LPAC Review Independent School District/Charter School Initial Annual Assessment determination Other: Student name: Enrollment date: Grade: LPAC date: Home Language Survey date: Academic year: Date received by district/charter school: Identification TEA-Approved Test: Oral: Written: Primary language score: TEA-Approved Norm-Referenced Instrument: Reading percentile: Language Arts percentile: Academic Progress State Assessment TELPAS Assessment Type Date Circle One Score Listening Beg. Int. Adv. Adv. High Reading Pass Fail Speaking Beg. Int. Adv. Adv. High Writing Pass Fail Reading Beg. Int. Adv. Adv. High ELA Pass Fail Writing Beg. Int. Adv. Adv. High Science Pass Fail Composite Score Beg. Int. Adv. Adv. High Social Studies Pass Fail Oral Language Proficiency Level (end-of-year): Math Pass Fail Instructional Linguistic Accommodations: Assessment Designated Supports: Other Assessments Other (specify): Reading Instrument Name: Score: Notes: TEA-Approved Norm-Referenced Instrument: Date: Reading Percentile: Language Arts Percentile: Level of Academic Achievement LPAC Recommendations Subject End-of-Year Grade English Learner Parent permission date: English/Language Arts Parent denial date: Math English Proficient Enter/Continue Bilingual Program Science Transitional bilingual/early exit Social Studies Transitional bilingual/late exit Other content areas Dual language immersion/two-way Dual language immersion/one-way Enter/Continue ESL Program LPAC Signatures English as a second language/content-based English as a second language/pull-out Bilingual or ESL Educator: State Assessment Determination __________________________ (see attached documentation) Campus Administrator: Served in Special Program(s) (specify): ____________________________ 1st Year–F 2nd Year–S 3rd Year–3 Parent Representative: Re-enter program as a result of monitoring ____________________________ Reclassification Bilingual or ESL program (met criteria) ARD Committee Representative (if needed): Other: Other (specify title): _______________________________
LPAC Review Independent School District/Charter School Initial Annual Assessment determination Other: Student name: Enrollment date: Grade: LPAC date: Academic year: Home Language Survey date: Date received by district/charter school: Identification TEA-Approved Test: Oral: Written: Primary language score: TEA-Approved Norm-Referenced Instrument: Reading percentile: Language Arts percentile: Academic Progress State Assessment TELPAS Assessment Type Date Circle One Score Listening Beg. Int. Adv. Adv. High Reading Pass Fail Speaking Beg. Int. Adv. Adv. High Writing Pass Fail Reading Beg. Int. Adv. Adv. High ELA Pass Fail Writing Beg. Int. Adv. Adv. High Science Pass Fail Composite Score Beg. Int. Adv. Adv. High Social Studies Pass Fail Oral Language Proficiency Level (end-of-year): Instructional Linguistic Accommodations: Assessment Designated Supports: Other (specify): Notes: Math Pass Fail Other Assessments Reading Instrument Name: Score: TEA-Approved Norm-Referenced Instrument: Date: Reading Percentile: Language Arts Percentile: Level of Academic Achievement LPAC Recommendations Subject End-of-Year Grade English Learner Parent permission date: Parent denial date: English Proficient Enter/Continue Bilingual Program Transitional bilingual/early exit Transitional bilingual/late exit Dual language immersion/two-way Dual language immersion/one-way Enter/Continue ESL Program English as a second language/content-based English as a second language/pull-out State Assessment Determination (see attached documentation) Served in Special Program(s) (specify): 1st Year–F 2nd Year–S 3rd Year–3 Re-enter program as a result of monitoring Reclassification Bilingual or ESL program (met criteria) Other: English/Language Arts Math Science Social Studies Other content areas LPAC Signatures Bilingual or ESL Educator: __________________________ Campus Administrator: ____________________________ Parent Representative: ____________________________ ARD Committee Representative (if needed): Other (specify title): _______________________________