LAU EXIT RECORD FORM

ESOL Program

Check one only. This form is being filled out:ELL/LEP Entry Date: ______

1. ______to initiate exiting process.

2. ______to document a previous program exit which was not documented.

3. ______to review former ELL student's progress only.

I. STUDENT INFORMATION

Student's Name ______APSCN ID# ______

School ______Grade______Age ______DOB ______Gender M F

Parent/Guardian Name(s)______

Address ______Zip ______

II. RATIONALE FOR PLACEMENT

Check as appropriate: Student must demonstrate English proficiency through ALL THREE areas of English Language

Proficiency Assessment, Academic AchievementTesting, and Classroom Performance to be classified as FEP

  1. _____English Language Proficiency Assessment (student must meet criteria on all 5areas listed):

a._____Proficient in listening on ELPA (ELDA = 5)

b._____Proficient in speaking on ELPA (ELDA = 5)

c._____Proficient in reading on ELPA(ELDA = 5)

d._____Proficient in writing on ELPA (ELDA = 5)

e._____Comprehensionon ELPA (ELDA = 5)

Test Form: ______Test Date: ______

Speaking (Raw Score/Level): _____/______Listening (Raw Score/Level): ______/______

Reading (Raw Score/Level): ______/______Writing (Raw Score/Level): ______/_____

Comprehension (Raw Score/Level): _____/_____

  1. _____Classroom Performance:

_____Grades of C or above (or “3” or above on standards based report card) in English Language Arts, Mathematics, Science, Social Studies without accommodations (attach copy of report card).

  1. _____Academic Achievement Testing (IfLEPaccommodations were used, proceed with caution; at least one score must be available; use most recent score):

a._____Proficient or Advanced on standard (not portfolio) state literacy assessment

Test Name: ______Test Date: ______Performance level: ______

b._____Proficient or Advanced on standard (not portfolio) state mathematics assessment

Test Name: ______Test Date: ______Performance level: ______

c._____Norm Referenced Achievement Test Scores at the 40%ile or above in total reading and total language

Test Name: ______Test Date: ______Reading %ile: ______Language %ile: ______

III. LPAC RECOMMENDATIONFEP status can be recommended only when LPAC can ensure that studentcan perform regular class work in English without compensatory assistance and all three areas documented above meet exit criteria.

CIRCLE RECOMMENDED STATUS EL______(*)FEP1/M1FEP2/M2FEP______ELL/LEP Exit Date ______

(*) If EL is selected, LEP testing accommodations must be documented using LPAC Accommodations Form.

LPAC MEMBERS' SIGNATURES (All required) / POSITION
1. / Administrator
2. / ESOL Teacher/Specialist
3. / Mainstream Teacher
4. / Counselor
(Gr. 6-12)

eSchool Updated by: ______Date: ______

Yellow Copy - Student's cumulative fileLau Exit form (rev.8.27.15)White Original - ESOL Office