you that your child is experiencing difficulty in the area(s) checked below: The Pupil Progression Plan for Palm Beach County requires that students demonstrate continuous progress in the academic areas of reading, writing, mathematics, science, social studies and computer literacy. Classrooth performance, maturity, and attendance, as well as physical, emotional and social factors are also considered In promotion decisions. It is our judgment that your child may experience difficulty meeting the minimum requirements for promotion. Students who do 'not meet minimum requirements may be subject to retention. We believe that significant progress can be made if parents, students and teachers work together during the remainder of the school year. It is urgent that you arrange a conference with your child's teacher. Please sign the form below and return it to the school. Sincerely, lea cc: Cumulative Guidance Folder I have been advised tha1.111111 may have difficulty meeting the minimum requirements for promotion. N C -S-95 store . Dish EFTA01710437 THE SCHOOL BOARD OF PALM BEACH COUNTY Elementa School Special Session Registration Student NumbeMarade Last name First name) Addre Street Address CI Zip Name of Parent/Guardian Telephone: Home me enc Home School Home School Teacher Special Session School Assignment Student's Date of Birth High Risk Medical Information Legal Information on Record: no yes (Call home school.) Student is on free lunch reduced lunch SPECIAL PROGRAM ASSIGNMENT (Check services needed.) ESOL Intensive ESOL Support ESE (Program) Other TRANSPORTATION Special Session Bus # Needed: 2 no yes regular ESE lift) SAC# Ming/ RECOMMENDATION FOR SPECIAL SESSION (Check all that apply.) Students who require more than the normal 180-day term to complete the expected course of study may attend Special Session. The following guidelines are recommended: • Flexibility for students (K-5) to allow for maintenance of skills (at grade level) • Consideration of special needs students (e.g., ADHD, ADD. ESOL, DOP, Chapter 1, etc.) Students promoted to the next level who need "maintenance" and alternative methods to sustain their continuous progress may attend Special Session. Students who receive a score in the first or second quartile in the reading and/or mathematics section of the CTBS/4 may be recommended, but are not required, to attend Special Session. Note' Students retained in their current grade level may be eligible for pm s. r.n u on corn etion of Special Session. tr/T—ne Sitti / Date gna ure o nncipa / Date iliARENT/GUARDIAN NOTIFICATION Yet, my child will attend the Special Session (summer school). The information on address and telephone numbers it correct or I have noted changes on -my copy of the registration-form. 0 No, my child will not attend the'Special Session (summer school). Signature of Parent Guardian Attaphments to the registration form sent to the Special Session school: Parent/guardian copy - signed registration form Copy of completed ESE IEP, if appropriate Other information To be completed at the conclusion of Special Session: STUDENT ATTENDANCE RECORD: /1 Days Present 3 Days Absent Days Tardy Teacher comments: PLACEMENT DECISION Made following Special Session 0 Promoted 0 Administrative Placement 0 Retained 9Y Signature of Home School Principal / Date Signature of Special Session Administrator I Date PBSD D673 FY 94 Revision WhitelSpocial Session School then Home School YellowlHonio Schoolt0flice PinkfTransportation GoldiParentiGuardian then Home School EFTA01710438 PANEL: A15. DAILY SUMMARY YEAR: 00 Monday October 25, 1999 3:23 pm STDT: SCHL: 1691 GR: 07 ST: A CAL: 01 1111111111222222222233 ASSIGNMENTS 1234567890123456789012345678901 ABS PRS MBR SCHL ENTRY WITHDRAWL JUL 0 0 0 1691 E01 081699 AUG 0 12 12 SEP A... 1 19 20 OCT 0 16 16 NOV 0 0 0 DEC 0 0 0 JAN 0 0 0 FEB 0 0 0 MAR APR MAY 0 O 0 O O 0 JUN JUL NJ/L. I 0 0 0 0 AUG 0 0 0 TOTAL: 001 047 048 % = 2 98 PF1=HELP 3=EXIT 7=BKWD 8=FWD 12=ESCAPE RECORD IS DISPLAYED...NEXT? TERML: CB16 ,e/2"_,t ;Jut_ , d_o{ 1,r\ /147 6r3d-tet f 54. .27 1101V1 MeX. ,11.144tP 196S6'Arr Ala MA« hS it' i - sc S"-"", 111. - \g=Z: LX:; -/d~ yOW .,Q.&,--11--kL24-- (FYI 947M - 7 -JA-r0 Lt- EFTA01710439 FCAT Total Score The Total Score Indicates the student's level of achievement on FCAT Mathematics. The Total Score that a student could achieve ranges from 100 to 500. 19 8: , titlividual Profile Total Report Score The Total Mathematics Score of 297 indicates that scored in the middle third of grade 5 students who took FCAT Mathematics in 1998. ID !Number The Subscores indicate the student's level of achievement on separate content areas Subscores of FCAT Mathematics. Each Subscore represents the percentage of content In that Grade 5 area that the student responded to successfully. 25 50 75 100 .AT- Mathematics ColapiSisit)8: • Number Sense Measurement AsSessment . Test Geometry Algebraic Thinking Data Analysis The Sunshine State Standards content tested by FCAT Mathematics Is described on the back of this report. Message to Parents: The Florida Comprehensive Assessment Test (FCAT) is a new achievement test for Florida students. FCAT measures the Sunshine State Standards for reading and mathematics. Adopted in 1996, the Sunshine State Standards are challenging expectations for Florida students. They apply to all students whether they plan to enter the world of work or go on to further education after high school. The Standards signify what students should know and be able to do as they progress through school. The Sunshine State Standards are the foundation for a strong accountability .Soh ol,Humbar. 1701 system for Florida's schools. st 01 Number-50 • :PALI? BEACH • . FCAT was administered for the first time in Florida schools in January 1998. The 1998 test scores will set the baseline for future achievement of the Sunshine State Standards in reading and mathematics. FCAT scores are an overall indicator of achievement of these challenging new standards. FCAT results will not be used in making Run.pate: 4/30/98 decisions concerning the promotion of students in 1998 but will be one consideration in promoting students In future years. griw CTB McGraw-Hill Cr",-,v7 EFTA01710440 Mathematics Content Tested Área de contenido del examen de Matemáticas PCA'!' Mathematics is an assessment of the Sunshine State El examen de Matemáticas PCA'I' es el examen que evalúa las normas Standards In mathematics. PCAT Mathematics assesses content educativas de Matemáticas del estado de la Florida (Sunshtne Sute from the following arcas: Standards). Este examen evalúa las habilidades siguientes: Number Sense, Concepts and Operations Compresión numérica, conceptos y operaciones • Identifying operations (+, x, +) and effects of operations • identificación de operaciones (+, x, +) y efectos de operaciones • determining estimates • estimación de resultados • knowing how numbers are represented and used • uso y representación de números Measurement Medidas • recognizing measurements and units of measurement • reconocimiento de medidas y de unidades de medidas • comparing, contrasting, and converting measurements • comparación y conversión de medidas Geometry and Spatial Sense Geometría y noción espacial • describing, drawing, identifying, and analyzing two- and three- • descripción, dibujo, identificación y análisis de figuras de dos y tres dimensional shapes dimensiones • visualizing and illustrating changes in shapes • visualización e ilustración de cambios en figuras • using coordinate geometry • uso de geometría coordinada Algebralc Thinicing Razonamiento algebraico • describing, analyzing, and generalizing patterns, relationships, • descripción, análisis y generalización de patrones, relaciones y funciones and functions • uso de expresiones, ecuaciones, desigualdades, gráficas y fórmulas • using expressions, equations, inequalities, graphs, and formulas Análisis de datos y probabilidad Data Analyzing and Probablilty • análisis, organización e interpretación de datos • analyzIng, organizIng, and interpreting data • Identificación de patrones y elaboración de predicciones, Inferencias y • identifying patterns and making predictions, Inferences, and conclusiones válidas valid conclusions • uso de probabilidad y estadística • using probability and statistics Mensaje a los padres de familia: La Prueba de Evaluación Comprensiva de la Florida: Florida Comprehensive Assessment Test (PCA'!') es un examen nuevo diseñado para los estudiantes del estado de la Florida. El examen 17CAT mide las normas educativas (Sunshine State Standards) de matemáticas y de lectura. Dichas normas, que fueron adoptadas en 1996, tienen expectativas altas CAT de los estudiantes del estado y se aplican a todos los estudiantes ya sea que vayan a trabajar o que sigan con estudios universitarios después de la escuela secundarla. Las normas educativas representan lo que los estudiantes comprebensive deben saber y pueden hacer en su avance académico. Las normas educativas establecen la base para un sistema Assessment que define una mayor responsabilidad para las escuelas de la Florida. Test El examen PCA'!' fue administrado por primera vez en enero de 1998 en las escuelas del estado de la Florida. Los resultados del examen de 1998 determinarán la base para el futuro logro de las normas educativas del estado de la Florida en las áreas de lectura y matemáticas. Los resultados del PCA'!' son un reflejo general de estas nuevas normas educativas y sus altas expectativas. Los resultados del PCA'I' no se usarán en 1998 para decidir en qué grado se colocará el estudiante pero si será uno de los factores que se considerarán en el futuro. t. CTB fr McGraw-HIll EFTA01710441 Student Name: 1997 Florida Writing Assessment Student I.D. No.: STUDENT REPORT School: District: PALM BEACH COUNTY Florida Grade 4 Writing Assessment TYPE OF WRITING TESTED: WRITING TO EXPLAIN Program Description of Writing Scores Your Student's Score 6.0: The writing focuses on the topic, is logically organized, and includes ample development of Dear Parents or Guardians: supporting ideas or examples. It demonstrates a mature command of language, including precision in word choice. Sentences vary in structure. Punctuation, capitalization, and spelling are generally correct. The paper your student wrote in January as part of the Florida Writing Assessment Program has been read independently by two people trained 5,5: The writing was given a 5 by one reader and a 6 by the other reader. to score this test. Each reader judged the paper against a set of 5.0: The writing focuses on the topic with adequate development of supporting ideas or examples. It standards and gave it an overall score. Your student's final score is the has an organizational pattern, though lapses may occur. Word choice Is adequate. Sentences average of the two readers' scores. vary in structure. Punctuation, capitalization, and spelling are generally correct. 4.5: The writing was given a 4 by one reader and a 5 by the other reader. This writing score will help you, your student, and the teacher understand how well your student performed on this statewide writing 4.0: The writing focuses on the topic, though it may contain extraneous information. An test. A description of each possible score is printed on the left side of organizational pattern is evident, but lapses may occur. Some supporting ideas contain specifics and details, but others are not developed. Word choice is adequate. Sentences vary this report. somewhat in structure, though many are simple. Punctuation, capitalization, and spelling are usually correct. Students were given 45 minutes to read the assigned topic, plan what to 3.5: The writing was given a 3 by ono reader and a 4 by the other reader. write, and then write their responses. The conditions under which your student writes papers in class or at home may not be the same as those 3.0: The writing generally focuses on the topic, though it may contain extraneous information. An for this test; therefore, the writing may not be the same. You and the organizational pattern has been attempted, but lapses may occur. Some of the supporting ideas teacher should consider the score on this test along with all of your or examples may not be developed. Word choice is adequate. Sentences vary somewhat in structure, though many are simple. Punctuation and capitalization are sometimes incorrect, but student's other writing when planning activities to continue developing most commonly used words are spelled correctly. your student's writing skills. 2.5: The writing was given a 2 by ono reader and a 3 by the other reader. 2.0: The writing may be slightly related to the topic or offer little relevant information and few supporting ideas or examples. There is little evidence of an organizational pattern. Word choice may be limited or immature. Semences may be limited to simple constructions. Frequent errors DESCRIPTION OF THE TOPIC: may occur in punctuation, capitalization, and spelling. 1.5: The writing was given a I by one reader and a 2 by the other reader. Students were asked to explain why The writing may only minimally address the topic because there is little or no development of everyone should know how to read. 1.0: supporting ideas or examples. No organizational pattem is evident. Ideas are provided through lists, and word choice is limited or immature. Unrelated information may be included. Frequent errors in punctuation, capitalization, and spelling may impede communication. RUN DATE: 04/19/97 50-1761-00000T402 U: The writing is unrelated to the assigned topic or cannot be read, or there is no response. EFTA01710442 EVALUACION DE SECRITURA DE LA FLORIDA PRIMAVERA DE 1997 REPORTE ESTUDIANTIL INFORMES DE LOS ESTUDIANTES DE 4' GRADO Descripción de las Notas de Redacción Estimados padres o tutores: 6.0: La redacción se concentra en el tema, está lógicamente organizada e incluye un La prueba escrita por su niño(a) en enero como parte del Programa de amplio desarrollo de las ideas o ejemplos fundamentales. Demuestra un dominio maduro del Evaluación de Redacción de Florida, fue leida independientemente por dos idioma, incluyendo precisión en la elección de términos. Las oraciones varían en su estructura. La puntuación, uso de mayúsculas y ortografía son generalmente correctas. personas capacitadas para evaluarla. Cada lector juzgó la prueba en relación 53: La redacción recibió un 5 por parte de un lector y un 6 por parte del otro lector. a un conjunto de normas y la calificó con una nota general. La nota final de 5.0: La redacción se concentra en el tema y tiene un desarrollo adecuado de las ideas o su niño(a) es el promedio de las notas otorgadas por los dos lectores. ejemplos fundamentales. Tiene una estructura organizada, aunque haya algunos lapsos. La elección de términos es adecuada. Las oraciones varían en su estructura. La puntuación, uso Esta nota de redacción le ayudará a usted, a su niño(a) y a los maestros a de mayúsculas y ortografía son generalmente correctas. comprender cómo se desempeñó su niño(a) en esta prueba de redacción 4.5: La redacción recibió un 4 por parte de un lector y un 5 por parte del otro lector. realizada en todo el estado. Una descripción de cada una de las notas 4.0: .• La redacción se concentra en el tema, aunque puede contener información ajena al mismo. És evidente una estructura organizada, aunque puede haber algunos lapsos. Algunas p6sibles aparece en el lado izquierdo del informe. Ideas fundamentales contienen datos específkos y detalles, pero otras no están desarrolladas. La elección de términos es adecuada. Las oraciones varían algo en su estructura, aunque la Los estudiantes dispusieron de 45 minutos para leer el tema asignado, mayoría son simples. La puntuación, uso de mayúsculas y ortografía son generalmente conectas. planificar lo que iban a escribir y escribir sus respuestas. Las condiciones 3.5: La redacción recibió un 3 por parte de un lector y un 4 por parte del otro lector. bajo las cuales los estudiantes redactan otras pruebas en clase o en el hogar La redacción se concentra generalmente en el tema, aunque condene Información pueden ser diferentes a las empleadas en esta prueba; por lo tanto, la 3.0: ajena al mismo. Se intentó una estructura organizada, aunque puede haber algunos lapsos. redacción puede ser diferente. Ustedes y los maestros deben considerar la Algunas de las Ideas o ejemplos fundamentales pueden no estar desarrollados. La elección de términos es adecuada. Las oraciones varían algo en su estructura, aunque la mayoría son nota de esta prueba junto con todas las otras redacciones del estudiante, al simples. La puntuación y la ortografia son a veces incorrectas pero las palabras más planear actividades para continuar desarrollando las habilidades de comunmente usadas están escritas correctamente. redacción del estudiante. 2.5: La redacción recibió un 2 por parte de un lector y un 3 por parte del otro' lector. 20: La redacción está apenas relacionada con el tema u ofrece poca información relevante, así como pocas Ideas o ejemplos fundamentales. Hay poca evidencia de una estructura organizada. La elección de términos puede ser limitada o Inmadura. las oraciones se limitan a construcciones simples. Pueden encontrarse errores frecuentes de puntuación, uso de mayúsculas y ortografía. 1.5: La redacción recibió un 1 por parte de un lector y un 1 por parte del otro lector. 1.0: La redacción considera mínimamente el tema porque no hay o hay muy poco desarrollo de las ideas o ejemplos fundamentales. No hay evidencia de una estructura organizada. Las ideas aparecen enumeradas en listas y la elección de témunos.e1.11.mitada o inmadura. Puede aparecer información no relacionada con el tema. Los errores frecuentes de puntuación, uso de mayúsculas y ortografia pueden impedir una comunicación efectiva. U: La redacción no tiene relación con el tema asignado, no puede leerse o no obtuvo respuesta. EFTA01710443 action( OA 1.,100/1. 01WLERN1 AEJMJAT TEACHER: FOR: SCHOOL: GRADE: 06 DATE OF TESTING: 4/13/99 TEST: CTBS/4 LEVEL 16 FORM A STUDENT NUMBER: SCORE RANGES LOWEST AVERAGE HIGHEST PERCENTILE TESTS RANKS LOW HIGH TOTAL READING READING COMPREHENSION READING VOCABULARY TOTAL MATHEMATICS MATH CONCEPTS & APPLICATION MATH. COMPOTATION RANGES OF 1-25 26-50 51-75 76-99 PERCENTILE PERCENTILE PERCENTILE PERCENTILE PERCENTILE RANKS Dear Parent/Guardian: This spring, was given the Compr Tests of Basic Skills/Fourth Edition (CTBS/4). This report explains .s test results. When compared with students across the nation, s scores were in the high-average range on all tests taken. Additional information about these tests can be the back of this page. If you would like more information about 's test scores, please contact our school. Sincerely, Principal ogpxtro f,,,:orkz:. SCH06100Prt 4.ssv= EFTA01710444 KtrUKS WA LT.I3b/9 bTULMNT NtieVNT TEACHER: FOR: SCHOOL: GRADE: 05 DATE OF TESTING: 4/20/98 TEST: CTBS/4 LEVEL 15 FORM B STUDENT NUMBER: SCORE RANGES LOWEST AVERAGE HIGHEST PERCENTILE TESTS RANKS READING COMPREHENSION MATH CONCEPTS & APPLICATIONS TOTAL LANGUAGE LANGUAGE MECHANICS LANGUAGE EXPRESSION RANGES OF 1-25 26-50 51-75 76-99 PERCENTILE PERCENTILE PERCENTILE PERCENTILE PERCENTILE RANKS Dear Parent/Guardian: This spring, was given the Comp • Tests of Basic Skills/Fourth Edition (CTBS/4). This reportexplains s test results. When compared with students across the nation, s scores were in the low-average range on all tests taken. Additional information about these tests can be found on the back of this page. If you would like more information about 's test scores, please contact our school. Sincerely, Principal EFTA01710445 REPORT #1 CTBS/4 STUDENT REPORT TEACHER: FOR: SCHOOL: GRADE: 04 DATE OF TESTING: 4/15/97 TEST: CTBS/4 LEVEL 14 FORM A STUDENT NUMBER: SCORE RANGES LOWEST AVERAGE HIGHEST PERCENTILE TESTS RANKS LOH HIGH TOTAL READING READING COMPREHENSION READING VOCABULARY TOTAL MATHEMATICS MATH CONCEPTS & APPLICATION MATH COMPUTATION SCIENCE SOCIAL STUDIES RANGES OF 1-25 26-50 51-75 76-99 PERCENTILE PERCENTILE PERCENTILE PERCENTILE PERCENTILE RANKS Dear Parent/Guardian: This spring, rill' was given the Comprehensive Tests of Basic Skills/Fourth Edition (CTBS 4 . This report explains IIIIIIIIts test results. When compared with students across the nation, s scores were in the low-average range on all tests taken. Additional information about these tests can be found on the back of this page. If you would like more information about IIIIIIIrs test scores, please contact our school. Sincerely, Principal EFTA01710446 5/07/96 NON-STANDARD ADMINISTRATION STUDENT REPORT PAGE 189 SCHOOL: GRADE: 3 DATE TESTED: 4/17/96 20018305 TEST: CTBS/4 LEVEL 13 FORM A PERCENT OF QUESTIONS CORRECT "{ 1" shows the number of test questions in each objective "---" in the percent column indicates that this part of the test was not taken EFTA01710447 REPORT #1 CTBS/4 STUDENT REPORT TEACHER: FOR: SCHOOL: GRADE: 02 DATE OF TESTING: 4/18/95 TEST: CTBS/4 LEVEL 12 FORM A STUDENT NUMBER: SCORE RANGES LOWEST AVERAGE HIGHEST PERCENTILE TESTS RANKS LOW HIGH TOTAL READING READING COMPREHENSION READING VOCABULARY TOTAL MATHEMATICS MATH CONCEPTS & APPLICATION MATH COMPUTATION RANGES OF 1-25 .26-50 51-75 76-99 PERCENTILE . PERCENTILE PERCENTILE PERCENTILE PERCENTILE RANKS Dear Parent/Guardian: This spring, was given the Comprehensive Tests of Basic Skills/Fourth Edition (CTBS/4). This report explains s test results. When compared with students across the nation, scored in the lowest range on all tests taken. Additional information about these tests can be found on the back of this page. If you would like more information about Mas test scores, please contact our school. Sincerely, Principal EFTA01710448 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, s. 10D-3.088, F.A.C. and a. 10M-12, F.A.C. LAST NAME T_ Iva DOB MO/DA/YR PARENT OR GUARDIAN Child's SS# (optional) STATE IMMUNIZATION Directions: • Enter all appropriate doses and dates below. • Sign and date appropriate certificate (A-1, A-2, B, or C) on reverse side of form. • If the child is presenting for the 7th grade requiremeitt-MilVilierlias:preximusly filed a Certificate of Immunization (680A or 680A-1) with their current Florida school,fill iii doer(; areas beBitvantiComplete Part A-2 on the reverse side of this form. • • For additional information: Seeiminunifrtatipszathlefinea4or-araolarittthintare Facilities for information and instructions on form completiquAud hiritipiliatiOMIquirreiritits.::cuiclefirte0 . re ufailtAd annually and are available .. from the local county health.degattutrti.z.: ::..; - •.„*, %:. ft Si --.- :7•2•:.: . , ' .'•‘.. • ' , `•:7% . •.).f: • .:...\•., . . f/ .'N... -. • (..;_l -. ..-7.-fl!:::: ,. . :• .•.i•••• '‘f <-7- • - • ' ,';': '''''.' k,,.Dose 4 VACCINE DOgi -•- •21:-.:1;:tettii Lt ' ' ' :., O0,d-2 -.;.7. ....F.,.:O4;43. . Pose 5 COPE — i''\'•/14 OIPA47:2 • — •I7 % . MO/DriTt. .... ; 7.:MOLD A/YR MO/DA/YR DTaP/DTP2 1,1 . : ) .t.. . Dr It . 4.. ... ' r It lie't C Y Folios' t' • .. • H1B6 /Y.':", MMR (Combined)' Fa,. (Separate)8 G, H, Hepatitis B9 • ; The state immunization ID# is an identifier-so/Mg:SI:741k sratommunizationzegistry (optional). 2 DIP 5 doses required. If the fourth primary dose idthiltistererkofikliV‘r the fourth birthday a fifth dose is not required. DTaP is an acceptable alternative for one or more doses of DTP. 3 DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) • Td (Adult) Vaccine is recommended for children 7 years of age or older. 5 Polio 4 doses required. If the third dose is administered on or after the fourth birthday, a fourth dose is not required. IPV is an acceptable alternative for one or more doses of OPV. Polio vaccine is not required for children 18 years of age or older. 6 Hib is required for child care and preschool entry and attendance only. 7 Ist dose valid if given on or after 1st birthday. Second dose (measles) valid if given at least 1month.after 1st dose. A second dose of measles (preferably MMR) is required for students in grades K-4 in the 1997-98 school year, and 7th grade entry and attendance effective with the 1997/98 school year. In each subsequent year thereafter, the next highest grades are included. Includes single measles vaccine (G), single mumps vaccine (H) or single rubella vaccine (I). 9 Hepatitis B vaccine series is required for seventh grade entry and attendance effective with the 1997-98 school year and kindergarten entry and attendance effective with the 1998-99 school year. In each subsequent year thereafter, the next. highest grades are included. EFTA01710449