THE SCHOOL DISTRICT OF PALM BEACH COUNTY
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THE SCHOOL DISTRICT OF PALM BEACH COUNTY
Elementary Student Transfer
To Be Completed for All Transfers (Print or Type)
Psychological on file Yes Li No
Physical Exam on file Yes No Cl Date Sifq)q 3
Immunization Dates: ..54*DPT g'1410 MMRa -shq/93
Health Problems/High Risk Yes U Copy of form attached Yes O N/A EL.
N/A
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REGULAR INSTRUCTION PROGRAM INFORMATION Copp of Report Card Method
Teacher Name(s).
A 09. i)-itt rename 4
Instructional Materials (indicated level)
GRADE KG 1 2 3 5 PAGE
Mathematics KG 1 2 3 rtiC. 5
Macmillan O Level Level Level Level LeveUeyfi l9 Level
fiedfA ,,,
Reading FOCUS O / I i i Teter . L. r iceekSu-5r4
r 9 .0- r i-% I.-
Other ei / 8,14 Maid; e
Student meeting Pupil Progression Standards Yes No O /Student currently repeating grade ... Yes O
Pupil Progression Letter sent Yes O No Wei, School Patrol Yes O
Letter signed Yes O No Ore Workbooks sent with student Yes O
ILS Disk Yes O No OW
SPECIAL INSTRUCTIONAL PROGRAM INFORMATION student is in special Program (drcle)
Migrant Current-. Date
504 Staffing/Testing in Progress EH LAD Speech Alt. Ed.
EMH SEH SOI ESOL
Gifted SLD VE Chapter 1
OBLIGATIONS FULFILLED
Textbooks returned Yes CV No O Library books etumed ....Yes No O
TIAGEstsOcnc'Eg.
PEW 0938 (REV 8/99) alAtAvilh sluded vaLOwisen ng school office Other (name program) No a. No IL
No
N/A ta,
ITCCAnd7e)(1 198
PiNKtcumdative folder
CONFIDENTIAL MMUS-M LIL.A I A-UU0U /0
3501.135-025
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EFTA_00066395
EFTA01246761