Series 602.6.1.5P - Report of Data Collection for Consideration of Grade Acceleration
Adopted: November 1981
Revised: September 2008
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