Page 41 - 2016 Handbook FINAL 4.18.16
P. 41

APPENDIX H (2) Secondary Summary of Services Form


                                Secondary Summary of Student Services



        Name: _____________________________________________Student #: _____________



            School: _________________ School Year: __________  Proficiency Level:____

           Hours Tutored: ___________ Enrolled in ELD/LD Classes: _____YES_____NO

           Comments	and	staff	signature:






            School: _________________ School Year: __________  Proficiency Level:____

           Hours Tutored: ___________ Enrolled in ELD/LD Classes: _____YES_____NO
           	 Comments	and	staff	signature:






            School: _________________ School Year: __________  Proficiency Level:____

           Hours Tutored: ___________ Enrolled in ELD/LD Classes: _____YES_____NO
           	 Comments	and	staff	signature:






        	   School: _________________ School Year: __________  Proficiency Level:____

        	  Hours Tutored: ___________ Enrolled in ELD/LD Classes: _____YES_____NO

        	  Comments	and	staff	signature:



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