C. ELEMENTARY SCHOOL Special Education & Other Enrollment Academics Attendance & Social/Emotional Services School Year: Grades Attendance SST Date: Subject: T1/T2/T2 Concerns: Grade: Mental Health/Attention/Behavior/Discipline Intervention Plan: CST Testing ELA: 504 Plan Date: School: Math: Disability: District: Intervention Plan: ERH Consent? School Type: CMA Testing: ELA: Assessment Date: Math: CA: CG: Enter Date: Summary of Results: CAASPP Testing: Exit Date: Recommendation(s): ELA: Math: IEP Date: Eligibility: CELDT Overall Level: Relevant Placement & Services: Noted Academic Concerns/ ERH Consent? Interventions: Sample (Grade 2 only) School Year: 05-06 Grades Attendance None Subject: T1/T2/T3 Days Absent: 4 Grade: 2 Reading: 2/3/_ Tardies: 2 Writing: 2/2/_ Attendance Band: >95% Math: 3/2/_ School: Moss Mental Health/Attention/Behavior/Discipline Listening: 2/2/_ Elementary 2/3/06: Children’s Bureau Diagnosis of Speaking: 3/3/_ ADHD District Hills Social Science: 2/3/_ Science: 4/4/_ Unified SD School Type: CST Testing ELA: Basic Comprehensive Math: Proficient School CELDT Overall Level: Intermediate Enter Date: Beg. of Noted Academic Concerns/ Year Interventions: Teacher Note on T1 report card: Practice decoding. Exit Date: 3/12/06 Grades Attendance School: Wise None Subject: S1/S2 Days Absent: 0 Elementary Scale: O=Outstanding, Tardies: 3 S=Satisfactory, NI=Needs District: XYZ Attendance Band: >95% Improvement Unified SD Reading Decoding: _/NI Reading Comprehension: _/NI School Type: Writing: _/ S Comprehensive Math Fluency: _/ S School CELDT: None (ELL status gone) Enter Date: Noted Academic Concerns/ Interventions: Report Card notes 3/15/06 referral for retention due to Exit Date: End of reading skills. Year Elementary School Specific Notes & Instructions:
C. ELEMENTARY SCHOOL Enrollment Academics Attendance & Social/Emotional Special Education & Other Services School Year: Grade: School: District: School Type: Enter Date: Exit Date: Grades Subject: T1/T2/T2 CST Testing ELA: Math: CMA Testing: ELA: Math: CAASPP Testing: ELA: Math: CELDT Overall Level: Noted Academic Concerns/ Interventions: Attendance Mental Health/Attention/Behavior/Discipline SST Date: Concerns: Intervention Plan: 504 Plan Date: Disability: Intervention Plan: ERH Consent? Assessment Date: CA: CG: Summary of Results: Recommendation(s): IEP Date: Eligibility: Relevant Placement & Services: ERH Consent? Sample (Grade 2 only) School Year: 05-06 Grade: 2 School: Moss Elementary District Hills Unified SD School Type: Comprehensive School Enter Date: Beg. of Year Exit Date: 3/12/06 Grades Subject: T1/T2/T3 Reading: 2/3/_ Writing: 2/2/_ Math: 3/2/_ Listening: 2/2/_ Speaking: 3/3/_ Social Science: 2/3/_ Science: 4/4/_ CST Testing ELA: Basic Math: Proficient CELDT Overall Level: Intermediate Noted Academic Concerns/ Interventions: Teacher Note on T1 report card: Practice decoding. Attendance Days Absent: 4 Tardies: 2 Attendance Band: >95% Mental Health/Attention/Behavior/Discipline 2/3/06: Children’s Bureau Diagnosis of ADHD None School: Wise Elementary District: XYZ Unified SD School Type: Comprehensive School Enter Date: 3/15/06 Exit Date: End of Year Grades Subject: S1/S2 Scale: O=Outstanding, S=Satisfactory, NI=Needs Improvement Reading Decoding: _/NI Reading Comprehension: _/NI Writing: _/ S Math Fluency: _/ S CELDT: None (ELL status gone) Noted Academic Concerns/ Interventions: Report Card notes referral for retention due to reading skills. Attendance Days Absent: 0 Tardies: 3 Attendance Band: >95% None Elementary School Specific Notes & Instructions:
Sample-Education-Evaluation.docx