Houston County SchoolsEL Student Profile

Student Name: ______FTE ID#: ______GTID #: ______

Date of Birth: ______Country of Birth: ______Primary Language(s): ______Gender: _____ Date of Enrollment: US Schools ______Houston County ______

Initial Eligibility

Qualified for Services ______ESOL Entry Date ______LAC: Yes No
Qualifying Criteria (circle one) W-APT ACCESS (from another county/state) Date administered: ______
Other ______Date administered: ______
Scores: Overall ______Speaking _____ Listening ______Reading ______Writing ______

Yearly Services

School Year ______Grade ___ School ______ESOL Teacher ______
ESOL Services: Pull Out Push In Scheduled Class Period Waived Consultative
ESOL Level: 1 - Entering 2 - Emerging 3 - Developing 4 - Expanding 5 - Bridging 6 - Reaching
Number of segments: ______Additional Services: EIP SpEd Speech Gifted Other: ______
ACCESS Date: ______Tier: ____ Overall (Composite) Proficiency Level: ______
Scores: Listening _____ Speaking ______Reading ______Writing ______Literacy ______
Other Assessments: ______Date: ______Score: ______
(such as Milestones, ______Date: ______Score: ______
EOCT, GHSGT, ______Date: ______Score: ______
ITBS, HCLI, etc.) ______Date: ______Score: ______
LAC: Yes ______No ______Date: ______
Placement for next school year: ESOL Program Waiver Monitored (EL-M)
Notes:
School Year ______Grade ___ School ______ESOL Teacher ______
ESOL Services: Pull Out Push In Scheduled Class Period Waived Consultative
ESOL Level: 1 - Entering 2 - Emerging 3 - Developing 4 - Expanding 5 - Bridging 6 - Reaching
Number of segments: ______Additional Services: EIP SpEd Speech Gifted Other: ______
ACCESS Date: ______Tier: ____ Overall (Composite) Proficiency Level: ______
Scores: Listening _____ Speaking ______Reading ______Writing ______Literacy ______
Other Assessments: ______Date: ______Score: ______
(such as Milestones, ______Date: ______Score: ______
EOCT, GHSGT, ______Date: ______Score: ______
ITBS, HCLI, etc.) ______Date: ______Score: ______
LAC: Yes ______No ______Date: ______
Placement for next school year: ESOL Program Waiver Monitored (EL-M)
Notes:
School Year ______Grade ___ School ______ESOL Teacher ______
ESOL Services: Pull Out Push In Scheduled Class Period Waived Consultative
ESOL Level: 1 - Entering 2 - Emerging 3 - Developing 4 - Expanding 5 - Bridging 6 - Reaching
Number of segments: ______Additional Services: EIP SpEd Speech Gifted Other: ______
ACCESS Date: ______Tier: ____ Overall (Composite) Proficiency Level: ______
Scores: Listening _____ Speaking ______Reading ______Writing ______Literacy ______
Other Assessments: ______Date: ______Score: ______
(such as Milestones, ______Date: ______Score: ______
EOCT, GHSGT, ______Date: ______Score: ______
ITBS, HCLI, etc.) ______Date: ______Score: ______
LAC: Yes ______No ______Date: ______
Placement for next school year: ESOL Program Waiver Monitored (EL-M)
Notes:
School Year ______Grade ___ School ______ESOL Teacher ______
ESOL Services: Pull Out Push In Scheduled Class Period Waived Consultative
ESOL Level: 1 - Entering 2 - Emerging 3 - Developing 4 - Expanding 5 - Bridging 6 - Reaching
Number of segments: ______Additional Services: EIP SpEd Speech Gifted Other: ______
ACCESS Date: ______Tier: ____ Overall (Composite) Proficiency Level: ______
Scores: Listening _____ Speaking ______Reading ______Writing ______Literacy ______
Other Assessments: ______Date: ______Score: ______
(such as Milestones, ______Date: ______Score: ______
EOCT, GHSGT, ______Date: ______Score: ______
ITBS, HCLI, etc.) ______Date: ______Score: ______
LAC: Yes ______No ______Date: ______
Placement for next school year: ESOL Program Waiver Monitored (EL-M)
Notes:
School Year ______Grade ___ School ______ESOL Teacher ______
ESOL Services: Pull Out Push In Scheduled Class Period Waived Consultative
ESOL Level: 1 - Entering 2 - Emerging 3 - Developing 4 - Expanding 5 - Bridging 6 - Reaching
Number of segments: ______Additional Services: EIP SpEd Speech Gifted Other: ______
ACCESS Date: ______Tier: ____ Overall (Composite) Proficiency Level: ______
Scores: Listening _____ Speaking ______Reading ______Writing ______Literacy ______
Other Assessments: ______Date: ______Score: ______
(such as Milestones, ______Date: ______Score: ______
EOCT, GHSGT, ______Date: ______Score: ______
ITBS, HCLI, etc.) ______Date: ______Score: ______
LAC: Yes ______No ______Date: ______
Placement for next school year: ESOL Program Waiver Monitored (EL-M)
Notes:
School Year ______Grade ___ School ______ESOL Teacher ______
ESOL Services: Pull Out Push In Scheduled Class Period Waived Consultative
ESOL Level: 1 - Entering 2 - Emerging 3 - Developing 4 - Expanding 5 - Bridging 6 - Reaching
Number of segments: ______Additional Services: EIP SpEd Speech Gifted Other: ______
ACCESS Date: ______Tier: ____ Overall (Composite) Proficiency Level: ______
Scores: Listening _____ Speaking ______Reading ______Writing ______Literacy ______
Other Assessments: ______Date: ______Score: ______
(such as Milestones, ______Date: ______Score: ______
EOCT, GHSGT, ______Date: ______Score: ______
ITBS, HCLI, etc.) ______Date: ______Score: ______
LAC: Yes ______No ______Date: ______
Placement for next school year: ESOL Program Waiver Monitored (EL-M)
Notes:

Program Exit and Monitoring

ESOL Exit Date: ______
ESOL Exit Reason: Proficient LACed Out
1st Year Monitoring: School Year ______Grade _____ School ______Contact ______
2nd Year Monitoring: School Year ______Grade _____ School ______Contact ______

Revised 10/15/2018