EFTA01248871.pdf

THE SCHOOL DISTRICT OF PALM BEACH COUNTY sA _Elementary School Special Session Registration re of Pa .ame Scho Special Session School Assignment Student's Date of Birth igh Risk Medical Information 1-9 0179 Legal Information on Reco : no yes (Call home school.) Student is on free lunch reduced lunch SPECIAL PROGRAM ASSIGNMENT (Check services needed.) ESOL Intensive ESOL Support ESE (Program) Other TRANSPORTATION Special Session Bus # Needed: no Z_ yes regular ESE lift) SAC# /O6 C) 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. _11 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. ft wi Students retained in their current grade level may be eligible for promo' lion of Special Sessign. 4k, rer—Sc 4 5gnalure of Teacher I Dal Signal rk, of Pnnopal / Date PAFIENT/GUARDIAN NOTIFICATION 10 Yes, my child will attend the Special Session (summer school). The information on address and telephone numbers is correct or I have noted changes on my copy of the registration form. 17] No; my child will not attend the Special Session 1stimmer school). s Signature o are / Guardtan - 91/ 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 qSpecial Session: STUDENT ATTENDANCE RECORD: P& Days Present 0 Days Absent 0 Days Tardy Tea 9r commes: dieldC)74e PLACEMENT DECISION er Made !Wowing Special Session Promoted 0 Administrative Placement 0 Retained Zlefil /4.7 / S)-3 4- sr MLa-t Signature of Spada Session I 4 -e- 7s' Strati,/ / Date Signature of Home SHwol Principal / Date PEW 0673 FY 95 Reyisio WhitalSpecial Sudan Sohoor&4 H eila4ecwI Moms SthoogOffico Pinkfrransportatioa GokliParentlGuardian then Name Sdmol MM08-V ZALIS-000032 3501:725-020 CONFIDENTIAL Page I of I EFTA 00075168 EFTA01248871