Students Name (Print)___________________________________________________ Grade: _______ School: _________________________________________________ Program: ______________________________________ Date Referred ___/___/___
CURREN S!US "here is the student currentl#$ G%!&S "here does student need to go$ !C'(''ES )o* *ill the student meet their goal$ !SSESS+ENS )o* *ill ,no* the student met their goals$ Chec, all that a--l#. SPED: /01 -lan: E&: itle ' Social "or,er Chec, all that a--l#. X 2asic S,ills 'm-ro3ement X Stud# S,ills %ther (i.e. social4emotional) Chec, all that a--l#. !ttend argeted Ser3ices Program. !ttend !&C Program/S%!R X !ttend Summer Program Chec, all that a--l#. X 5ormal !ssessment X 'nformal !ssessment %ther Ser3ice !ddendum Current Status Goals Activities Assessments o increase reading and math s,ills. o de3elo- com-rehension of glo6al issues. o dee-en s,ills 7 interest to su--ort -ositi3e learning outcomes. o 6uild and nurture relationshi-s Enrollment in District 889 Summer 2ridge -rogram Classes %ffered: &anguage !rts +ath Glo6al Citi:enshi- ; th 4< th grade +iddle School ransition S,ills ; th Grade heme 2ased Enrichment %--ortunities 'ncreased achie3ement as measured 6# the N"E! achie3ement test and classroom -rogress re-orts issued each trimester. Parent Signature: __________________________________________________________________ Date: _____________________________