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Series 602.6.1.2P - Referral Team Summary for Grade Acceleration

Adopted: September 1980
Revised: September 2008

 

To be completed by referral team:

Student’s name                                                                                                             

Date of birth                         School                                                 Grade                     

Name of parent(s)/guardian(s)                                                                                        

Address                                                                                   Phone                            

1.  Reason(s) why grade acceleration is being considered.

 

 

 

 

2.  What alternatives/interventions have been tried to meet the student's needs?

 

 

 

 

3.  Standardized test data. (MAP/Standardized Achievement/Cognitive scores or percentiles)

 

 

 

 

4.  Other test data or pertinent information.

 

 

 

 

_____________________________           _____________________________________________________

Date of referral meeting

                                                         _____________________________________________________

 

                                                         _____________________________________________________

 

                                                         _____________________________________________________

                                                                         Signature of referral team members

 

Please check one:

   ❏ Complete 602.6.1.3P, Permission for Grade Acceleration Consideration

   ❏ Complete 602.6.1.4P, Denial of Consideration for Grade Acceleration

 

______________       __________________________________________________________

Date                       Signature of principal

c: case studies file 

Procedures/602.6.1.2P/9-22-08