Leon County Schools Student AIP Form Elementary School

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Leon County Schools Student AIP Form Elementary School Powered By Docstoc
					     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)