FY 2018 Student Records Monitoring Checklist

Instructional Services

FY 2018 Student Records Monitoring Checklist

Program: / Administrator:
County/Site: / Contact Person:
Date: / Reviewer:
Selected Student Records (name, EFL, etc.)
1.  / Select an EFL / 2.  / Select an EFL / 3.  / Select an EFL
4.  / Select an EFL / 5.  / Select an EFL / 6.  / Select an EFL
7.  / Select an EFL / 8.  / Select an EFL / 9.  / Select an EFL
Checklist Criteria / R1 / R2 / R3 / R4 / R5 / R6 / R7 / R8 / R9
Intake Assessment Form
·  Student data complete w/ signature / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  Student goals complete w/ signatures / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  Test data / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  Initial Conference Notes / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  Quarterly Conference Notes: Written ☐ GALIS ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Verification of Eligibility Affidavit (18+)
·  Completed w/signatures & notarization / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  Not Applicable / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Assessment and Attendance Documentation
·  Maintained per requirements / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  BEST Literacy / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  BEST Plus 2.0 / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  TABE Online (Student Profile) / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  TABE (Paper-based) / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  TABE (Braille) / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  TABE CLAS-E / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  Correlates to the IAF / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Underage Youth Application (if applicable)
·  Complete w/ signatures / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  Not Applicable / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Individual Student Learning Plan
·  Has required elements / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
·  In Use / ☒ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐ / ☐
Record 1: / SS#
Yes ☐ No ☐
Record 2: / SS#
Yes ☐ No ☐
Record 3: / SS#
Yes ☐ No ☐
Record 4: / SS#
Yes ☐ No ☐
Record 5: / SS#
Yes ☐ No ☐
Record 6: / SS#
Yes ☐ No ☐
Record 7: / SS#
Yes ☐ No ☐
Record 8: / SS#
Yes ☐ No ☐
Record 9: / SS#
Yes ☐ No ☐
Notes:
For Local Program Use - Technical Assistance Follow-Up
Signature – Program Administrator/Designee / Signature – Program Instructor/Substitute
Date of Review / Date of Review
Rev: 7/28/17 Office of Adult Education · Student Records Monitoring / 2 of 2