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Series 602.6.2.5P - Report of Data Collection for Consideration of Single Subject Acceleration


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


School ______________________________  Grade_____ Subject area                                 

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

Address________________________________________________ Phone                                     

Achievement data:

MAP Scores:

Report Cards (for elementary students in subject being considered):

Data collection by:_____________________________________ Date:_________________

Cognitive Ability Test – Must have been completed within two years. 

Name of test:

Date Administered:


Data collection completed by:____________________________ Date:_________________

Critical Questions:

A.  Has the student been single subject accelerated previously?       ❏ Yes   ❏ No

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

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

D.  Does the student currently have like-ability peers in their grade level in the

subject being considered for single subject acceleration?                                      ❏ Yes   ❏ No                                                                                   

Report by classroom subject teacher:









Teacher:______________________________________________ Date:_________________

District Placement Assessment Results:









Teacher:______________________________________________ Date:_________________


c: case studies file