Page 39 - 2016 Handbook FINAL 4.18.16

SECONDARY MONITORING FORM - YEAR 4

Last Name____________________________________ First Name__________________________________

Date Exited________________________________ Student Number ________________________________

Student Assessment Profile is attached to this form

Fourth Year of Monitoring Fall 20____ (Satisfactory= Grade of C- or higher)

Report Card #1 __________ Satisfactory __________Unsatisfactory

If unsatisfactory, action taken:
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________

Report Card #2 __________ Satisfactory __________Unsatisfactory

If unsatisfactory, action taken:
_____________________________________________________________

_____________________________________________________________
_____________________________________________________________

Report Card #3 __________ Satisfactory __________Unsatisfactory

If unsatisfactory, action taken:
_____________________________________________________________
_____________________________________________________________

_____________________________________________________________

Report Card #4 __________ Satisfactory __________Unsatisfactory

If unsatisfactory, action taken:
_____________________________________________________________

_____________________________________________________________
_____________________________________________________________

Summary of Exited Year 4:

______ Student is succeeding without ELD support in general education. Continue monitoring.

Or:

______ Student is receiving grade of D or lower in one or more content classes. Consult with
counselor and classroom teacher. Decide to:

______ Continue monitoring ______ Return for service in ELD Program
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