Series 602.6.2.2P - Referral Team Summary for Single Subject Acceleration
Adopted: June 2007
Revised: October 2021
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
c: student's cumulative folder
Procedures/602.6.2.2P/10-01-21