School Board of Levy County - Exceptional Student Education

Joyce Bullock Elementary -to-Williston Elementary Transition Registration

(Second Grade Students)

Affix Label if Available

Student Name: ______Date of Birth: ______
Student Number: ______
Parent’s Name: ______Phone Number (Daytime): ______
Home Address: ______Phone Number (Evening): ______
Sending School: Joyce Bullock Elementary School

Current ESE Teacher: ______Receiving School: Williston Elementary School

Current IEP Information

Current IEP Date: ______
Disability (ies): ______
ESE Services on IEP: ______
______
Related Services on IEP: ______
______
Supplemental Services on IEP: ______/ Agency Involvement: c Yes c No
If so, please list: ______
______
FBA Completed: c Yes c No c Partial
BIP Written: c Yes c No Date: ______
Self-Contained Program: c Academics c Behavior
Matrix Rating: ______
Last Reevaluation Date: ______

Academics

Please attach printouts of Grade History, Discipline, and Attendance prior to meeting with the receiving school. Sending school completes Current Placement and Current Performance sections prior to meeting with the receiving school.

S = Satisfactory Levels of Achievement N = Needs Support and Modification

Current
Placement / Language Arts/ Reading
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c / Mathematics
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c / Social Studies
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c / Science
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c / Social Personal Skills
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c
Current
Perform-ance / Decoding S N
Comprehension S N
Writing S N
Curriculum Used
Curriculum Level
Assessment Used ____
Score ______/ Computation S N
Problem Solving S N
Curriculum Used
Curriculum Level
Assessment Used ____
Score ______/ Strengths
Needs
Assessment Used ____
Score ______/ Strengths
Needs
Assessment Used ____
Score ______/ Compliance S N
Self-control S N
Social Interaction S N
Self-Expression S N
Special Needs:
Uses Organizational Skills: Yes c Sometimes c No c
Receiving School Notes (complete at conference):
IEP Committee
Decision for
Next Year / Basic c
ESE c / Basic c
ESE c / Basic c
ESE c / Basic c
ESE c / Basic c
ESE c

Sending Teacher Signature: ______Date: ______

Receiving Teacher Signature: ______Date: ______


School Board of Levy County - Exceptional Student Education

Elementary to Middle School Transition Registration

(Fifth Grade Students)

Affix Label if Available

Student Name: ______Date of Birth: ______
Student Number: ______

Current ESE Teacher: ______Receiving Middle School: ______

Current IEP Information

Agency Involvement: c Yes c No If so, please list: ______
FBA Completed: c Yes c No c Partial BIP Written: c Yes c No Review Date: ______
Self-Contained Program: c Academics c Behavior
Matrix Rating: ______Last Reevaluation Date: ______Assessment Type ______

Does the Student Use Assistive Technology? Yes No Previous Year FCAT Scores: _____ Math ______Reading ______Writing

Academics

Please attach printouts of Grade History, Discipline, and Attendance prior to meeting with the receiving middle school. Sending school completes Current Placement and Current Performance sections prior to meeting with the receiving middle school.

S = Satisfactory Levels of Achievement N = Needs Support and Modification

Current
Placement / Language Arts/Reading
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c / Mathematics
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c / Social Studies
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c / Science
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c / Social Personal Skills
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c
Current
Perform-ance / Decoding S N
Comprehension S N
Writing S N
Curriculum Used
Curriculum Level
LIA I ______
II ______
III ______/ Computation S N
Problem Solving S N
Curriculum Used
Curriculum Level
LIA I ______
II ______
III ______/ Strengths
Needs
Assessment Used_____
Score ______/ Strengths
Needs
LIA I ______
II ______
III ______/ Compliance S N
Self-control S N
Social Interaction S N
Self-Expression S N
IEP Committee
Decision for
Next Year / Gen Ed c
ESE
Access Pts.c / Gen Ed c
ESE
Access Pts.c / Gen Ed c
ESE
Access Pts.c / Gen Ed c
ESE
Access Pts.c / Gen Ed c
ESE
Access Pts.c
Special Needs:
Uses Organizational Skills: Yes c Sometimes c No c

Sending Teacher Signature: ______Date: ______

Receiving Teacher Signature: ______Date: ______

Receiving School Notes (complete at conference):


School Board of Levy County - Exceptional Student Education

Middle to High School Transition Registration

(Eighth Grade Students)

Affix Label if Available

Student Name: ______Date of Birth: ______
Student Number: ______

Current ESE Teacher: ______Receiving High School: ______

Current IEP Information

Agency Involvement: c Yes c No If so, please list: ______
FBA Completed: c Yes c No c Partial BIP Written: c Yes c No Date: ______
Self-Contained Program: c Academics c Behavior
Matrix Rating: ______Last Reevaluation Date: ______

Does the Student Use Assistive Technology? ____Yes ____No

Academics

Please attach printouts of Grade History, EPEP Results, Discipline, and Attendance prior to meeting with the receiving high school. Sending school completes Current Placement and Current Performance sections prior to meeting with the receiving high school.

S = Satisfactory Levels of Achievement N = Needs Support and Modification

Current
Placement / Language Arts/Reading
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c / Mathematics
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c / Social Studies
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c / Science
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c / Social Personal Skills
Reg.Ed. c Consult c
ESE c CoTeach c
Support Facilitation c
Current
Perform-ance / Decoding S N
Comprehension S N
Writing S N
Curriculum Used
Curriculum Level
LIA III ______
FAIR ______/ Computation S N
Problem Solving S N
Curriculum Used
Curriculum Level
LIA III ______/ Strengths
Needs
Current Grade _ ____ / Strengths
Needs
Assessment Used ____
Score ______/ Compliance S N
Self-control S N
Social Interaction S N
Self-Expression S N
IEP Committee
Decision for
Next Year / Gen Ed c
ESE
Access Pts.c / Gen Ed c
ESE
Access Pts.c / Gen Ed c
ESE
Access Pts.c / Gen Ed c
ESE
Access Pts.c / Gen Ed c
ESE
Access Pts.c
Special Needs:
Uses Organizational Skills: Yes c Sometimes c No c
Diploma Option:
Standard Diploma c Standard Diploma w/Access Points (Please note: if applicable AND meets specific criteria) c
Please note: Parent/Guardian must give written consent for their child to receive instruction in the access points and to be administered the Florida Standards Alternate Assessment (FSAA) AND meet the state criteria which is part of the IEP process.

Sending Teacher Signature: ______Date: ______

Receiving Teacher Signature: ______Date: ______

Receiving School Notes (complete at conference):

School Board of Levy County 2/8/2016 revision Transition Registration Forms