Transfer Student Information Form

Information by Phone / Fax

Current Date of Entry ______Grade Level ______

Student Name: ______Date of Birth: ______

I.D. Number: ______Days Present:______Days Absent:______

Former School: ______Former School District:______

Former School Number:______Fax #______

Person Contacted: ______Title:______Date:______

Person Receiving Information: ______Title:______

HOME LANGUAGE SURVEY: Date:______

___Eng/Eng ___Span/Span ___Eng/Span ___

LPAC RECOMMENDATIONS:

CLASSIFICATION: _____Bilingual

_____Original Non-LEP _____ESL

_____LEP Entry Date:______Regular Program

____ Beginner ___Intermediate ___Advanced _____Two Way

_____Reclassified Non-LEP Exit Date:______

_____ 1st Yr. Follow-Up ___2nd Yr. Follow-Up

OLPT SCORES: Name of OLPT:______

Spanish Date:______English Date:______

Raw Score:______Raw Score:______

Level:______Level:______

TELPAS REPORT : Use TELPAS Student Confidential Report to find rating for each Language Domain and Score/Level for RPTE.

Texas Observation Protocol (TOP)

B= Beginner I= Intermediate A= Advanced AH= Advanced High

Listening _____ Speaking_____ Reading_____ Writing ______

Reading Proficiency Test in English (RPTE): (3rd – 12th) Score/Level: _____/____

TEST SCORES

Standardized Test: Name of Test ______Date: ______Reading____ % Lang.____%

TAKS Scores

Reading Date: _____Eng.__ Sp.___ Met Standard Y or N Exempt___

Math Date: ____ Eng. __ Sp. __ Met Standard Y or N LAT ______

Writing Date: ____ Eng. __ Sp. __ Met Standard Y or N Exempt ____

ELA Date: ____ Eng. __ Sp. __ Met Standard Y or N Exempt ____

SDAA/LDAA Level/Grade _____ Met Standard Y or N

Recent Immigrant

Date of Entry to U.S. Schools:______Immigrant Status: 1 2 3 4+