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 / Tardies
06-07 / 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