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NNPS - Pre-Child Study and Child Study Process Handbook

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(CS-2) NOT FOR COPYING REFERRAL TO CHILD STUDY COMMITTEE Student DOB Student ID# School Grade English/Reading PALS SUMMARY: Student Score/Benchmark MATH: Circle: 1P, 1E, 2E, 2T, 3 Most Current Reading Data: Fall Spring Date _______________ Kindergarten _____/____ _ _____/___ __ Above grade level Above benchmark DRA running record %/LV________ First Grade _____/____ _ _____/___ __ On grade level Meets benchmark DRA comprehension score ________ Second Grade _____/____ _ _____/___ __ Below grade level Below benchmark Reading Benchmark score ________ Third Grade _____/____ _ _____/___ __ Math Benchmark score _____ Latest SOL Score ________ Latest SOL score _____ Check if applicable: Gifted Education Title I Reading Recovery Literacy Group SOL Remediation ESOL Other Retention: grade ______ AREAS OF WEAKNESS Check if attendance is a problem COMPONENTS OF MATH INSTRUCTION: WORK-STUDY SKILLS: S U ______ Number and Number Sense ______ Measurement ______ Computation and Estimation ______ Geometry ______ Probability and Statistics ______ Patterns, Functions, and Algebra Description of Weakness: Ability to follow directions Ability to work independently Ability to handle distractions and interruptions Ability to complete learning tasks SOCIAL-ADAPTIVE BEHAVIOR: S U COMPONENTS OF READING INSTRUCTION: Relationships with teacher(s) ______ Phonemic Awareness ______ Phonics ______ Fluency ______ Vocabulary ______ Comprehension Description of Weakness: Reaction to teacher/adult correction Compliance with rules and regulations Reaction to failure experiences Physically aggressive toward peers Disrupts learning activities of peers Withdraws from interaction with peers HEALTH: COMPONENTS OF WRITING INSTRUCTION: Date of last physical exam __________________________________ ______ Composing ______ Written Expression ______ Usage/Mechanics Description of Weakness: Normal: Yes No If physical exam notes a disability, describe it below _________________________________________ __________________________________________________________ Medication taken _________________________________________ Hearing: Hearing aids worn Not worn Vision: Glasses worn Not worn SPEECH/LANGUAGE SKILLS: Is the child receiving speech services? Yes No S U S U Speech is easily understood by peers and adults Verbally interacts socially with peers and adults Voice is clear; loudness appropriate to situation Verbalizations remain on topic during conversation Speech flow and rate are smooth and even Responds to oral requests without undue delay Uses language to ask questions, give information, or explain Vocabulary is consistent with age and experiences Dates of parent conference (Attach parent contact log/conference Dates: forms) Student Intervention Plan (C.S. #1) (Check that it is attached ___________) Signature of Classroom Teacher/Referring Source Date NOT FOR COPYING 23 SIGN
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