Series 602.6.1.5P - Report of Data Collection for Consideration of Grade Acceleration

 

Student's name ______________________________  Date of birth ________  C.A._________

                                                                                             yr/mth

School __________________________________________  Grade________________________                                                                                                   

Name of parent(s)/guardian(s) ____________________________________________________

Address___________________________________________ Phone ______________________

Individual Intellectual Ability Test – Must have been completed within two years. (The Slossen is not an approved measure.)

Name of test:

Results:

 

 

 

Assessment completed by:______________________________ Date:_________________

Name of test: Woodcock Johnson Achievement Test (scored for aptitude)

Results:

Total Reading Percentile: ____________

Total Math Percentile: _______________

Written Language Percentile: _________

Assessment completed by:______________________________ Date:_________________

Name of test: Woodcock Johnson Achievement Test (scored for achievement)

Results:

Total Reading Percentile: ____________

Total Math Percentile: _______________

Written Language Percentile: _________

Assessment completed by:______________________________ Date:_________________

Critical Questions:

A.  Has the student been grade accelerated previously?           ❏Yes ❏No                            
(including early entrance)

B.  Does the student want to be considered for grade acceleration?    ❏Yes ❏No                  

C.  Will a sibling be in the same grade if the student is grade advanced?     ❏Yes ❏No          

Assessment completed by:______________________________ Date:_________________

Observation report by classroom teacher:

 

 

 

 

Teacher:______________________________________________ Date:_________________

 

Observation report by other teacher(s):

 

 

 

 

Teacher:______________________________________________ Date:_________________

c: case studies file

Procedures/602.6.1.5P/9-22-08