THE SCHOOL DISTRICT OF PALM BEACH COUNTY As _Elementary School Special Session Registration re of Pa .ame Scho Special Session School Assignment Student's Date of Birth igh Risk Medical Information 1-9 0179 Legal Information on Reco : no yes (Call home school.) Student is on free lunch reduced lunch SPECIAL PROGRAM ASSIGNMENT (Check services needed.) ESOL Intensive ESOL Support ESE (Program) Other TRANSPORTATION Needed: no Z_ yes regular ESE lift) SAC# /O6 C) Special Session Bus # RECOMMENDATION FOR SPECIAL SESSION (Check all that apply.) Students in grades K-5 who are in ESOL (LEP students), Dropout Prevention, and those in ESE whose IEP includes a recommendation for Special Session. _11 Students in grades K-twho receive recommendation from the principal may attend for remediatIon purposes only. Students in grades 2-5 who received a score in quartile 1 in the reading comprehension and/or mathematics concepts and applications on the most recent norm-referenced test Students In grades 2-5 who received a score in quartile 2 in the reading comprehension and/or mathematics concepts and applications on the most recent norm-referenced test along with the recommendation of the principal. ftwi Students retained in their current grade level may be eligible for promo' lion of Special Sessign. 4k, 5gnalure of Teacher I Dal 4 Signal rk, of Pnnopal / Date rer—Sc PAFIENT/GUARDIAN NOTIFICATION 10 Yes, my child will attend the Special Session (summer school). The information on address and telephone numbers is correct or I have noted changes on my copy of the registration form. 17] No; my child will not attend the Special Session 1stimmer school). s Signature o are / Guardtan - 91/Date Attachments to the registration form sent to the Special Session school: Parent/guardian copy - signed registration form Copy of completed ESE IEP, If appropriate Other information To be completed at the conclusion qSpecial Session: STUDENT ATTENDANCE RECORD: P& Days Present 0 Days Absent Tea 9r commes: dieldC)74e Zlefil MLa-t I 4 -e- 7 s' Signature of Spada Session Strati,/ / Date PEW 0673 FY 95 Reyisio WhitalSpecial Sudan Sohoor&4 H eila4ecwI Moms SthoogOffico 0 Days Tardy PLACEMENT DECISION Made !Wowing Special Session er Promoted 0 Administrative Placement 0 Retained /4.7 / S)-34- sr Signature of Home SHwol Principal / Date Pinkfrransportatioa GokliParentlGuardian then Name Sdmol CONFIDENTIAL MM08-V ZALIS-000032 3501:725-020 Page I of I EFTA 00075168 EFTA01248871