Get documents about "Leon County Schools Student AIP Form Elementary School
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Page 1 of 2 Leon County Schools Forms Control No.: LCS-9382-1001
Student AIP Form Expiration Date: As Needed
Elementary School School Year _________
A School: Student Name: Sex: Race: Grade:
Student Number: (Leon County 9-digit code, as identified on mainframe):_______________________________________________________
Birth Date: Age: Exceptionalities/Matrix Code: Referred for Evaluation: No ____ Yes ____ Date: ___________________
B Retention History/Placement for Cause (Administrative Placement): Grade Level(s) Retained: Grade Level(s) Placed for Cause:
C Report Card Grades CORE FCAT FCAT WUR ALTERNATIVE ASSESSMENT
BMKS NRT ACH 1 2 3 4 KTEA WJ TOWRE STAR WUR
1 2 3 4 % %ile LEVEL NA EX NA EX %ile %ile %ile %ile NA EX
Reading XXXXX XXXXX XXXXX XXXXX XXXXXXX XXXXX
Mathematics XXXXX XXXXX XXXXX XXXXX XXXXXX XXXXXXX XXXXX
Writing XXXXX XXXXX XXXXX XXXXXX XXXXXXX
Science XXXXX XXXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXX XXXXXX XXXXXXX XXXXXXX XXXXX
IEP for upcoming year has been developed: Yes_______ No_______ Only administer if there is no clear majority of criteria determined.
D Academic Improvement Plan Teacher Signature:_____________________ Date Initiated:_________ Date(s) Parent/Guardian Notified (AIP):____________________________
IEP READING IEP WRITING IEP MATHEMATICS IEP SCIENCE
Phonemic/Phonological Awareness Focus Number Sense, Concepts, & Operations Content Comprehension
Vocabulary Strategies Organization Measurement Life Physical Earth/Space
Phonics Support Geometry
Comprehension Strategies Conventions Algebraic Thinking Using Process Skills
Other: Other: Data Analysis and Probability
Enter date of implementation for intervention strategies (AIP) R = Reading M = Mathematics W = Writing S = Science
E INTERVENTION R M W S INTERVENTION R M W S INTERVENTION R M W S
Modified Curriculum Summer School Additional Class
Extended-day Services Class Size Reduction
Tutoring/Mentoring Computer Assisted Instruction
Comments:
(AIP) Teacher Signature: _____________________ Date: _________ Parent Signature: ____________________ Date: ________ Principal Signature: ____________________ Date: ________
Student Placement Form Date: __________
F Placement for Cause for the following reasons (if applicable): (Check appropriate boxes and provide information/documentation for the checked items with an asterisk*)
`
Gains have been made in academic performance* To facilitate Placement for Cause to an alternative setting
Classroom performance indicates ability to apply grade level skills* Retained at some point in his/her educational career
Physical, socio-emotional maturity exceeds the norm for the grade Other: Please Explain
Classified as LEP two or more years as recommended by the LEP Committee
Retained the previous year and received a different program
A recent traumatic experience impacted performance*
Special progression for the next school year
Student's disability adversely affected mastery (disability:______________)*
Signatures for Placement
G Designated Teacher Signature: Promotion Date: Summer School Date: Retention Date: Placement for Cause Date:
Summer School Teacher Signature: Promotion Date: Summer School Date: Retention Date: Placement for Cause Date:
School Administrator Signature: Promotion Date: Summer School Date: Retention Date: Placement for Cause Date:
Executive Director Signature (if applicable): Promotion Date: Summer School Date: Retention Date: Placement for Cause Date:
Parent/Guardian Notified of Final Decision (signature and/or date contacted)
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