Student Profile Form
Tier I (Used at Tier 1b)
Student Grade Date
School Teacher
Name of Parent/Guardian
A. School History
Grade(s) retained: ______
Grades attended in current school system: ______
Number of schools previously attended: ______n/a
If a recent enrollee, amount of time in current school setting: ______n/a
B. Discipline History
For the current school year, does student have more than two office discipline referrals?
Yes No If yes, reason(s) for referrals:
For the previous school year, does student have more than two office discipline referrals?
Yes No If yes, reason(s) for referrals:
C. Current Program Placement
General Education
General Education with Accommodations
Behavior Intervention Plan
Section 504 Plan
Title I: Math Lang. Arts/Reading
Bilingual/ELL: Spanish Other:
Tutoring
Other:
D. Language
Based on New Mexico Access for ELLs (ACCESS) and/or other approved language proficiency assessment, language proficiency has been determined to be:
BilingualEnglishSpanishOther:
E. Attendance
Are school absences a factor: Yes No If yes, most frequent reason(s) for absences:
Attendance history:
History of excellent attendance Unremarkable attendance history
History of numerous excused absences
Accumulated five or more unexcused absences (In Need of Early Intervention)
If yes, has the district developed a corrective action plan in accordance with NMAC-B(5)(b) 6.10.8.8 Yes No
Accumulated the equivalent of ten or more unexcused absences within the school year
(Habitually Truant) If the student is habitually truant, has the district followed procedures outlined in NMAC-B(5)(e-g). Yes No
Describe.
F. Documents Attached or Available for Teacher and Principal Review
The following documents have been gathered and are attached or available for teacher and principal review during Teacher and Principal Conference:
Student’s cumulative record
Student’s attendance record
NM Standards-Based Assessments (NMSBA)
Student observations (if any)
Short cycle assessments
Curriculum-based measures
Progress report(s)
Office discipline referral(s)
Vision screening and referral form
Hearing screening and referral form
Home language survey
Language proficiency assessment (NM ACCESS for ELLs)or other approved language proficiency assessment), if applicable n/a
Written communication between home and school
Other: