CORRECTIONAL EDUCATION INTAKE and UPDATE MODEL FORM CE

Definitions, Policies, & Directions for Staff

DLLR-LWIS

Last Update: June5, 2013

DLLR-LWIS MODEL FORM CE

CORRECTIONAL EDUCATION INTAKE and UPDATE FORM

Definitions, Policies, and Directions for Staff

To provide an accurate profile for real-time data analysis, routinely provide to your MIS all learners’ entry and update information, and close records of learners as they exit the class or program throughout the fiscal year. Your report periods to the MIS must be at least quarterly in order to minimize incomplete reports and potentially false data that result from longer time periods between report cycles. Another reason for frequent reporting is that errors or problems may be identified and corrected on an ongoing basis.

Policy: Programs shall establish and follow procedures that will assure all learners’ data shall be submitted to the MIS that accurately reflects the learners’ entry and update status as of the last day of each quarter of the fiscal year until they exit the class or program.

Prior to submitting this form for data entry, staff must carefully review the information for errors and/or omissions. Question learners about any item where clarification is needed.

SPECIAL NOTE
  1. The order of the data elements presented here follows the order that appears on the LWIS Model Form CE: Correctional Education Intake and Update Form.
  2. Learners can complete all personal information with appropriate assistance from staff.
  3. Instruct learners to neatly print the information requested with a pencil.

The Correctional EducationIntake and Update Formis used to collect basic information about a learner who is enrolled in a class. This includes demographics, goals, assessment results, hours attended, achievement, progress, and exit status.

LEARNER CAN COMPLETE THIS INFORMATION WITH STAFF ASSISTANCE

LEARNER DOC NUMBER OR SOCIAL SECURITY NUMBER

Definition: The DOC Number is assigned by Corrections and is unique to each individual. A SSN is assigned by the U.S. Government and is unique to each individual.

Policy: Learner must report a valid and accurate SSN. All LWIS data is protected by federal and state laws.

Directions: (Learner does nothave to include theDOC number this FY.)Learner prints his/her9-digit Social Security Number (SSN).If every effort has been made to obtain a SSN and none is available, in the SSN spaces, learner should print 9 + his/her DOC number + any zeros needed to fill the 9 spaces.

Information: Every effort should be made to continue to secure a SSN.If a learner has a pseudo SSN and is a GED® candidate, make certain you change (and report to data entry staff) his/her pseudo SNN to the number assigned by theDLLR GED® office.[1]Using the correct SSN is the only way DLLR is able to share/match data to determine a learner’s achievement and progress for NRS Core Indicators 2 and 3. If learner achievement cannot be validated, your program’s DLLR funding may be reduced or eliminated.

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CORRECTIONAL EDUCATION INTAKE and UPDATE MODEL FORM CE

Definitions, Policies, & Directions for Staff

DLLR-LWIS

Last Update: June5, 2013

SCHOOL START DATE

Definition: This is the date of learner’s first contact/activity in the program–generally registration and orientation. This date may be prior to, or the same as, the Class Start Date, depending upon local program intake procedures or if a Continuing learner.

Policy: Learner must report a School Start Datefrom July 1to June 30 of the current fiscal year unless a Continuing learner.

Directions: Learner prints School Start Datein the MM/DD/YY format. Check that learner has completed all boxes and has used zeros where necessary. Note: Continuing (Returning) learners should not enter a date, as LWIS will automatically display their enrollment date.

NAME: FIRST

Definition: This is learner’s first name as recorded on official documents such as Social Security card, birth certificate, driver’s license, etc.

Policy: Learner must report a First Name.

Directions: Learner prints legal First Name.

NAME: MIDDLE

Definition: This is learner’s middle name as recorded on official documents such as Social Security Card, birth certificate, driver’s license, etc.

Policy: Learner must report a Middle Name or initial, if available.

Directions: Learner prints legal Middle Name. If only an initial is available, learner enters the initial followed by a period. If no middle name, learner should print NONE in the middle name space.

NAME: LAST

Definition: This is learner’s last name as recorded on official documents such as SSN, birth certificate, driver’s license, etc.

Policy: Learner must report a Last Name.

Directions: Learner prints legal Last Name.

MALE

Definition: This is what learneridentifies as his gender.

Policy: Learner must report gender.

Directions: If applicable,learner checks the box by the word, Male.

FEMALE

Definition: This is what learneridentifies as her gender.

Policy: Learner must report gender.

Directions: If applicable, learner checks the box by the word, Female.

DATE OF BIRTH

Policy: Learner must report a complete Date of Birth. Learner must be at least age 16 and officially withdrawn from school upon program entry.

Directions: Learner prints Date of Birth in the MM/DD/YY format. Check date for accuracy and verify that learner is at least 16 years old.

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CORRECTIONAL EDUCATION INTAKE and UPDATE MODEL FORM CE

Definitions, Policies, & Directions for Staff

DLLR-LWIS

Last Update: June5, 2013

ETHNICITY/RACE

Definition: This is the ethnic/racial category to which learner self-identifies, appears to belong, or is regarded in the community as belonging.

Policy: (1) Learner must first indicate if of Hispanic or Latino ethnicity. (2) Learner must then indicate any racial category which applies.

Directions: (1) Learner selects either YES or NO for Hispanic or Latino. Learner circles the number in the box by any racial category which applies.

ETHNIC CATEGORY / DEFINITION
Hispanic or Latino / A person of Mexican, Puerto Rican, Cuban, Central, or South American, or other Spanish culture or origin, regardless of race.
RACIAL CATEGORIES / DEFINITION
1 / American Indian/Alaska Native / A person having origins in any of the original peoples of North and South America (including Central America), and who maintains a tribal affiliation or community attachment.
2 / Asian / A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
3 / Black or African American / A person having origins in any of the Black racial groups of Africa.
4 / Native Hawaiian or
Other Pacific Islander / A person having origins in any of the original peoples of the Pacific Islands of Hawaii, Guam Samoa, or other Pacific Islands.
5 / White / A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

IF OTHER THAN USA, NATIVE COUNTRY?

Definition: This is learner’s country of citizenship at birth if other than the USA.

Policy: This is completed only if learner is foreign-born and native language is other than English.

Directions: Learner prints name of Native Country in the space provided.

NATIVE LANGUAGE

Definition: This is learner’s primary/native language if other than English.

Policy: This is completed only if Primary/Native Language is other than English.

Directions: Learner prints the name of Primary/Native Language in the space provided.

HIGHEST DEGREE or LEVEL OF SCHOOLING COMPLETED

Definition: This is learner’s highest number of years of formal schooling completed or the credential or degree achieved.

Policy: Learner must report Highest Degree or Level of Schooling Completed in the U.S. or Other Country.

Directions: Learner selects one applicable description.

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CORRECTIONAL EDUCATION INTAKE and UPDATE MODEL FORM CE

Definitions, Policies, & Directions for Staff

DLLR-LWIS

Last Update: June5, 2013

SIGNATURE & DATE

Definition: The signature is the learner’s signature and the date entered is the current date.

Policy: All learners must sign and date this form on the lines provided.

Directions: Learner signs name and enters current date.

Learner must be assisted with completion of Primary and SecondaryGoals.

PRIMARY & SECONDARY GOALS

Information: Your program will be held accountable for whether the learner achieves the Primary Goal and theSecondary Goalas identified. In the goal-setting process you should consider whether there is a realistic chance that the learner can achieve the goal within the class and current fiscal year. Also, it is important that the program’s instruction and services are oriented toward helping the learner achieve his or her goal(s).

Examples: A learner with a Primary Goal of earning a high school diploma by completion of the GED® test should be at a literacy level that will make this goal likely within the class and current fiscal year. The learner should receive instruction that will help him/her acquire the additional skills needed to earn a high school diploma. But if it is determined that earning a high school diploma would be more appropriate as a long-term goal, then Skills Upgrade should be selected as the Primary Goalwithin the class and current fiscal year.

Note: Skills Upgrade would also be selected as the Primary Goal for a high school graduate who seeks services or for the developmentally disabled.

If a learner is unemployed and has a Secondary Goal of Get a Job, the program should explore with the learner the skills needed to get a job and then provide the appropriate instruction and services.

In both cases, realistic short-term and long-term goals need to be established, and some goals may extend beyond the class duration or fiscal year.

Your program should have a procedure in place to orient the learner to the program and help the learner set goals for instruction. Either as part of the intake process or at a time shortly thereafter, the learner should meet with the Intake/Assessment Specialist or a teacher at least once to help establish goals for instruction. This goal-setting process will help identify the learner’s appropriate Primary Goal(mandatory), SecondaryGoal,or Additional Goals (optional).

Establishing goals helps define the areas in which instruction and learning are to be focused. Goals also provide a benchmark by which programs and learners can assess their progress. For these reasons, the goals set should be attainable and measurable within the class and current fiscal year.

PRIMARY GOAL

Definition: This is learner’s main educational goal that realistically can be attained during learner’s available instructional time within the class and current fiscal year.

Policy: Learner’s Primary Goal must be reported. There can be only one Primary Goal.

Directions: Learner discusses Primary Goal with staff and must select onlyonePrimary Goal. This can only be an educational goal.

PRIMARY GOAL / DESCRIPTION
Education-Skills Upgrade /
  • Needs to improve overall basic literacy skills; or
  • Enters at too low a level to obtain either a high school diploma or the skills needed for a specific job or personal use within the class and current fiscal year; or
  • Is a high school graduate who needs to improve basic skills for job or personal use; or
  • Is developmentally disabled; or
  • Is enrolled in a Workplace Literacy Class; or
  • Has a very specific, limited educational objective, such as pass driver’s license test, improve math skills, prepare a resume, etc.

Education-High School Diploma-GED® / Has sufficient skills to pursue an educational program that will lead to a high school credential within the class and current fiscal year.
Education-English Literacy Skills / For ESL learner only. Needs instructional time to improve speaking, understanding, reading, and/or writing the English language.

SECONDARY GOAL

Definition:Thisis learner’s Education goal that realistically can be attained during learner’s available instructional time within the class and current fiscal year.

Policy: Although optional, learner is encouraged to select the Secondary Goal, if appropriate.

Directions: Learner discusses Secondary Goal with designated staff to determine if it is appropriate.

SECONDARY GOAL / DESCRIPTION
Education-Enter Post-Secondary Education or Occupational Skills Training / Needs to develop or improve skills in order to enroll in a post-secondary education or job training program. Post-Secondary education is defined as enrollment in a program leading to an Associate’s or Bachelor’s degree or career training, trade school, or apprenticeship.

STAFF COMPLETES WHEN LEARNER ENTERS CLASS

CODESFORCOUNTY, PROVIDER, TEACHER, AND CLASS

County Code (CE has been assigned County Code 25)

Definition: The County Code is a unique identification number assigned to your program’s jurisdiction by DLLR, regardless of the jurisdiction where the learner resides or where services are provided.

Policy: The CountyCode is required. Only DLLR is authorized to assign or change a CountyCode. Each CountyCode must be unique.

Directions: No action necessary. The CE County Code has been pre-entered on the form.

Information: The CountyCode enables a program’s data to be organized and sorted in the LWIS database.

Provider Code

Definition: The Provider Code is a unique identification number assigned to your program by DLLR, regardless of the jurisdiction where the learner resides or where services are provided.

Policy: The Provider Code is required. Only DLLR is authorized to assign or change a Provider Code. Each Provider Code must be unique.

Directions: Enter the assigned 4-digit Provider Code. If you do not know your Provider Code, ask your program administrator for it. The first digit has been pre-entered on the form.

Information: The Provider Code enables a program’s data to be organized and sorted in the LWIS database.

Teacher Code

Definition: The Teacher Code is a unique identification number assigned to each teacher by local program administrators.

Policy: The Teacher Code is required. Only local program administrators are authorized to assign or change a Teacher Code. Each Teacher Code must be unique.

Directions: Enter the assigned 4-digit Teacher Code. When more than one teacher is providing services to the class, enter the designated code for the lead teacher. If you do not know theTeacher Code, ask your program administrator for it.

Information: The Teacher Code enables a program’s data to be organized and sorted in the LWIS database.

Class Code

Definition: The Class Code is a unique identification number assigned to each class by local program administrators.

Policy: The Class Code is required. Only local program administrators are authorized to assign or change a Class Code. Each Class Code must be unique.

Directions: Enter the assigned 4-digit Class Code. If you do not know the Class Code, ask your program administrator for it.

Information: The Class Code enables a program’s data to be organized and sorted in the LWIS database.

CLASS START DATE

Definition: This is the date learner first entered class for instruction (or initial intake, if this is the program’s procedure) in the current fiscal year.

Policy: Learner’s Class Start Date must be reported.This date must be from July 1 to June 30 of the current fiscal year. It can be the same as, or different from, learner’s School Start Date depending upon your program’s intake procedures.

Directions: EnterClass Start Date in the MM/DD/YY format. Check that all boxes have been completed zeros used where necessary.

Information: If a Continuing learner, the Class Start Date will differ from the School Start Date.

ABE/ASE ENTRY LEVEL

Information: The ABE/ASE Educational Functioning Levels (EFLs) describe the Basic Reading & Writing Skills, Numeracy Skills, and Functional & Workplace Skills of ABE/ASE learners. These level descriptions were developed as part of the Adult Education National Reporting System (NRS) and are mandated for all federally-funded DLLR programs.[2]The learner’s Entry EFL must be reported for the class and could be different for each class.

For ABE/ASE programs funded by DLLR, the Comprehensive Adult Student Assessment System(CASAS) is the required assessment instrument used to determine learner levelwith the exception of Correctional Education, which may use theTests of Adult Basic Education (TABE). Note: While the Official GED® Practice Test (OPT) cannot be used to determine level, programs are encouraged to administer it to learners who, after TABE conversion to CASAS scale scores, achieve an assessmentminimum converted scale score of 236 on CASAS Reading and 226 on CASAS Math. The OPT results can be used to help guide instruction. All OPT results must be entered in LWIS so local programs and DLLR can analyze its relationship to CASAS assessments, the GED®test, and other areas of interest.