CLD Student Information Summary
Student: Eugenio Manzana___DOB: 6/12/2001___ Date:_April 23, 2009
School:____Eugene Elementary______Current Grade:___2__
Person making request:___General Education Teacher______
IIPM team:_Gen Ed. teacher SPED teacher, Title I coordinator, ELL teacher, School Psych, SLP, Principal.______
Language(s) student speaks other than English:___Spanish______
Language(s) student speaks with parent/guardian:___Spanish & English__
Siblings/friends:_Spanish & English______
Parent Interview/Developmental History conducted YN
(please attach collected info/form)
Need interpreter? Y N (if yes contact ELL office)
Current ELL status: in ELD program_X_ year exited______
Number of years in ELD Program: ____3___years
Current frequency/duration in ELD Program:______30 minutes 4/week
Area(s) of concern (check boxes)
Reading
___Basic Reading Skills _X_Reading Fluency ___Reading Comprehension
Mathematics
___ Application ___Calculation
Communication
___Receptive Language ___Expressive Language
Written language
Social Skills
Behavior
Health
Motor Skills
Specific areas of concern: ______
* Fill in this page as part of the information used for decision making between Tier I and Tier II
Educational Background
Year / Grade / School/District/Country / Days Present / Absences / Tardies06-07 / K / 4J / 181 / 2 / 1
07-08 / 1 / 4J / 176 / 7 / 2
08-09 / 2 / 4J / 2 / 3
Has the student repeated any grades?_no__
Stipulate language of instruction if other than English?__possible pre-school in Mexico_
Previous concerns as indicated in student file (i.e., behavioral, academic):
No class participation, attention, is shy, looks the other way when teachers speak to him.__
______
Has the student ever received services from any of the following programs:
Title 1 Reading: YN Date:__K-2Title 1 Math:YNDate______
ELD/ELL: YN Date:_K-2_Counseling:YNDate______
Speech/Language:YN Date_____Phys/Occ. Therapy: Y N Date______
Other______
English Language Proficiency Data
Information found in cum and ESIS/Data Warehouse (if not, please call ELL office)
1. Home Language Survey (please attach)
2. Woodcock Muñoz/Language Proficiency Intake Assessment (list newest to oldest):
2a) Date: _9/06___Broad: _1__, Oral: _2__, Reading & Writing: _1_, RPI_3/90_
2b) Date: _____Broad: ___, Oral: ___, Reading & Writing: ____ RPI____
3. ELPA/English Language Proficiency Assessment Test (list newest to oldest):
3a) Date:__4/07_ Composite:__1__ Reading:__1__ Writing:__1___
Listening__1 Speaking:_1__ Comprehension:___1__
3b) Date:_4/08__ Composite:__2_ Reading:__1_ Writing:__1__ Listening__2_
Speaking:_2__ Comprehension:___1__
3c) Date:_4/09_ Composite:_2__ Reading:__1__ Writing:__2__ Listening_3__
Speaking:_2__ Comprehension:___2___
*descriptors of Woodcock-Muñoz and ELPA can be found on the 4j website
Additional Language Tests:
--Bilingual Verbal Abilities Test (BVAT-Language Dominance)
Date:_____ Comments:______
--Spanish Woodcock-Muñoz
Date:_____Comments:______
Data Warehouse Information
Other assessment/intervention information attached
Dibels/ EASYCBM
OAKS
Curriculum Based Assessments (attach summary grid)
ELD Unit Assessments (Avenues)Reading Unit Assessments
- Houghton-Mifflin
- McMillan-McGraw Hill
- Open Court
TIER I
Program used:____Houghton Mifflin______
Frequency/Duration:___60 minutes__5/week______
Service provided in:_____Gen. Ed. Whole Group______
TIER II
Program used:_____Houghton Mifflin_- Leveled Reader______
Frequency/Duration: __30 minutes 5/week___
Service provided in:____Gen. Ed – Small Group______
TIER III
Program used:______Reading Mastery______
Avenues______
Frequency/Duration: __40 minutes 2/week______
30 minutes 4/week______
Service provided in:____Double Dose 1:1______
__ELL Classroom______
Eugene School District 4j
May 2009