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7/24/2019 Jcs Dell Handbook Revised May 2010
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ESL
(English as a Second Language )Handbook
May, 2010
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Table of Contents
ESL Staff List ...
Iowa Code.
Program Overview
Program Goals..
ESL Standards..
ESL Staff Responsibilities
Identification Procedures..
I-ELDA Proficiency Levels.
General ESL Program Guidelines
ESL Record Keeping & Parent Notification
Program Model..
Coordination of Curriculum.Parent Communication.
Transition and Exit Procedures
Assessments.
ELLs and Special Education.
Appendix:A-1: Suggested Accommodations.
A-2: ELL Student Progress Report...
A-3: Elementary ELL Communication ToolA-4: Secondary ELL Communication Tool..
A-5: ELL-Special Ed Service Checklist...
A-6: ESL Program Transitional and Exit Criteria Checklist
A-7: ELL/Special Education Student Exit Checklist...
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See ESL folder on the building server for a copy of GUIDELINES FOR THE INCLUSIONOF ENGLISH LANGUAGE LEARNERS (ELLs) IN K-12 ASSESSMENTS and Educating
Iowas English Language Learners: A Handbook for Administrators and Teachers.
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ESL Staff
Suzie Pearson
Merima Pasalic
Lisa Mueller
Cheryl Henkenius
Maureen Fry
Mary Haden
Joy Palmer
Linda Hansen
Melissa Grinstead
Brian Carico
Bruce Hukee
Emily Nymyer
Wallace Principal
Wallace ESL Teacher
Wallace & Timber Ridge ESL Teacher
Timber Ridge Principal
Timber Ridge ESL Teacher
Timber Ridge ESL Teacher
Wallace and Timber Ridge Dean of Students
Summit Principal
Summit and Middle School ESL Teacher
Middle School Principal
High School Principal
High School ESL Teacher
2010-2011 School Yea r
District Central Office Staff
Clay Guthmiller
Bruce Amendt
Debra Cale
District Superintendent
Director of Academic Services
Reading/Language Arts/ESL Coordinator
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English as a Second Language ProgramJohnston Community School District
Iowa Non-English Speaking Legislation:Chapter 280.4, Uniform School Requirement Iowa Code
This section of the Code requires that transitional bilingual education or English as a secondlanguage programs be provided for students whose primary (first) language is one other thanEnglish, until the student demonstrates a functional ability to understand, speak, read andwrite the English language.
Section 670.57 of the Department of Education Administrative Rules sets the standards forthese programs.
District Program Overview
The English as a Second Language Program (ESL) provides English Language Learners(ELL) with an opportunity to acquire proficiency in listening, speaking, reading and writingEnglish. The ESL Program promotes a positive learning environment in which eachstudents first language, culture and ethnic heritage is valued. The ESL teachers work withstudents whose first language is a language other than English and who qualify for ESLservices through a testing and referral process. There are specific strategies, methodologiesand curriculum used to help students acquire English.
Program Goals
1. To educate ELL students to the same standard of excellence as all students in theschool district.
2. To teach listening and reading English skills with an emphasis on comprehension inboth social and academic settings with emphasis on academic rich language.
3. To teach speaking and writing English skills with an emphasis on quality productionin both social and academic settings with emphasis on academic rich language.
4. To instill positive self-concepts and attitudes toward school in ELL students.5. To assist ELL students and their families in functioning and understanding within
their school and community.6. To promote pride in ELL students cultural and linguistic backgrounds.
English as a Second Language Standards
Standard 1: English language learners communicate for social, intercultural andinstructional purposes within the school setting.
Standard 2: English language learners communicate information, ideas, and conceptsnecessary for academic success in the area of language arts.
Standard 3: English language learners communicate information, ideas, and conceptsnecessary for academic success in the area of mathematics.
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Standard 4: English language learners communicate information, ideas, and conceptsnecessary for academic success in the area of science.
Standard 5: English language learners communicate information, ideas, and conceptsnecessary for academic success in the area of social studies.
The Johnston Community School District recognizes the following facts:
1. Language acquisition is an intellectual process; even the youngest learners do notsimply pick-up a language.
2. Language acquisition takes time. It can take six to nine years for an English LanguageLearner to achieve the same level of academic proficiency as a native English speaker.
3. Effective education for English Language Learners calls for comprehensive provisionof excellence in education based on the latest research, standards, and known bestpractices in the area of English as a Second Language.
ESL Staff Responsibilities
The ESL teachers, in communication with other school personnel, are responsible foridentification of English Language Learners (ELL).
Teachers will use the identification and placement processes outlined in this handbook. The ESL teachers will maintain student rosters for building and district administration. The ESL staff will be responsible to oversee the language acquisition process of the ELLs
and provide formal language instruction in speaking, listening, reading, and writing andcomprehension of the English language.
The ESL teachers will assist in determining if an ELL is entitled to other or additionalprograms and services. (i.e. Extended Learning Program, Special Education)
ESL staff will work with classroom and content area teachers to provide appropriateaccommodations, modifications, and differentiated instruction and assessment for ELLs.
The ESL and core classroom teacher will promote pride in all students cultural andlinguistic backgrounds.
The ESL and core classroom teacher will work together to involve families in theeducational process and the community.
A member of the administrative staff of the JCSD will be responsible for collecting andmaintaining student rosters for all buildings and grade levels. Administrative staff will
serve as I-ELDA coordinator for all grade levels.
Identification Procedures
Students who may need ESL services are identified by:1. Enrollment documentation of home language use.
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2. There is a Home Language Survey on file in the students native language (whenavailable) that indicates that the students first language is a language other thanEnglish.
Placement Procedures
Students will receive ESL services when: 1. There is an IPT assessment on file for the student that indicates eligibility.
2. Parents have been notified using the Notification of English Language ProgramPlacement form.
English Language Learner Composite Proficiency Levels From I-ELDA
Level 1 - Pre-functional indicates that the student is: Beginning to understand shortutterances. Beginning to use gestures and simple words to communicate. Beginning tounderstand simple printed material. Beginning to develop communication skills in writing.Level 2 Beginning indicates that the student can: Understand simple statements,statements, directions and questions. Use appropriate strategies to initiate and respond tosimple conversation. Understand the general message of basic reading passages. Composeshort informative passages on familiar topics.Level 3 Intermediate indicates that the student can: Understand speech delivered inschool and social settings. Communicate orally with some hesitation. Understanddescriptive material within familiar contexts and some complex narratives. Write simple textsand short reports.Level 4 Advanced Intermediate indicates that the student can: Identify some of themain ideas and relevant details of discussions or presentations on a wide range of topics.Actively engage in most communicative situations familiar to him or her. Understand thecontext of most text in academic areas with support. Write some multi-paragraph essays,
journal entries, personal/business letters, and creative texts in an organized fashion witherrors.Level 5- Advanced indicates that the student can: Identify many of the main ideas andrelevant details of discussions or presentation on a wide range of topics. Actively engage inmany communicative situations, familiar or unfamiliar. Understand the context of manytexts in academic areas with support. Write many multi-paragraph essays, journal entries,personal/ business letters, and creative texts in an organized fashion with some errors.Level 6 Full English Proficiency indicates that the student can: Understand and identifythe main ideas and relevant details of extended discussions or presentation on familiar andunfamiliar topics. Produce fluent and accurate language. Use reading strategies the same astheir English speaking peers to derive meaning from a wide range of both social andacademic texts. Write fluently using language structures, technical vocabulary, andappropriate writing conventions.
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General ESL Program Guidelines
1. All students admitted to the ESL Program will follow the identification and placement procedures outlined above . This will assure that the proper individuals have beenconsulted and that parents and teachers have been contacted.
2. Following the completion of identification and placement procedures, the ESL teacher,along with the classroom teacher, will determine the appropriate level of service for eachstudent.
3. ESL students in grades K-5 will be assigned to the school with the ESL Program Site.High School, Middle School and Summit students will be served in their buildings.
4. ESL instructional groupings will be determined based on the learning needs of thestudents being served.
5. Students in the ESL Program will be assessed annually using the I-ELDA data todetermine progress, future leveling and service.
6. ESL teachers will meet classroom teachers to discuss each students level of Englishacquisition using I-ELDA data, the Language Acquisition Chart: Guidelines forDifferentiating Instruction and Assessment and any other data or information needed.
ESL Record Keeping and Parent Notification
Every student in the ESL Program should have a record on file containing the following:A. Home Language SurveyB. Copy of IPTC. Parent Program Notification FormD. Program Refusal Waivers, if applicableE. Student Progress ReportF. I-ELDA results & other program assessments used to determine ESL statusG. Copies of Transition and/or Exit Notification Letters
ESL records should be kept on file by the ESL teacher in the ESL classroom. At the end ofeach school year or upon the students transfer to a different school, the records should bekept in a separate file folder and/or binder and put inside the students cumulative record.
Program Model
Elementary Programming: K-5 students will be served at ESL program sites. This willallow for the best use of resources, allow for grouping of ELL students with similar needs,provide additional time for instruction, and allow for a more interactive and engagingenvironment. Pullout The pullout model is typically used only for those students who are non-English
proficient. Students spend part of the school day in a core classroom, but are pulled outfor a portion of each day to receive instruction in English as a second language.
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Collaborative or Push-in: In the collaborative model the ESL teacher is pulled into thecore classroom where he/she provides instruction to whole classes and small groups usingmethods that reflect best practice for ELLs.
Secondary Programming: 6-12 students will be served at their building. ESL Class Period This model is generally used in secondary school settings. Students
receive ESL instruction during a regular class period and receive course credit. Theymay be grouped for instruction according to their level of English proficiency.
Coordination of Curriculum
Classroom and ESL teachers must collaborate and coordinate curriculum for all ELLs.This includes:
1. Intentional and periodic communication and collaboration between ESL andclassroom teachers.
2. Collectively determine appropriate academic materials.3. Provide support in differentiation.4. Share strategies and adoption of materials.5. Sharing of materials.6. General education teachers provide curriculum materials and assessments to ELL
ahead of time for proactive measures.7. Provide opportunities for pre and/or re-teach.8. Support motivation and engagement issues.9. Use and communicate student progress reports, achievement documentation and
performance assessments to indicate student progress.
Parent Communication
All information is to be provided in a language that the parent understands, to the extentpracticable (See 3302[c]). To meet this requirement, the Iowa No Child Left Behind ParentCommunication Center (formerly the Iowa Translation Library) is available as an on-lineresource at http://www.transact.com to provide necessary documents in 23 languages.
Furthermore, parents are to be given information regarding how they can: Be involved with their childs education (Sec. 3302[e][1][A]) Help their children to learn English, achieve academically, and meet the academic
content and achievement standards expected of all students (Sec. 3302[e][1][B])
It is recommended that this outreach be carried out through regular meetings, which parentsare to be informed of. During these meetings, parent questions, concerns, and
recommendations can be addressed. (Section 3302[e][2]) For a comprehensive list of parentcommunications required under NCLB in addition to those mandated by Title III, visitwww.transact.com .
Johnston Community School District will notify students parents of: The reason for placement in a program for English Language Learners. The students level of language proficiency, the assessment used to determine
proficiency, and their level of academic achievement. The method of instruction used in the childs educational program.
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How the program will meet the needs and build on the academic strengths of thechild.
How the program will go about teaching the child English and preparing him/her tomeet academic standards for promotion and graduation.
Exit requirements for the program. Information regarding parental rights.
Transition and Exit Procedures for the ESL Program
The Johnston Community School Districts English as a Second Language program willwork to transition and exit students from the program who meet the following criteria:(see Appendix 5 for exit sheet)
Checklist for Transition of ELLs A composite score of a 5 or 6 on the Iowa English Language Development
Assessment (I-ELDA) Student is at or near the expected reading level Recommendations of ESL teacher classroom teachers At or near proficiency on district-wide assessments Opinion of parents Note: These students continue to take the I-ELDA even when they are in the
transition stage
Checklist for Exiting ELLs A composite score of a 6 on the Iowa English Language Development Assessment (I-
ELDA)The student must also meet at least 3 of the 4 following criteria:
Student is at the required reading level Student is showing evidence of success in the core classroom including good
participation, average grades, homework completion, few accommodations made At or near proficiency on district wide assessments ESL support no longer needed Has demonstrated success during the transition stage
o In the transitional stage two weeks to two yearsIt is also recommended, but not required, that parental input is obtained.
Checklist for Re-entering ELLsIf during the transition process or after exiting a student begins to fail he/she may be re-entered into the ESL program. The decision to re-enter a student should include:
Meeting with parents Meeting with all appropriate school staff, including classroom teachers, counselors,
administrators, and any special staff, such as at-risk, that can give insight into thestudents performance and abilities
Discussion of other programs that might be available to assist the student
After the above steps have been taken, a student may be re-entered into the ESL programwhen:
All of the Entry Criteria from page 2 have been met There is a recent IPT on file
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Assessments for English Language Learners
English Language Learners should be included in district-wide testing as directed by theIowa Department of Education. At this time, MAP, ITBS/ITED, Phonological AwarenessProfile, Benchmarking, 8 th grade BRI, 10 th grade Portfolio, Six Traits of Writing, and Scienceassessments should be given to every ELL who has been in the United States longer than 12months. Math tests should be given to every ELL student.
Additionally, all ELLs will be tested annually using a state and NCLB approved test tomeasure their English language proficiency. Currently the Iowa English LanguageDevelopment Assessment (I-ELDA) is used.
The Iowa Department of Education manual, Guidelines for the Inclusion of EnglishLanguage Learners in K-12 Assessments, should be used as a reference to clarify questionsregarding testing ELLs. When testing ELLs, appropriate accommodations can be made.ITBS/ITED Administration manuals are good sources to help in making decisions about thetypes of accommodations that are appropriate for each student. Guidelines for the Inclusionof English Language Learners in K-12 Assessments also contain good suggestions for typesof accommodations to use with ELLs.
English Language Learners and Special Education
ELLs may receive assistance from special education. However, during the decision-makingand problem solving process, some important questions about the students language andeducational background need to be answered.
1. Is the student having difficulties primarily because he/she does not speak/understandthe language of instruction?
2. Is the student having difficulties primarily because he/she has not had similaropportunities to learn as peers to whom he/she is being compared?
If the answer to these questions is No, the classroom teacher and ESL teacher should workwith other staff to rule out language and acculturation as reasons for the students need forassistance. To rule out language and acculturation, reviews, interviews, observations, andtests should take place.
Review records: to find out students home language. to find out the number of years the student has attended school. to find out the frequency of school changes. to find out how many years of ESL or other English Language instruction the student
has had. to find the number of years the child has attended school in an English speaking
school. to find out how the student performed when instructed in his/her primary language. to find work samples and compare them to those of peers with similar educational and
linguistic background.
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Interview: parents, guardians, siblings, caregivers, and the student. Ask them questions arising
from the review items. the student about his/her understanding of English. Ask if he/she is able to speak and
understand peers when speaking English. the ESL teacher regarding the students performance compared to other ELL students. classroom teachers regarding the students performance compared to other ELL
students. Ask about the students rate of acquisition of rules and expectations.
Observe: the student in different settings. Note the language the student uses to communicate
with English speaking peers, ELL peers, teachers, and family. the student and compare to culturally and socio-linguistically similar peers in the
regular and ESL classroom. the instruction to see if effective teaching strategies for ELL students are used and
attempts are made to modify instruction for the student.
Test: the student on grade level when possible. Results should be compared with results of
average students in the general population. the student in the native language to whatever extent possible. If there is significant
discrepancy, a native language test should be sought. Compare the results toculturally and socio-linguistically similar peers.
the student to determine language proficiency.
NOTE: During the referral process, ELL documentation/data should be used. A general
education intervention should be implemented with a systematic progress monitoringsystem to measure the intervention effects.
Interpreters should be used during testing process if needed. ELL teachers must be included in the referral process and coordination of
programming should occur when students are staffed. Heartland AEA will help fund translators for the initial IEP meeting. Special considerations will be given to an ELL who is also identified for special
education services. The district has established an exit checklist for ELL SpecialEducation students who will not be able to exit ESL services due to a learningdisability. Data must support that the ELLs learning disability is not impacted orresulted from any language barriers. See Appendix 6.
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Suggested Accommodations for English as a Second Language Students
Pacing Extend time requirements Advance communication with ESL
teacher for difficult assignments andprojects
Environment Seating near the center of the room
Presentation of Subject Matter Emphasize critical information Pre-teach vocabulary-share
vocabulary lists with the ESL teacher Make and use vocabulary files Reduce the reading level of
assignment Use complementary text at the
appropriate reading level Have the text read to the student by a
peer tutor or the ESL teacher
Materials Allow student to use a bilingual
dictionary Use supplementary text and materials
when needed
Directions Give directions in small distinct steps Restate directions in simplified
language Use written directions Have directions restated by a peer Use visual cues and demonstrations
when possible
Self-Management Visual daily schedule Visual reminder of ESL time Help with use of assignment book Request ESL reinforcement Check often for understanding
Assignments Shorten assignments Lower difficulty level Provide the ESL teacher a written
copy of the assignment Give students alternative or modified
assignments when the demands of theclass conflict with the studentslinguistic abilities
Allow peer assistance whencompleting assignments in class
Testing Adaptations Read the test to the student Allow the student to take or re-take
the test with the ESL teacher Modify the questions Modify the amount of information
and vocabulary the student is requiredto master
Extend time frame for test taking
Social Interaction Supports Use peer advocacy Use peer tutoring Structure activities to create
opportunities for social interaction Use cooperative learning groups
Parent Communication Use a first language report card
provided by the ESL teacher Use a translator for conferences Ask ESL teacher for translated field
trip forms etc.
Appendix 1
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Student Name: ______________________________
ELL Student Data Report
Home Language Survey Date Qualifies Comments
YES or NO
IPT Placement Report & Current Placement ReportTests Date Assessment for
Placement Level ofProficiency
Current PlacementProficiency Level
IPT-OralIPT-Reading
IPT Writing NES, NER, NEW- Non-English Speaker, Reader, Writer LES, LER, LEW - Limited English Speaker, Reader, Writer FES, FER, FEW - Fluent English Speaker, Reader, Writer
**IPT (Idea Proficiency Tests) tests used for the placement in ESL Program
I-ELDA Individual Progress Report: (English Language Development Assessment ) staterequired assessments for English proficiency
List assessment date in gray boxes.
ReadingWriting
ListeningSpeaking
ComprehensionComposite
Scores: 0-6
The ELDA assessment enables Iowa to meet the following Title III NCLB requirements: provide an annual assessment of English proficiency and show annual progress
in acquisition include all LEP (Limited English Proficiency) students in English language proficiency assessments obtain independent measures of listening, speaking, reading, writing report a measure for comprehension measure school environment + academic skills align assessments with state ELP standards.
Appendix-2
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Student Name: Year: Grade: Language Level:
Teacher: MAP Reading Comp: Fall: Spring:ITBS Reading Comprehension: ELDA Reading: Speaking: Listening: Writing:
Y = Yes, S = Sometimes, N = Not YetMidT1
T1 MidT2
T2 MidT3
T3
Listening: Listens attentively Follows directions Responds to questionsSpeaking: Pronounces words clearly Expresses ideas Speaks willingly in English Uses correct English grammar Reading: Uses concepts of print Identifies letters Identifies letter sounds Reads with fluency
o Rateo Accuracyo Prosody (expression and phrasing)
Reads with understandingo Uses schema (organizes and uses background knowledge)o Inferso Determines Importanceo Visualizingo Questioningo Synthesiso Summarizeo Use fix-it strategies
Understands and uses correct vocabulary o Science vocabularyo Social Studies vocabularyo Math vocabulary
Writing: Writes words Writes complete and accurate sentences Writes with strong ideas (narrow topic) Writes with organization
Writes with appropriate word choice Writes with voice Writes with sentence fluency Writes with correct conventions Writes with correct grammar Behaviors: Treats self and others with respect Able to stay on taskMath: Able to read and understand directions Able to read and understand word problems
Elementar ELL Communication ToolAppendix-3
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Student Name: Year: Grade: Language Level:
Teacher: MAP Reading Comp: Fall: Spring:ITBS/ITED Reading Comp: ELDA Reading: Speaking: Listening: Writing:
Y = Yes, S = Sometimes, N = Not Yet
1 24
3 4Listening: Listens attentively Follows directions Responds to questionsSpeaking: Pronounces words clearly Expresses ideas
2
Speaks willingly in English Uses correct English grammar Reading: Uses concepts of print
Identifies letters Identifies letter sounds Reads with fluency
o Rateo Accuracyo Prosody (expression and phrasing)
Reads with understandingo Uses schema (organizes and uses background
knowledge)o Inferso Determines Importanceo Visualizingo
Questioningo Synthesiso Summarizeo Use fix-it strategies
Understands and uses correct vocabulary o Science vocabularyo Social Studies vocabularyo Math vocabulary
Writing: Writes words Writes complete and accurate sentences Write with strong ideas (narrow topic) Writes with organization Writes with appropriate words choice Writes with voice Writes with sentence fluency Writes with correct conventions Writes with correct grammar Behaviors: Treats self and others with respect Able to stay on taskComments:
Secondar ELL Communication ToolAppendix-4
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Appendix-5
ELL Special Education Service Review Checklist
Please use the review checklist when considering placement and services of ELL students into specialeducation. This list is designed to provide consistency across the district. IEP service discussions need tobe individualized according to each students individual language and academic needs.
Who isresponsible?
What action will betaken?
ESL teachers must be part of the STAT meetingsand know what data to collect prior to thesemeetings. These data can be collected from theESL or classroom teacher, depending on who isinitiating the STAT meeting.
During this STAT meeting determine a list oftools and assessments that will be used todetermine student needs.
As a team, define the strategies & skills thatneed to be priority areas in order to meet thestudents learning needs.
After entitlement, establish protocol for collectingstudent performance data that will be used indeveloping the IEP.Clarify who will collect those data. Those datashould be used in determining types of supportservices for ELL/special ed student.
Throughout the IEP process, clearly define theroles of the ESL & special education teachers.This can occur in the IEP meeting or in a collaborative planningsession between all parties involved. The definition of the rolesneeds to be documented and shared wit the building administrator.
Academic content is taught by the classroomteacher, unless otherwise designated in the IEP.Supplemental support is provided by the specialeducation &/or ESL teacher, as determined bythe STAT or IEP process.
Determine the amount of collaboration neededbetween ELL, special ed, and general edteachers. Must consider the language needs ofthe student as you determine the services for thechild. The collaborative discussion must includeinformation on the students progress from datacollected.
As the team considers transitioning &/or exitingELL students who are also identified as specialed, the district guidelines in the handbook mustbe followed.
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Appendix-6
Johnston English as a Second LanguageProgram Transitional and Exit Criteria
The Johnston Community School Districts English as a Second Language Program will work totransition and exit students from the program who meet the following criteria :
Transitional Checklist
District Data:Students reading level is _________.
Requirements:! Composite Score of a 5 or 6 on the I-
ELDA! Student is at or near required reading level! Recommendations from ESL and
classroom teachers! At or near proficiency on district wide
assessments! Opinion of parents
I-ELDA Scores:Reading Score _____
Speaking Score _____
Composite _____
Writing Score _____
Listening Score _____
Date ______
Exit ChecklistELL must demonstrate proficiency on the first bullet and meet four of the five criteria that follow.
District Data:Students reading level is _________.
Requirements:! Composite Score of a 6 on the I-ELDA! Student is at required reading level! Student is showing evidence of success in
the core classroom! At or near proficiency on district wide
assessments! Has demonstrated success during the
transition stage! ESL support no longer needed
I-ELDA Scores:Reading Score _____
Speaking Score _____
Composite _____
Writing Score _____
Listening Score _____
Date ______
**It is also recommended the opinion of the classroom teachers and parents be obtained.
Teacher Signature: Subject: Date:
Parent contact date: _________
Based on the criteria checked above, the following student is dismissed from ESL services:
Student Name: ____________________________________ Date: _____________________
School: _________________________ Grade: ________ ESL Teacher: ___________________
Copy Sent to Cathy Robison on: ____________________
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Johnston Community Schools Checklist for ESL Exit for ELL Special Education Students
Very few ELLs who quality for special education services will not be able to pass the ELDA due to their learningdisability. In order for an ELL/Special Ed student to be exited from ESL services, many things must be considered.As a district, we must be very confident that this students disability is due to an academic learning disability, and isnot the result of English language acquisition. It is recommended that students below 3 rd grade not be considered forthis process. An ELL should be in the ESL program for at least 3 years and dual served for at least one year beforeexiting is a consideration.
Student Name: Grade: School:
ITBS Score MIALT Score ELDAReading Math Science Reading Math Speaking Listening Reading Writing
Benchmarking Level: *PA Profile: Progress Report proficient areas:
*use report card criteria to determine proficiency.
Questions Yes No Provide Supporting Details!" #$$ &' ()*'&'+,*+-. *)*/01)2&(&,*+
3(()14&*5 +) 3+ -,3'+ 6 43+3 0)&*+' &*73+8"
9" #$$ &' ()*'&'+,*+-. *)*/01)2&(&,*+3(()14&*5 +) 3+ -,3'+ 6 43+3 0)&*+' &*:,34&*5"
6" #$$ &' ()*'&'+,*+-. *)*/01)2&(&,*+3(()14&*5 +) 3+ -,3'+ 6 43+3 0)&*+' &*;(&,*(,"
" #$$ &' 1,(,&?&*5 '@00-,A,*+3- #;$ 0@--)@+ ',1?&(,'" !"#$%# '()*+#,- -.#$+(*,- (/ -0+# %-*'#,- 0% 1#)#020,3%*44"#+#,-$" %*44(1-5
B" #$$ &' 1,(,&?&*5 ',1?&(,' +81)@58 3 0@'8&* A)4,-" C,'(1&D, +8, A)4,-"
E" F8, (@11&(@-@A @',4 =&+8 +8, #$$ 83'D,,* 4&22,1,*+&3+,4 3(()14&*5 +) +8,&1-3*5@35, *,,4'"
G" #$$ 83' D,,* 01)?&4,4 =&+8 3(34,A&(3*4 -3*5@35, 5)3-' 3*4 83' *)+ D,,*3D-, +) 0,12)1A &* ,&+8,1 31,3"
H" I-3''1))A +,3(8,1 83' 01)?&4,4 +8,*,(,''31. 4&22,1,*+&3+,4 &*'+1@(+&)* +)34,J@3+,-. A,,+ +8, 3(34,A&( 3*4-3*5@35, *,,4' )2 +8, '+@4,*+"
Appendix-7
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Questions Yes No Provide Supporting Details!K" #$$ 0,12)1A3*(, 83' D,,* ,?3-@3+,4
3*4 4)(@A,*+,4 D. (-3''1))A +,3(8,1L#;$ +,3(8,1L 3*4 3 +,3(8,1 =&+8 '0,(&3-,4 D3(M51)@*4"
!!" C,'0&+, (@11&(@-@A N &*'+1@(+&)*4&22,1,*+&3+&)*L +8, '+@4,*+O' -,31*&*54&22&(@-+&,' 0,1'&'+"
!9" $&'+ )+8,1 01)513A' )1 3-+,1*3+&?,' +83+83?, D,,* ,P0-)1,4 3*4 &A0-,A,*+,43*4 8)= )2+,*"
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Please return this completed and signed document to Bruce Amendts office. Upon the arrival of this form, it will besent to John Scott at the Iowa Department of Education for final approval. After the district receives final notification,an update will be made to the ESL student roster and you will be notified.
DATE
Classroom Teacher Signature:
ESL Teacher Signature:
Special Education Teacher Signature:
Building Administrator Signature:
Parent Signature:
Date of District Notification: __________ Date of State Approval: ___________