Adopted: November 1981
Revised: September 2021
Download 602.6.1.5P - Report of Data Collection for Consideration of Grade Acceleration
Student's name _________________________________ Date of birth _________ Age______________________________________________
yr/mth
School _______________________________________________ Grade
Name of parent(s)/guardian(s) ____________________________________________________________________________
Address________________________________________________ Phone ________________________________________________________
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Individual Intellectual Ability Test – Must have been completed within two years and administered by a psychologist.
Name of test: ____________________________________________________________________________
Results: ____________________________________________________________________________
Assessment completed by: Date:
Standardized Social-Emotional Rating Scale: ____________________________________________________________________________
Name of measure: ____________________________________________________________________________
Results: ____________________________________________________________________________
Assessment completed by: Date:
Name of test: Woodcock Johnson Achievement Test Age Based Norms
Results: ____________________________________________________________________________
Total Reading Percentile: ______________
Total Math Percentile: _________________
Written Language Percentile: __________
Assessment completed by:__________________________________ Date:____________________________________________________________
Critical Questions:
Yes No
A. Has the student been grade accelerated previously?
(including early entrance)
B. Does the student want to be considered for grade acceleration?____________________________________________________________
C. Will a sibling be in the same grade if the student is grade advanced?____________________________________________________________
Assessment completed by:__________________________________ Date:____________________________________________________________
Observation report by classroom teacher: ____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Teacher:____________________________________________________ Date:____________________________________________________________
Observation report by other teacher(s): ____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Teacher:____________________________________________________ Date:____________________________________________________________
Attach Iowa Acceleration Scale form (if applicable)
c: case studies file