WVABE Intake InformationStudent Name:
PERSONAL DATA / EMPLOYMENT STATUS
Age:Educational Level: / Employed (Unsubsidized) Full-timePart-time
Marital Status: / Occupation/Employer:
Native Country/Language: / Unemployed:Looking for unsubsidized work
# of Children:Ages: / Not in Labor Force: RetiredSubsidized employment
Homemaker Volunteer
BARRIERS / LEARNING STYLES
SPECIAL NEEDS / PERSONAL GOALS/CAREER INTERESTS
Observable Physical Disabilities:
Vision:Hearing:
Other Health Problems/Medications:
Learning Difficulties: / SUPPORT SERVICES/REFERRALS NEEDED/MADE
As a result of screening, should a referral be made? YesNo
As a result of screening, should class modifications be made? Yes No
POTENTIAL TESTING ACCOMMODATIONS NEEDED
(Put an asterisk * to indicate those that are verified by documentation)
STRICTLY CONFIDENTIAL INFORMATION PLACED IN CONFIDENTIAL FILE
Learning Needs ScreeningReferral
CorrespondenceDocumentation of Disabilities
Other

ASSESSMENT RECORD FOR ACADEMIC STUDENT: Mark with asterisk * the score to be entered in AEMIS. Should student have an ABE or an ESL FFL in AEMIS?____

Date / # Contact Hrs. on Test Date / Exception?
Y/N
See Below / Assessment / Test Title / Level
(Indicate ONE) / Test Form /
Subject
/
Raw Score
/
Scale Score or GLE
/ FFL
Entry
Pre-Assessment / __ __ / __ __ / ______/ TABE
CASAS
ESL / CASAS
BEST
BEST Plus
WorkKeys / L E M D A
LIT A B C D CIT None / Math
__ __ / __ __ / ______/ L E M D A
LIT A B C D CIT None / Reading
__ __ / __ __ / ______/ L E M D A
LIT A B C D CIT None / Language
__ __ / __ __ / ______/ L E M D A
LIT A B C D CIT None / Listening/Speaking
Interim
Post-Assessment / __ __ / __ __ / ______/ TABE
CASAS
ESL / CASAS
BEST
BEST Plus
WorkKeys / L E M D A
LIT A B C D CIT None / Math
__ __ / __ __ / ______/ L E M D A
LIT A B C D CIT None / Reading
__ __ / __ __ / ______/ L E M D A
LIT A B C D CIT None / Language
__ __ / __ __ / ______/ L E M D A
LIT A B C D CIT None / Listening/Speaking
Exit
Post-Assessment / __ __ / __ __ / ______/ TABE
CASAS
ESL / CASAS
BEST
BEST Plus
WorkKeys / L E M D A
LIT A B C D CIT None / Math
__ __ / __ __ / ______/ L E M D A
LIT A B C D CIT None / Reading
__ __ / __ __ / ______/ L E M D A
LIT A B C D CIT None / Language
__ __ / __ __ / ______/ L E M D A
LIT A B C D CIT None / Listening/Speaking

Waiver: Indicate if an exception was made to the established pre-/post-testing timeframes stated in the NRS Publisher’s Assessment Guidelines.

I certify that the student met ALL THREE of the following conditions:

The student completed a minimum of 30 contact hours between assessments.

The student demonstrated in classroom assessments (e.g. OPT, PLATO, KeyTrain, IGOs Benchmarks, etc.) that he or she had completed an FFL and was ready to be post-tested.

The student was recommended for post-assessment by his/her instructor.

In addition, AT LEAST ONE of the following exception(s) were also true (select all that apply):

The student’s goal was to study and improve in only one skill area and was only pre- and post-tested in that skill area:

This was a part-time or short-term course (up to 65 contact hours total for the course) that involved study outside of class hours, and the post-test (interim or exit) was given at the end of the course. Special course:

This was an intensive course that met more than 15 hours per week (e.g. SPOKES, HTGR, etc.), and the post-test (interim or exit) was given at the end of an instructional period. Special course:

The student had an entry level of FFL #5 or FFL #6, and had one or more of the following core goals (please indicate):

Enter EmploymentRetain EmploymentObtain GEDEnter Post-secondary Education or Training.

The student was leaving the program before the scheduled post-test time due to the following circumstances:

The instructor believed the initial assessment (and placement) was inaccurate.

ASSESSMENT FOR SPECIAL STUDENTS

OPT / Date / Test Form / Reading / Writing / Math / Science / Social Studies / Total
__ __ / __ __ / ______
__ __ / __ __ / ______
Date /
SPOKES Module
/
Pre-Test Score
/
Percent
/ Contact Hrs. on Post-Test Date / Date /
Post-Test Score
/
Percent
/ Pass?
Work-based Project
Assessment / __ __ / __ __ / ______/ __ __ / __ __ / ______
__ __ / __ __ / ______/ __ __ / __ __ / ______
__ __ / __ __ / ______/ __ __ / __ __ / ______
__ __ / __ __ / ______/ __ __ / __ __ / ______
__ __ / __ __ / ______/ __ __ / __ __ / ______
Computer Literacy / Date /
Computer Literacy Checklist
/
Pre-Test Level
/ Contact Hrs. on Post-Test Date / Date /
Post-Test Level
/ Improved?
__ __ / __ __ / ______/ __ __ / __ __ / ______
__ __ / __ __ / ______/ __ __ / __ __ / ______

PROGRAM GOALS: Indicate how goals changed (or might change) after interim assessment.

Entry
Date / Interim Date / Entry
Date / Interim
Date
Improve basic literacy skills / Complete vocational/assessment testing
Pass the GED / Complete OPT (Official GED Practice Tests) ONLY
Enter post-secondary education or job training / Complete College Preparation Activity
Complete Career Exploration Activity
Obtain a job (unsubsidized) / Complete a short-term (12-30 hrs.) work-based project
Retain current job (unsubsidized) / Complete WVABE computer literacy program
Improve English language skills (non-native speaker) / Become a US Citizen
Prepare for the TOEFL (non-native speaker)
Increase involvement in child’s education / Increase involvement in community activities
Complete other personal goal, specify: / Register to vote or vote for first time

PLAN OF STUDY

Program Goals / WVABE SkillsChecklist:
Specify FFL / Short-Term (12-30 hrs.) Work-based Projects(SPOKES Topic Areas) / Instructional Resources
Improve basic literacy skills
Improve English skills (non-native students)
Pass the GED
Enter post-secondary education or job training
Complete a College Preparation Activity
Obtain a job (unsubsidized)
Retain current job
Complete Career Exploration Activity
Increase involvement in child’s education
Increase involvement in child’s literacy activities
Improve citizenship skills
Increase involvement in community activities
Complete WV ABE computer literacy program
Complete a short-term (12-30 hrs.) work-based project
Complete OPT (Official GED Practice Tests) ONLY
Complete GED Orientation
Complete vocational/ assessment testing
Complete a personal goal
Register to vote or vote for first time / ABE Skills:
Reading:
Writing/ Composition:
Math: / Personal Development:
Self-Esteem
Goal Setting
Time Management
Money Management / Teaching Strategies for student learning style(s):
Small group instruction
Large group instruction
Independent study / One-on-one
Collaborative learning
Computer-assisted
ESL Skills:
Oral Communication:
Reading/Writing: / Employability Skills:
Communication with the Public
Decision Making/Coping with Change
Problem Solving
Stress & Health / Texts:
Literacy & Basic Level / Pre-GED level / GED &College Prep Level
GED Skills:
Lang Arts Reading:
Lang Arts Writing:
Mathematics:
Science:
Social Studies: / Workplace Knowledge:
The 21st Century Company
Workplace Ethics
Workplace Professionalism and Diversity
Rights and Responsibilities / Learning Express Library at WVInfodepot.org:
Computer Skills
Workplace Skills Improvement
Occupation Practice Tests
Job and Career Accelerator / GED Preparation
College Preparation
US Citizenship
Ready to Work:
Maintaining Balance In Life and Work
Working Productively
Preparing for & Taking Employment Tests
Employment Portfolio / WIN Units:
Applied Mathematics
Locating Information
Reading for Information
Writing/Business Writing / Applied Technology
Listening
Observation
Teamwork
Work Habits / ESL Online:
Rosetta Stone
USA Learns
Computer Literacy Skills / Daily Activities:
Job Readiness
Computer Applications—Word, Excel, PowerPoint or equivalent applications
Email
Internet / GCFLearnFree.org:
Careers
Job Development
Everyday Life
Computers
Internet Basics / CFWV.com:
Career Planning
Off to Work/Get a Job
College Planning
Financial Aid Planning / Test Prep Online:
4Tests.com:
TestPrepPractice.net
March2success.com
Personal Goals and
Objectives: / Electives:
Listening for Understanding
Dealing with Difficult Situations
Writing in the Workplace
Personal Accountability
Substance Abuse
Disaster Preparedness
Personality Choice for Employment and Self Discovery
Core Abilities
Parenting / SPOKES Customer Service Units:
Why Customer Service Matters
What Customers Want
Essential Customer Service Skills, Part I
Essential Customer Service Skills, Part II
Handling Complaints & Dealing with Angry People
Customer Service as Strategic Marketing Tool
Customer Service Teams / Computer Lit:
This is the “On Button” Curriculum
Inpics.net tutorials
baycongroup.com tutorials
Jegsworks.com
spclc.org/curricula/computer
PLATO Pathways:
GED Learning Path
FastTrack to GED
CASAS Levels / Math FFL
Reading FFL
Writing FFL / Accuplacer
Compass
CTLC LPN / ACT
SAT

STUDENT ACHIEVEMENTS

Select One: Student Withdrew Withdrawal Date: __ __/__ __/______Student is continuing into the next Program Year (PY)

Check all achievements accomplished and documented as a result of the student’s participation in ABE.

Educational
Increased at least .5 grade level, 3 points on CASAS Scale, Or 1 SPL In any assessment area
Increased at least one level in a learning management system in any assessment area (e.g., WIN, PLATO, etc.)
Completed entire vocational / assessment battery / test (i.e., LPN, TABE, CASAS, ACT, Work Keys)
Completed OPT (GED Official Practice Test)
Passed all Parts of the OPT (GED Official Practice Test)
Completed GED Orientation
Passed 1-4 of the GED Tests
Completed a Career Exploration Activity
Completed a College Preparation Activity
Obtained Computer-based Testing (CBT) Skills
Other (Specify),______/ Employment-Related
Obtained a better job or job promotion
Obtained / retained subsidized job
Earned a Ready To Work Certificate
Completed a worksite learning experience
Completed an approved job readiness program (i.e. SPOKES, Hit The Ground Running, LINKS)
Passed an employment or state licensing exam
Entered the military
Earned a Governor’s Career Readiness Certificate
Earned a Customer Service Certificate (i.e. SPOKES)
Earned a Customer Service II Certificate (i.e. SPOKES)
Earned an Achievement Certificate (i.e. SPOKES)
Earned a Microsoft Office Certificate (SPOKES Only)
Earned IC3 Certification (Must achieve all 3 credentials, SPOKES Only)
Earned IC3 Achievement Credential (Must achieve all 3 credentials, SPOKES Only)
Earned an Certificate
Earned an Achievement Certificate (Select all that apply, SPOKES Only)
Computing FundamentalsLiving Online Key Applications Community
Other (specify),______
Further Education/Training
Met requirements for entrance into technical training
Met score requirements on entrance exam for college
Enrolled in WV college/ university, specify: ______
Enrolled in out-of-state post-secondary/ job training, specify: ______
Enrolled in private/ local training outside of WV’s public school vocational system
Enrolled in online post-secondary or CTE training, specify: ______
Enrolled in local CTE program
Other (Specify),______
Personal Goal
Obtained Computer Skills
Other Goal, Check One:
Educational Employment related Further ed/Training
Personal Goal Family Community
Family--Increased Involvement In Children’s Education
Helped children more frequently with school
Increased contact with children’s instructor
Increased involvement in children’s school activities / Family--Increased Involvement In Children’s Literacy Activities
Read to children more frequently
Visited library more frequently
Purchased books or magazines for children
Other (Specify),______
Work-Based Project
Completed all project objectives
Completed objectives for a WVABE Computer Literacy program / Community
Increased involvement in community activities
Voted or registered to vote for first time
Passed state-approved test of citizenship skills
Became a US citizen
Volunteered for community service
Institutional Education Only
Cognitive SkillsABE/GED
CTECollege 101