School and District Information/Resources (A-3)

DIRECTIONS: With your support provider, discuss and complete the information that applies to your teaching context. This information is designed to provide you with a better understanding of the students in your class. During your discussion, record pertinent information here so that it is available later in the year. The statements may prompt you to explore other topics related to the local teaching context.
1. / My Site Administrator(s):Kristi XXX
2. / Explore and attach a Calendar of School Events
3. / My school is a (check those that apply):
Blue Ribbon School / California Distinguished School
Immediate Intervention-Underperforming Schools Program (IIUSP)/SAIT / Bilingual Waiver Program/ Language Immersion School - which languages?
Title I School-wide Program / Program Improvement School
Charter School – Type: / Magnet School – Type:
Professional Development School / Other:
4. / School-Wide Programs (check those that apply):
Reading Intervention / Character Counts / Drug Alcohol, Tobacco Ed. / Other
AVID / Conflict Resolution / RTI2 / Other
5. / School Wide Discipline Plan- Describe or attach:
See attached forms. (Under Construction with implementation of PBIS Training.)
6. / School Accountability Report Card
API Score: 856 / API Target Score: 860 / AYP:
Based on your school’s API score, what is the school’s academic focus for the year?
To increase CST scores in Math and English/Language Arts in all students, especially in the following sub-groups: EL, SES, and Hispanic.
7. / My School has (check all that apply): / Facilities / Committees
Academies/Houses/ Families / Computer Lab Schedule / Technology
Department Grouping/PLC / Bus/Recess / Leadership
Teaching Teams / Library Schedule / Safety
Special Day Classes / Other / Other
8. / School Enrollment: 562 / Percent of English learners:40%
# of Languages of students: 11 / Ethnicities represented:.1% Americn Indian, 3% Chinese, .1% Japanese, .3% Korean, 45% Vietnamese, .7% Asia Indian, .3% Laotian, .3% Samoan, .3% Tahitian, .7% Pacific Islander, 1.2% Filipino, 13% Hispnic/Latino, 1% Black/African American, 30% White, 1% Other
9. / Teachers in my grade level/department
Name / Room Number / Phone/email
Lynn XXX / B-1 / 555-0000
Michelle XXX / E-2 / 555-0000
Margaret XXX, Kristi XXX / B-7, E-3 / 555-0000

School and District Information/Resources (A-3)

DIRECTIONS: With your support provider, identify the personnel and instructional resources available to help you gather information in each area listed below:

If your district/school provides this information in another format, copy and attach it.

Instructional Resources
(Information about) / Contact Person / Information
Phone # / Room # / e-mail
California Academic Content Standards and Frameworks / Linda XXX / 555-0000 / Building E / zzzz@
Classroom Supplies / Lynn XXX / 555-0000 / B-1 / zzzz@
Duplication of Materials / Holly XXX / 555-0000 / D.O. Building E / zzzz@
Technology / Margaret XXX (on-site
Sue XXX (district office) / 555-0000 / B-7
D.O. Building E / zzzz@
Instructional Materials / Terrie XXX / 555-0000 / D.O.
Building E / zzzz@
Library Resources / Betty XXX (on-site)
Terri XXX (district office) / 555-0000 / Library
D.O. Building E / zzzz@
Textbooks / Betty XXX
Terrie XXX / 555-0000 / Library
D.O. Building E / zzzz@
English Learner / Judy XXX / 555-0000 / MPR / zzzz@
Other:
Student Data Information (Information about) / Contact Person / Information
Phone # / Room # / e-mail
District/School Test Scores / Margaret XXX (on-site)
Chris XXX (district office) / 555-0000 / B-7
D.O. / zzzz@
Individualized Education Plan/IEP / Melinda XXX / 555-0000 / B-8 / zzzz@
Standardized Tests / Kristi XXX
Chris XXX / 555-0000 / Office
D.O. / zzzz@
Online District Data System / Sue XXX / 555-0000 / D.O. Building E / zzzz@

Student Support Services

/

Contact Person

/ Information
Phone # / Room # / e-mail
Counselor / N/A / N/A / N/A / N/A
CPR Certified School Staff / Kim XXX
Michelle XXX
Connie XXX / Office
Emergency Coordinator / Dr. Bill XXX
Kristi XXX / 555-0000 / D.O.
Office / zzzz@
Healthy Start Coordinator / N/A / N/A / N/A / N/A
Nurse / Connie XXX (Health Aid)
Michelle XXX(Nurse) / 555-0000 / Main Office / zzzz@
Crisis Counselor / N/A / N/A / N/A / N/A
Resource Specialist (RSP) / 555-0000 / B-8 / zzzz@
School/District Psychologist / Frank XXX / 555-0000 / B-8/
Main Office / zzzz@
Social Worker / Social Services Agency of Child and Family Services / 555-0000 / N/A
Other: Speech
Vietnamese Translator
Music / Becky XXX
Tung XXX
Kim XXX / 555-0000 / Main Office
Main Office
MPR / zzzz@

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Formative Assessment for California Teachers (FACT) – 2010

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