EFTA01710352

MOO RBuIeN Answers I S bIS OM oak Oda W u boa • to •WOO i• OP OOP Po. Admit Ate. Math HI 34 zcrn, CPY 14.4 SATI and usa M. 1M It Van led niPM=IMIfl allfliall•dii al 200 HO 3.* 410 am -del di*. 4. wY ••.e.. fear •• omen ronet* 1.4C4".. 4 'unt, Oh* N. ...Owl Nis IS - Vale l•I •• ••••kl ••••••I woody. •••••61 id I MS Improve Slu'ilsYour ::=.1=1":::: le amain I?. fl• led s i s. • flreddlebd • Send% dad aY 'SOW k • sated* roe tr ..,76.tr........"'""""n " loon.k* Ms (gegen' SS.* war the arida dand Ida NS I% is.* dd.. lindid 'led* i• w. Dopers ••••• wows areempese Oen. wee • ea •••••••••• now ••• sae.. we Mira II •••• we sand Mena •• MOO SNOOP •••• IO/ sena 0•1•••••••••• Se. Fe r. MON a •.M n.. Vorway ra••••1 PO one l•••• s ee 'roma anal an en pm. Fel- "nos geese •••••• User. Ma saa la . P ia • Mr Mina. • =Mw. geniis's MSG romaown MKS. Ole •••••. • lOpOWn rad a•Ope• i. wee. P• Wenn. Yoe T.. !swan. re. nen ••• ewe" ma Oen ••••••• 0 wee moss weeper sus swam MOW ••• Ogee% MVOS OS laps co• erne etre • IS le. we 'ono roans Pee. on Va add addl. IJ di, wane* UM IONNION ••••••ekl114 GOMM) My odd - - *Oa ddreets•••••••• le• %On or sr lea l• We* •••• 1••••r wawa wee taw • Itetedildd ind•dit gad las ISMS` IRIER I-5- ~eV de Wee. Oen, Wine *Marren/ mo tenon •I seems d ed M VOr. WOOS le NO 1W en./ %Odd Men I%MICI lad•da• tddwere Prodien Sera= Me AS Mna Woe. e A` lin l• Yeto kb • • OS inn Set Odd Ode 4• drydom.Cm OS • anew •• wet • •• =allot n - •• sinew la sows a on( • le woes • ••• aro.. airs wawa waS •• Maw CZOn* boot 8. IS. r •••• loons. e ons", ••• • ad, *mato. woo •• •••• often. on.... MM.. • ••• en. ••••• ewe. ma lows twee sow •••••• wools rune, •• elf. , Owe •••••••• Po. Do. vs. • ••• cooeuete•••• ogee •• ISIS • ••• mesa saes wa maim m wa PROT0 Students Full Name Address Name of Parent or juardian Select A. HEALTH EXAMINATION He lit STUDENT HEALTH EXAMINATIONS Date ,/e. /Is Phone Aoe Race Sex Dirhdate Blood Pre-sure (I) Normal-It Abnormal =A 1. Appearance 2. Skin/Nose 2 Head/Scalo Nt y ( COMMENT: Abnormal Findings, by number 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 1 DM 3040. 1046 (Rap-aces HRS-H Form 3010 wh c.h may be us•O) (Sto4.4 N4mOar. 5744.003.3040-2) PROT1 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 Ail1/4_, '---Le attic_ c HRS-H Form 3041, MAY 80 (3) PROT2 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES CUMULATIVE SCHOOL HEALTH RECORD (This form is not intended for physician's use) Special Health Problems - See Narrative Name _ Race L) Sex F School Address, Father's Name Date of Birth Immunization Special Immunization Place Certification: Yes Prcgrams Mother's Name Fl Birth Recorded: of Birth CO (Sri- ?Dial BPGehr Yes El - No O Ear No O A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES Screening and Assessment Grades K-3 K 1 2 3 Screening Date 13. ii, 0 ft Outcome •E a) C a CD CD A O 33 CD 16 ZS cc Outcome a) C *E m ? 8 8 i 8 G sio=utcome Screening Date 7.! 8 so cc Outcome Vision Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Physical Assessment Other Other Screening and Assessment Grades 4-8 4 5 6 7 8 ci, c 'E CD ine 0 o cn o t 0 II cc I Outcome ci) -C 0•-• 0 to Es 0 o co Ts t 0 1S CC I Outcome ai c •E a) e to I' 0 o cn To t 0 115 cc Outcome ci, C '2 m 0 to e. 0 m TO 't 0 15 CC i Outcome Screening Date 13' ZI:, • CC 4. g o 5 0 Vision Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Scoliosis Other Other PROT3 atuan Lae 3"`t- r e, , each, jr hipzienrlifie ,avaderenview AgjAri.XaytelaZ atria Aiapi %%Banos Blurt ofAgrAWAV aledetatafeilelata4 Atredhteied Awid ',re/meads PROT4 V., 09 FLORIDA CERTIFICATE OF IMMUNIZATION (HRS 680 - PART A) OF MALIII PAO 0.1 flutida Statutes 232.032) FOR CHILDREN WHO HAVE COMPLETED ALL REQUIRED IMMUNIZATIONS FOR SCHOOL ATTENDANCE RATE OF R'RTH CHILD'S NAME MO DA YR 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 PARENT OR GUARDIAN 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 PROT5 N JSe STATE OF FLORIDA DEPARTMENT OF HEALTH If REHABILITATIVE SERVICES STUDENT HEALTH EXAMINATIONS rh A 7- ao Lj sex zadi Scalp /4 Eyes 5. Visua Acuity I I! t 4-s 1--- G Ears 7. luditor 8. Ncse / Throat ett Latty 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 1 I-17: I:2 DitIthrei ctri.,L.O5.; NAMI: TITLE ADD (PiirsiiA'0t(m) PALM BEACH BLVD. SUITE 201 ROYAL PALM sena'. FL 33411 F. Obsolete. previous 'dittos.) (Stock Nunber: 5744-000-3040-2) Stool (O PI Sickle Cell 30 . 9 L Tuberculin Date PROT6 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES CUMULATIVE SCHOOL HEALTH RECORD (This form is not intended for physician's use) Name Address Race Lc) Sex F School Father's Name Mother's Name Special Health Problems • See Narrative__ fir. Date of Birth Al /. / ■ Place of Birth (4 es4 -Palo .3eGeh F1 Birth Recorded. El Yes El - No 0 Immunization Certification: Yes Er No 0 Special Immunization Programs A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES Screening and Assessment Grades K-3 K 1 2 3 c cn c O m ,,, 00 Z.5 (I) Referral Outcome Screening Date Referral Outcome Screening Date IL3 IS 0 tr Outcome Screening Date I Referral Outcome Vision Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Other Other Screening and Assessment c Grades 4-8 4 5 6 7 8 I crooning Date Referral 'Outcome I creening Date 4.1. r, O CD E OO, c c co Et, 0 2 To '- €3) 0 cr Outcome Screening Date Referral Outcome a "E 0 s a t.) u) To I:, IL Outcome Vision Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Communicable Disease Records Review Scoliosis Other Other L PROT7 Students Full Name Address cTI inENT HEALTH EXAMINATIONS Date 7/'/T3 Nans of P e 1 or d s Phone Age Race Sex Girth ate A. HEALTH EXAMINATION Hear (/) Normal-N. Abnormal-A comment I: Aoriormai rindings, Dy numoer Pressure 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 & Tuberculin test: LP 1C1 Sickle Cell d NAME: TITLE: ADDRESS: (Please Print) 1 7A /7 5 OH 3040. 10/16 (Rapacas HRS-ef Form 3040 when may 0* oseie) (Stock Nwnbsr 57444430 JU0 2) Authorized Signature Date PROT8 STATE OF FLORIDA DEPARTMENT OF HEALTH AND REHABILITATIVE SERVICES CUMULATIVE SCHOOL HEALTH RECORD (This form is not intended for physician's use) Name. Adore Special Health Problems - See Narrative Race th Sex F School eatewnese 77(.1 45 1 Father's Name Mother's Narre MalL Date of Birth Place of Birth CO e54 Fl Birth Recorded: Yes 9 No K Immunization Certification: Yes a' No D Special Immunization Programs A NARRATIVE NOTE IS REQUIRED FOR REFERRAL AND OUTCOME ENTRIES Screening and Assessment Grades K-3 K I 2 3 Screening Date To 0 t:i CC Outcome at Screening Date 7! IS co cc Outcome Screening Date -5 O 71) cc r- Outcome Screening Date 1.a. To 0 cc Outcome Vision Hearing Height, Weight & Graphing Nutrition Dental Health Mental Health Ccmmunicable Disease Records Review Other Other 4 5 6 7 8 Screening and Assessment Grades a)c E e O tor - co Outcome 3creening Date 45 Outcome 3creening Date - B cr) c .E 0 co to. - w Outcome a, c 'Ee - O a) E 8 4-8 e 0 O en TD cc CD en 0) O cc: : -0- cr '5 PROT9 -1°° AIN THE SCHOOL DISTRICT OF PALM BEACH COUNTY F 0 a 9-12 Academic 1,k--74 O, Improvement Plan (AIP) Marking Period Monitoring Dates: First /D' Second Third Fourth $Y: 04 DC6: FISRT: FCAT: wAP: PRIM: ABS: MA 3 TH:RET: READ: MATH: 4.0 - FZ W - ZZ FIR I S - FL LEP: 504: Et READING D WRITING 0 MATHEMATIC orb 014extbook Assessments YED. CAT Diagnostic I Practice Tests S iagncstic Soltwae D Otter (see attached) O Palm Beach Wrtes O Portfolio 0 Performance Assessments K FCAT DagnostdPract ce Tess O Diagnostic Software K Other (see *Midler!) K Textbook Assessments 0 Pored 0 0 Performance Assessment K FCAT Diagnostic/Practice Tests 0 Diagnostic Schware 0 Other (see attached) ad) Textbook Assessments El Portioiio Performance Assessments FCAT Dagrostc/Prachce Tests O Diagnostic Software 0 Other (see attached) K Phonemic Awareness M i li etter Recognition WV -Phonies: Sound /Symbol Ccrrespondence Decoding/Encoding LW Meaning 0 Structure Visual (Phonics) c), Flue Prevent Words 0 Rafe v ing cabulary art Comprehension Types of Writing O Word/Sentence wiring O Paragraph Writng O Composition Writing Awareness /Application of FCAT Writing Rubric El FOCUS K Support El Organization 0 Conventions Compositions K Narrative K Expository K Persuasive Number Sense, Concepts andNU Operations K Measurement K Georretry K Al)ebraic Thrikirg O Data Analysis and ProbabiTityNa O Readhg n Content Area Specific Concepts N zo The Nature of Matter O Energy O Force and Motion K Processes that Shape the Earth K Earth and Space Processes of Lie How Living Things Intend with Mel Environment K The Nature of Science concepts Reading it Content Area Specific Concepts N O a N Fe d gI wing ng Schad Day After/Before School /Saturday instructional Artematives O Temporary Skill Groups O Cooperative Learning Groups Uri dsd Readng/Nriling Groups Technology O Other (see attached) Assignment Alternative O Time O Quantity O Product Requirements p Child Study Referals rW Instmotional Reading Tutoring K During School Day ID After/Before Schod I Saturday Instructional Alternatives O Temporary Skit Groups O Cooperative Learning Groups O Guided Reading/Writing Groups O Technology 0, Other (see attached) Assignment Alternative O Time K Quantity O Product Requirements O child Study Referrals 0 Instructional Language Arts Tutoring Tutoring D During School Day 0 Outing Sd000l Day O After/Before School; Saturday AfterlB9tor ora ehcol / Saturday Instructional Alternatives Instruction itemativee K Temperay Skip Groups ----N D. o cooperative Learning Groups K Technology ID Other (see earned/ Assignment Alternative O Time K Quantity El Product Requirements El Child Study Referrals K Irstrudicnal Mathematics 0 Temporary Skil Groups Cooperative Learning Groups D Gutted ReacfinghWiting Groups O Technology O Other (see attached) Assignment Alternative Time U Quantity K Produd Requirements O Child Study Referrals K Instrudinnal Reaeing Student progress will be monitored throughout the school year, and student progress will be reflected on the report card. K Suxessfttly Remediated K Sumessfully Remediated K Successf illy Rertoedated K Successtufy Remediated 0 Requires New AID Next School 0 Requires New AIP Next School K Requires New AIP Next Soled 0 Requires New AIP Next School Year [repeated 4 times] ED Special Services! Placemert K Special Services / Placement 0 Special Services / Placement 0 Special Services I Placement 0 Other (see enacted) 0 Other (see attached) 0 Other (see attached) K Other (see attached) [1] Deficiencies due to non-attendance (refer to Attendance Specialist) Number of Days Absent ParentlGuardlan Contact Commitment/Contribution Check as that appiy D Monitor Attendance / 'rarefies EI Read with Child Every Night O Attend Parent Conferences O Attend Parent Curriculum/ Information Meetings O Check Homework O Reinforce Skills O Sign Daily/Weekly Notes GNATCR£ OF PARENT/ GUARDIAN DATE SIGNATLPE OF PEIS0 1697 (REV. 9/11/20021 ORIGINAL - Cumulative Folder COPY Teacher COPY • Parent/Guardian Pμ PROT10 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW/RETURNING STUDENTS REGISTRATION BACK DI STUDENT S Wilt (CHECK OK) DOT) PATIENTS K MOTHER K FA HER . SHARED CUSPODT I OTHER (32) TRANSPORTED IV( Stpoiem .44 44 i ..... 4/I44 'SR.', by Wm. .1 •04. thew ...twill (III IS THERE A COURT ORDER BARRING EITHER PARENT FROM REITOViNS OI CONTACTING THE STUDENT DURING THE SCHCOL DAM n YES n NO IF YES, PLEASE PROVIDE THE SCHOOL WITH A COPY OF THE COURT ORI1PR I 4 FAT R/ AR IAN DOES FATHER HAVE CUSTODY> OYES 0 NO YES T ' r DIAN DOES MOTHER HAVE CUSTOOW 0 YES 0 NC YES I .mm. t A" ROYAL PALM BEACH FL 33411 illillill.MM bay,. kat 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 A D RICHEST LEVEL OF EDUCATION COMMTED *PT ONAL) a B 0 w-2O, C 0 .0........ CITA011 KAI WWII t. TA TWOUATO 0 .......,../DamouTr TITOSICADCOLDTAI E 0 ",""uw, (37) D H CHEST LEVEL Or EDUCATION COMPETED (OPTIONA.1 0 ''" 0 30/00.. C 0 "4" SCCC4 ❑COADD I•O ❑ISTAOlt AID M ' ITTOIMICALKOLLIGO E 0 c".`,,,,,"'" " A.,"," (39) LEGAL GUARDIAN OF Ala) COES LEGAL GUARDIAN NAVE CUSTODY? riEc 0 NC SA Inc As MA tilt C- IAO TAM Mtal -Tr VOMCASEICS lilt WTATE R. C6R em.L•ATRA Rya CA /MAO/ WC Ai Mutratt ream EMERGENCY HEALTH AND SAFETY INFORMATION PART I PERSONIS) OTHER THAN PARENT AUTHORIZED TO PICK UP STLOENT I35) PASSWORD (LIMIT 10 CHARACTER& HA AATTTARIDO Ace 0021ACTI WNW 1411 NAME ADDRESS PHONE RELATIONSHIP U rn YES 0 NO (42) NAME ADDRESS PHONE RELATIONSHIP U (-4 YES 0 NO (43) NAME ADDRESS PHONE RELATIONSHIP U rl YES 0 NO (44) NAME ADDRESS PHONE RELATIONSHIP u I-1 YES 17 Dan (45) NAME ADDRESS PHONE RELATIONSHIP 0 El YES NO (46) PART II IF SCHOOL PERSONNEL ARE UNABLE TO CONTACT YOU II CASE OF ILLNESS OR ACCIDENT, MAT WE HAVE YOUR PERMISSION TO CALL YOLR UOC 7O14 OR EMERGENCY SERVICES Slit PON TRANSPORT 7O THE HOSPII44( 0 YES NO (411) FAMAY DOCTOR 48) PHONE NUM3ER 491 HOSPITAL PREFERENCE (50) LIST YOUR CHAPS ILLNESSES. ALLERGIES OR OTHER PHTSICAL LIMITATIONS YOUR CHILDREN IN OTHER PALM BEACH COUNTY SCHOOLS! ISO NAME OF CH LD SCHOCL ATTENDING STUCENT NO (OPTIONAL) GRACE 8)1414 DATE (511 NAME OF CH40 ACTIOCI. ATTENDING STUCENT NO (OPTIONAL) GRACE SLATS DATE (53) NAME OF CHAO SCHOCL ATTENDING STUCENT NO (OPTIONAL) GRACE BIRTH DATE 154) NAME OF GILD SCHOOL ATTENDING STUCENT NO (OPTIONAL) GRACE BIRTH DATE (55) NAME OF CHID SCHOOL AT HEADING STUCENT NO. (OPTIONAL) GRACE SIREN DATE ISO) I VERIFY THAT THE INFORMATION GIVEN IS TRUE AND ACCURATE TO THE BEST CF MT KNOWLEDGE. SIGNATURE OF PARENT OR AGE( GjAROIAPT WTI FOR OFFICE USE ONLY: 19) SEMI WO 1091 ISA: Sliin(NT ARMOR (5§; stinitt I ANctiaci EN FA COPT US 0:l 0 ENTRY TOM E01 i TM 'MEV DATE 08/19/98 'hi) SAE tOif 106D (641 PARENT/GLARDIAN LANGUAGE EN tiEP) GRACE Ltd; Oa IFS) CALENDAR 01 .e7) TEACH! A NO. 1681 REASSIGNMENT CODE OA/ AGM OE•FSE OB4ES4k 0M/MAG RS) TRANSPORTATION 0 YES El Ng 0 1 2 3 4 t) 6 (70) VERIFICATION W BIRTH 1 I 3 4 5 6 7 8 9 T On RAS z 4 B t MI DOCUMENTATION (*CRUST CHECK AND DATE WHEN O CA EC IMMLNIZATIONS 0 OAT( EaDED) VERIFICATION Ol OP Kles RECORDS Doan SODIAk, SECURITY n NO DPT OTIAL g..4 OAT{ PHPSOCAL IIXMAS (73) DATA ENTRY COMPLETED BY: GATE' P650 0636 (REV. 3/58) PROT11 THE SCHOOL DISTRICT OF STUDENT NUMBER: ily10OLO4sTha\ X 5 PALM BEACH COUNTY NEW/RETURNING STUDENTS VERIFICATION FOR NEW/RETURNING STUDENTS: TO THE PARENTS OR GUARDIANS: NEW STUDENTS: Complete all non- shaded areas on both sides of form RETURNING STLOENTS: Please review both sdes for correctness of typed information. If the information printed is incorrect, please correct it by carefully and lightly crossing out the incorrect information and writing the correct information above it. REGISTRATION TCHR ThER: 021STDT • 1STR : 1891 8/05/9 8 Lar. TIN. P. 17 ID STUDENT'S LEGAL •I ID ALSO KNOWN AS 21 LOCAL ADORE55 m MAI. ING AGGRESS KJRM r nuny ...my ir. e6 ir root 2ir, 15) 3TM/a S SOCIAL SECURITY NO. IIIPTI3NAJ IM In ME PHDNE No I (1 141 U MAA SEX F ICI I I RAC AVGAlcAs onotAv OR ALASKAN NAIVE B viltoArtc-4mISPANK I 0 A PICIAINFIC,ISLANDER H HISPANIC I W "VON-HISPANIC .4i$PANIC 0 MMIATiRAGIAt (9) OATS OF BIRTH ma/ow 1'O1 MALE Of B RTH WEST PA1.,01 BEACH R. U A" FLORID(,,,,,,, OD RESIDENT I STATUS 0. FOREIGN EXCHANGE STUDENT I. OUT-01-COUITT RESIDENT I ll 2. OUT-CFI -STATE RESIDENT 3. IN-COUNTY RESILIENT II2) ENTRY DATE INTO USA FIJI FEDERAL O YES 0 I IMPACT AID Mality ND A. THE STUDENT S NO _ B. THE STUDENT as I ywa C THE PARENT TES THE PARENT TES 0 E. THE PARENT IF YES, RESIDES ON RESIDES IN IS MAPIOTED IS EmPtOTEC IS IN THE IS THE PARENT AIR FORCE MERAL LOW RENT ON MOM ON LOW UNIFORMED ON ACEliE I ARMY PROPERTY. HOUSING. RENT SERVICES CUM PROPERTY LOCATED ROSSINI. (CENTER Of THE UNITED 0 TES I COAST cum IN PAINE REACH COUNTY IN PALM BEACH COMM STATES. I NO 0 ITARINIS I NATMNII GUARS 0 NAVY II4 AS THIS CHILD BEEN ENROLLED IS ANT PRESCHOOL? Err C. CHAPTER I 0 0 PRE-K DISABILITIES 0 E PRE-A EARLY INTERIENTION 0 (PLEASE PEACE A CHECAMARK I ye BY EACH PROGRAM ATTENDED. WITH AN ASTERI5A I *I Tilt PROGRAM TOUR CHILD WAS I H HEA)START I I M. MIGRANT PRE-H 0 I N. NON-SUBSIDIZED CH LO CARE ALSO. INDICATE IN THE MINGEST.I 0 OTHER S. SUBSIDIZED CHILD CARE 1I S) IS THE STUDENT A SINGLE PARENT? ill NC M.T. (IS) CURRENT GRADE LEVEL 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 (APPLICATION IS PROVIDED WITH THIS REGISTRATION FORK* LUNCH* E TPL, iii NO UM HEALTH sCREENiiics, I GIVE PERMISSION FOR MY CHILD TO BE GIVEN MALIN THESE TESTS NAY BE GIVEN INDIMULIALLT OR IN GROUPS. SCREENINGS. E - 0 NO YES (214 SODIUM FLUORIDE. I GIVE PERMISSION FOR MY CRIED TO PARTICIPATE IN TO PREVENT DENTAL DECAY PERMISSION IS VALID THROUGH THE S)DIUM FLUORIDE PROGRAM 0 YES GRADE SIX. YES I NO NEW STUDENTS TO PALM BEACH COUNTY: HOME LANGUAGE SURVEY 1261 WHAT ANGUAGF It SPOKEN IA THE HOME ID THE PARENT or GUNMAN 071 WHAT LANCIIACE IS SPOKEN IN THE HOME 3Y THE STUDENT' 128) DATE OF ENTRY INTO THE ESOL PROMIAM 129) LANGUAGE SURiET I. IS A IINGUAGI OTHER THAN ENGLISH USE) IN THE HOME? 2. 00(5 THE sTUCENT HALE A EMT LANGUAGE OTHER THAN ENGLISH? 3. DUES THE slUEEN1 MOST FREQUENTLY SPEAK A LANGUAGE OTHER THAN ENGLISH? 0115 I YES Olf 5 I NO I NO 0 NO 130/ DISC OSURES IM liftl ten) int; this SCRUM. DISTRICT HAS THE STUDENT EVER T. KEEN EXPELLED FROM SCHOOL? 2. HAD AN ARTIST RESULTING IN A CHARGE? 3. HAD ANT JUVENILE JUSTICE ACTIONS? ,YES OTES ,TES I No I NO Ill NO PROT12 D THE SCHOOL DISTRICT OF li l 4HOOLD4s7A [STR: ail Q ../. 1891 TCHR: 08/05/99 1 NEW/RETURNING STUDENTS REGISTRATION TNBR:055STOT: 1001040 EEC t 04 BLDG 00 AMe F4 NEW STUDENTS: Complete all non-shaced areas on both Sides of form RETURNiNG STUDENTS. Pease review both sides for correctness of typed information. If tho information printed s inco rect. please correct it l:N carefully and lightly crossing Out the nCOrrect information and writing the correct information above it. il FRE, 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 (OPTIONAL) 161 HOME PHONE RO. IT/ SEX F 0 ",," 18/ R CE 0 ASCR.CAN INDIAN 0 A ASIAN OR • w voon...,..wc 0 MALI 0 01 ALASKAN NAT« B N . DANC-tiSPANiC 0 H HISPANC 0 M muLTRAGIAL (9) DATE Of BIRTH " O ., u n 110 PLACE OF BIRTH WEST PALM BEACH FL U%." FLORID(,""", II) RESIDENT STATUS 3 1 0. IOREIGN EXCHANGE STUDENT I nin-OF-pueirr RESIDENT I 2. OUT-01-STATE RESIDENT I 3 IM-rnuerf mrsnrra 1121 ENTRY CATE INTO EGA 13/ FEDERAL IIILLLIII IMPACT AID SURVEY V SWUM MS NU A. THE S U ES B. THE STUDENT S C. THE PARENT 1ES D. THE PARENT ' ICS NO E. THE PARENT IF TES RESIDES UN IWIRAL RESIDES RESIDES IN LOW RENT IS EMPLOYED ON FEDERAL IS EMPLOYED ON LOW IS IN TNT UMTOPME0 IS THE PARENT ON ACTIVE I AIR FORCE 0 ARMY PROPERTY. HOUSING. PROPERTY RENT MOUSING SEA/ICES OF DUTY? 0 COAST LOCATED LOCATE) THE .0111(0 0 TES GUARD IN PAIN BEACH COUNTY. IN PALM BEACH COUNTY. STATES. 0 NO 0 MARINES 0 NATIONAL GUARD I NAVY 1141 HAS IRIS CHILD BIEN ENROLLED IN ANT PRESCHOOL? t v ... I C. CHAPTER I p U. Plit-1( DISABILITIES F ARE•K FARM INTER:411MM (PLEASE PLACE A thitEGMARK IfrIBY EACH PROGRAM V WITH AN ASTIRISI I Lk 1 THE PROGRAM LOUR CHID i H. NEADSTART p M MIGRANT PM-il I N NON-SURSIOI7F0 CIIIITI CARE ATIENOCLI AISO, INDKATE SAS IN THE IONCEST / 0 0. OTHER 0 S. SUBSIDIZED WILD LAM (ESN IS THE STUDENT A SINGLE PARENT? 0 TES NO 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? APPLICATION IS PROVIDED WITH THIS REGISTRATION FORM) 0 TES Er Eu LIE) HEALTH SCREENINGS: I GIVE PERMISSION FOR MY CRIED TO BE GIVEN IRALTH SCIREFNIES. THESE TESTS MAY BE GIVEN INDIVIDUALLY OR IN :ROMPS YES 0 NS p NO 12E4 SODIUM FIUORIDF: I GIVE PERMISSION FOR MI [SILO TO PARTICIPATE IN TIE SODIUM FEMME PROGRAM TO PREVENT DENTAL DECAY. PERMISS ON IS VALID TIROLGH GRADE SIX. YES Ill YES 0 NO NEW STUDENTS TO PALM BEACH COUNTY: HOME LANGUAGE SURVEY (26) WHAT LANGUAGE IS SPOKEN II IMO HOME BY THE DAEMON or GUARDIAN: 1 r,..,,,\,4t1/4 s PhIA5 WI WHAT ,ANWACE is STOLEN IN THE HOME BY THE STUMNI? e.-. ..,\Isk 1211 DATE OF ENTRY NTO THE (SOL MOEN" 1231 UNGVAGL SURTET L. II A LANGUAGE OTHER THAN !MAISIE USED IN TEE ROME? 2. GOES IRE STUDENT HAVE A 'IRS! LANGUAGE OTIIR THAN ENGLISH? 3. DOES THE STUDENT MOST TRECIUENTlf SPEAK A LANGUAGE OTHER THAN ENGLISH? Ei NO 1301 ousao>om, IM in. ...! 40.0 On SCHOOL DISTRICT AS THE STUDENT EVER: I MEN EXPELLED /NOM SCAM? 2 hAD AN ARREST MSATERG IN A VOW 3 PAO ANT ,NPRIIII1 ADM( ACTIGNIT O PROT13 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.?) IF YES. PLEASE PROVIDE THE SCHOOL THE COURT nixnnt M YES :HO WITH A COPY OF I F T i DOES f ATIER NAVE CUSTODY, OYES 0 NO YES IDS) MG N DOES MOTHER NAVE CUSTODY, D YES 0 NO YES MM.. max. lAS4 FL 33411 vat, wet sADOL1 LAST 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 AD D • rii4HrsrisvEr OTTCLICITR511 COMPLETED (OPTIONAL) n" en4•"-sic"'" B 0 '''''':I scca n c n , soma - KADOSCI ....., POST -144044•Jv E 0 ..0.41444.1COullit MI AtteammAtoste.c caA4mAn .. Arm. IlT) HIGHEST Weft OF EDJCATIDN COMPLETED (0, TiONAL) AO "P4Tay,."°°' B D a - .0 - c ORAIN4 Am n 0 SW 4011.50:00, 44 E 0 11154•CALCOu404 RA❑ aLlcaktal IIAACUAR 04 wow OYES M4APA4IP )g) LEGAL GUARDIAN (IC APO) R est eAs DOES LEGAL GUARDIAN HAVE CuSTOEY) El NO w,(ai LAST PC.it ACcilsi CITY ITA/1 2d COpI 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$200 004 14400PC• 4.44-44 rii s L ko '41 ADDRESS PHONE RELATIONSHIP S;i4e, 4 I42) ADDRESS le ".'. RELATIONS-OP 1, 4 i' r .....e IC TES 0 NO 43 MANE ADDRESS PMCNE RE,ATONS4IP s YES NO gmai pc 1441 NAME ADDRESS PHONE RELATIONSHIP 0 YES In NO G$ 42104 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 STUDENT •10. (01-10NALI GRADE MTH DATE (52) NAME OF CHID STUDENT NO. lOrIONALI GRADE BIRTH DATE (53) MAME OF CHILD STUDENT •10. (OPTIONAL) GRADE BIRTH DATE ISA) NAME Of CHILD STUDENT NO. IOPIONALI GRADE BIRTH DA•E (55) NAME OF CHILD 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. 1691 1541 SI VAN' NLAU31 N (SD) STUDENT LANGUAGE EN SD) CUR US iblI MITI LUCIE E01 (biT LATE, URft 08/16/99 MO) SM. LODE 1060 IDS) GLADE EMI. 07 (65) CAlt743AR 01 16T1 TEACHER NO. (441 PAREMMUAROIAN LANGUAGE EN EOM REASSIGNMENT CODE DA•ADM DE•Ea OD-ISOL OM -NAG ISO. TRANSPORTATION Ei vis 0 Ng, C I 2 4 5 0 NI VliutiCATTON OF DIRER i I D 4 6 0 7 IS S T (III WS z A D t 17.1/ COCIALEMEAT ON EHE:IAIST CHM AND DATE WIEN RECOY£T 00ATE iPALAJMEATiONS 0 DATE 11IlisiCATION of 'NTH RECORDS °GATT Sor ou. TISPC,UR h0 LOPOVAD TY 0 OATt. fARY51CAL EXAMS OW DATA ENTRY (OWIETIO BY: DAM PESO 06M1 (At,. PROT14 .STUDE. Legal SEX F RACIAL/ETHNIC GROUP O Hispanic arNhite. Not Hispanic O American Indian/Native Alaskan O Black, Not Hispanic O Asian/Pacific Islander STUDENT NUMBER 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 P G OA BIRTHPLACE: Wes-i- -Pain, -Paeaell ci CURRE Name Street City T SCH OL: enCil in this space, until final.) Da e First Entered This District 9 - P-5.- 9g. Withdrawal Date [repeated 3 times] .1kr..,, a I --P. h-r, 'lead, F I i FLORIQPi PERMANENT RECORD CARD CATEGORY A - Education Records GRADES K-5 School Year: 19- c) a •19 Grade: 9 t Grad e i Grade: •19 Grade- School Vac 19 -h., Grad @: s..9_7_ School Year 19 4'3 -19 95/ School Tear 19 al aSchool Year ;19 4.P___. Days Present: /7/ Days Absent Days Present: 1% Days AD flu Days Present Days Absent: Days e 7r - - i Data.nnt Days Present f i-r,ct Days Absent: Subject Subject le ubject Teacher Subject Teacher Mark Subject Teacher i. u. LOS i n. 17nraIMMIS rMa Mlitial N Illl ill I I li2trorraM liriratt IFTOTET IMI IIMAMaAliAllila. Itzi•Di Eu. I Grade: 4 t. ' I Grade: ,4.: I. 14 A i , e- ; g I A E .A. • A4; it • E SCIENCE and HEALTH rtim ,t IlrirdEX II ria"741.911FM I n READING NGUAGE SPELLING :EL'1•]47;DIG3. Tirign CIENCE and EALTH HANDWRITING it:WM[4cIdelridelEd LUBI OrRM.. BEHAVIOR CODE AVERAGE Indicate: Promote (P) Retain (RI Summer School (SS School: SOCIAL STUDIES SCIENCE H BEHAVIOR AVERAGE and A TN SCIENCE and HEALTH BEHAVIOR CODE AVERAGE EHAVIOR CODE VERAGE CODE BEHAVIOR CODE AVERAGE Indicate: Promote (P) Retain (R) Summer School (SS Indicate: Promote (P) Retain (R) Summer School (SS) Indicate: Promote (P) Retain (R) Summer School (Ss) SS Indicate: Promote (El Retain VD Summer School (SS) School: S I rat School: Grade: Sctmot Grade I School Year: 19- C -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: Subject arbor Subject Teacher Mark Subject Teacher Mark Subject Teacher Mark Subject Teacher Mark READING MATHEMATICS READING LANGUAGE ANGUAGF LANGUAGE i ANGUACE LANGUAGE SPELLING SPEI LING SPELLING HANDWRITING SOCIAL STUDIES HANDWRITING HANDWRITING SOCIAL STUDIES SOCIAL STUDIES SOCIALSTUDIES SOCIAL STUDIES SCIENCE and HEALTH SCIENCE end HEALTH SCIENCE end HEALTH SCIENCE and HEALTH SCIENCE and HEALTH BEHAVIOR CODE AVERAGE BEHAVIOR CODE AVERAGE BEHAVIOR CODE AVERAGE BEHAVIOR CODE AVERAGE BEHAVIOR CODE AVERAGE Indicate: Promote 01 Retain (R) Summer SeenolISSI Indicate: Promote (P) Retain IR) Summer School (SS) Indicate: Promote (P) Retain IRE Summer School fESI Indicate: Promote (P) Retain (R) Summer School ISSL Indicate: PromoteIP/ Retain(R) Summer SchgoUSSI PB5D0932 01.9340 PROT15 THE SCHOOL DISTRICT OeldiLNI BE71eI1320 ELEMENTARY REPORT CARD tt . Student Teacher MARKING CODES - ACADEMIC SUBJECTS GRADES 1 and 2 E - Excellent S - Satisfactory V - Very Satisfactory N - Needs Improvement A - B - C - D - F - 1 - GRADES 3-5 Outstanding (94% - 100%) Above Average (85% - 93%) Average (75% - 84%) Below Average (65% - 74%) Failing (0% - 64%) Incomplete ACADEMIC SUBJECTS r; Pi."' • 4 .irate Composition Language Spellin. Handwriting/Penmanship Social Studies Science/Health • Grades not given this nine w FINE ARTS REPORT Marking Period Art. Music Physical Education PARENT/GUARDIAN/TEACHER Marking Period CONFERENCE 1•t 2nd an, I Conference conducted (Indicate"dato School Principal SOCIAL DEVELOPMENT/CLASSROOM STUDY HABITS Please work on the area(s) that have a check (✓) tit 2nd 3rd Overall effort Works cooperatively Works independently Completes classwork on time Completes homework on time Follows classroom rules and routines Uses time wisely Follows directions Accepts responsibility for own actions Comes to class prepared with materials ALTERNATE ASSESSMENTS Indicate those used with a check (.1"). Marking Period 1•t 2nd and oh Skills Checklist(s) Portfolio Audio Cassette Recording Video Recording Computer Program Standardized Test(s) Observations/Written Comments Other ATTENDANCE Regular attendance and punctuality are essential for quality education. Days Present Days Absent Days Tardy Information Included Marking Period PLACEMENT • Grade Special Session if Special ssion program is indicated, grade placement WA be determined by the home scribal. PBSD 0700 (Rev. 7/94) Goldenrod/1st Period PInkfteceBerJO: .::;,Denaryard Period Green/4th Period wotworna, copy PROT16 TlaHOOL DISTRICT OF PALM BEACH COUNTY rc l 1997-1998 END-OF-YEAR REPORT CARD INSERT for GRADES 1-5 Dear Parent(s)/Guardian(s), Grade 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* *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 PROT17 `STUDE Legal SEX IAL/ETHNIC GROUP 0 Hispanic RAC Le<thite, Not Hispanic 0 American Indian/Native Alaskan El Black, Not Hispanic 0 Asian/Pacific Islander STUDENT NUMBER 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 Name Street City Iker I 11/4 Irn encil in thi -"Sec ch it til final.) Date First Entered This District 8-as- 9a Withdrawal Date I FLORIDA PERMANENT RECORD CARD CATEGORY A • Education Records GRADES K-5 • Grade: School: Grade ( ride: Gredo3 Greg : K School Year: 19- 4:1 a -19 • 41S 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: 17/ Days Absent: Days Present: 1% Days Ab nt: Days Present Days Abair, 172 Days present /7 Days A• Days Present ,q Days Absent Subject Teacher Subject bject Teacher Subject Teacher M rk Subject Teacher Mark 1 .. L , Aj; ii I .., IAL T DIE SCIENCE and BEHAVIOR CODE I I I 1 I ATHEMATICS MATHEMATICS A. /1/4219 'te aUITOMIIII UITITIT IMI MI IN Irrfifla M U READ( G I IlltucoLuilIMINII I I Ell.ma•thatimcS II Illk•folat I 1 • Mia/IMPailill Mr E MEILINsIWIUIRIc IM II Ear' I I I I I Cal !tuiesclaitua B.m...m.inta l Icyltalcipm.4-MI IENC1. E and LY$Ie1M Mira BEHAVIOR CODE AVERA E Indicate: Promote (P) Retain IR) Summer School (S$) it:201•1 :*, SCIENCE and H BEHAVIOR CODE AVERAGE a'i . L 1St • LA-'-SCIENCE and BEHAVIOR CODE AVERAGE .EHAVIOR CODE VERA Indicate: Promote IP) Retain (R) Summer School (SS) cam emote (E) mein IR) ummer School (SS) ''S 3 Indicate: Promote (P) Retain (R) Summer School 1551 MI Indicate: Promote IP) Retain IR) Summer School 1551 Gra hoot (Grade: School: I a• School: G School: Grade: School Year 18- 19 School Year: 19_-19_ School sear 19_-19_ School Year: 19_-19 - School Year: 19 •19 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 MATHEMATIOI READING READING • READING LANGUAGE [repeated 5 times] SPFI I ING SPELLING SPELT ING SPELLING SPELL ING HANDWRITING SOCIAL STUDIES SCIENCE and HEALTH SCIENCE and HEALTH SCIENCE and HEALTH SCIENCE and HEALTH SCIENCE and HEALTH BEHAVIOR CODE AVERAGE BEHAVIOR CODE AVERAGE BEHAVIOR CODE AVERAGE BEHAVIOR CODE AVERAGE BEHAVIOR CODE AVERAGE Indicate: Promote (P) Retain (R) Summer School ($5) Indicate: Promote (P) Retain (RI Summer School 1551 Indicate: Promote IP) Retain (R) Summer School (SS) Indicate: Promote (P) Retain (R) Summer School MS) Indicate: Promote IP) Retain (RI Summer School (55) PROT18 4 BOOL THE SCHOOL DISTRICT OF ~NREGISTRATIONS DISTR: 1691 TCHR AIM TNBR:O59STDT 08/09/00 CRS:2002100 SEC:06 BLDG:00 RM:801 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) I I SEX p FEMALE MALE 18) I II RACE W I Otatt.:smi:Atig=lvE B lieLof-KHISPANIC i I A gr:Flinsuoven H HISPANIC i w :e,,74,s,..i. I M MULTIRACIAL IS/ DATE OF BIRTH mcqui DAY IVO OM PLACE OF BIRTH FL US an r FLORIDA tot.rinv (I I) RESIDENT I STATUS 3 0. FOREIGN EXCHANGE STUDENT I. OUT-OF-COUNTY RESIDENT I I 2. 3. OUT-Of-STATE RESIDENT IN-COUNTY RESIDENT (12) ENTRY DATE INTO USA (13) FEDERAL I YES IMPACT AID SURVEY. I NO A. THE STUDENT I NO B. THE STUDENT I NO C. THE PARENT I NO D. THE PARENT I NO E. THE PARENT IF YES. I RESIDES ON RESIDES IN IS EMPLOYED IS EMPLOYED IS IN THE IS THE PARENT AIR FORCE FEDERAL LOW RENT ON FEDERAL ON LOW UNIFORMED ON ACTIVE I ARMY PROPERTY. HOUSING. RENT SERVICES DUTY? PROPERTY HOUSING I OF COAST LOCATED LOCATED THE UNITED I YES GUARD IN IN I PALM BEACH COUNTY. PALM BEACH COUNTY. STATES. NO I MARINES I NATIONAL GUARD I NAVE (MI HAS THIS CHILD BEEN ENROLLED IN ANT PRESCHOOL? 0 C. CHAPTER I I 0. PRE-K DISABILITIES I I. PRE-K EARLY INTERVENTION PLEASE -PLACE A CXECKMARK (1.1 BY EACH PROGRAM WITH AN ASTERISK ( */ THE PROGRAM TOUR CHILD I H. HEADSTART I IA. MIGRANT PRF-K 0 N. NON-SUBSIDIZED CHILD CARE ATTEN3EO. WAS I I ALSO, INDICATE IN THE LONGEST.) 0. OTHER S. SUBSIDIZED CHILD CARE (16) IS THE STUDENT A SINGLE PARENT/ NO I YES I NO (OS) CURRENT GRADE LEVEL 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. YES FOR EXAMPLE: VISION, HEARING, SCOUOSIS, HEIGHT A WEIGHT I IFS S nn 125) SODIUM FLUORIDE: I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE IN THE SODIUM FLUORIDE PROGRAM YES E 'as TO PREVENT DENTAL DECAY. PERMISSION IS VALID THROUGH GRADE SIX. i NO NMS.XleMgtittSITO PALM. BEACA,POUNTY;;;;;;Ppinplgte the 1909W,ipaus.eclictris UM HOME LANGUAGE SURVEY (a's 26.20) I. A THAN I YES I NO II ye; what loacrege? IS LANGUAGE OTHER 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 HOME BY THE PARENT ee GUARDIAN? (281 WHAT LANGUAGE IS THE STUDENT'S FIRST (151) LANGUAGE? UM DATE OF ENTRY INTO AN ESOL PROGRAM (30) DISCLOSURES FOR ENTRY lato this School Olorld HAS THE STUDENT EVER: I. Been expelled from scbool? 2. Had are arrest reselling In a charge? 3. Had my Ovalle justice actions? I ES IIES ,YES I NO ono ONO NEW STUDENTS: Complete all non - shaded areas on both sides of form RETURNING STUDENTS: Please review both sides for correctness of typed information. If the information printed is Moo rect. please correct it by carefully and lightly crossing out the incorrect information and writing the correct information above it. PBSO 0030 Mee 4/00) PROT19 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW/RETURNING STUDENTS REGISTRATION BACK fr (31) STUDENT LIVES WITH (CHECK ONE) 0 BOTH PARENTS 0 MOTHER i li FATHER 0 SHARED CUSTODY i OTHER - .(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 YES (3:51 MO DOES MOTHER HAVE OUSTCOTT AYES 0 NO YES Mint FliiiiiIIIIIIIIIII FL 33411 Off alli MOM FL 33411 WI 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) CM SCSOOL AO unitsar "°°1 B 0 " 6" "" CS to ;.,sr, C 0 latra•ATO D 0 ser.2,":7,:"" E 0 71""r4".?:,,vo (37) HIGHEST LEVEL Of LDUCATION COMPLETED (OPT L1 AO il"UnsIAR•al 11 °.31 Bn SOW /OW SO•1001. '6-1 MANS 9-1.1 C El'="4": 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 K 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 SOTHER itr El YES NO 1421 ADDRESS PHONE RELATIONSHIP A h YES 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. MEDICATIONS TAKEN, OR OTHER PHYSICAL LIMITATIONS: (59 DOES YOUR CHILD CURRENTLY HAVE HEALTH INSDRANCE? OYES 0 NO II hiss, Oman isdkato--... 0 Mmlinid CI Flabby Kids/KM Cue 0 Pthesto 0 Lowdoss4 a witoiving Ommokis raWIFOA. 13 fit) OM P H (62) NAME OF CHILD STUDENT NO. (OPTIONAL) GRADE BIRTH DATE S i ' (531 NAME OF CHILD STUDENT NO. (OPTIONAL] GRADE BIRTH DATE 4. (541 NAME Of CHILD STUDENT NO. (OPTIONAL) GRADE BIRTH DATE 455) NAME OF CHILD STUDENTNO. (OPTIONAL) CR.40€ BMW DATE . (56) NAME OF CHILD 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 ' EN 71; CU.; E01 i ;41.' BILE 08/16/00 I 1060 1091). t6b,".PAH NT,/ kaint;i : r,,:,..,cu,Lci t. EN . I (C ': CHt.1 US j OF. 1 IL/I LAiCIJ1H 01 1'HI TrAC,grt 210. r /;•-. PF.Y.SICNWP,- C Li> r•C'.• DC,•(5C al.} SU: 0.•.1.•'S •3( lt:SSVcW,U,Vt:•, 11,1 dS 11 NN " a N I f" E i I II •-•'. ' UK ;!.,Ps1A- :,: .. 3 f, - in. 0 vli. r to ) 1, 1:".1.: ciur CL!...?"7ED Bu P650 0636 (REV. 4/001 PROT20 i..lai.,.thil.ctativt THE SCHOOL DISTRICT OF. 1 N A e,,,ccdpNEW/RETURNING 4 STUDENTS NEW STUDENTS: Complete all non - shaded areas on both sides of form RETURNING STUDENTS: Please review both sides for correctness of typed Information. If the Information printed is Moo rect. please correct it by carefully and lightly crossing out the incorrect Information and writing the correct information above it REGISTRATION IISTR:1761 TCHR: TNBR:504STDT: HaIRM: 504 MAY PATA (I) STUDENT'S LEGAL NAME 121 ALSO KNOWN AS LAST THSI MOM CT) LOCAL ADDRESS (4) MAILING ADDRESS m 1 Fl I I 1 i m ..rer ica. ... SiPiif PAM API. t STATL sr iWI (6) STUDENT'S SOCIAL SECURITY NO. (OPTIONAL) 16) HOME PHONE NO. (7) I f4MALE I SEX F UNaL5 MALE (8) I I RACE W OR MA ALASKAN 101 OR ALASKAN NATTVE B r/LOActi-KmiSPANIC i I A II CAACDRISLANCIER PACIFIC ISLANDER H HISPANIC I I W WHITE NON-HISPANVC NI ImATIRACIAL (9) DATE Of BIRTH MONTI MY VIM (ID) PLACE OF BIRTH FL US CITY STATE FLORIDA CMYTAY (II) RESIDENT I STATUS 3 D. FOREIGN EXCHANGE STUDENT I. 01/7-0E-COUNTY RESIDENT I I 2. 3. OUT-OF-STATE IN-COUNTY RESIDENT RESIDENT (IV ENTRY DATE INTO USA (13) FEDERAL I 0 0 IMPACT AID SURVEY YES NO A. THE STUDENT YES NO B. THE STUDENT i YES cla NO C. THE PARENT YES NO D. THE PARENT Yu NO E. THE PARENT IF YES, RESIDES ON RESIDES IN IS EMPLOYED IS EMPLOYED IS IN THE IS THE PARENT AIR FORCE LOW UNIFORMED ON I FEDERAL RENT ON FEDERAL ON LOW ACTIVE ARMY PROPERTY. ROUSING. RENT SERVICES DUTY/ PROPERTY HOUSING OF I COAST I LOCATED IN LOCATED IN THE UNITED TES I GUARD PALM PALM STATES. I BEACH COUNTY. BEACH COUNTY. NO MARINES I NATIONAL GUARD I NAVY (141 HAS THIS CHILD BEEN ENROLLED III ANY PRESCHOOL.? C. CHAPTER I D. PRE-K DISABILITIES E. PRE-X EARLY INTERVENTION p0 (PLEASE PLACE A ONEXMARK 10/BY EACH PROGRAM WITH AN ASTERISK ( * I THE PROGRAM YOUR CHILD I N. NEADSTART I M. MIGRANT PRE-K I N. NON-SUBSIDIZED CHILD CARE ATTENDED. WAS I I ALSO. INDICATE IN THE LONGEST.) D. OTHER S. 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 (APPLICATION IS PROVIDED WITH THIS REGISTRATION FORM) LUNCH? P ° I YES NO ig (24) HEALTH SCREENINGS: I GIVE PERMISSION FOR MY CHILD 70 BE GIVEN HEALTH THESE TESTS MAY BE GIVEN INOIWDUALLT OR IN GROUPS. SCREENINGS. YES I YES I NO (25) SODIUM FLUORIDE: I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE. IN TO PREVENT DENTAL DECAY. PERMISSION IS VALID THROUGH THE SODIUM FLUORIDE PROGRAM YES GRADE SIX. I YES I NO ;4:NEW STUDENTS.0 PALM BEACH COUNTY: HOME LANGUAGE SURVEY (26) WHAT LANGUAGE IS SPOKEN IN THE HOME BT THE PARENT xi GUARDIAN: (27) Y/HAT LANGUAGE IS SPOKEN IN'THE HOME BY THE STUDENT? (28) DATE OF ENTRY INTO THE ESOL PROGRAM 129) LANGUAGE SURVEY I. IS A LANGUAGE OTHER THAN ENGLISH USED IN THE HOME? 2. 0014 THE STUDENT RAVE A FIRST LANGUAGE OTHER THAN ENGLISH? 3. DOES THESTMENT MOST FREINANTLY SPEAK A LANGUAGE OTHER THAN ENGLISH? I YES I YES I YES I NO I NO I NO PLOD 0636 (Am 6/97) PROT21 higW/NelUNNINU STUDENTS MEGISTRATION BACK (30) STUDENT ll LIVES WITH (CHECK ONE) BOTH PARENTS I I 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 YES 134) MOTHER/GUARDIAN DOES MOTHER HAVE CUSTOM? 0 YES 0 NO• YES non MAINZ MO RC LAST FL 33411 MST ALMS MOW 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) de1/40 o HIGHEST LEVEL OF EDUCATION COMPLETED ratIri A.:"."-3" B I critt PC:T.S/LOroARY E ,OPTIONALI SO 0 . 1","•in c El BACA SCHOOL ScsAWATO • n4MC mtlx,`""1 OM HIGHEST LEVEL OF EDUCATION COMPLETED AO fahn'ar.."4-ct B ,--1 0 O USW POSTISCO.O...tv E (OPTIONAL) n :CAC pa :CAM Caseis s M C O WON Taro 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 , , Ilaiel a flo ",, (3E0 PART c PERSON'S) OTHER THAN PARENT AUTHORIZED TO PICK UP STUDENT. DTI PASSWORD CO. uoteciac 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 n t-i YES O NO (44) NAME ADDRESS PHONE RELADOCCR. Ei YES O Pm 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 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 EN nn COS ILE EI rilri tUL Y.k.t.)E 01 I 2) E. TFI JiUF 08120/07 1 .e . 0 1761 P ullAPUI YE .E./"I.E4'F. EN 1561 GF,,CE ;fit, US OS ,46 IF; CE1IttE049 01 0 R 0 , .,. F.L.• t- I I II IE EE III Er ; E. TEE a nt) ALES ; A1/4effTV/ D9PjtitEKTArrt tStSCHE Qaaie ° a" " If S' a I n FitEt IXI gi n • fl uff TIGN Of INTO. RECMUS M' . f ,E. 9 ., • .1L) o i 7 1 Z . I, I [MA Srxt44.5 (Can i.r .-1 •st.4.,;>, A L tOP•VONAL, U 0...."T PHYSICALf. EXAMS 2 Ec 1'!,1E EirlEl '1;;;EiTP1 0 is 04't PBS 0(E 6 (REV. Sr 97) PROT22 NEW STUDENTS: Complete all non- shaded areas. RETURNING STUDENTS: Please review both sides for correctness of typed information shown below and on the other side. If the Information printed is incorrect. please correct it by carefully and lightly crossing out the incorrect information and writing the correct information above it. occx_D is›The School District of Palm Beach County La \71-t11"N ic sile,e2+RIBUTION:1761 A :1 - NEW/RETURNING STUDENTS REGISTRATION" TCHR:EICHNER, TNBR: 402 HMRM: 402 ex, Oe1,, 8/14/96 STOT : 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 WV SIMI tar osix City OYU ZAP wit (El STUDENT'S SOCIAL SECURITY MI (OPTIONAL) (CI HOME PHONE NO. (71 I !MALI El SEX F MALE OD I I RACE W AMERICAN INDIAN B MACK NON - HISPANIC I A tIrCAI7IC SUMMER 0 0 H MSpμlc 0 V iii 'NVCITIrE - MISPANIC M mULTI-RACIAL (9) GATE Of BIRTH WNW OAT YEAR (10) PLACE Of BIRTH FLORIDA FL US CITY new cccinyy (I I) RESIDENT STATUS 3 0 0. FOREIGN FRI:MANGE STUDENT I. OUT-OF-COUNTY RESIDENT (ID ENTRY DATE INTO USA 03) FEDERAL IMPACT AID SINIT£Y (IF APPLI ABLE) (CHECK THE LETTER CODE FOR ONE CODE ONLY) federal (14) HAS THIS CHILD BEEN ENTERED IN ANT PRESCHOOL? Url 0 2. OUT-DF-STATE RESIDENT 0 3. IN-COUNTY RESIDENT D A. Spirtg tyrespidJsinoaa Igiroi:ml ipicterctriepareet employed on D I. Student resides on linholl property, parent not employed on federal r 9 J. Modem erty resides In low rent housing. parent eraemployed on lean) prop (Please place a cAralmark ($ by each program emended. Also. indicate with an asterisk ( * ) the program year child was in the longest.) 1 3 C. CHAPTER I El M. MIGRANT PRE-I( (1W IS THE STUOENY NOA SINGLE PARENT? El YES 0 NO D K. Stvdeit 'nides ode nonle4eral prepay, pant employed on federal property Palm Beach Canty 0 0. sari IsiifeersyiN s meafeeeral property, punt on salve duty la 0 0 . PRE-K DISABILITIES ❑0 N. NON-SUBSIDIZED CHILD CARE K in 0E. PRE-II EARLY INTERVENTION 1K 0. OTHER Oii. HEADSTART 0 S. SUBSIDIZED CHILD CARE (ID) GRADE LEVEL 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 Der 4l2F t, Til ...2:i p. (231 HAVE YOU FILLED OUT MI APPLICATION FOR FREE or REDUCED LUNCH? (lppikaien is provided with ills animation Form) TES a NO Mg HEWN SCREENINGS: YES I give permission la ay child to he given health screenings. These tests may be Diva ladivIdally Or In groups. Et YES NO us SODIUM FLUORIDE: YES I give permission (or my child to participate In Ihe Sodium fluoride Program to to previa dental decay. EtIMISSICE Is valid through grade six. YES' NO NEW; STUDENTS TO PALM BEACH COUNTY: HONIMArgGraStittW:¢ (261 WHAT LANGUAGE IS SPOKEN IN THE NOME BY THE PARENT or GUARDIAN (27) TTHAT LANGUAGE IS SPOKEN IN THE HOME BY TEE STUDENT? (281 DATE Of ENTRY INTO THE 'SOL PROGRAM (292 1. Is a tanguara other than English used In me home 2. Coat the student have a first language othee thin Englitig 3. Oen me memo malt fretwonlif meek a language other than Englich2 I YES 0 .0 I yes 0 me DYES 0 NO .1 .WONLY: C212,'S Ilfice PI yarattmsB 1761 I EN US ita iNri1 CIITI I ITI:; II,TMI TATA E01 I 08/21/96 A. 1060 II',,.1 GRAIII LEVI. 1 119 CAUNTAR 04 i 01 ITT: IITI.c&III. N.. 402 an I'ApI.: A.- tl.tit :;A It tiI41-C EN WI At /IITIONIMNT ION 9 ,......ttl OF ,,," 9 t,,t:,:.. 0 M•IIAT 121 TRANPORTATION N D YiC C I 2 4 4 5 G. (l cat TIOA II lit z II 11 It 51 OCCI.A.IiSTATICN Ch IF I, ICIIIIIK AM IIIAT1. droN It .TO il 0 '4 tTt ...11'.55tAt Ic'ti 0 04Tc 4 4 I AL., 1' .'.-,v : 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. t; ( 46 citNtaltlif Ile PARENT OR if CAI TIMIlfilell min `tin; REV. 5/14 FRONT PROT23 The School District of Palm Beach County - NEW/RETURNIMG STUDENTS REGISTRATION BACK TOT MI STUDENT LIVES WITH (CHECK ONE) BOTH PARENTS 0 MOTHER 0 FATHER 0 SHARED CUSTODY OTHER 1491 I NI w.0 be Van eeeee 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 YES 521 MOTEER/GUAROUIN: DOES MOTHER HAYS cumobv? DYES 0 NO YES FL 33411 Mil MOM 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) An D HIGHEST LEVEL OF EDUCATION COMPLETED •INCPITAM :6100% B' D SON 00iiiSKNONY Itsainikelity• E (OPTIONAL) ri...1nr"' C 0 Cl Ill .",`7":,,n.'t,"::: (54) A D HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) ill (ISHnITMO seem B 0 r....7.2," C o μ 0 :7...ante:ea. E 0 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 IP Ainete ta in ?Jiiil "?' (SG) PART I PERSONIS) OTHER THAN PARENT AUTHORIZED Ti) PICK UP STUDENT. (57] PASSWORD: 1k) NAVE TS% AfOIRIS (SO) PHONE (Si) LATIORSHP 9 M IN ALITNICISO MO EINI r IIIILK Pall tli rash Er 9 - rn NO h 4 istior El-ItS 0 NO MPS EtIES 0 NO Pis 0 ats f 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 ft sk i ,P-1 vvikoh our a r"ti 1./ I T. IT Pt .NUMBERzpsik, Si m te, Hospiym PREFERENCE toTer Vies A p e &S I: 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 PROT24 4 .14 - OOL Di's, \ 41 NEW STUDENTS: Complete all non- shaded areas. RETURNING STUDENTS: Please review both sides for correctness of aped information shown below and on the other side. If the information printed is incorrect, please correct it by ca efully and lightly crossing out the incorrect information and writing the correct Information above it Li K <,:r.: \ A r e 0 ..-, ict9 ; E, ;-I The School District of Palm Beach County • NEW/RETURNING STUDENTS REGISTRATION! nSTRIBUTION:1761 TCHR: TNBR:304 HMRM:304 OUT DAM 8/22/95 STDT. co swears LEGAL NAME PP (2) ALSO KNOWN AS (3) LOCAL ADDRESS 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. (OPTIONAL/ (5) HOME PHONE NO. 1) I I SEX F FEMALE MALI lb I ii RACE W "N B SLACK NON-HISPANIC / A ASIAN PACIFIC ISLANDER I H HISPANIC I W WHITE NON-HISPANIC IS: DATE OF BIRTH :101 PLACE Of BIRTH FLORIDA FL US (II) RESIDENT STATUS 3 0 0. FOREIGN EXCHANGE STUDENT 0 1. OUT-OF-COUNTY RESIDENT 0 2. OUT-OF-STATE RESIDENT 0 3. IN-COUNTY RESIDENT dal GRADE i.tvtt. 03 SIT/ STAY{ 00011/7 (13) FEDERAL IMPACT AID SURVEY (IF APPLICABLE) (CHECK THE LETTER CODE FOR ONE CODE ONLY) K A I >,.. ;,, IM Federal Wintry Samna. K I in, a civilise *boobs b the annul atuniabinninn and Ihe B cell of my child's mItseallon Is provided In part or wholly by Federal **HO. 04/ HAS THIS MILO BEEN ENTERED IN ANY PRESCHOOL? Please plus a chackmerk 11/5 by each program 'Needed. Also, indicate with an 0SNIIM I * ) Ike program you child was in the longest) DC. CHAPTER I O M. MIGRANT PRE-K 0 D. PRE-K DISABILITIES O N. NON-SUBSIDIZED CHILD CARE O E. PRE-K EARLY INTERVENTION O 0. OTHER OH. HEADSTART O S. SUBSIDIZED CHILD CARE IN NO I Is the Medea( 'single YES a wen? I NO K • 2. 5. ..51- ) 0 Yak 9 Yr . (IS) NAME OF SCHOOL TRANSFERRING FROM lf N:., Le a y y .v. a `I: er' 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 I give :remission her my child may be gives Ielirliftolly or In YES I groups. a be given health ncieenhigs. These lasts NO (24) SODIUM FLUORIDE: YES I give poraissice for my child to pertIcipate In the Sodium Flaorlde to prevent denial deny. Permission Is Mid through glade six. TES ONO Program to itg IlalBEACH COUNTY: HOME LANettak-Gea/ li 4: ..). ee v ; ,C i (25) Whet linguine Is spoken in the home by ibe pun] or mardlen. (26) Whit lesg.rce it :peke° it the home by Me swdeetT 2?) Ore c! Enry isle VSO' i'r oy :7 pal I. is a language other than English used in the horn? 2. Deer th• student have • llmt language ether Thin Fagltsh? 3. Dv : the stoomil east Ham...v , ;rt/I a language ether than Ent, YES OYES g YES I No II NO 0 NO FOR OFFICE. USE .ONLY: In >.5:-.3,,.. 41 cq:11 ,7:::!i iii ii 1,.: H - l;l i"C EN I:,3 I ,' COI 34' ifin: OAL 08/23/95 1060 1761 EN US '•7' :./.;"` IICI: 03 01 3C.1 .:C.II hic,-, c.,r;0.,m N t '.!a 0 A, tPA [H-zsE :I: E,I;,NSF.1,17.t!:-.. I ,II :, ,TI O USES : j 4f, I .W.LMEr 0...: torrICT cv I chi 0,..f .. 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. cUO jF ./2S S n art PBSD 0636 REV. 4/95 FRONT PROT25 DATA ono ...girds wtot.rn..t yr room own@ loVulity - mcw/MCIUMNLMU *!MUCtIllb KCOLb1MAIAUN STDT: (n) STUDENT LIVES WITH (CHECK °Hifi V OTH PARENTS MOTHER FATHER 9 SHARED CUSTODY K OTHER PM TRANSPOO k BY: Stuelont willbt aaapenod IA MT se4al by Isame • Hew dan paeasU 1 91 M THERE A COURT ORDER BARRING EITHER PARENT FS IOM R5 VI OR 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 0 NO YES (50 MOTHER/GUARDIAN. DOES MOTHER HAVE CUSTODY? II£ NO ,,". FL 33411 FL 33411 04 AMU% Co, li *lc CMNo fl Olt k1A.te JD • CC QCtw. io n.0 Or Amy wi noa Or 1 MilOYMINI lw.att (i2r A D NTORE ci 1 Etter OF MOTOCAriai ZoltR.ETO 9 Egg - aa K.:rya l ;inct"3"- " E MO I rOPHOIIALF I gt:LTIrl'' C l ount-.."...Au""ta WON I WON SCA001. 153) A D si p,,,,,[ NOM[ t HIGHEST LEVEL OF EDUCATION COMPLETED (OPTIONAL) I t t,""n wn igt: 145eu B 0 WI IX c... ,.ilatOOT C aIt?: a 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 A I l ' ACI P""n°T^441 await Had AkEtigg.K.. tl S4MigIngTTYAOAMOI1. 1.M :T tv 4"' 'WTI 155) PART L Parses()) other than parent authorind to pick up slucloat 1161 • z • ti (Si) NAME ADDRESS Oil MOOS et piorel nerimuzo 1•10.00•• i ll All} 14.11S D NO -bkboi, EFIES 0 NO Sm -kr RklyES 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 pa/As (Ales 1- (661 2 year thild sellers ham • :Muss el eel way physical delects the ...e gheult1 ba swan of. p aaaaa hat 10 X011MtiliigiBRATAIKOSVALIVIMACW.couNrametiO,Cis • ' I i (67) NAMEMI OF CHILD(REM 168) SCHOOL ATTENDING Teel STUDENT NO. (OPTIONAL) A oi-Ne. PROT26 PICTURE CARD NAME School_ Year Y-2- 13 Schoo Year Grade I 99 3-9V Schoo I Year 94-11 t r ". F ll at Middle School. Year Crade School Year PROT27 6, H.L. JOHNSON ELEMENTARY SCHOOL SOBS ge tie 40 4e de le 0 ROYflL PALM BEACH, FLORIDA 33411 PHONE: PA: FAH: Principe* Dear Pan brit 8- 1/- r Oats 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 PROT28 _e L THE SCHOOL DISTRICT OF PALM BEACH COUNTY Elementary School Special Session Registration ,e of ParenUGuardian ame School Special Session School Assignment Student Number Telephone: Home Home School Teacher 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 Needed: no it, yes regular ESE lift) SAC# /06 ID Special Session Bus # 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-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. Da re of Principal / Date Sin] ir -en_r Effeu'Achifittk"tpititiF?1,41149 eqtreircif $1O 6'j'h9;11 ieleYostitionikli0M 4 018,4004re <'-;! ?setionn: endiffht"., :Spectialgec s.4s4on isumme Arm, .rime v ignature (la n In otrillitic eallikabontforrtn 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 STUDENT ATTENDANCE RECORD: Tea t9r comme s: Ziee llja15"fi 1--€7-9-s - WhitelSpecial Session School PBSD 0673 FY 95 Revisio Wstrator I Date om coo ome SchoollOffice Special Session: Days Present 0 Days Absent C) Days Tardy PLACEMENT DECISION Made following Special Session in Promoted O Administrative Placement CI Retained P- 54 r Signature of Home ool Principal / Date PinkfTrensportetion GoltrerentIGueniian then home School PROT29 THE SCHOOL DISTRICT OF PALM BEACH COUNTY (SDPBC) New and Returning Student Registration 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. (I) STUDENT NUMBER (2) SAC GIME (3) GRACE LEVEL 1060 12 DIST:2331 TCHR (4) STUDENT LEGAL NAME (last MIL middle) MICORESS (5) ALSO MOM AS (house no. 4 UrnilfiliM (... no.) (a)0 (ask.) Op code) (7) MAIUNG ADDRESS Poem he & skeet hene) (pt no) OM (state) OP code/ (8 ITY ) SOCIAL SECUR Negooneo (9) HOME TELEPHONE NO. (10) SIEC I P (11) RACE/EThNIC ORIGIN W 0 I-American Indian/Alaskan Native 0 B-Black, Non-Hispanic 0 H-Hispanic 0 A-Asian/Pacific Islander 0 W-Whlte, Non-HI panic 0 %Multiracial (12) DATE Of GIRTH (M4.41DONYTy) (13) PLACE 0 WEST PALM BIRTH 9*. oak cow*y) BEACH FL US FLORIDA (14) RESIDENT STATUS 0 0. Foreign Exchange Student 0 1. Out-of-county Resident 0 2. Out-of-state Resident 0 3. In-county Resident (IS) USA ENTRY DATE (HAVDDeryn) (Is) FEDERAL IMPACT YEs NO 0 0 A. The 0 0 B. The 0 0 C. The SURVEY student resides on federal property. student resides in low rent housing. parent is employed on federal property located in PB County. parent is employed on low rent housing located in PB County. parent Is al the uniformed services of the United States. YES, Is the parent on active duty? Cheek service below: Army 0 Coast Guard 0 Marines 0 National Guard 0 Nary Indicate with an longest Prekindergarten Prekindergarten Parent Program Applicable (17) PRESCHOOL ENROLLMENT INFORMATION Place an X by each program encoded. Also. asterisk n filo program your child was in the 0 C. Title I Prekindergarten 0 M. Migrant 0 D. Pre-l< Disabilities 0 N. None 0 F. Fee for Services 0 P. Private 0 H. Head Start 0 T. Teenage K III L. Readiness Program 0 Z. Not D. The 0 0 E. The 0 • If E. Is 0 Air Force M 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? If yes, what school? • YES 0 NO (24)DATE ATTENDED 94 PSC All new and returning students compete the remaining form including page 2 p2si Students will receive non-Invasive health screenings pursuant to Florida viSlon, hearing, scoliosis, height, and weight. These tests may be ghien individually right to request an exemption In writing. If you DO NOT want your child (This exemption wit cover at types Statute §381.OO56(7)(d). Non-invasive screenings may include or In groups. Parents or guardians, however, have the to receive the screenings, write the words "Do not screen" here: of screenings) to prevent tooth decay. 0 YES 0 NO 0 Interested in receiving information Gar) I give permission for my child to participate in the sodium fluoride program (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 (28) HOME LANGUAGE SURVEY (chock WI ghat app.') In A language other than English is used in the home. 0 The student has a first language other than English. 0 The student most frequently speaks a language other than English. What language/ What language? What language/ (29) DISCLOSURES FOR ENTRY INTO PSC SCHOOL DISTRICT (Check ON the! apply) had juvenile justice aerials taken against himiher. 0 The student has been expelled from school. • The student has III The student has arrested resulting In a charge. (30) STUDENT LIVES WITH (check one) 0 Mother 0 Father 0 Both Parents 0 Foster 0 Group Home 0 Other (31) CUSTODY STATUS OF STUDENT (check one) 0 Mother 0 Father 0 Shared Custody 0 Other NBR:O23 STDT: CRS:21O46OO SEC:OO4 BLDG:O2 RM:226 08/11/04 IMPORTANT INFORMATION - MUST BE COMPLETED (32) Is there a court order barring either parent from removing or contacting the student during the school day? K 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 PROT30 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 FL 33411 (47) CITY STATE ZIP CODE FL 33411 (37) OCC (PATON (38) HIGHEST ED. LEVEL (48) OCCUPATION (49) HONEST 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) CELUPAG ER 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 OTHER (80) TELEPHONE (61) CS.UPAGER NUMBER (65) RELATIONSHIP (66)1ELEPHDNE (67) CGLUPACIER NUMBER (86) STUDENTS ALE RGES (chick all Mel applyand specify) 0 Birds 0 Reptiles 0 Amphibians 0 Plants 0 Food 0 Other Specify 0 Ncne • Animals (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 verify that the Information given Is true and accurate to the best of my knowledge. FOR OFFICE USE ONLY COB US CAL O1 St. Entry Code E01 Enlry Dale ESOL Entry Date 08/11/04 PBSD 0636 (REV. 03/17/2004) PARENT/GUARDIAN CONSENT I understand and agree that all educational records of my child may be shared with the Districts health care partners and other governmental and social agencies jointly seeing the child or having 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 r No. Reassign. Code Birth Verification DCF IMRE CF IT/LEGAL GL/ Documentation Checklist Transportation K Immunizations 0 RC Bus 0 Birth Records Verification 0 Palm Iran CI Social Security Number 0 Parent/Student Transportation 0 Physical Exam 0 Walk 0 Bke 0 Address Verification page 2 of 2 PROT31 The Score Is a number between 100 and 500. Florida Comptitens'Are Assessment Test Spring 2003 Florida Comprehensive Assessment Test (FCAT) Sunshine State Standards Grade 10 Student Report Student Number School Name and Number 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. State Comparison Lowest Middle Science Score Highest 590 450 400 350 330 250 230 150 100 Science Content Scores Content Areas Points Possible Points Earned State COMpdt SOn 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 PROT32 FCAT Reports Separate reports are produced for the Sunshine State Standards tests in FCAT Reading and Mathematics, Science, and Writing. A separate report is also printed for the norm-referenced tests in Reading and Mathematics. FCAT Norm-Referenced Test (NRT) Report The FCAT NRT report shows reading and mathematics scores on a Florida version of the SAT9 (published by Harcourt Educational Measurement). Student scores are compared to a national "norm" group, where a percentile rank score of 50 is average. Sunshine State Standards (SSS) Reports The FCAT SSS Reading, Mathematics, and Science reports show test stores from Florida's tests of academic standards. These reports contain subject scores and content stores. Subject scores describe the overall achievement, and content scores giva the number of points earned in specific skill areas. Success on the Reading and Mathematics tests can be best understood by using the achievement levels where a 3 or higher is on or above grade level. Achievement Levels Five categories of achievement describe the success students have with the content tested on the FCAT Reading and Mathematics. Level 5 is the highest and Level 1 is the lowest. Since science achievement levels have not been determined, science stores are ranked as to whether they fall in the lowest, middle, or highest third of statewide student performance. 5 This student has success with the most challenging content of the Sunshine State Standards. A student scoring in Level 5 answers most of the test questions correctly, inciuding the most challenging questions. 4 This student has success with the challenging content of the Sunshine State Standards. A student scoring in Level 4 answers most of the test questions correctly, but may have oniy some success with questions that reflect the most challenging content. 3 This student has partial success with the challenging content of the Sunshine State Standards, but performance is Inconsistent. A student scoring in Level 3 answers many of the test questions correctly, but is generally less successful with questions that are the most challenging. 2 This student has limited success with the challenging content of the Sunshine State Standards. 1 This student has little success with the challenging content of the Sunshine State Standards. FCAT Certificates Students who earn Level 5 scores or whose science state scores are greater than 400 receive Certificates of Achievement. For writing, certificales are given to all students with scores of 5.5 or 6 and to fourth graders with scores of 5, 5.5, and 6. Certificates are not awarded based on the FCAT Norm-Referenced Test scores. Informes FCAT (Spanish) Se preparen informes separados para los exåmenes del FCAT de lectura y matemåticas, ciencias y redacción según las normas estatales Sunshine State Standards. También se imprime otro informe por separado para los exåmenes de lectura y matemåticas de acuerdo a las normas de aplicación nacional. Informe sobre el FCAT cefiido a normas de apficación nacional (NRT) El Informe del FCAT NRT presenta los resultados de lectura y matemåticas en una varslar' del estado de Florida del SAT9 (publicada por Harcourt Educational Measurement). Los resultados obtenidos por los estudiantes se comparan con el grupo modelo o norma", en el que la clasificación es de un 50% del promedio. Informes según las normas estatales Sunshine State Standards (SSS) Los informes según las normas estatales SSS del FCAT presentan las calificaciones de los exåmenes de lectura, matemåticas y ciencias de las normas académlcas de Florida. Estos informes contienen calificaciones por materias y calificaciones por contenido. Las calificaciones por materia proporcionan un resumen general del rendimiento y las calificaciones por contenido que proveen el numera de puntos obtenidos en åreas de habilldades especfficas. El éxito de los exåmenes de lectura y matematicas puede entenderse meder utilizando los niveles de rendimiento en los que una callficacIón de 3 o superior estå al nivel del grado o por encima. Niveles de rendimiento El éxito que un estudiante ha lo9rado en el contenido examinado en el FCAT de lectura y matematicas se describe por medio de cinco categorias. El nivel 5 es el mås alto y el nivel 1 es el mås bajo. Como los niveles de rendimiento en ciencias no se han determinado, las calificaciones de ciencias se clasifican con respecto a si entran dentro del tertio inferior, medio o superior del rencfimlento estudiantil a 'livet estatal. 5 Este estudiante tiene éxito con el contenido mås dit fall de las normas Sunshine State Standards. Un estudiante del Nivel 5 responde a la mayoria de las preguntas del examen correctamente, incluyendo las preguntas mås diffciles. 4 Este estudiante tiene éxito con el contenido difícil de las normas Sunshine State Standards. Un estudfante del Nivel 4 responde a la mayorfa de las preguntas correctamente, pero es posible que säl° tenga alerta éxito con las preguntan que reflejan el contenido mås difícil. 3 Este estudiante bitne un éxito parcial con el contenido difícil de las normas Sunshine State Standards, pero su rendimiento es inconsistente. Un estudiante del Nivel 3 responde muchas de las preguntas del examen correctamente, pero por lo general tiene menos éxito con las preguntas que son mås dit ides. 2 Este estudiante tiene éxito limitado con el contenido dit kil de las normas Sunshine State Standards. 1 Este estudiante tiene poco éxito con el contenido difícil de las normas Sunshine State Standards. Certificados del FCAT Los estudiantes que se claslfiquen en el Nivel 5 o cuyos resultados de dendas seen superiores a 400, recIben Certificados de rendimiento. En redaccian, los certificados se otorgan a todos los estudiantes que han obtenido calificaciones de 5.5 y 6, y a los estudiantes de cuarto grado que han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados en los resultados del FCAT cefiido a normas de .aplicación nacional. Rapò FCAT (Hattian Creole) Yo prepara rapa apa pou egzamen lekti ak matematik, syans ak redaksyon FCAT bay swivan prensip Sunshine State Standards yo. Yo ekri yon rapa apa tou pou lekti ak matematik pou "modél egzamen ofisyél FCAT itilize pou fé evalyasyon" an. Rapb egzamen oflsyél FCAT Itillze pou fé evalyasyon (NRT) Rapa FCAT NRT a montre nöt lekti ak matematik nan vésyon Florida genyen pou SAT9 la (Se Harcourt Educational Measurement kl plbillye li.) Yo konpare nät elév la ak yon gwoup nät yo konsidere kam "mod& pou egzamen ofisyér la, kote swivan klasman pa pousantaj la, nöt mwayén nan se 50. Rapö Sunshine State Standards (SSS) Rapö FCAT SSS pou lekti, matematik ak syans lan montre nät elév yo fé nan egzamen Florida bay sou prensip akademik yo. Rapa sa yo gen nät pou matyé ak nöt pou kantni ladan yo. Nöt pou matyé yo dekri tout sa elev la reyalize anjeneral epi nöt pou kontnl yo bay kantite pwen elév la fé nan yon matyé byen detémine. Ou ka konprann kisa elév la reyalize nan egzamen lekti ak matematik la pi byen si w itilize yon nivo siksé kote 3 oswa plis se yon nät kl nan nivo klas la oswa yon nät kl pi wo pase nivo klas la. Nivo siksé elév yo Gen sank kategori siksé ki dekri nivo siksé elev yo pote nan kontnl yo teste nan egzamen lekti ak matematik FCAT la. PI gwo nivo a se nivo 5 epi pi pitt nivo a se nivo 1. Fiske yo poko detéminen nivo siksé nan egzamenn syans lan, yo klase nåt pou syans lan swivan si II tonbe pi ba, nan mitan oswa pi wo yon tyé péfamans elév toupatou nan eta a. 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 nan syém Nivo reponn pitt, kesyon egzamen yo körékteman, elév la menm reponn kesyon kl gen pi plis difikilte ladan yo. 4 Elév sa a gen siksé nan matyé ki te gen difikilte ladan yo nan egzamen Sunshine State Standards la. Yon elév ki nan 4yém Nivo reponn pitt' kesyon egzamen yo körékteman, men li ka gen kék siksé sélman nan kesyon ki sanble yo gen pi plis difikilte ladan yo. 3 Elév sa a gen enpe siksé nan matyé ki gen difikilte ladan yo nan egzamen Sunshine State Standards la, men péfömans lan pa rete estab. Yon elév ki nan 3yém Nivo reponn analt nan kesyon egzamen yo körékternan, men anjeneral li gen mwens siksé ak kesyon ki sanble yo gen pi plis difikilte ladan yo• 2 Elév sa a gen siksé limite nan matyé ki gen difikilte ladan yo nan egzamen Sunshine State Standards la. 1 Elév sa a gen yon ti siksé tou piti nan matyé ki gen difikilte ladan yo nan egzamen Sunshine State Standards la. Shtifika FCAT Elév ki fé nät 5yém Nivo oswa elév ki fé gwo nöt kl pi plis pase 400 nan syans ap resevwa Sétifika pou Siksé. Yo bay tout elév kl fé nät 5.5 oswa 6 ak elév klas katriyém ki fé nöt 5, 5.5, ak 6 yon sétifika pou redaksyon. Yo pa bay sétifika swivan nöt elév fé nan egzamen kl baze sou "mod& egzamen oflsyél FCAT itilize pou fé evalyasyon" (NRT) an. PROT33 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. 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 Words/Phrases Main Idea/Purpose Comparisons Reference/Research Points Possible Points Earned FCAT Score 2003 Mathematics Content Scores Content Areas Points Possible Points Earned Number Sense I I Measurement Geometry Algebraic Thinking I Data Analysis Year Grade Tested Achievement Level FCAT Score 2001 2002 2003 FCAT Score 2000 500 4000 Congratulations! You have passed the Mathematics test and your score is on grade level. You have answered many of the questions on FCAT correctly. 2500- 2000- 1500- 1000- Reading Grade 3 Grade 4 Grelp 5 Orede e 0 • Your Score O On Grade Level Mathematics • Your Score 0 On Grade Level Grok 3 GM* 4 Grade Grade t 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 PROT34 FCAT Reports Separate reports are produced for the Sunshine State Standards tests in FCAT Reading and Mathematics, Science, and Writing. A separate report Is also priMed for the norm-referenced tests in Reading and Mathematics. FCAT Norm-Referenced Test (NRT) Report The FCAT NRT report shows reading and mathematics scores on a Florida version of the SAT9 (published by Harcourt Educatlonal Measurement). Student scores are compared to a national "norm" group, where a percentile rank score of 50 is average. Sunshlne State Standards (SSS) Reports The FCAT SSS Reading, Mathematics, and Science reports show test scores from Florida's tests of academic standards. These reports contain subject scores and content scores. Subject scores describe the overall achievement, and content scores giva the number of points eamed in specific skill areas. Success on the Reading and Mathematics tests can be best understood by using the achievement levels where a 3 or higher is on or above firade level. Achlevement Levels Five categories of achievement describe the success students have with the content tested on the FCAT Reading and Mathematics. Level 5 is the highest and Level 1 Is the lowest. Since science achievement levels have not been determined, science scores are ranked as to whether they fall in the lowest, middle, or highest third of statewide student performance. 5 This student has success with the most challenging content of the Sunshine State Standards. A student scoring in Level 5 answers most of the test questions correctly, including the most challenging questions. 4 This student has success with the challenging content of the Sunshine State Standards. A student scoring in Level 4 answers most of the testquestions correctly, but may have only some success with questions that reflect the most challenging content. 3 This student has partial success with the challenging content of the Sunshine State Standards, but performance Is inconsistent. A student scoring in Level 3 answers marw of the test questions correctly, but is generally less successful with questions that are the most challenging. ≥ Thls student has limited success with the challenging content of the Sunshine State Standards. 1 This student has little success with the challenging content oi the Sunshine State Standards. rCAT Certificates Students who earn Level 5 scores or uhose science scale scores are greater than 400 receive Dertificates of Achlevement. For writing, certificates are given o all students with scores of 5.5 or 6 and to fourth graders with 5cores of 5, 5.5, and 6. Certificates are not awarded based on he FCAT Norm-Referenced Test scores. Informes FCAT (SpanIsh) Se preparan informes separados para los exåmenes del FCAT de lectura y matemåticas, ciencias y redaccIón segön las normas estatales Sunshine State Standards. También se imprime otro informe por separado para los exåmenes de lectura y matemåticas de acuerdo a las normas de aptit:eden nacional. Informe sobre el FCAT cehldo a normas de aplicación nacional (NRT) El informe del FCAT NRT presenta los resultados de lectura y matemåticas en una versiön del estado de Florida del SAT9 (publicada por Harcourt Educational Measurement). Los resultados obtenidos por los estudiantes se comparan con el grupo modeto o "normen, en el que la clasificación es de un 50% del promedlo. Informes se un las normas estatales Sunshine State Standards (SSS) Los informes segön las normas estatales SSS del FCAT presentan las calificaciones de los exåmenes de lectura, mateméficas y clencias de las normas académicas de Florida. Estos informes contienen calificaciones por materias y calificaciones por contenido. Las calificaciones por materia proporcionan un resumen general del rendimlento y las calificaciones por contenido que proveen el número de puntos obtenidos en åreas de habilidades especfficas. El éxito de los exåmenes de lectura y matemåticas puede entenderse mejor utilizando los niveles de rendimlento en los que una calificación de 3 o superior estå al nivel del grado o por encima. Niveles de rendimlento El éxito que un estudiante ha logrado en el contenido examlnado en el FCAT de lectura y matemåticas se describe por medio de cinco categodas. El nivel 5 es el mås alto y el nivel 1 es el mås bajo. Como los niveles de rendimiento en ciencias no se han determinado, las callficaciones de ciencias se clasifican con respecto a si entran dentro del tercio inferior, medio o superior del rendimiento estudiantil a nivel estatal. 5 Este estudiante tiene éxito con el contenido mås difícil de las normas Sunshine State Standards. Un estudiante del Nivel 5 responde a la mayorfa de las preguntas del examen correctamente, induyendo las preguntas mås dit folies. 4 Este estudlante tlene éxito con el contenido diffcil de las normas Sunshine State Standards. Un estudiante del Nivel 4 responde a la mayorfa de las preguntas correctamente, pero es posible que ebb tonga cierto éxito con las preguntan que refiejan el contenido mås dirka. 3 Este estudiante tiene un éxito parcial con el contenldo (fiffel! de las normas Sunshine State Standards, pero su rendimiento es inconsistente. Un estudiante del Nivel 3 responde muchas de las preguntas del examen correctamente, pero por lo general tiene menos éxito con las preguntas que son mås dif fåles. 2 Este estudiante tiene éxito limitado con el contenido dirka de las normas Sunshine State Standards. 1 Este estudiante tiene poco éxito con el contenido difícil de las nornas Sunshine State Standards. Certificados del FCAT Los estudiantes que se claslfiquen en el Nivel 5 o cuyos resultados de clencias sean superiores a 400, reciben Certificados de rendimiento. En redaccien, los certificados se otorgan a todos los estudiantes que han obtenido calificaciones de 5.5 y 6, y a los estudiantes de cuarto grado que han obtenido 5, 5.5 y 6. Los certificados no se otorgan basados en los resultados del FCAT cehido a normas de aplicación nacional. Rapti FCAT (Haitian Creole) Yo prepare repe apa pou egzamen lekti ak matematik, syans ak redaksyon FCAT bay swivan prensip Sunshine State Standards yo. Yo ekrl yon rap?) apa tou pou lekti ak matematik pou "model egzamen ofisyél FCAT itilize pou fé evalyasyon" an. Rapti egzamen ofisyél FCAT Rilke pou fe evalyasyon (NRT) Rapti FCAT NRT a montre nät lekti ak matematik nan vésyon Florida genyen pou SAT9 la (Se Harcourt Educatlonal Measurement ki pibiliye li.) Yo konpare nöt elev la ak yon gwoup nöt yo konsidere kem "modet pou egzamen ofisyél" la, kote swivan klasman pa pousantaj la, nät mwayén nan se 50. Rap?) Sunshine State Standards (SSS) Rapti FCAT SSS pou lekti, matematik ak syans lan montre nöt elév yo fé nan egzamen Florida bay sou prensip akademik yo. Rapti sa yo gen nöt pou matyé ak nät pou kontnl ladan yo. Nät pou matyé yo dekri tout sa elév la reyallze anjeneral epi nöt pou kontni yo bay kantite pwen elev la fé nan yon matyé byen detémine. Cu ka konprann kisa elev la reyalize nan egzamen lekti ak matematik la pi byen si w itilize yon nivo siksé kote 3 oswa plis se yon nät ki nan nivo klas la oswa yon nöt kl pi wo pase nivo klas la. Nlvo siksé elév yo Gen sank kategori siksé ki dekri nivo sikse elev yo pote nan kontni yo teste nan egzamen lekti ak matematik FCAT la. PI gwo nivo a se nivo 5 epi pi pitt nivo a se nivo 1. Fiske yo poko detérninen nlvo siksé nan egzamenn syans lan, yo klase nät pou syans lan swivan si II tonbe pi tia, nan mitan oswa pi wo yon tyé pefemans elev toupatou nan eta a. 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 nan 5yém Nivo reponn pleti kesyon egzamen yo körékteman, elév la menm reponn kesyon kl gen pi plis difikilte ladan yo. 4 Elév sa a gen siksé nan matyé kl te gen difikilte ladan yo nan egzamen Sunshine State Standards la. Yon elev ki nan 4yém Nivo reponn pile kesyon egzamen yo kärékteman, men II ka gen kék siksé selman nan kesyon ki sanble yo gen pi plis difikilte ladan yo. 3 Elév sa a gen enpe siksé nan matyé kl gen difikilte ladan yo nan egzamen Sunshine State Standards la, men pefbmans lan pa rete estab. Yon elév ki nan 3yém Nivo reponn anpil nan kesyon egzamen yo körékteman, men anjeneral Il gen mwens siksé ak kesyon ki sanble yo gen pi plis difikilte ladan yo• 2 Elev sa a gen siksé limite nan matyé ki gen difikilte ladan yo nan egzamen Sunshine State Standards la. 1 Elév sa a gen yon ti siksé tou pill nan matyé kl gen difikilte ladan yo nan egzamen Sunshine State Standards la. %Mike FCAT Elév ki fé nät 5yém Nivo oswa elév ki fé gwo nät kf pi plis pase 400 nan syans ap resevwa Sétifika pou Siksé. Yo bay tout elev ki fé nät 5.5 oswa 6 ak elév klas katriyem Id fe nät 5, 5.5, ak 6 yon skinka pou redaksyon. Yo pa bay sétifika swivan nät elév fé nan egzamen ki baze sou "mode' egzamen ofisyél FCAT itilize pou fé evalyasyon" (NRT) an. PROT35 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) ALSO KNOWN AS (5) LOCAL ADDRESS Mouse in 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 F (10);RACETETHNIC ORIGIN w Di -American Indian/Alaskan Native 0 B-Black, Non-Hispanic • H-Hispanic 0 A-Asian/Pacific Islander 0 W-White, Non-Hispanic 0 M-Multlraclal Oh DATE OF WM 00414:0111/0 (12)PLACE OF BIRTH (cozy, suit oouncy) FL US FLORIDA 03) RESIDENT STATUS 3 0 0. Foreign Exchange Student 0 1. Out-of-county Resident p 2.9ut-of-state Resident USI!.*17 In-county Resident (14) USA ENTRY DATE nuAtaavvvv) (15) FEDERAL WACT SURVEY YES NO7 o 0 / . p±The student resides on federal property. 2 /6 " The student resides In low rent housing. 0 ' The parent is employed on federal property located in P.B. County. 0 The parent is employed on low rent housing located in P.B. County. 0 E. The parent Is In the uniformed services of the United States. 0 0 If E. Is YES, Is the parent on active duty? Check service below: 0 Air Force 0 Army • Coast Guard 0 Marines 0 National Guard 0 Navy (10 PRESCHOOL ENROLLMENT INFORMATION Place an X by each program attended. Also, indicate with an asterisk r ) the program your child was In the longest. 0 N. Non-subsicized Child Care 0 M. Migrant Pre-K 0 D. Pre-K Disabilities 0 H. Headstart 0 I. Pre-K Early Intervention 0 C. Chapter 1 0 S. Subsidized Child Care 0 0. Other (TY) IS THE STUDENT A SINGLE PARENT? NO 0 YES 0 NO (18) CURRENT GRADE LEVEL 09 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 , , .. . REDUCED FREE OR REDUCED:- QS) Students vall receive non-invasive health screenings pursuant to Florida Statute 381.0056(7)(d). Non-invasive Include hearing, height, These tests be individually PRICE LUNCH screenings may vision, scokosis, and weight. may given or 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: (27) Have you fired out an application for free and (This exemption wet cover at types of screenings) (26) I give permission for my child to participate In the sodium fluoride program to prevent tooth decay. • YES ONO (permission is veld through 6th grade) YES reduced lunch? 0 YES 0 NO (Application is provided with this form) 11SEVY:i§IP,Ota",01.PALAI 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. r• 3\ if k IL CA. A. 5\ VA 5. (30) What language is the students first language? (31) What is the date of entry Into an ESOL program?7 (322e796ff LIVES VW. plink coo) er Father 0 (33) DISCLOSURES FOR ENTRY INTO PSC SCHOOL CTSTRICT L Mother Both Parents 0 Other YES e 0 as the student ever been expelled from school? 0 Has the student ever had an arrest resulting in a charge? 0 3. Has the student over had any juvenile Justice actions? pe CUSTODY STATUS OF STUDENT (chock one) 0 Mother 0 Father • Shared Custody 0 Other (35) Is there a court order barring either parent from removing or contacting the student If YES, provide the school with a copy of the court order. during the school day? 0 YES 0 PBSD 0636 (REV. 5/29/2001) page 1 of 2 PROT36 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION • (30) FATHER OR LEGAL GUARCW OSA snick* Melia( last) PU: Y (37) MOTHER OR LEGAL GUARDIAN first mickIT• Mac rasp PU: Y ADDRESS MANN ~neer, act name. aparlmenf number) ADDRESS (sired matt sbre: name, apartrwr: number) CITY STATE ZIP CODE FL 33411 CITY STATE ZIP CCOE FL 33411 OCCUPATION 1 ePA Ilk .1 5 vfiforf Com pieti OCCUPATION PLACE OF EMPLOYMENT NUMBER NOME TELEPHONE SUSNESS TELEPHONE CB. PAGER NUMBER EMAIL ADDRESS (cptional) SA gt:MENP AP ifil D AfkrAINEPRINATI0N CS.] Person(s) other than parent authorized to pick up student (2.3) PASSWORD Ma* 10 characters) r (39) NAME Oat mato* inNal, lade (41) NAME (Pat Inkrthe Arbet NV ADDRESS faIscl number. steel name, eparlanzal nuns ADCftESS (etrix4 nombsv, skeet mem Oparthefal nuenbc) CITY STATE. •ZP CODE an STATE ZP CODE TELEPHONE RELAT3I4SHP OTHER (40) AUTHORIZED FOR EMERGENCY PICKUP D YES O NO V TELEPHONE RELATIONSHIP (42) AUTHORIZEDFOR EMERGENCY P13(UP O YES O NO (43) If school personnel are unable to contact you In may we have your permission to call your doctor emergency services (91 ) for transport to the hospital? case of illness or accid or YES O NO (44) MEDICAL NFORMAT/ON (Nsl sturfesa illnesses. Cohort; heetth Mouesalfagies. medications. or other phymcal Artrlaboist) n ine (45) FAMLY PHYSICIAN (40) PHYSICIAN PHONE (KR Does your child currantflve health insurance? OrYES O NO If YES, indicate: (47) HOSPITAL PREFEREIC ekk•fts teiesAlidt0 e h O Medicaid El rNate O Healthy Kicks/Kid Care O 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 I verify that the information given is true and accurate to the best of my knowledge. S - /4Q ( jEMO.FFIO.SgcPS)ta W ID) SCA W) 2331 OS STUDENT NO (55) COB US %) ENTRY CO. (57)EWIRY DATE E01 08/14/01 (MGR LY 08 (H)M. 01 (50) TEACHER NO (61)REASSION ONE OR TRANSAATA71011 O MOOSE O Pain Tran tea NTH Mr. 1 2 3 4 51 (64) HS* A O Parent/Student Trans. O Walk O Bike 6 7 8 9 T B2 (65) 00CULIEMATI011 CHECNIStatert al 46 to naiad) O Immunizaborts (date) O Birth Records Verif. (da e) O Soc. Sec. No. (date) O Physical Exams (date) (46f DATA ENTRY COMPLETED BY DATE S/ DATE PBSD 0636 (REV. 4/6/20015.29/2001) page 2 of 2 PROT37 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 PARENT OR GUARDIAN 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...- DOE' Iowa .1),3?•0 3 CODE"." 64:Th. A/ l t `M.9.6 4 :Arlz- =map Ail(R MI DOB 111O/DANR Child's SS# (optional) STATE IMMUNIZATION IDO VACCINE DTaP/DTP2 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. t 'IC \Dose 4 tae PA/YR Dose 5 MO/DA/YR PROT38 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 of this form. 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 required for entry and attendance in 7th grade effective with the 1997/98 school year: tetanus-dip ter, hepatitis B vaccine series, and second dose of measles vaccine as documented on the reverse side of this form (boxed are Physician or Clinic Name: Physician or (Print or stamp) _Authorized Signatu Address: oyal Palm Lie. # each, FL 33411 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 this form and has commenced a schedule to complete the required immunizations. Additional immunizations are not medically indicated at this time. Physician or Clinic Name: (Print or stamp) Address: Expiration Date: (r9 dart after nest humanization appo Physician or 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: DH 6s0,11/96, °tacker" earlier eclitiorn (Stock[ Number 5740/003-0680-6) Date: PROT39 PANEL: --STDT: START: 081998 A DATE 082898 111398 010899 Tuesda DLY A17. ABSENCE DETAIL January 12, 1999 11:22 am SCHL: CAL: PERIODS 12345678901234 A A 006 PieldTwp A SCHL 1691 PF1=HELP 3=EXIT 5=REFRESH 6=KEYBOARD 7=BKWD 8=FWD 12=ESCAPE NO ADDITIONAL PAGES...NEXT? 169 01 uniAg eiata /J.& (4 axilti;(5 It24 P03 a4 a4 Avic- uJ ak. A - - CAL 01 YEAR.: 99 clAig :46'.szt A . VIPtc. FY 99 TERML: CB1B "at tr rbor s3-0 maul aieuafr Kit La4Pc A-(4/{-0-1-17 J1,4- An. 01-0u- A•ewi 41_,L Wa-0 CAIll ezom. sac 7- 4Qt "64- 2-4-h` I - a yrac O1a ot- 6Alta et,w0 /ea" - /14A Aaa a kamic- PROT40 4 A10. CURRENT SCHEDULE 12, 1999 11:21 YEAR; 99 am SCHL: 1691 GR: 06 ST: A STDT: 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 PROT41 Name STUDENT RECORD FOLDER COMPOSITION Grades 3-6 tz-st PALM BEACH COUNTY PUBLIC SCHOOLS GRADE 3 INTEGRATED F II Test'n School Teacher Date • (0 - q5 Rank r--9 The student needs further work on: Response to Prompt Audience Development Organization/Sequence Details Vocabulary ,entence Structure <,..Grammar Mechanics COMPOSITION Spring Testing School Teacher Date c 2 ) Rank .43 The student needs further work on: Response to Prompt Audience Development Organization/Sequence Details Vocabulary Sentence Structure Grammar LZMechanics UNIT EVALUATIONS UNIT ONE - UNIT TWO - UNIT THREE - Photo Story Journal Entry How-To Report Date Ran Date //- " gc"-- Date -AA )? r gic7 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 PROT42 Student: Teacher School: Principal: 6 THE SCHOOL BOARD OF PALM BEACH COUNTY PALM BEACH COUNTY, FLORIDA KINDERGARTEN REPORT CARD KINDERGARTEN CHECKLIST MARKING CODES formal instruction has not yet begun student receiving formal instruction to meet specific needs and ex- periencing difficulty with skill student receiving formal instruction and making satisfactory progress student consistently performs skill accurately and efficiently The asterisks (*) indicate critical skills.• The areas listed on the checklist as well as music, art and physical education are included in the kindergarten curriculum. The checklist is composed of skills that are essential for students to master if they are to be successful in the primary grades. All activities provided in kindergarten lead toward the attainment of these skills. The teacher determines the appropriate time for the student to begin formal instruction in each skill. Beginning with the second marking period, the checklist is used to report student progress. NONACADEMIC BEHAVIOR GRADES /ft This grade reflects the student's overall conduct in all school activities. 4 = Very Good 3 = Good 2 = Fair 1 = Poor Parent conference requested. Parent conference requested. Stalking Period ATTENDANCE Marking Period Regular attendance and punctuality are essential for quality education. 1st 2nd 3rd 4th Days Present • 0 4 45- Days Absent c2) 6 - I / Days Tardy 7 sA II INFORMATION INCLUDED 7 1 TEACHER REQUESTS CONFERENCE 1 1 *PLACEMENT Grade - Licy - Summer School Program 'If summer school program is indicated, grade placement will be determined by the home school. CENTRAL PROCESSING BODY IMAGE Imitates Body Movements Identifies Body Parts Assembles Body Parts GROSS MOTOR Creeps Runs Jumps MOPS Balances Gallops Bounces/Catches Ball HAPTIC Moves Through Obstacle Course Follows Commands Using Body Identities Objects by Touch 3.3 Sorts/Matches Objects by Touch 3.4 I.1 1.2 1.3 2.1 2.2 2.3 2.4 2.5 2.6 2.7 3.1 3.2 FINE MOTOR/EYE HAND Strings Beads 4.1 Assembles Puzzle 4.2 Copies Shapes Matches/Pastes Shapes Cuts Circle Colors Objects Sequences Fingers 4.3 4.4 4.5 4.6 4.7 VISUAL DISCRIMINATION Sorts by Color 5.1 Sorts by Shape 5.2 Sorts by Size 5.3 Matches Pictures 5.4 •Identilks Likenesses/Differences of Numbers 5.5 ' Identifies Objects by Relationships 5.6 identifies Likenesses/Differences of Letters 5.7 Identifies Size Relationships 5.8 VISUAL MEMORY 'Recalls Colors Sequences Shapes 'Sequences Numbers ' Sequences Letters 6.1 6.2 6.3 6.4 AUDITORY DISCRIMINATION Names Sounds 7.1 'Identifies Likenesses/Differences of Words 7.2 Identifies Rhyming Words 7.3 wentules Likenesses/Differences of Sands 7.4 AUDITORY MEMORY Repeats Sound Pattern Repeats Sentence 'Sequences Numerals 'Follows Dkections "Sequences Letters 8.1 8.2 8.3 8.4 8.5 LANGUAGE LISTENING Recalls Information 9.1 Predicts Outcome 9.2 'Retells Story 9.3 SPEAKING 'States Full Name 10.1 Describes Common Objects 10.2 Uses Complete Sentences with Proper Speech Patterns 10.3 PREREADING Interprets Pictures Recognizes Labels 'Recognizes Own Name 'Ilkistrates Story 'Recognizes Letters PREWRITING 'Demonstrates Mastery of Fine Motor Skills 12.1 'Reproduces First Name 122 24 3rd 4th ENVIRONMENTAL AWARENESS Observes Accurately Makes Comparisons Predcts Outcomes Phrases Significant Questions 2nd 3rd 4th 13.1 13.2 13.3 MATHEMATICS 2nd 3rd 4th NUMERATION 'Matches One•t0One 'Names Numerals 0.10 'Matches Sets and Numerals to 10 14.1 14.2 14.3 'Identifies Ordinal Position 14.4 FRACTIONS 'Identifies One-Hall 15.1 GEOMETRY 'Identifies Shapes 16.1 MEASUREMENT Compares Objects 'Orders Objects Identifies Use of Measurement Tools 17.3 Measures Objects SPECIAL TOPICS Identifies coins 18.1 States Values of Coins 18.2 Joins/Separates Sets 18.3 17.1 17.2 17.4 P850 0767 FY 93 Revislei Goldenrod/1st Period Pink/2nd Period Yellow/3rd Period Green/4th Period While/Office Copy CC 6307 PROT43 El ,;rod;min the odor form 'loader whole numbers and decimals 1.4 toted and subtract wMlen,m,betup to 6 • t• mess id round Whale menten and titian ae toadd ind sitar Orimals through thinwats 7 • to solver WS. 4. pisklans Initallofic attlidp K . 21 Devalune addition and subtraction expiation, - O 2.2 to (mite aldizion. subtraction. and muhiplica • don thigessint O 23,.to find tte least common muliipk of MO or K der Merles 24..to find oodlesof 2- and Idige multiplicands and I-. 2-. and 3-dtgamuleplies 23 to solve related problem in realistic settings 3:l tocydiwe bale fact expressions 3.2 to divide by 1.cligit divisors 33 •to divide by 2-digit divisors 3.4 to find the prime famorthadon of a number 33 to find the greatest common factor of two or • Three nun s • 3.6 to solve related problems in realistic seamy 0 4.1 *fiddle mean. median. arid range of a set of dan 0 4.2 to analyze den in Ethe Fern 0 43 to analyze an in double-begraphs and K double-line graphs 4.4 to analyze dan in cirele rapid using fractions 0 4.5 to soke related problems in tali* swings 0 Si to give the Conan ufil obi. 0 5.2 to find te miners of a Irgobra irregular. OIrE 6 a 5.3 to add and subtract unia of time to find elapsed time 0 5.4 to compare times in dictates 1.13. dine zones. 0 -5•5 aspire runt! Pithier,* in molar settings 0 6.1 to multiply decithals trough tents by whole tai nlbes • 0 6.2 to multi* decimalathrotto thousandths by Atholentuntat- 0 63 io Multiply decimals by decimals 6.4 MulliPlY Money intents by :Mule numbers and decimals 0 • 6.5 to Solve related problems in =link stoning? K 7.I• to divide a &ibnal by a I -dish whole number with quotient to thousands 0 72 to write mot* place holden indarnel K quodent 7.3 to esdnumand . divide a money amount by a .wbole number 0 7.4 to Ina:ally 'divide a whole number by a whole number, with a decimal quotient 0 73. to solve related problems, in realistic seninp 0 8.1.6 Classify. quadriLuerals by appearance 0 82 to reompure the congruency of corresponding paste of a figure and its slide, flip. K K a C 0 K . mein% image 0 83 tojdentifyfiguns andloraurn synergy 0 8.4 to Classify thangks asequilatend, isoscelet or solar 0 8.5 matinee rioted pars of whole mantel with paints on a grid 0 8.6 towlve seined problettis in tealisti satiny 0 ;. 9.1 tO ivrite %vivaria crashers and fractions in Papist form- 0 9.2 to write mixed nurntets and whole manta as fraction greater than one ad rice versa 9.3 to Compare and ode &anions and mixed numbers 0 9.4 to salve reined problem in realistic settings 0 I ilt attl or Subtract fractions with like deranintiors 102 fo Os or tonna fractions with unlike derspninucts 10.310 adds snort mixed numbers with hit or unlike dmorninnos. no regrouping 2 10.40 subtract ranted nu mten with like or urdike denominators, requiring repaying D. MI to solve related ors. in =liege settings Z. :". 11.1 *Multi* fraction by whole numbers 112 to mtthiply fraction by fraaions a missing 200;4 4 thinker* *bole number '". 1/.1 *delaHIS wl"111" Ins arc " IL tin ' `• 83' mortis ?men toe qv both maten are 123 to find ning tarn siren a pair degas! 0 12.4 in write a percent as a incites ,r decimal and vice vent 0 12.5 to find a mare of a numba 126 to write a probability ratio (or a tiniatien involving vitally likely events I 27 to wive ;elated problems in tealistie whop C 13.1 tofu* the areas of rectangles ancisquarth 0 132 to identify the number of bases. otha faces. edges. and vertices in prisms and pyramids 13.3 to find the volumes of rectangular plasm' 13.4 to solve related problems in realistic settings ci - a Teacher: Comments: Level 6 1.1 to idcmify the value °fa digit by its place a whok number or decimal 1.2 to round whole numters and decimals 1.3 to add and interact decimals through ten thousandths 0 1.4 to write one-variabk addition cc subtraction exptessions involving whole numbers, IS to ?wive mined problems in realistic satin, 0 LI to evakiale one-vanabk multiplication expressions 1 0 22 tO Wive muPiplication equations 0 2.3 Druid the leap common multipk of two numbers 0 2.4 to multiply whole numben by 2-digit ' multipliers 0 23 *mutt ply dentists by whole numbers I 0 2.6 10 miikiplydecitnals by 6:cirnals 0 7-7 to solve related problems in realistic settinp 3.1 to solve division equatom 12 to simplify numerical expressions mini the °nitro( °pennons • 3.3 *divide by a 1- or Zdiglt divisor I 3 3.4 to find the prime fanixizatien of a number D 3.5 to find fie meat common factor of two numbers •-t 16 to solve Maned problems in realistic satiny 2 4.1 winter kne pica • J " 4.2 to find and use meant median. mode. and *nee *describe dap 4.3 to analyze data in tor graphs 4.4 to analytic dua in line graphs 43 to analyze data in circle graphs I II *divide a whok number by a smaller or larger_ whole number I 5.2 *divide a money amount by a whok number 5.3 to divide a decimal by a decimal - - r 5.4 to round decimals 53 to estimate unit prices codetermine the bitter - - buy , 5.6 to solve related problems in realistic sating:a 6.1' to write equivalent curtailer units 6.2 to write equivalent mark win 6.3 to classify angles as acute. right, obtuse. or 4 Stotrailincl gill I tbe circtunferate of a cisek 63 to construct a circle graph and to identify taps _ related to clicks - 6.6 to solve elated problems in realistic sittings Z 7.1 to write fractions plater than 1 as mixed numbers and vice versa I - 7.2 to add and sulanci frardons ard mixed nuristen with like &nominalism 7.3 to compare and order fractions with like and unlike denominators 7.4 to mentally add and subtact fractions and ei mixed numbers in which ate denominator is a multiple of the other 73 madder subtract customary Measures 1 7.6 to add and subtract fractions and mixed numbers with unlike denominators in which neither is a multiple of the other 7.7 to solve related problems in realistic seeing, Z 8.1 to multiply fraction and whole numbers 8.6 *change footle; and. reixeintimtert: dm-grab a* *covet* 81 to solve related problem in tannic sat 9.1 D unite a lido intim differern.ways , 9.2 *rite:Milt Mick( ittiti nibs are Nu* 93 (Intl nitsing terms in prop3sions 9A to kin* die comic tazionica fora gra 93 to trite the proMbditr ntientsirriong *Zak y°9103 66 • 96 to.salve timed problemin realistic Sane 10.1 Dre* congruent rote parallel puts grit figure end in slide or.flip ithage • 10.2 toadennfy . Foilsmen art/parallel tins given a fireless:Air lt71..or I 1 ' 10.3 to iderxify figures a tidying turn and/or Ith synametrY 10.4 to write the caked pair fora given paint o 10.5 to classify pictures of garnet* *lids • 10.6 to solve related problems in realistic wing 11.1 to write a german for di shaded•ponionott figure 112 to write fractions and ckeimals as ream' 11.310 compute a patent of a number ' ' " 11.4 to computtelescke gitql theorigirialpic and diswras[}ar!' - II-Itocarp= tones; given the pricsand ru rate , • 11.6 tot:emu" annual inners gnat the rimer and interes rase 11.7 to !dye reined problem iitiealMiesetingt 12.1 io find etc wade mangler Male Mtos 12.2 to find die arat and przineterbfa trinigle . 12310 fitd the ales of pattlkloimm 124 to 64 the aplitoxiintfe 664 bilacirck •. 123 in raid the volumsofa rectangular .piles: . 12.6 to solve (eked problems in :realistic ;sittings 13.1 to write new tempaannagiveri tiro ii increases from given tenthearthet • 132 to ordir signed number 13.3 to add two signed numbets:with unlike sign 13.4 to subtract a biter whole number front a 115 to nitre datzet4 dine 13.6 to solve rehied probierniin Slink inings Teacher: t Comments: Level? 1.1 to road whokiitintherun•eldedthaft ; 1.2 to add and subtrandetinials. 7.. Li to write variable expression 1.4 to write 1 -stepadd/donor hibernation equations for reined problemS, 1.5 to solve I -sup *Mort oraubtaiticit a••••. • equations 2.1 to solve one-step multiplinticit •Ottfivision equations 2.2 to sirtnplify evaluate. Compare:1nd cirri exponential expression 23 to find die least comrnorr multipk of 2 Oil 24 to solve 2-step ethttrions 23 us solve related problems by writing linear 491446016 3.1 to evaluate simple multiplicationnorm-owe with decimal replacements 3.2 to multiply decimals by decinult and by adroit numbers 3.3 to divide decimals by whole minters.td by (lanais 3.4 to compote picas to deten6ineibe best 64. . 3,3 to writeand:multiply numbers-in sciaitifiC notation 3.6 to solvelewd problems in realistic semis PROT44 4. ognasissi 43 to analyze dies lea wale plebs O 5.1 to determine pecitica aradgmatest pang* cent./ a lints Maitinirnall a les multiply rah do* teas ad nlarartg lay whole nurnben O :53 m irlissify dial:rag types of stiles eel pia of N gles O' 5.4 Loftin trA trait a eitele graph 53 to solve rented problem in restate wings 0 6.1 tot/nava *via fractions O 62 to order fractions from lent to groan O 63 to add ad maraca fractions with catlike O 6A to solve apntiolls mithfacOre O 63 to add and subtract mixed numbers, Main* a whole numbers O 64 to solve related problein lit realistic Settings O 7.1 to multiply Mains and mixed mantas O 72 to mite and use dre recipmcaLs of fractions and whole numbers O 7.3 to divide fractions and mixed numbers' O 7.4 to was a Inane or mixed nominees a decimal and via van O 73 to solve 1, aid 2-sep equation wit fact• and mixed numbers Q 7.6 tp solve related problems in realistic settnis O • 8.1 to add signed numbers O 82 to subtract signed mantas O 8.3 to multiply and diode sigried nurntas O 8.4 to Waxily equivalent foam of signed numbers O. 23 to evaluate expressions involving ado of 83 toSolve 1 - an:12.step musing with sipiech O . opetion inchiding examen a 2.4 to solve muld photon and division cessations O Mantas' • 8.6 toverite the inequality (resents graph O 23 to solve two-sepoustion in one rentable O .81 4 min allied problerns in really& sto w a 24 to solve related problems in statistic settinp O 9.1 4, use tit wale damp et sea &nog a , 3.1 to interpret data presented in a line pioz O 91 to find a percent of a number O 3.2 to inierpret dan presented bi a sem-and-leaf 9.3 M find the patent when the time Pint O. pates tagean given Q 3Y to interpret data presaged in a fnamencyl 9:4 to Ad.the base I/tram= of it is Itmown a a histogram . 94 to fed timple interest a . 4. z.3.4 iii find the upper and Iowa quanties for a uem- O 9.6 th calculate pavan of increase or decrease • O I ond•lof pia 9.7 to solve reined-problems in realmic settini - O . 3-5 M find the median tad quartiles (roma 10.1 to recognize transigias. reflection and rum • box plot O , a 3.6 so solve reined problems in realistic settings O - images of figures 4.1 to identify in.a diagrams radius. diamear. 10.2 to identify the medians and attiturks in ' semicitsk. nujor arc. and tninor me O Mangles ' O 42 to find distance M nautical milestenvem 10.3 to use tatsformadas to identify congruent .1. • nvo locations on earth given their antral angle O line segments and angles great in a figure and- ' its turn image O 4.3. to find the length of an as of a cafe given the measure of its antral angles and dr radius of 10:4 ad idanify the scale factor in rwo similar die cluck C Mangles given theirdimensiorg r• 4.4 to recognize lines of symmetry in differmt 103 to identify perpendicubr. parallel, and skew figures t-i edges of a sight month: prism a tasoi solve related problems in mastic settings O., ' 43 m rec9/O24 4964ave• convex' and retiuliar 11.1 to calculate pennon and area of parallel> PalYficAls grams O 112 to caloilaie Mignon and area of Ma/4ln O I I.3 to cakunte penneter and area of trapezoids O 11.4 toplculate de area of a circle O I '15 to a volumes of prism cylindas. ' cores. and mond' O 11.6 to catalog the surface area of pins and cylinders 11.7 to solve rebated problenn in realistic settings O in to solve one-step inequalities O 12.2 to find and graph ordered pairs.. 123 tonne the coordinates for a aandation image ^..... eta given point 12.4 to •yniteitticoordinnes fors reflection image of a given point O 12.5 to, write the coordinates for a half-turn image oft given point 1".... 124 to solve reused problems in nialinc settings O 13.1 to calculate the probability eta event smog equally likely outcomes rt 3.4 in caloadise the utida.ui eve!. ;rag ovally o likely 133 to determine the pvtehnny Mao flan O 13.6 m prolia duepribillslity of in evert when -1101 aully likely 13.7 to use a randart manta table to solve modems Teacher. Comments: O K E i l D,C. Heath and Company LexingtonNassatusens / Tonto HEATH • Cepydghtt 1992 D.C.Headt and Company 9 Level 8 • it to identify elements of the ccenmuutive. associative. and zero popmies for aderitkel O 1.2 to write a variable equation locatable or a ptoblem situation O 13 to detennine whether two ante ovarian at equivakni O 1.4 to solve ore-sap addian and sultan:a equations in one variable K IS odetennine wheMer inenstlisy is tree false for given values of die variable O 1.6 to solve related problems in realistic settings O 7..1 to simplify ccenpuuton by using the propenin of multiplication O 2.2 to multiply and divide decimals I O 44 to solve related problems in realistic soar 5.1 to compare and order tractions and mixed numbers 52 to add and subtract fractions and mixed , . numbers 5.3 to multiply fractions and mixed numbo4 5.4 to divide rots and mixed numbas 53 to solve one- and two-step equations contairing Frieda* 34 to solve related problems in realistic settings 6.: to compare two signed numbers 1 6.2 to add two sired numbers 63 to subtraa two signed numbers 6A to multiply two signed numbers 63 to divide nvo signed numbers 64 to solve one- and two-step equations involving signed numbers 6.7 to solve related problarts in realistic settings 7.1 to write expressions using positive exponents with negative exponents. and vice versa I 2 O K .3 name and 73 to mite lantining gad die ratio of hin. gain • 76. to solve aged pateemsiii • Al to write and we pruportint, 8-2 to use ratiotot owe/Wen tensa; from ere customary unit to mote I° 8.3 ps fisd percent penzonge or btu Meatier two are given 8.4 to ompute simple and cattpewel • 83 to cempute salts tax, ant narb4. 8.6 to use tea apratonet prim indp co esda4e, damsel in nix 8.7 to solve retard problems in malign solids 9.1 to simplify expressions by conibining like; tams 9-2 to save muskeg consoling life tents 93 to simplify expressing by using the dismlitnive property 9.4 to solve equating that apply the disuibutive Pf9FritY 93 to solve and grar the soling* set for 1- and 2 istep Spain 9.6 to win options. or ineastigies for stated re 9.7 to solve related poisons n realistic swings 10.1 to identify ins:fes as trieslationt tellections. andraatiors flpan: - 102 to iderrify cotsgmen sides and *leg in a figure Ind ilia 10.3 to identify angke relMOOOSigya given hues parallel lines and a agOiersal 10.4 to fmd the length ofintifile philight miemsle given de lengths of tte other two soles 10-5 to apply popatinof inalar figures 10.6 03 sole related problems in realistic settings 11.1 to find its atria eta trapezoid 11.2 to fmd the so of a cale • I1.3 to fwd the 'Mace trea of a prism a pyramid : 11.4 to fool the surface meta a cylinder t 11.5 to find the volume of a psismce cylinder ' - 11.6 to find the voturtm, again. and mass of wale in given is inetriC dimensions 11.7 to solve toned nada= in realistic fl ings 12.1 to give the condi:ran of the vertices of an Stage:triangle alto a refleetice - or hall(-can 122 to give the condenses of the vertices of an. image triangle resulting from a translation 12.3 to list the Send pairs-Mal belong to 4. given reLvicin I2A to &turning whether a relation is a funcdce 12-1 arta a aziphito Wye a syrem of linear equaling 12.6 to solve relied problems in realistic settings 13.1 a detennine the didactical probability of equally-likely even I3.2 w deennine she thew:idol notability of the . accurate of eider Of two mutually exclusive event!' to doennine the ditaetital probability of the cccurrace of adi of two incieprocant vacs OA to determine the theca:tied probobility.dthe I:incurrence of both of twe dependent event 13.5 to ?ermine dr. number °Combinations aid permutations possible fog a given set of objects C 13.6 to solveyelased pothlattin Statistic settings Teacher. Comments. 1415. PROT45 • &ma flma 33 use representabons tocompare ard ceder • mom than two gate 3.4 use tally marks to represent symbobally • the number of abject a a group f 4.1 identify ow-dimensional shapes as laces a three thmensiong Naas 42 cram a single whole goia from Om Palls 4.3 ore= pas= of two. and daec-dinunsiong objects using pastoral locations& and dimetionalrobrionshipe 4.4: gasify the mad figs= In diffam . orimarions 5.1. Identify a given numerrl (0-5) to reptant the quantity of a given gag 5-2 mite numerals firm 0 to 5 5.3 use ordinal words fire through firth 5.4 solve simple vettel problems involving subtraction 6:1 chafe the long:slasher= object from a of obtaa 6.2 bola more than two objects on the basis of length 63 identify. continue and crustaceans with tepid to length and one** 6.4 pse physical and picurial representations to PUMIAlit ind order lengths 7.1 dotty synanary 7.2 cows annex with congruent figures 7.3 identify and illustrate slides 7.4 Identify and Warm a* &I Identify a grasp of a given sire with a 'numeral 640 8.2 identify and contioue a numerical patron 8.3 ortkr two or more natal 8.4 μse ading worth first through tenth 83 equalize groups 8.6 solve simple probkms involving addition and Subtraction 9.1 tyse physical and pictorial represent:dials to compare and nets rwo figures on the basis of area 9.2 &` cog nut titan= of a figure is the same 31 die total and of its componimts 9.3 pzlentify a pictorial rcpesentation of a weight comparison 9.4 it TOM than two objects on the basis of neighs 9.5 mance and order containers on the basis of FOPElY lot Tad and write the numerals 11.20 10.2 *stun a pap of a specified size 10.33.Plve simple problems involving addition and *aka 0103 11.14 ante &single event in tams of its daytime a nighttime O Lend IC 1.1 Wady, demote. and pat an object In a specific kcal= above. below, next to. top. Conan cn croft K 1.2 Jambe to object a being Wt or tight of anodes object K 1.3 physkally represent movement along even open and dosed parka 1.4 deseribe an object in a specialc Ication usivg parietal arra 21 identify an object toe Ls different fan *a object, u 22 identify and (Mate an objea tha is the same as a differna torn maker object in one arena ways 23 sort theca into gawps on the tests of their* 24 eau* and centime Ikea pontos using objects pictwes of atm with • wallahasuses C 2.5 seta a specific object from a given '• gat of object ang de pans of ' climatal and logical dating ' 3.1 tae *mac needing to &sonnet if IWO &TIMM are equal a not equal in anger 34 comma a gnxtp equal in numba to a K Cumulative Record Folder indicates topic was studied ' 21 indicates topic was mastered O a O K a K Ll 00000 O O K K C 3 O o K II.; tell meta the hour K 11.4 mach a grain of Cakes *a pnce IS desaike an evert in ants or its chase of happening O 11.6 discuss the 12 moan of the year I 1.7 ascribe the weather cacao:auks of ach of die fair seasons 12.1 identify objects aid flames with equal pads O 2.2 use die attributes of length ad area to divide objects and figures into heves. thirds. or founds 12.3 use the anxibutes of length weight and area to solve simple grouping problems 12.4 solve simple problems involving grouping and K cattiConing 12.5 use a calculator to awe number pineO Teacher: Comments: Level 1 1.1 to count 1-20 objects 12 to write numerals 1.20 i51 1_1 to determine which amber is taiga a smalkr and which a ofobjects ant* more a fewer 05 1.4 to count how many objects In a collect* are a given aortute 21 13 warder numbers 1.6 to solve elated problems in a tealispc; stains 2.1 to find how many in all using pawn of objets 2.2 to add zero to a number 2,3 to find sums through 6 2.4 ro find the sum of pennies in two picand Ma% 2,5 to write addition number unterces 2.6 to solve related problems in onc settings 3.1 to solve subtraction facts through 6 3.2 to subtract to compere groups 3.3 to solve related geoblems by writing number saunas a subtraction facts 4.1 to write addition facts through ill for pictures a 4.2 to find how many ane kft W a group 4.3 to write samara facts through 10 for paw* et 4.4 fato complete addition and subtraction fact milies 6 4.5 to solve related addition and subtraction fact families 5.1 to count up to 1C0 objects and write the numeral 52 to compare two angers, 0 through 99 53 to order nurnbess to S9 5.4 to identify ordinal positions. through tents 5.5 to solve related problems In realistic settings 6.1 oidcntify and order the d.ays of die week 62 to read ad write time to the hour a half hout 6.3 to count and write the value of a collection claim 6.4 to den:imam whether there it enough moray in a collection of aim 6S to solve related problems in realistic settings }2 7.1 to add three I digit nuts with sums toll 1 72 to write addition saw* for pica* 73 townie salaam sentaices for pictures li g d • 7.4 to solve subtraction fact through 12 0. 7.5 to complete addition and subtraction fact families 7.6 co solve relaxed problems in realistic settings S 8.1 to draw a figure with a given number of sides or comers 8.2 to identify figures that have a line of syromeoy 1 8.3 to identify firt(04 divided into equal pats X 8.4 to color I. . or deplane figure 8.5 to solve related problems in realistic settings 9.1 to solve addicts faces through 20 ZA 9.2 to valve subtraction facts through 20 9.4 to anti= ,]sties and sutencuon (la . lamas 9.5 tO sole relaxed probiom in tali* settings 10.1 to measat krigths in inches aid centimeters 102 to estimate which of two pictured object is heavier 10.3 to choose the alleiropine thermometer for piaured clothing ot weather 10.4 to choose the comet mentoing tool 103 attain raced problems in realistic settings II. lib fad how many in all given several • . equal sets 112 at find how many sets can be made from . asetofobjecn I!3 tared hone many are in .1. }.a}" of a set 11.4 to separate a group ot objects into coal sets. identifying many kft ovhocv.r i many in each set and how many left II-5 to solve rased problems in reallsec settings 12.1 to add a I- or 2-digitmonta to a 2-digit number '22 subareas l- or 2digit number from a • 2diga number 123 to SOINt maid problems in realistic sentries Teacher: J Comments Level 2 toconnote 20 objects in a set .2 main de nornaaht 0.20 I.3 to conspire tWO nurnerils nvo sea *fajta:1i IA to aorta a pogrom and condnue Of ciantlae et 1.5 *solve as* warns in realistic lacings 2.1 toad tweet dote namkers with sums alt 2-2 to find missing addends 2.3 to solve subtraction facts through 12 1.4 10 complete addition and subtraction rich families 2-5 to solve related problems m realistic settings by finding how many (evict or tare by subtraction 11 to coat objects and write tow many tens and tea 3.2 to write a number up to 100 in differtni forms 3.3 to compose two numbers up to KO using <>. or a 3.4 to write a sequence of number up to I03 in circa 3.5 midget& flutdiers as odder even 34 to identify *eat in a picture by their ordeal names 3.7 to solve rebned problems in realistic settings 41 to solve addition facet through 20 42 to add dace addends with sums so 20 43 to solve subtraction facts through 20 4.4 to complete addition and sutaaction fact families 4.5 to solve related problem in realistic servings 5.1 to tell tine from an analog clock 5.2 to wax MUM in order 5.3 to know de Intledflot the year in sequence 5.4 *count combinations of coins 5.5 to solve raged problems by telling how much time has ti46ed 6.1 to add motets of ten to multiples nf five r aim 6.1 to adds 2-digit number to a k or 2-4 igit number 63 to add money smart 6A to adddaee24igit addends 43 to solve selaid *bans III realistic utungs 7.1 to recognize solids in pica* 7.2 to manna 'maces of plane figures (te.sides sedans) F PROT46 7.6 to Mee rehired prookrhs in realistic sating, g 4.1. to,ulerammultiplei. 0 fives and tern from K multiples of fives and rem 8.3 to subtract a hoc 2digit number from, 2<tipC number 8.4 to subsea a I- or 2-digit numy stmetra gran ir 83 to solve related problents in teaCc cp p,.. 2-digit money amount 9.1 to measure the length of an object using an inch ruler 9.2 to estimate (be weights of (unitise objects as 12 93 to commie capacities measured in customary lat diax or more dun a pared units 9.4 w message the length of an object using a ceninmer tuler 9.5 to estimate capacities of farniliar amain«, at less dun, abort. or mom Measlier .21. 9.6 to solve related piobians in realistic settings ..K 10.1 to con*C addition :Mintres for equal sen 10.2 to complete muhiplication sentences for Nitel sets ;5 103 uti sotve multipp anon fax Cough 6 - 10.4 tolind how many sen of a given size can X trade horn a pouted set, and how many will te left over 103 to solve related problems in realistic settings 11.1 to identify die number of ones. tens, and - I f hundreds in p 3-699: comber E3 •112:65;fite In arodard form a 3-cligit manta 113 to Tmene 3-digit numbers using < and > t I Moist in eitendedlbrin . a otirnmon difference of 1, 5, IQ 50. or 1 DO • I IA to conanue a sacra of 3-digit numbers with e 1130,91m relaxed chime in reds« avian 12.1 to aid two 3-digit numbers with no regronpitsig 12.2 to kids 2- a3-digit number to a 3-dlgit L matiber with rellicuttn8 1/4-1 123 to ,abtract two 3-digit numbers with no ref facansing Teacher: 423 co add or subtract 2- cc zit money testmos 12.4 to sebran 2-or 3- digit number from e 12.6 to (dive 3-digit number with rooming Cornmanta: NP- ( Level 3 I.1 so «der nurnIrs - 1.2 muse doubles phis and minus one to find sums toa IS to aid tree or morel digit numbers IA io Swat -digit number from a number to 2g 1.5 to find missing adiknds 44 to iclinify and We addition and subtraction fat families 0 • 1.7 mstilve related problems in realistic seeing, 2 21 so reaöre a number expressed in standard . expanded or word fainin eider of the other forne' 22 bada whole numbers ni - 2.3 to write the value of a collection of bills and coins- 2.4 to make change for =cures up to 5200 .7 23 to write die timess shown on an analog clock C 2.6 to solve related problems in realistic settings O 3.l to ack! 2.- or 3-digit addends - 32 to add up to four 2-a 34 igit addends n - 3.3 to subtract 2. and 346git numbers from 2- and 3-diga numtas - 3.4 so subtract 3-digit numbers from 3-digit numbers with zeta - - 33 to solve related problems in realistic senings 2, - 4.1 to reacipinographs 4.2 to read horizontal and vertical bar graphs ' .2 43 to solve related problems by reading (tau ina ruse graph 5.1 to multiply anctor divide with 2 52 to multiply Clot divide with 3 C K a in to save related probtans in :Max CIF a 6.1 to find missing fat-ors • K 6.2 to complete (xi families for mulaplicaion division se tenon K 6.3 to solve multiplication and division fatt with 6. 7. 8. and 9 K 6.4 to solve related problems in realistic settings CI 7.1 co identify examples of slides. flips. and half treats by position. shape. and size 7.2 to classify angles as smaller than Equal to.« greaser than a nght angk CI 73 »dam lines of symmetry in a figure 7.4 to enceinte:solaced pair of kaos and numbers with a specific square on a grid 0 7.5 to solve related problems in realistic sating, a 8.1 to write franktos for shaded figures K 8.2 to write mixed numbers for two a me shaded figures divided into copal pans K 83 to read an analog clock and write the time using a fiction K 8.4 to solve related problems in realistic settings 0 9.1 to mescaline segmes to the nearest inch. half inch. or centimeter C3 92 to fuel the perimeter of a polygon C3 9.3 to choose the berm «tannery or manic unit fora given measurement K 9.4 to compare two mantra in unlike customary wits K 93 to read time to die minute famn analog clock K 9.6 to solve related problems in realistic scamp C 10.1 to write tenths decimals for fixtioro. mixed numbers. and word names K 102 to compare tenths decimals using c, >, and. 0 10.3 at order up to 4 tents decimab K 10.4 to add and subtract 2 tendu decimals CI 10.5 to solve related cinema in realistic settings a at to !midi* 2<ligh muldpicands by 1-digit multipliers Ill to muldplytivee_I digit factors C 11.3 to multiply 3-digit mutt:lotions« by 1-digit multipliers K 11A to multiply 3-digit money smarm by I-digit numbers K 113 to solve related problems in realistic settings K 12.1 to write de fraction of a pictured sa lining a specified =but C 112 to divide 1- and 2-digå dividends by 1-digh divisors resuking in 1-digii quotients K 113 W divide 24ign dividends by I-digit divisors resulting in 2digit quotian K 124 to divide 3-digit dividends by 14igit divisor, maim in 2.digit quotienn 113 to solve related problems in realistic setungs t2 Teacher. Comments: Level 4 I .l to write whole mattes from word namna expanded form D 1.2 to identify die value origins digit 1.3 m round whole numb• 1.4 to order whole numbers forn least to greatest or Mtn greatest to least IS tomtre Cap for amowas up to 320 1.6 to solve mined problem, in reallsOe %taints 2 2.1 muse properties and rules for addition and subtraction 2.2 to add two 2- or 3-digit addends 23 2.4 23 to add up to four addends with 2. 3. or 4 digirs to alma numbers with up to 4 digits to subtna a 2-. 3-. or 4-digit number from a 3- or 4-digit mantel with zeros 2.6 to solve related problems in realistic settings • 2. 3.1 to analyze dau in a bar graph 3.2 to analyze data in pictographs 33 to analyze data in line graphs 3A to analyze data in circk graphs 33 to «press the probablity of an event 3.6 to solve related problems by comparing outcomes as more/less likely. most/least likely "Z. 7u3Joilt":""" """ 4.4 to know tonic multiplication'and division (acta 43 to solve related emblems in ra bs« km 5.1 to idmnty and Cesaite chareeterisnotof rip angles 5.2 to identify and draw slides 5.3 to pkt points ona grid horn «deredpairs 5.4 to find die as ea of a figure 55 to solve related pmblerns in realistic settings 6.1 mamba* 2-digitriumters 6.2 to multiply 3-digit numbers 63 to &Oak 4-digh runben - 6.4 tqgolve related problems in realistic settings 74 tt; maw 3-digit dividends by I -digit 71 to Arvide 3- and 4-digit dividen'ds by 1-digit divisors 73 to divide 3- and 4-digit dividends by I -digit divines with wain the quotient including money 7.4 to divide up to adigh matey dividendltibY I. digit divisor% 73 to find die whole number ava-age'bfup to.5 ~Men 7.6 to solve related problems in realistic settings 81 to writ Maims representing shaded parts of Fraction Bars 82 to write an equivalent fraction with a given' dationannix 8.3 to capon ad order up to tow twice* C 8.4 to find a fraction of a whole number ' • 83 to represent staled pans of Fraction Bap by • both fractions and mixed numbers . 8.6 to solve misted «them% in realistic servings 9.1 to addend sr.ibna like fractions 9.2 to add two fractions whet ore denominaux is tt midge «the «me 9.3 to subtract two francs when ore demist is a multiple of the other 7. 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 • 0 102 to trout« a line segment to die'neamst contact or minisatar C 10.3 to choke de best estinwe for the length. capacity, weight, or tams of a given object ID 10.4 to compere two measures excised in ditiefera _ canary cc mark maces 2' 10.5 to choose the most appríishmaieit or _ Celsius tempera= for condician 10.6 to determine elapsed tine between two given times 10.7 to solve related problems in realistic menings 11.1 to smile a decimal grec than one in word form 11.2 to wile the value of an underlined digit in a decimal caw than we 11.3 corder up to four decimals through Inesdredths 11.4 to add up to dime decimals through hundnalzhs 115 to tuba= decimals through hundredths C• alb to solve reined problem in a realistic setting . ILI to multiply 2- and 3-digit numbers by multiples of 10 -1 122 to multiply two 2-digit numbers using tin any ditgrgn 12.3 to multiply 3-digit numbers by 2-digit numbers - including money - II. »multiply dine 1.- or 2-digit numben - - 123 to solve related gmbitins in realistic seninp 2 13.1 to divide 2- and 3-digit dividends by /digit - divisors muffing in 1<ligit quotients - 13.2 to divide 3-digit dividends by 2digit divisors ' resulting in 2-digir citients 133 to find the average of a set of numbers - 13.4 03 solve relaxed problem in realistic 'mines Teacher: Comments: PROT47 Student THE SCHOOL DISTRICT OF PALM BEACH COUNTY Elementary School Special Session Registration Last nam Address First name Student Number ale a. ZIP Name of Parent/Guardian Telephone:: Ho mergency Home School Home School Teacher -Special Session School Assignment Student's Date of Birth 6/4/5igh 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 Needed: no Special Session Bus # 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 purposes 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. 9 '6.-. Signature 0 ea er Dal S V ipa Si 11 )1 c 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 Teacher comments: Days Tardy PLACEMENT DECISION Made following Special Session El Promoted O Administrative Placement O Retained Signature of Special Session Administrator / Date PBSD 0673 FY 95 Revision WhitelSpecial Session School then Home School Signature of Home School Principal / Date Yellovolliome Schoolloffice PinklTransportation GoldlParentlGuardian then home School PROT48 A I r I's. • • Tip 4. 'V . ct a ''-' '-it 4 - ' la."9-..et. • Vk I I- :IN C.', •;' •2 le • .1' w N" 4. r..... if A . o• : e • 4" 1 1 -.% •••ficir. 4 .. r ti t" .1 %I - ;le he l''.4'f•L+.' -,...,"' •si r: ....• :2 .. :c. . 1 4 • A . tiffs. iii• :k 'fah - - 3. - ••i• a *tt tc,2•7.• • • 0 it C.' 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Jon. _kees 4.th "Fe 111,9177 ~Y101 mg. _Ai- PROT56 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 NORM-REFERENCED TEST Student Report Grade 08 This report shows your results from the FCAT National Norm-Referenced TeSt. School Name and Number District Name and Number 60 • PALM BEACH 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 Scale Score National Percentile Rank Stanine Reading Comprehension Mathematics Problem Solving. The Scale Score expresses your performance and allows comparisons from year to year. Reading Comprehension Scale Scores range from 510 to 820. Mathematics Problem Solving Scale Scores range from 527 to 836. The National Percentile Rank and Stanine Indicate your relative standing In comparison to the national reference group. National Percentile Ranks range from 1 to 99. Stanlnes range from tog. If you took the test again, your National Percentile Rank might be slightly higher or lower than stated here. However, your National Percentile Rank would probably fall within a certain range. For Reading Comprehension, your National Percentile Rank should be between 43 and 67. For Mathematics Problem Solving, your National Percentile Rank should be between 24 and 44. CONTENT SCORES Number Number of Points of Points Possible Eained Number of Questions Attempted Readlnr Com•rehension I I Initial Understanding interpretation I Critical Analysis Strategies Mathematics Problem Solving Measurement Estimation Problem Solving Number Relationships Number Systems Patterns & Functions Algebra Statistics Probability Geometry Each question was worth 1 point. Run Date: 04/25/2001 0182069 PROT57 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2001 SUNSHINE STATE STANDARDS Student Report Grade 08 Student Name Student Number School Name and Number 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. FCAT Student Achievement Levels Scale Score Ranges Reading Mathematics Level 5: 394-500 371-500 Level 4: 350-393 347370 Level 3: 310-349 310-346 Level 2: 271-309 280-309 Level 1: 100-270 100-279 Your scores are shown below. Student Achievement Level Descriptions 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 student answers most of the test questions correctly, including the most challenging questions. 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 answers most of the questions correctly but may have only some success with questions that reflect the most challenging content. LEVEL 3: Performance at this level Indicates that the student has partial success with the challenging content of the Sunshine State Standards, but performance is Inconsistent. A Level 3 student answers many of the questions correctly but Is generally less successful with questions that are most challenging. LEVEL 2: Performance at this level indicates that the student has limited success with the challenging content of the Sunshine State Standards. LEVEL 1: Performance at this level indicates that the student has little success with the challenging content of the Sunshine State Standards. SUBJECT SCORES Student Achievement Level Reading Mathematics Scale Score State Comparison: Thirds Lowest Middle Highest 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. CONTENT SCORES 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 PROT58 arkanamoresa*** 70LENDL- Ilca~~~~ 313~2k DATE FEB-17-2005 WIalc TIME 12:25 tTT***** STN N3 MODE e TETORY TRANSMISSICN FILE mp.-7s5 CKF-TOUCNI STATIC NOMF-ITS_ N3. OffiBR NO. eat ac a 47033 WHAT Dore YOUR SCORE Mat Han NO Engle hunareal scare can exaCy represent au' reacting ant u you ea tar dare% means of la tat waln 8 that ~a Of Mat your praffarOe IsOal probably vary someralf On MO 200 to 803 scale. HOW DO YOU ~PARE WITH COLLEOECOUSID aillOR37 Per mace In.3~ ~I pereenas Of Wet :akin canal It Ø. lost dun yours. 1110 raga reran% e br >Ow verbal scot* el 1.94 It 42. ne «ea am did bear tar 42 % ol the national grwg V ea lej•420,w43 ~ors. The ~one Parana far your no, yen or a* N 27 indatla you skr beta Dia 27 14 of the ~al group el cedeg•~4 felon ow YOU DO Inn VI Ill VERRAL OR MATH? Yew ~es Ind eats tat yOJ pa!~ salarly on Me ma, I.at 11, 42 MO verbal teal. STARTsFEB-17 12:24 END..FEB -17 12:25 PncEs 13.ROIT I CN 3024302 ØØ:Øa:20 -RPENS RECORDS -RECORDS OFFICE - ideas 561 753 4022- aleleaca~ 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 who took al teat Ttus anemia n en namste of tar potocfitsge of carfge «une saner% wee earned • raw sae Cwt' tnln yJts en ear tya of 04msc on. ninett r,wQ. ono nuYtow ~ad. Raw ~a as Dated nl a spa IN ~Ion of ter test tat you WOK You amyl ~pare fa stow On efferent atlas of It,. lost of serva Glotann lams a ~boa For fah syp. Of Ix -silo^. yo.. STUDENT SCORE REPORT REPORT DATE: 6117104 Seclit war% TIN AVERAGE VERRAL OR MATH Salta ror collage-0014 salon In Me Dan of 2003, ta average verbal score Was 801 are Um ayer~ war stue was $19. Vat YOUR SCORES CHOICE IF YOU TAKE THE Tat MIMI? If you take the 1.91 egam, espeali yas may bell~ row ave UVIM. your ~a may go up. Mang Mara with wail scone of 430. 58% sore agar en a Nand lestIno. $1% sore low, and 0% ~In the lame score. On average, • person WM I Vera wore of WI Islet II pelelt•7 on • name ~la Among Italha era nab corm Of 4.50, V% score »Dar 441 • second ~ 112, 30% son loaf, end II% maws ha afro score. On avenge • plena an. mom MOO of 15000% 17 Puna/ rise:0nd tera. SUMMARY OF SCORES Register new for nest når nr rehab; *1 rww cCc;cboard.corn eel I, Re40•ala. Tnt Sol s• InIs Ins ~bones ID INFORMATION RAT *Inn 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 PROT59 IDREstVE, REMOVE UREA TO EXPOSE ADHESIVE, REMOVE tHEER TO EXPOSE ADHESIVE, REMOVE EIRER TO EXPOSE 11 H3R11 3/01138 lAtt3HOV 3SOAX3I 01 tl3HI1 3/01138- MMROV 3SINIX3 1B/01 3A0Pi3H VIISIROV 3S0031 IORESIVE, REMOVE EMEt TO EXPOSE monit, REMOVE MER TO EXPOSE ADHESIVE, REMOVE WIER 70 EXPOSE .1.4a -na.... 'in...Amu, lenne, nii blurt 'Wm' lenni. AA Winn UAW, il,nnitels•In/ 'Mira 0Ct6-W arlisprij ststiP.2 ADHESIVE, REMOVE URM TO EXPOSE ADHESIVE. REMOVE LINER TO EXPOSE ADHESIVE. REW Ol HIND 3AOM1 1JUS3NOV 3SOdX3 01 H3RI1 3A0H32/ lAIS3ROV 3S0a) OL 113III1 3" ADHESIVE. REMOVE LINER TO EXPOSE ADHESIVE. REMOVE urns 70 EXPOSE ADHESIVE. REMI Hi3w pNv, V331 HI.VW 1.11.e..• •••......6••••• *es as %nun laanie nnnaPintne 'en no* A. WINO £6b1AE clxO100428 0P03 letland0 b MMD 30 JA•A V301% diP3 WWW VI) HIVW YOUA I dWUD KLVW HIVIS. 1101 _MM OV311 cmoaansai 3 513 r6 SAUVN . eu tilie33 'LYN diVUJ aygli UUUMS McriMm CIV313 10'031 3tIODS ira adlvlN 34.0.1.316305 SOU 08ZOGSEld lbSYINALVHd. Iqul 100IPOIAS 111N5 64111.% WIN Pclim nm V WHOA 91 13A31 t/SH13 IKILLYMOTiiti2R1.0 owvdnd OT - TI 301 =CMI 90 Barn mmm WHOA 51 13A31 •"/S813 Z • WY" V WHOA h T 13A31 plana S T-6 3.:Y0 30,s Iona V WHOA ZT 13A31 y/5813 NOIMMMI eonom OT - L ao MW/ PROT60 Le RACE: M SEX: F BIRTHDATE: - 5.5AL BIRTHDATE: I VerTied by Binh Certificate: G Yes G No If No. What Type Verification? SEX: M RACIAr DC GROUP: White Not Hispanic El Black Not bespeak El Hispanic G American IndiarYNallye AkIskan 13 Asian/Pacific Islander O Mufti RacIst BIRTHPLACE: iez • CURRENT SCHC'X: (use pencil hi this space until final) Name 0RES11NOOD MIDDLE Mi I0Of Street City P a OA NAME OF EARENT(S) OR LEGAL QVARDIAN OR OTHER RESPONSIBLE ADULT AT HOME: Date First Entered This patriot School: Grade: School Grade: School: OWE Sena* Gsadox Scher* Breda Sehoo I 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 REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED INDICATE AchninIstraWo Placement (ADMP) Premoto (P) Retain (R) Special Session (SS) INDICATE Administrant* Placement (ADMP) Promote (P) Ratan (A) Special Seeable (SS) INDICATE AcInDlstralhe Recomem (ADMP) Promote (P) Noah GI) INDICATE Adrolnlarathie Racerrent (AMP) Promote (P) Rath GB INDICATE Admiristmees Plammont (ADAM) Promote (P) Retain (n) 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 REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED COPY OF REPORT CARD INCLUDED INDICATE Adminbuative Plant (ADMP) Promote (P) Retain INDICATE Admblatrathe Piecemeal (ADMP) Promote (P1 Retain (Ft) INDICATE Adintrisnathie PLUG/noel (ADMP) Prattle (P) Retain (R) INDICATE AdmIrdshaavo Ptacement (ADMP) Promote (P) Retain (R) SpodelSesslon (SS) INDICATE Adnirietnelee Plecement (ADMP) promote (P) Retain ge Special Session (SS1 PSSD 0932 (REV ún PROT61 For Secondary Cumulative Grades: SEE STUDENT RECORD SCREENS STUDENT GENERAL QUERIES A01 Student Name (District) A02 Student Name (School) BASIC RECORD A03 Demographics A04 General Assignments A05 A06 A07 A08 Contact Information Health Information Assigdment History Local Data Elements COURSES A09 A10 All • Al2 A13 A14 Course Requests Current Schedule Interactive Scheduler Current Grades Academic History Graduation Status ATTENDANCE A15 Daily Summary A16 Period Summary A17 Absence Detail Al8 Absences (Class Hours) A19 Letter Preview (PRD ATD) TESTING A20 Test Score Query A21 Test Score A2A Test Score Errors A22 Standard Mastery MISCELLANEOUS A23 Special Programs A24 Discipline A25 Fees and Fines A26 Recognition/Achievement A27 Letter History SPECIAL CHARACTERISTIC CARD 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 Confidential O See Migrant A23 O See ESE Confidential Folder A23 Sae ESOL Folder A23, A03 See 504 Folder A23 See DOP Folder A23 See Health Folder A06 PROT62 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: PROT63 'Par •••• 1 w V les• %sr PROT64 FLAT Reports Separate reports are produced for the Sunshine State Standards tests in FCAT Reading and Mathematics. Sunshine State Standards (SSS) Reports The FCAT SSS Reading and Mathematics reports show test scores from Florida's tests of academic standards. These reports contain subject scores and content scores. Subject scores describe the overall achievement, and content scores give the number of points earned in specific skill areas. Success on the Reading and Mathematics tests can be best understood by using the achievement levels where a 3 or higher is on or above grade level. Achievement Levels Five categories of achievement describe the success students have with the content tested on the FCAT Reading and Mathematics. Level 5 is the highest and Level 1 is the lowest. 5 This student has success with the most challenging content of the Sunshine State Standards. A student scoring in level 5 answers most of the test questions correctly, including the most challenging questions. 4 This student has success with the challenging content of the Sunshine State Standards. A student scoring in level 4 answers most of the test questions correctly, but may have only some success with questions that reflect the most challenging content. 3 This student has partial success with the challenging content of the Sunshine State Standards, but performance is inconsistent. A student scoring in level 3 answers many of the test questions correctly, but is generally less successful with questions that are the most challenging. 2 This student has limited success with the challenging content of the Sunshine State Standards. 1 This student has little success with the challenging content of the Sunshine State Standards. Graduation Requirements - Students graduating in the year 2003 and later must receive a passing score on both the FCAT SSS Reading and FCAT SSS Mathematics tests to meet graduation requirements. For students that first took the 10th grade test in calendar year 2001, an alternative passing score is still in effect. For students that first took the 10th grade test in calendar year 2002 or later, higher passing scores apply. Grade 10 FCAT Passing Scores Reading Mathematics Current Passing Score SS 300 .OSS 1926 SS 300. DSS 1889 Alternate Passing Score SS 287 . DSS 1858 SS 295 = DSS 1868 informes FCAT (Spanish) Se preparan informes separados pare los examenes del FCAT de lectura y matematicas segt las normas estatales Sunshine State Standards. Informes segtin las normas estatales Sunshine State Standards (SSS) Los informes segan las normas estatales SSS del FCAT presentan las calificaciones de los examenes de lectura y matematicas de las normas academicas de Florida. Estos informes contienen calificaciones por materias y calificaciones por contenido. Las calificaciones por materia proporcionan un resumen general del rendimiento y las calificaciones por contenido que proveen el n6mero de puntos obtenidos en areas de habilidades especificas. El exits de los examenes de lecture y matematicas puede entenderse mejor utilizando los niveles de rendimlento en los que una calificacit de 3 o superior esti al nivel del grado o por encima. Niveles de rendimlento El exito que un estudiante ha logrado en el contenido examinado en el FCAT de lectura y matematicas se describe por medic) de cinco categories. El nivel 5 es el mas alto y el nivel 1 es el mas bajo. 5 Este estudiante tiene exits con el contenido mas dificil de las normas Sunshine State Standards. Un estudiante del Nivel 5 responde a la mayoria de las preguntas del examen oorrectamente, incluyendo las preguntas mas dificiles. 4 Este estudiante done exito con el contenido dificil de las normas Sunshine State Standards. Un estudiante del Nivel 4 responde a la mayor(a de las preguntas correctamente, pero es posible que solo temp cierto exits con las preguntan que reftejan el contenido mas dificil. 3 Este estudiante tiene un exito partial con el contenido dif foil de las normas Sunshine State Standards, pero su rendimiento es inconsistente. Un estudiante del Nivel 3 responde muchas de las preguntas del examen correctamente, pero por lo general tiene menos kilo con las preguntas que son mas diffciles. 2 Este estudiante tiene exito limited° con el contenido (Illicit de las normas Sunshine State Standards. 1 Este estudiante tiene poco exito con el contenido (illicit de las normas Sunshine State Standards. Requisitos pare la graduation - Los estudiantes que se gradilan en el 2003 o despues deben obtener una calificacion de aprobado lento en el FCAT (SSS) de lectura como en el FCAT (SSS) de matematicas y asf cumplir con los requisitos de graduacion. Para los estudiantes que tomaron el examen del 10° grado por primera vez en el aim 2001, todavia esti) en vigor una calificacien de aprobado alternative. Para los estudiantes que tomaron el examen del 10° grado por primera vez en el arm 2002 o despues, puede que le sean aplicadas calificaciones mas alias que de aprobado. FCAT pare 10• grads Calificaciones de aprobado Lecture Matemetleas CalltIcachin de aprobado actual SS 300. DSS 1926 SS 300. DSS 1889 Calincacion de aprobado alternative SS 287. DS5 1856 SS 295 = ['SS 1868 Rapt) FCAT (Haitian Creole) Yo prepare rape apa pou egzamen lekti ak matematik FCAT bay swivan prensip Sunshine State Standards yo. Rape Sunshine State Standards (SSS) Rape FCAT SSS pou lekti ak matematik Ian montre net elev yo le nan egzamen Florida bay sou prensip akademik yo. Rape sa yo gen net pou matye ak net pou kontni laden yo. Net pou matye yo dekri tout sa elev la reyalize anjeneral epi net pou k ontni yo bay kantite pwen elev la fe nan yon matye byen detente. Ou ka konprann kisa el& la reyalize nan egzamen lekti ak matematik la pi byen si w itilize yon nivo sikse kote 3 oswa plis se yon net ki nan nivo klas la oswa yon not ki pi wo pase nivo klas Ia. Nivo sikse elev yo Gen senk kategori sikse ki dekri nivo sikse elev yo pole nan kontni yo teste nan egzamen lekti ak matematik FCAT Ia. Pi gwo nivo a se nivo 5 epi pi piti nivo a se nivo 1. 5 Elev sa a gen sikse nan matye kite gen pi plis difikilte laden yo nan egzamen Sunshine State Standards la. Yon elev ki nan 5yem Nivo reponn pito kesyon egzamen yo kereldeman, elev la menm reponn kesyon ki gen pi pits difikilte laden yo. 4 El& sa a gen sikse nan matye ki to gen difikilte Iadan yo nan egzamen Sunshine State Standards Ia. Yon elev ki nan 4yem Nivo reponn pife kesyon egzamen yo kerektemen, men li ka gen kek sikse selman nan kesyon Id sanble yo gen pi plis difikilte laden yo. 3 Elev sa a gen enpe sikse nan matye ki gen difikilte laden yo nan egzamen Sunshine State Standards Ia, men plfemans Ian pa rete estab. Yon elev ki nan 3yem Nivo reponn anpil nan kesyon egzamen yo koreldeman, men anjeneral li gen mwens sikse ak kesyon ki sanble yo gen pi plis difikilte laden yo. 2 Eliot sa a gen sikse limite nan matye ki gen difikilte laden yo nan egzamen Sunshine State Standards Ia. 1 Elev sa a gen yon ti siksi3 tou piti nan matye ki gen difikilte laden yo nan egzamen Sunshine State Standards la. Egzijans pou dipbme - Elev k ap diploma nan ane 2003 a oswa apre sa dwe fe yon net pou pase ni egzamen lekti FCAT SSS la ni egzamen matematik FCAT SSS la alaiwa pou yo ka ranpli kondisyon pou diplome a. Pou elev Id to pran egzamen Ides 1001" nan ane 2001 an, gen yon net altenatif pou pase egzamen an ki toujou an efe toujou. Pou elev Id to pran egzamen Ides 1Crtim nan pou lapremye fwa nan ane 2002 a oswa apre sa, yo mande pi gwo net pou pase. Not pou eery Ides 107em II pou pass *stamen FCAT la Laird Maternatik tibt pou pase koulye a SS 300- DSS 1926 SS 300= DSS 1889 NM alienist:II pou pass SS 287 = DSS 1856 SS 295 = DSS 1868 1504796 PROT65 FEAT 11,;:dc Coripronthe Assewnyntfrsi October 2003 Florida Comprehensive Assessment Test (FCAT) SUNSHINE STATE STANDARDS Grade 11 Student Report cncei numb: rand Name: 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 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 Words/Phrases Main Idea/Purpose Comparisons Reference/Research Year 2001 2002 2003 Grade Tested NA NA Achievement Level FCAT Score • FCAT Score 1000- GOO Grab 4 We were unable to find a Mathematics score that matched your student identification number. If you look the test this year, be sure to contact your school about locating your FCAT lest scores. 2003 Mathematics Content Scores Content Areas Points Possible Points Earned Number Sense Measurement Geometry Algebraic Thinking Analysis Data Analysis Year 2001 2002 2003 Grade Tested 10 Achievement Level NT FCAT Score • NT FCAT Scor Reading Mathematics • Your Sco e 0 On Grade Level _ Grade! Grab 1 Grades Credo i Grade? GMAot Grades Grade 10 11+ 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 PROT66 FCAT Florida fertps eh ersive Ar.sosmr, Te:I Spring 2003 FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) MATHEMATICS SUNSHINE STATE STANDARDS PERFORMANCE TASKS Student Report Grade 10 This report provides your results on the FCAT 2003 Mathematics performance tasks. Each performance task on FCAT requires you 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. One of the short-response tasks is shown below with a copy of your answer. The number of points you earned for your answer Is shown in the box to the right. -7 FCAT 2003 MATHEMATICS PERFORMANCE TASKS Student Name Student Number School Name School Number IM District Name PALM BEACH District Number 50 This Performance Task Response Points Possible AN Mathematics Performance Task Responses 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 alai east 2,O ec02 Number of tool kits mon 1- -sr. 18 +Wt . er %OM 2LZO$ _ lei St- 40 Data Run Date: 05/07/2003 C085312 851200288 PROT67 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 performance tasks. Each performance task on FCAT requires you 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. One of the short-response tasks Is shown below with a copy of your answer. The number of points you earned for your answer Is shown in the box to the right. This task required you to read a passage about an American zoologist's attempts to rehabilitate two young gorillas in Africa. Describe how Coco and Pucker change as a result of their experience with Dlan Fossey. Use details and Information from the story to explain your answer. FCAT 2003 READING PERFORMANCE TASKS student Name Student Number School Name School Number District Name PALM BEACH District Number 50 This Performance Task Response All Reeding Performance Task Responses 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 PROT68 Florida Comprehensive Assessment Test FCAT WRITING STUDENT REPORT 2001 Grade 8 WRITING TO CONVINCE Student Name: Student I.D. No.: School: District: PALM BEACH soma. How Papers Are Scored The student responses are scored by trained readers using the holistic method to evaluate a piece of writing for its overall quality. The readers consider four elements: focus, organization, support, and conventions. In this type of scoring, readers make a judgment about the entire response and do not focus on any one aspect of the writing. Focus refers to how clearly the paper presents and maintains a clear main idea, theme, or unifying point. Papers representing the higher end of the point scale demonstrate a consistent awareness of the topic and do not contain extraneous information. Organization refers to the structure or plan of development (beginning, middle, and end) and whether the points are logically related to one another. Organization also refers to (1) the use of transitional devices to relate the supporting ideas to the main idea, theme, or unifying point and (2) the evidence of a connection between sentences. Papers representing the higher end of the point scale use transitions to signal the plan or text structure and end with summary or concluding statements. Support refers to the quality of the details used to explain, clarify, or define. The 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 included in Florida's Sunshine State Standards. Papers representing the higher end of the point scale follow, with few exceptions, the conventions of punctuation, capitalization, and spelling and use a variety of sentence structures to present ideas. Dear Student The paper you wrote in February as part of the FCAT has been read independently by two people trained to score this test. Each reader judged the paper against a set of standards and gave it an overall score. Your score is the average of the two readers' scores. This writing score will help you, your parents or guardians, and your teachers understand how well you performed on this statewide writing test. A description of how papers are scored is printed on the left side of this report. A description of each possible score is printed on the back of this report. Remember, you were given 45 minutes to read the assigned topic, plan what to write, and then write your response. The conditions under which you write papers in class or at home may not be the same as those for this test; therefore, the writing may not be the same. You and your teachers should consider the score on this test along with all of your other writing when planning activities to continue developing your writing skills. DESCRIPTION OF THE TOPIC: You were asked to convince your friend to cat at your favorite place. RUN DATE: 04/16/01 60-1691_ PROT69 Description of Grade 4 Writing Scores 6.0: The writing focuses on the topic, is logically organized, and includes ample development of 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. 5.5: The writing was given a 5 by one reader and a 6 by the other reader. 5.0: The writing focuses on the topic with adequate development of supporting ideas or examples. It has an organizational pattern. though lapses may occur. Word choice is adequate. Sentences vary in structure. Punctuation, capitalization, and spelling arc generally correct. 9.5: The writing was given a 4 by one reader and a 5 by the other reader. 4.0: The writing focuses on the topic, though it may contain extraneous information. An 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 somewhat in structure, though many are simple. Punctuation, capitalization, and spelling are usually COMO. 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 contain extraneous information. An organizational pattern has been attempted, but lapses may occur. Some of the supporting ideas 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 most commonly used words are spelled correctly. 2.5: The writing was given a 2 by one 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. Sentences may be limited to simple constructions. Frequent errors 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. 1.0: The writing may only minimally address the topic because there is little or no development of supporting ideas or examples. No organizational pattern 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. U: The writing is unrelated to the assigned topic or cannot be read. Description of Grade 8 Writing Scores 6.0: The writing focuses on the topic, is logically organized, and Includes substantial development of 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. 5.5: The writing was given a 5 by one reader and a 6 by the other reader. 5.0: The writing focuses on the topic with ample development of supporting ideas or examples. It has an organizational pattern, though lapses may occur. Word choice is adequate. Sentences 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. 4.0: The writing focuses on the topic, though it may contain ' extraneous information. An 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 somewhat in structure, though many are simple. Punctuation, capitalization, and spelling are usually correct. 3.5: The writing was given a 3 by one reader and a 4 by the other reader. 3.0: The writing generally focuses on the topic, though it may contain extraneous information. An organizational pattern has been attempted, but lapses may occur. Some of the supporting ideas 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 most commonly used words are spelled correctly. 2.5: The writing was given a 2 by one 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. Sentences may be limited to simple constructions. Frequent errors 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. 1.0: The writing may only minimally address the topic because them is little or no development of supporting ideas or examples. No organizational pattern 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. U: The writing is unrelated to the assigned topic or cannot be read. Description of Grade 10 Writing Scores 6.0: The writing focuses on the topic, is logically organized, and includes substantial development of supporting ideas or examples. It demonstrates a mature command of language with freshness of expression. Sentences vary in structure. There are few, if any, usage, punctuation, or spelling errors. 5.5: The writing was given a 5 by one reader and a 6 by the other reader. 5.0: The writing focuses on the topic, is logically organized, and includes ample development of supporting ideas or examples. It demonstrates a mature command of language. Sentences vary in structure. Usage, punctuation, and spelling are generally correct. 4.5: The writing was given a 4 by one reader and a 5 by the other reader. 4.0: The writing focuses on the topic, though it may contain loosely related information. An organizational pattern is apparent. Some of the supporting ideas contain specifics and details, but others do not. Word choice is adequate. Sentences vary in structure. Usage, punctuation, and spelling are generally correct 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 contain loosely related information. An organizational pattern is demonstrated. Development of the supporting ideas may be uneven. Word choice is adequate. There is some variation in sentence structure. Usage, punctuation, and spelling arc generally correct. 2.5: The writing was given a 2 by one reader and a 3 by the other reader. 2.0: The writing addresses the topic, though limey lose focus by including extraneous information. An organizational pattern is demonstrated. Development of the supporting ideas may be nonspecific. Word choice may be limited. Frequent errors may occur in sentence construction, usage, punctuation, and spelling. 1.5: The writing was given a I by one reader and a 2 by the other reader. 1.0: The writing addresses the topic. though it may lose focus by including extraneous and loosely related ideas. The organizational pattern is weak. Ideas are presented through lists and limited or inappropriate word choice. Frequent errors may occur in sentence construction, usage, punctuation, and spelling. U: The writing is unrelated to the assigned topic or cannot be read. PROT70 F SAT Florida Comprehensive Assessment Test FLORIDA COMPREHENSIVE ASSESSMENT TEST (FCAT) 2000 NORM-REFERENCED TEST Student Report Grade 07 This report shows your results from the FCAT National Norm-Referenced Test. Student Number School Name and Number District Name and Number 50 - PALM BEACH et 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 Scale Score Reading Comprehension Mathematics Problem Solving National Percentile Rank Stanine The Scale Score expresses your performance and allows comparisons from year to year. Reading Comprehension Scale Scores range from 490 to 819. Mathematics Problem Solving Scale Scores range from 513 to 829. The National Percentile Rank and StanIna Indicate your relative standing In comparison to the national reference group. National Percentile Ranks range from 1 to 99. Stanines range from 1 to 9. If you took the test again, your National Percentile Rank might be slightly higher or lower than stated here. However, your National Percentile Rank would probably fall within a certain range. For Reading Comprehension, your National Percentile Rank should be between TO and 89. For Mathematics Problem Solving, your National Percentile Rank should be between 43 and 66. CONTENT SCORES Number of Points Possible Readint Com•rehension Initial Understanding Interpretation Critical Analysis Strategies Mathematics Problem Solving Measurement Estimation Problem Solving Number Relationships Number Systems Patterns & Functions Algebra Statistics Probability Geometry Number of Points Earned Number of Questions Attempted The content tested Is described on the back of this report. Each question was worth 1 point. Run Date: 08/21/2000 0142216 PROT71 Grades 5, 6, 7, and 8 The FCAT NRT Reading Comprehension Test assesses the following objectives: Initio/ Understanding - Demonstrate the ability to comprehend explicitly stated relationships in a variety of reading selections. Interpnetation Demonstrate the ability to form an interpretation of a variety of reading selections based on explicit and implica information in the selections. Criticar Analysis - Demonstrate the ability to synthesize and evaluate explicit and implicit information in a variety of reading selections. Strategies - Demonstrate the ability to recognize and apply text factors and reading strategies in a variety of reading selections. The aboye objectives are measured within the following contexto: Recreational - material typically read for enjoyment. Textual - material typically found in grade-appropriate textbooks and other sources of information. Functional - material typically encountered in everyday lile situations. The FCAT NRT Mathematics Problem Solving Test assesses the following objectives: Measumment - Demonstrate an understanding of the principies of measurement. Estimation - Determine the reasonableness of resulto and apply estimation in problem solving. Problem Solving Strategies - Demonstrate an understanding of the procoss of solving conventional and non-routine problems. Number end Number Relationships - Represent and use numbers in equivaient forms in real-world and mathematical problems, and demonstrate number sense for whole numbers, fractions, decimais, and integers. Number Systems and Number Theory - Demonstrate an understanding of relationships among arithmetic operations and apply concepto of number theory such as primes, factors, and multiples in real-world and mathematical problems. Pattems and Funclions - Identity numerical and geometric patterns and functions and use them to solve problems. Algebra - Demonstrate the ability to evaluate expressions and solve linear equations. Statistics - Demonstrate an understanding of the relationships in data sets. Probabilay - Demonstrate an understanding of the laws goveming chance. Geometry - Demonstrate an understanding of geometric principies. Grados 5, 6, 7, y8 La Prueba de Comprensión de Lectura FCAT NRT evalúa los siguientes objetivos: Entendimiento - Demostrar su habilidad para comprender explicitamente el contenido y la relación entre si dentro de una variedad de selecciones de lectura. Interpretación - Demostrar su capacidad interpretativa dentro de una variedad de selecciones de lectura, basándose en información explicita e implícita en dichas selecciones. Análisis critico - Demostrar la habilidad para sintetizar y evaluar información explícita e implícita en una variedad de selecciones de lectura. Estrategias - Demostrar habilidad para reconocer y aplicar el contenido del texto y estrategias utilizadas en una variedad de selecciones de lectura. Los objetivos anteriores se evalúan en los contextos siguientes: Recreativo - material utilizado para entretenimiento. Textual - material utilizado en libros de texto del grado apropiado y en otras medios Informativo. Funcional - material utilizado en la vida diaria. La Prueba para Resolver Problemas de Matemáticas FCAT NRT evalúa los siguientes objetivos: Medidas - Demostrar sus conocimientos de los principios de medir. Estimación - Deteminar cuán razonables son los resultados y aplicar la estimación en la solución de problemas. Estrategias para resolver problemas - Demostrar comprensión del proceso de resolver problemas convencionales y fuera de lo común. Números y relaciones entre números - Representar y usar números en formas equivalentes en problemas de matemática y de la vida diaria, y demostrar sentido para las fracciones, los decimales y los números enteros, positivos y negativos. Sistemas y teoria de los números - Demostrar conocimiento numérico de las relaciones entre las operaciones de aritmética y aplicar conceptos de la teoria de los números tales como números primos, factores y múltiplos en problemas de matemática y de la vida diaria. Pautas y funciones - Identificar funciones y pautas numéricas y usarlas para resolver problemas. Algebra - Demostrar la capacidad para evaluar expresiones algebraicas y resolver ecuaciones lineales. Estadistica - Demostrar conocimiento en procesamiento de data. Probabilidad - Demostrar conocimiento de las leyes que gobiernan el azar. Geometria - Demostrar conocimiento de los principios de geometría. Soaste: Stanford Adiereenent Test Sedes, Nrth Eciteon: Ceenpen6um of lostrueliceeal 00»ctNes Note: %Hect vdth permiselon [pi Harccort Educational Measurement 100 PROT72 11 . 91 .2:,50rii LEVEL & COURSE PERFORMANCE End of Year Report Total Course Time Total Corr/Att Exercises Total Percent Correct Enroll Level IPM Level Current Level Gain 1477 MCS 1:39 PS 0:46 TRN 0:45 RA Enroll Date - 1 26/98) Class 4.54 4.45 4.63 0.18 5.11 5.11 5.17 0.06 4.00 4.00 4.36 0.36 N/A PROT73 6/1/98 11:56am LEVEL 6 COURSE PERFORMANCE End of Year Report Total Corr/Att Percent Enroll IPM Current Course Time Exercises Correct 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 WIT 0:00 N/A PROT74 6/5/97 7:51am COURSE PERFORMANCE Page (continued) 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 PROT75 6/6/96 2:07pm COURSE PERFORMANCE Page Crs. Total Tot Cor/At Time Exer Total Per Enr Corr Lvl IPM Lvl Curr Lvl Tot Sess Gain 3330 8/22/95) 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 13 N/A PROT76 6/1/95 1:03pm COURSE PERFORMANCE Page 2 Crs. Total Tot Cor/At Time Exer (continued) Total Per Enr ' IPM Corr Lvl Lvl Curr Lvl Tot 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 PROT77 PALM BEACH COUNTY PUBLIC SCHOOLS Elementary Interim Report of Unsatisfactory Progress School: To the parent or guardian of Date: 6 (77 •Grade : 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• Parent's e Parent's Phone Humber(s) I wish to request a conference with the teacher. Yes (Alt Lys y kt (-130 PM White/Parent Copy Yellow/Cumulative Folder PBSD 0764 (FY 86 Revision) WN 0179890 smcit. qiu tb-1.1O 611 N' PROT78 PALM BEACH COUNTY PUBLIC SCHOOLS Elementary Interim Report of Unsatisfactory Progress School: To the parent or guardian of Date: This report is to advise you that your progress in: 6'6 '97 •Grade: Lf child is making unsatisfactory 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 PBSD 0764 (FY 86 Revision) Yellow/Cumulative Folder WN 01-9890 PROT79 ?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 PROT80 PROT81 IIII Oa*. a OP 4s * Cs PHONE: Dear ROYAL PALM BEACH, FLORIDA 33411 PM: FAH: Principal fl747 -)5/ Date 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 PROT82 PALM BRACH COCNTY PUBLIC SCHOOLS Elementary Interim Report of Unsatisfactory Progress 4 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. 3-. -9$ i/p ure Date 043C 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) all III ;MOO PROT83 * 44- 485- 1* , * a u.a' 0 a PHONF: u eMs Dear ROYAL PALM BEACH, FLORIDA 33411 Pik FAH:. PrISCION dik 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 I have been advised that may have difficulty meeting the nes Name minimum requirements for promotion. er s re Dee im PROT84 * 44 gie 'OP 911 is to 41 • ROYAL PALM BEACH, FLORIDA 33411 PHONE: FAH: Prtatrlpsl Dear On e 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 1.111111 I have been advised tha may have difficulty meeting the minimum requirements for promotion. N C -S-95 store Dish PROT85 Addre Street Address CI Zip Name of Parent/Guardian Telephone: Home me enc Home School Home School Teacher Special Session School Assignment THE SCHOOL BOARD OF PALM BEACH COUNTY Elementa School Special Session Registration Student NumbeMarade Last name First name) 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 / Date gna ure o Sitti 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: 9Y PLACEMENT DECISION Made following Special Session 0 Promoted 0 Administrative Placement 0 Retained 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 Schooltoflice PinkfTransportation GoldiParentiGuardian then Home School PROT86 PANEL: A15. DAILY SUMMARY YEAR: 00 Monday October 25, 1999 3:23 pm SCHL: 1691 GR: 07 ST: A CAL: 01 ASSIGNMENTS 1234567890123456789012345678901 ABS PRS MBR SCHL ENTRY WITHDRAWL JUL AUG SEP A... OCT NOV DEC JAN FEB MAR APR MAY O JUN 0 O JUL NJ/L. I 0 AUG 0 TOTAL: 001 047 048 % 2 98 PF1=HELP 3=EXIT 7=BKWD 8=FWD 12=ESCAPE RECORD IS DISPLAYED...NEXT? STDT: 1111111111222222222233 0 0 12 12 1 19 20 0 16 16 0 [repeated 15 times] 1691 E01 081699 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~ y OW .,Q.&,--11--kL24-- (FYI 947M - 7 -JA-r0 Lt- PROT87 FCAT 19 8: , titlividual Profile Report ID !Number Grade 5 .AT- ColapiSisit)8: • AsSessment Test .Soh ol,Humbar. 1701 st 01 Number-50 • :PALI? BEACH Run.pate: 4/30/98 griw CTB McGraw-Hill Total Score Total Score Subscores 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. The Total Mathematics Score of 297 indicates that scored in the middle third of grade 5 students who took FCAT Mathematics in 1998. The Subscores indicate the student's level of achievement on separate content areas of FCAT Mathematics. Each Subscore represents the percentage of content In that area that the student responded to successfully. 25 50 75 100 Mathematics Number Sense Measurement 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 system for Florida's schools. 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 decisions concerning the promotion of students in 1998 but will be one consideration in promoting students In future years. Cr",-,v7 PROT88 Mathematics Content Tested Área de contenido del examen de Matemáticas PCA'!' Mathematics is an assessment of the Sunshine State Standards In mathematics. PCAT Mathematics assesses content from the following arcas: Number Sense, Concepts and Operations • Identifying operations (+, x, +) and effects of operations • determining estimates • knowing how numbers are represented and used Measurement • recognizing measurements and units of measurement • comparing, contrasting, and converting measurements Geometry and Spatial Sense • describing, drawing, identifying, and analyzing two- and threedimensional shapes • visualizing and illustrating changes in shapes • using coordinate geometry Algebralc Thinicing • describing, analyzing, and generalizing patterns, relationships, and functions • using expressions, equations, inequalities, graphs, and formulas Data Analyzing and Probablilty • analyzIng, organizIng, and interpreting data • identifying patterns and making predictions, Inferences, and valid conclusions • using probability and statistics CAT comprebensive Assessment Test El examen de Matemáticas PCA'I' es el examen que evalúa las normas educativas de Matemáticas del estado de la Florida (Sunshtne Sute Standards). Este examen evalúa las habilidades siguientes: Compresión numérica, conceptos y operaciones • identificación de operaciones (+, x, +) y efectos de operaciones • estimación de resultados • uso y representación de números Medidas • reconocimiento de medidas y de unidades de medidas • comparación y conversión de medidas Geometría y noción espacial • descripción, dibujo, identificación y análisis de figuras de dos y tres dimensiones • visualización e ilustración de cambios en figuras • uso de geometría coordinada Razonamiento algebraico • descripción, análisis y generalización de patrones, relaciones y funciones • uso de expresiones, ecuaciones, desigualdades, gráficas y fórmulas Análisis de datos y probabilidad • análisis, organización e interpretación de datos • Identificación de patrones y elaboración de predicciones, Inferencias y conclusiones válidas • uso de probabilidad y estadística 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 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 deben saber y pueden hacer en su avance académico. Las normas educativas establecen la base para un sistema que define una mayor responsabilidad para las escuelas de la Florida. 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. fr CTB McGraw-HIll PROT89 Florida Writing Assessment Program 1997 Florida Writing Assessment STUDENT REPORT Grade 4 TYPE OF WRITING TESTED: WRITING TO EXPLAIN Student Name: Student I.D. No.: School: District: Your Student's Score Description of Writing Scores 6.0: The writing focuses on the topic, is logically organized, and includes ample development of 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. 5,5: The writing was given a 5 by one reader and a 6 by the other reader. 5.0: The writing focuses on the topic with adequate development of supporting ideas or examples. It has an organizational pattern, though lapses may occur. Word choice Is adequate. Sentences 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. 4.0: The writing focuses on the topic, though it may contain extraneous information. An 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 somewhat in structure, though many are simple. Punctuation, capitalization, and spelling are usually correct. 3.5: The writing was given a 3 by ono reader and a 4 by the other reader. 3.0: The writing generally focuses on the topic, though it may contain extraneous information. An organizational pattern has been attempted, but lapses may occur. Some of the supporting ideas 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 most commonly used words are spelled correctly. 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 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. 1.0: The writing may only minimally address the topic because there is little or no development of 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. U: The writing is unrelated to the assigned topic or cannot be read, or there is no response. Dear Parents or Guardians: The paper your student wrote in January as part of the Florida Writing Assessment Program has been read independently by two people trained to score this test. Each reader judged the paper against a set of standards and gave it an overall score. Your student's final score is the average of the two readers' scores. This writing score will help you, your student, and the teacher understand how well your student performed on this statewide writing test. A description of each possible score is printed on the left side of this report. Students were given 45 minutes to read the assigned topic, plan what to 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 for this test; therefore, the writing may not be the same. You and the teacher should consider the score on this test along with all of your student's other writing when planning activities to continue developing your student's writing skills. DESCRIPTION OF THE TOPIC: Students were asked to explain why everyone should know how to read. RUN DATE: 04/19/97 50-1761-00000T402 PROT90 EVALUACION DE SECRITURA DE LA FLORIDA PRIMAVERA DE 1997 REPORTE ESTUDIANTIL INFORMES DE LOS ESTUDIANTES DE 4' GRADO Descripción de las Notas de Redacción 6.0: La redacción se concentra en el tema, está lógicamente organizada e incluye un amplio desarrollo de las ideas o ejemplos fundamentales. Demuestra un dominio maduro del idioma, incluyendo precisión en la elección de términos. Las oraciones varían en su estructura. La puntuación, uso de mayúsculas y ortografía son generalmente correctas. 53: La redacción recibió un 5 por parte de un lector y un 6 por parte del otro lector. 5.0: La redacción se concentra en el tema y tiene un desarrollo adecuado de las ideas o 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 de mayúsculas y ortografía son generalmente correctas. 4.5: La redacción recibió un 4 por parte de un lector y un 5 por parte del otro lector. 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 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 mayoría son simples. La puntuación, uso de mayúsculas y ortografía son generalmente conectas. 3.5: La redacción recibió un 3 por parte de un lector y un 4 por parte del otro lector. 3.0: La redacción se concentra generalmente en el tema, aunque condene Información ajena al mismo. Se intentó una estructura organizada, aunque puede haber algunos lapsos. 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 simples. La puntuación y la ortografia son a veces incorrectas pero las palabras más comunmente usadas están escritas correctamente. 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. Estimados padres o tutores: La prueba escrita por su niño(a) en enero como parte del Programa de Evaluación de Redacción de Florida, fue leida independientemente por dos personas capacitadas para evaluarla. Cada lector juzgó la prueba en relación a un conjunto de normas y la calificó con una nota general. La nota final de su niño(a) es el promedio de las notas otorgadas por los dos lectores. Esta nota de redacción le ayudará a usted, a su niño(a) y a los maestros a comprender cómo se desempeñó su niño(a) en esta prueba de redacción realizada en todo el estado. Una descripción de cada una de las notas p6sibles aparece en el lado izquierdo del informe. Los estudiantes dispusieron de 45 minutos para leer el tema asignado, planificar lo que iban a escribir y escribir sus respuestas. Las condiciones bajo las cuales los estudiantes redactan otras pruebas en clase o en el hogar pueden ser diferentes a las empleadas en esta prueba; por lo tanto, la redacción puede ser diferente. Ustedes y los maestros deben considerar la nota de esta prueba junto con todas las otras redacciones del estudiante, al planear actividades para continuar desarrollando las habilidades de redacción del estudiante. PROT91 action( OA TEACHER: SCHOOL: TEST: 1.,100/1. 01WLERN1 AEJMJAT FOR: CTBS/4 LEVEL 16 FORM A GRADE: 06 DATE OF TESTING: 4/13/99 TESTS TOTAL READING READING COMPREHENSION READING VOCABULARY TOTAL MATHEMATICS MATH CONCEPTS & APPLICATION MATH. COMPOTATION Dear Parent/Guardian: PERCENTILE RANKS LOWEST RANGES OF PERCENTILE RANKS 1-25 PERCENTILE SCORE RANGES AVERAGE HIGHEST LOW 26-50 PERCENTILE HIGH 51-75 PERCENTILE 76-99 PERCENTILE This spring, was given the Compr Edition (CTBS/4). This report explains Tests .s test When compared with students across the nation, 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 of Basic Skills/Fourth results. s scores were in the ogpxtro f,,,:orkz:. SCH06100Prt 4.ssvPROT92 KtrUKS WA TEACHER: SCHOOL: TEST: LT.I3b/9 bTULMNT NtieVNT FOR: CTBS/4 LEVEL 15 FORM B TESTS READING COMPREHENSION MATH CONCEPTS & APPLICATIONS TOTAL LANGUAGE LANGUAGE MECHANICS LANGUAGE EXPRESSION Dear Parent/Guardian: PERCENTILE RANKS RANGES OF PERCENTILE RANKS GRADE: 05 DATE OF TESTING: SCORE RANGES LOWEST AVERAGE 1-25 PERCENTILE 26-50 PERCENTILE 51-75 PERCENTILE 4/20/98 HIGHEST 76-99 PERCENTILE This spring, was given s the Comp Tests of Basic Skills/Fourth Edition (CTBS/4). This reportexplain 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 PROT93 REPORT #1 TEACHER: SCHOOL: TEST: CTBS/4 STUDENT REPORT FOR: CTBS/4 LEVEL 14 FORM A GRADE: 04 DATE OF TESTING: 4/15/97 TESTS TOTAL READING READING COMPREHENSION READING VOCABULARY TOTAL MATHEMATICS MATH CONCEPTS & APPLICATION MATH COMPUTATION SCIENCE SOCIAL STUDIES PERCENTILE RANKS 1-25 PERCENTILE 26-50 PERCENTILE 51-75 PERCENTILE 76-99 PERCENTILE RANGES OF PERCENTILE RANKS LOWEST LOH SCORE RANGES AVERAGE HIGHEST HIGH 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 PROT94 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 PROT95 REPORT #1 TEACHER: SCHOOL: TEST: CTBS/4 STUDENT REPORT FOR: CTBS/4 LEVEL 12 FORM A GRADE: 02 DATE OF TESTING: 4/18/95 TESTS TOTAL READING READING COMPREHENSION READING VOCABULARY TOTAL MATHEMATICS MATH CONCEPTS & APPLICATION MATH COMPUTATION This spring, PERCENTILE RANKS RANGES OF PERCENTILE . RANKS LOWEST LOW SCORE RANGES AVERAGE HIGHEST 1-25 .26-50 PERCENTILE PERCENTILE Dear Parent/Guardian: HIGH 51-75 PERCENTILE 76-99 PERCENTILE 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 PROT96 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 PARENT OR GUARDIAN T_ Iva DOB MO/DA/YR 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-araolaritt thintare 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•:.: . .•.i•••• ''f <-7- ,';': '''''.' k,,.Dose 4 VACCINE DOgi -•- •21:-.:1;:tettii Lt ' ' ' :., O0,d-2 -.;.7. ....F.,.:O4;43. . Pose 5 - '' /14 OIPA47:2 •I7 MO/DriTt. ; 7.:MOLD COPE i \'• A/YR MO/DA/YR DTaP/DTP2 1,1 . : ) .t.. D r It . 4.. It lie't C r Folios' Y t' H1B6 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 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. PROT97