2014-15 PFS Eligibility Worksheet

2014-15 PFS Eligibility Worksheet

Michigan Migrant Education Program (MEP)

Office of Field Services, Special Populations Unit

Priority for Services: Eligibility Determination Worksheet

The Priority for Services (PFS): Eligibility Determination Worksheet will assist the local MEP in determining which migrant students meet the Priority for Services criteria and should receive migrant services first. This information should be used to update the Michigan Educational Database System (MEDS) and kept on file, along with supporting documentation, in a central location designated by the local MEP director. Achievement data used in making the PFS determination should be less than one year old.

Student Name : / Today’s Date: 9/5/2014
Date of Birth: / School:
Current QAD/LQM: Click here to enter a date. / District or MEP:
Current Grade Enrolled: Choose an item. / School Year: 2014-2015
Priority for Service Status: ☐ PFS ☐ NPFS / COE #:
Receiving Local MEP funded Services: ☐ Yes ☐ No
If yes, please note the type of MEP service received: Check all that apply
☐ Any Instructional Services
☐ Math Instructional Services
☐ Reading Instructional Services
☐ Credit Accrual Services
☐ Counseling Services
☐ Support Services:
☐ Referred Services: / Additional Information: Check all that apply
☐ Bi-National Enrollment
☐ Non-Migrant, District Counseling Services
☐ Formerly Migrant (FM) receiving continuation of services (COS)
☐ FLEP (exit date, assessment and score:
☐ Title I, Part A ☐ Section 31a
☐ Title III ☐ Title III, Immigrant
☐ Title I, Part D ☐ Homeless

To qualify as Priority for Services, a migrant student must have experienced one of the possible educational interruptions in Table A, and met one of the risk factors listed in Table B.

Table A. Qualifying Interruptions

One item must be checked to qualify. / Check the most recent cause / Qualifying Interruptions / Date Interruption Occurred
☐ /
  1. QAD/LQM after 9/1/2013 (or the start of the regular school year)
**Note QAD/LQM must be during the regular school year and within the last 12 months** / 9/6/2013 /
☐ /
  1. Moved from one district to another due to migrant lifestyle, but the move did not qualify as a new QAD/LQM
Describe event: / Click here to enter a date. /
☐ /
  1. Absent for at least 5 consecutive days due to the migrant lifestyle
Describe event: / Click here to enter a date. /
☐ /
  1. Officially withdrawn from school for at least five days and then re-enrolled due to the migrant lifestyle
Describe event: / Click here to enter a date. /

Table B can be found on page. 2Page 1 of 2

For additional guidance, see Michigan MEP PFS Guidance Document.8/2014

Table B. Risk Factors for failing to meet State Standards Criteria

☒ One item must be checked to qualify. / Check all that apply / Risk Factors
Assessments must be less than 12 months old / Description and/or Scores
☐ /
  1. Scored partially proficient or basic on the Michigan MEAP/MME Reading Assessment

☐ /
  1. Scored partially proficient or basic on the Michigan MEAP/MME Mathematics Assessment

☐ /
  1. Scored partially proficient or basic on Michigan MEAP/MME Writing Assessment

☐ /
  1. Scored partially proficient or basic on Michigan MEAP/MME Science Assessment

☐ /
  1. Scored partially proficient or basic on Michigan MEAP/MME Social Studies Assessment

☐ /
  1. Scored below proficient on State Assessments received from other states

☐ /
  1. Scored below the 50th percentile on norm-referenced test (reading and/or math)

☐ /
  1. Scored below grade level on locally administered assessment in reading or math (DRA2, Delta Math or other)

☐ /
  1. Is classified as Limited English Proficient and has not met the requirements from the Michigan’s Entrance and Exit Protocol to be exited from EL services.
LEP Assessment Date Click here to enter a date.
☐ /
  1. Qualifies for Special Education Services
Date Of IEP Click here to enter a date.
☐ /
  1. Is behind in accruing credits toward graduation requirements

☐ /
  1. Has grades indicating below average performance in math and/or language arts at the elementary level

☐ /
  1. Has grades indicating below average performance in math, language arts, sciences, or social studies at the middle or high school levels

☐ /
  1. Repeated a grade level or course

☐ /
  1. Pursuing a GED course of study (OSY only). Note program and enrollment period.

☐ /
  1. Enrolled in a structured, early childhood program for at-risk children (PS only). Note program and enrollment period.

Student’s Name: Page 2 of 2

Today’s Date: 9/5/2014

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