Carlos

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					RECORD OF STUDENT ASSESSMENT AND INTERVENTION STRATEGIES
Name of Student:__Carlos Blanco______________ YOG: ______Course :_________________________ Quarter/Semester:_____

Teacher’s Name:________________________ Date Form Initiated: _____Is student Identified: ELL       SPED     504    CHAT

Is this course a ____graduation requirement? a____ pre-requisite for another course?        Attended extra help ____times
Interventions:

DATE          STRATEGY                                                                        OUTCOMES
              CALLED HOME           CASE MANAGER CONTACTED         EXTENDED TIME GRANTED
              EMAILED PARENT        IEP ACCOMMODATIONS USED        REFERRAL TO TUTORIAL
              MEETING W/ PARENT     MONITOR REPORT FILED           AFTER SCHOOL HELP
              ELL ACCOMMODATION     GUIDANCE REFERRAL              OTHER
              CALLED HOME           CASE MANAGER CONTACTED         EXTENDED TIME GRANTED
              EMAILED PARENT        IEP ACCOMMODATIONS USED        REFERRAL TO TUTORIAL
              MEETING W/ PARENT     MONITOR REPORT FILED           AFTER SCHOOL HELP
              ELL ACCOMMODATION     GUIDANCE REFERRAL              OTHER
              CALLED HOME           CASE MANAGER CONTACTED        EXTENDED TIME GRANTED
              EMAILED PARENT        IEP ACCOMMODATIONS USED        REFERRAL TO TUTORIAL
              MEETING W/ PARENT     MONITOR REPORT FILED           AFTER SCHOOL HELP
              ELL ACCOMMODATION     GUIDANCE REFERRAL              OTHER
              CALLED HOME           CASE MANAGER CONTACTED         EXTENDED TIME GRANTED
              EMAILED PARENT        IEP ACCOMMODATIONS USED        REFERRAL TO TUTORIAL
              MEETING W/ PARENT     MONITOR REPORT FILED           AFTER SCHOOL HELP
              ELL ACCOMMODATION     GUIDANCE REFERRAL              OTHER
              CALLED HOME           CASE MANAGER CONTACTED         EXTENDED TIME GRANTED
              EMAILED PARENT        IEP ACCOMMODATIONS USED        REFERRAL TO TUTORIAL
              MEETING W/ PARENT     MONITOR REPORT FILED           AFTER SCHOOL HELP
              ELL ACCOMMODATION     GUIDANCE REFERRAL              OTHER
              CALLED HOME           CASE MANAGER CONTACTED         EXTENDED TIME GRANTED
              EMAILED PARENT        IEP ACCOMMODATIONS USED        REFERRAL TO TUTORIAL
              MEETING W/ PARENT     MONITOR REPORT FILED           AFTER SCHOOL HELP
              ELL ACCOMMODATION     GUIDANCE REFERRAL              OTHER


Assessment:
         st                                          nd
Grades: 1 Progress Report:______ Quarter: ______ 2 Progress Report:______ Quarter:______ Final:______ Semester: ___
Teacher’s Assessment for reason of failing grade: (Please check all that apply and explain/provide examples in the box)
ABSENCE: ____0-5 ____6-10 _____11-20 _____ 20+;



FAILURE TO COMPLETE WORK:___



SCORED POORLY TESTS/PROJECTS:___


NOT APPROPRIATE LEVEL/COURSE:___



POOR FOUNDATION FOR COURSE: (NO PREREQUISITES COMPLETED)____


OTHER:___Please explain:


REGARDING NASHUA BOARD OF EDUCATION APPENDIX IMBC-R                                        Revised 12/16/09 @ 11:00 am
Is Competency Recovery an option? _____Y _____N
        If Yes, please list competencies failed:




Is there an exceptional reason the student should not take this course again in Day School? ___Y _____N
          If Yes, please provide explanation below:




***********************************TEAM RECOMMENDATION*******************************
___ Retake course in day school
___ Credit Recovery: ___ VLACS/on-line
                           th
___ .Credit Recovery: ____5 Block           ____ Adult Ed _____ Summer School
___ Competency recovery: ____ VLACS/on-line
                                th
___ Competency recovery: ____ 5 Block       ____ Adult Ed _____ Summer School
___ Other:




REGARDING NASHUA BOARD OF EDUCATION APPENDIX IMBC-R                                           Revised 12/16/09 @ 11:00 am

				
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posted:12/1/2011
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