Series 602.6.2.2P - Referral Team Summary for Single Subject Acceleration

 

To be completed by referral team:

Student’s name                                                                                                     

Date of birth            School                                                          Grade         

Subject area                                                                                                          

Name of parent(s)/guardian(s)                                                                                

Address                                                                            Phone                            

1.  Reason(s) why single subject acceleration is being considered. 

 

 

 

 

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

 

 

 

 

3.   Standardized test data specific to subject being considered.

 

 

 

 

4.  Other test data or pertinent information.

 

 

 

 

_____________________________           _____________________________________________________

            Date of referral meeting

                                                                        _____________________________________________________

 

                                                                        _____________________________________________________

 

                                                                        _____________________________________________________

                                                                         Signature of referral team members

Please check one:

❏ Complete 602.6.2.3P, Permission for Single Subject Acceleration Consideration

❏ Complete 602.6.2.4P, Denial of Consideration for Single Subject Acceleration

 

______________       __________________________________________________________

        Date                                    Signature of principal

c: case studies file 

Procedures/602.6.2.2P/9-22-08