ell program placement and parent notification form

APPENDIX B – Eng/Span/Kreyol
ELL PROGRAM PLACEMENT AND PARENT NOTIFICATION FORM
School ___________ Student Name ______________________________________________ , _________________________________________
(Last Name)
(First Name)
School ID # __________ Student ID # _____________________ Grade _______ Survey Date (Referral) _____ /_____ /_____
Title III Participation
Dates (S706)
Participación en Título III
Classification ______ /______ /_______
(Date Tested)
Student Ed. Plan ______ /______ /_______
(Date of initial “LY” plan)
Basis of Entry (S706)
A – Aural/Oral
(KG – 12)
(Date Parent/Guardian signed Enrollment Form)
Program Entry ______ /______ /_______
(Same day as Classification date)
Date Entered US school ______ /______ /_______
(First time attended any US school)
Basis of Entry (S706)
R – Reading/Writing
(3 – 12)
CELLA Form 3 Online (S735)
Test Date ______ /______ /________
Test ID _____________________
Reading Score __________
Proficiency Level _______
Listening/Speaking Score _________
Writing Score __________
Proficiency Level _______
Proficiency Level _______
*Proficiency Levels
B = Beginning L = Low Intermediate H= High Intermediate P = Proficient
Program Participation (S706)
E = English Speakers of Other
Languages
N = Sheltered Model
Mark
Below
Patisipasyon nan Tit III
Basis Of Entry (S706)
L - ELL Committee
(KG – 12)
ELL Committee Date (S322)
______ /______ /_______
(Code L01)
Attach ELL Committee Form
Program Instructional Models (S615)
I = Mainstream/Inclusion – English
C = Mainstream/Inclusion - Core/Basic Subject Areas
E = Sheltered – English
S = Sheltered – Core/Basic Subject Areas
ENGLISH DISPOSITION
DISPOSICIÓN EN ESPAÑOL
DISPOZISYON AN KREYOL
The professional staff of the
District School Board of Collier
County has determined, through
_____testing and interviewing
and/or _____ by recommendation
of the ELL Committee, that your
child:
Qualifies for (ELL) English
Language Learner program. (LY)
El personal profesional del Distrito
Escolar del Condado de Collier ha
determinado a través de_____
exámenes y entrevistas, y/o ____
por recomendación del Comité
de ELL, que su hijo(a):
Pwofesyonèl k-ap travay pou Komite
Egzekitif Distri Eskolè Collier Countya te deside, apre yo te fin fè_____ seri
tès a k kèk chita tande ak pitit ou-a
ak/oubyen ____ sou rekòmandasyon
Komite ELL, la ke piti ou-a:
Does not qualify for the ELL
Program. (ZZ)
____________________________
Principal's or Designee’s Signature
Revised 08/06/2012
Califica para el programa de ELL
(Aprendices del Idioma Inglés).
(LY)
No Califica para el programa de
ELL. (ZZ)
______ /______ /_______
Date
Kalifye pou pwogram ELL la (Anglè
pou Elèv ki Pale Lòt Lang yo) (LY)
Pa Kalifye pou pwogram ELL la. (ZZ)
______ /______ /_____ __
Parent Copy sent home on
__ __________________
Data Entry’s Initials