GPC Form A: SAISD Student Reading Data Grade 5 ID Number: 00000001 Student: Jane Q. Student Assessment Results / Summary Data Complete the STAAR Information after each administration. STAAR 1st Administration Date 3/31/15 STAAR RC 1 # Correct RC 2 # Correct RC 3 # Correct 18 of 46 _4_of 10 8_ of 19 _6_ of 17 ____ of 46 2nd Administration Date 3rd Total # Correct STAAR Administration ____of 46 Date __________ ____of 10 ____of 10 ____ of 19 ____of 19 ____of 17 ____ of 17 AREA FOR ACCELERATION Reporting Category 1 2 3 Reporting Category 1 2 3 Reporting Category 1 2 3 Other Reading Assessment Information Fountas and Pinnell Level EOY Month _______ Istation BOY Month _______ MOY Month _______ EOY Month _______ Overall Level SRI EOY Word Analysis Level Lexile Fluency Level Vocabulary Level Comprehension Level Level Month _______ It is the policy of San Antonio ISD not to discriminate on the basis of race, color, national origin, age, sex or handicap in its vocational programs, services or activities as required by Title VI of the Civil Rights Act of 1964, as amended; Title IX of the Education Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended. Es norma del distrito de San Antonio no discriminar por motivos de raza, color, origen nacional, edad, sexo o impedimento, en sus programas, servicios o actividades vocacionales, tal como lo requieren el Título VI de la Ley de Deprechos Civiles de 1964, según enmienda; el Título IX de las Emmiendas en la Educación, de 1972, y la Sección 504 de la Ley de Rehabilitación de 1973, según enmienda Revised ELAR Department April 2015 Page 1 of 2 GPC Form B: Acceleration Instruction Plan after 1st Test Administration – Grade 5 Name: Jane Q. Student ID Number: 00000001 Total Correct 1st Administration Areas of Acceleration Category 1 18 of 46 Category 2 Category 3 _4_of 10 8_ of 19 _6_ of 17 DURATION Daily during 10 day(s) to implement a targeted Accelerated Instruction Plan. Daily instruction will be 1 hour per day 2 hours per day 3 hours per day 6 hours per day Other: ___________ May Acceleration Instruction Prior to 2nd Test Administration (AIP) Day 1 Day 2 Day 3 Assessment Results 3/5 Assessment Results 4/5 TEK Focus 5.11A, Fig. 19D TEK Focus 5.11A, 5.11D Close Reading Strategy Close Reading, Hot Seat Strategy Day 6 Day 4 2/5 Assessm ent Results Day 5 Assessme nt Results 5/5 Assessment Results 4/5 TEK Focus 5.11C, 5.10A TEK Focus 5.11C, 5.10A TEK Focus 5.11D, 5.13B Strategy Text Organization It Says, I Say Strategy Text Organization It Says, I Say Strategy Interpreting Text Features Day 7 Day 8 Day 9 Day 10 Assessment Results 3/5 Assessment Results 4/5 Assessment Results 4/5 Assessment Results 4/5 Assessment Results 3/5 TEK Focus 5.3A, Fig.19F TEK Focus 5.3A, Fig.19F TEK Focus 5.6A, Fig.19E TEK Focus 5.6B, Fig.19D TEK Focus 5.4A, 5.8A, Fig.19D Strategy Paired Passage Process Strategy Paired Passage Process Strategy Reading Comp. Process, Somebody - Wanted Strategy Inferring Character Feelings Strategy It Says, I Say, and So Date Time 4/20/15 1:15 PM Complete Admin Initials DJ DJ DJ DJ Parent / Guardian Contact Person Contacted Jane Doe (mother) Summary of Discussion Discussed results and the planned intervention Attached Documentation Please check the complete box to indicate any documentation included and initial to verify that you have included the documentation. Form R.2 (Notification of Student Performance-Not meet passing standard)/ R.2 Spanish (Notification of Student Performance- Not meet passing standard) CSR (Confidential Student Report) Teacher Notes/Observations I Station Reports / SRI Other Principal / Designee Approval of AIP Signature Debra Jones (must be actual signature) ItPosition is the policy of San Antonio ISD not to discriminate on the basis of race, color, national origin, age, sex or handicap in its vocational programs, services or activities as required by Title VI of the Civil Rights Act of 1964, as amended; Title IX of the Education Amendments of 1972; and Section 504 of the Principal Rehabilitation Act of 1973, as amended. Date 4/20/15 Es norma del distrito de San Antonio no discriminar por motivos de raza, color, origen nacional, edad, sexo o impedimento, en sus programas, servicios o actividades vocacionales, tal como lo requieren el Título VI de la Ley de Deprechos Civiles de 1964, según enmienda; el Título IX de las Emmiendas en la Educación, de 1972, y la Sección 504 de la Ley de Rehabilitación de 1973, según enmienda Revised ELAR Department April 2015 Page 2 of 2 GPC Form C: Acceleration Instruction Plan after 2nd Test Administration – Grade 5 Name: Jane Q. Student 2nd Administration Area of Acceleration ID Number: 00000001 Total Correct Category 1 Category 2 Category 3 21 of 46 6 of 10 8 of 19 7 of 17 Use the Strategy Menu and Targeted Tested TEKS to Complete AIP Summer School Intervention (AIP) Day 1 Day 2 Day 3 Day 4 Day 5 Assessment Results 3/5 Assessment Results 3/5 Assessment Results 4/5 Assessment Results 3/5 Assessment Results 5/5 TEK Focus 5.3, 5.4A, 5.6, Fig.19E TEK Focus 5.3, 5.4A, 5.6, Fig.19 TEK Focus 5.3, 5.4A, 5.5A, Fig.19D, E, F TEK Focus 5.4A, 5.14, Fig.19, Fig.19E TEK Focus 5.4A, 5.11, 5.11A, 5.11B, Fig.19D, Fig.19E Strategy Mental Images, SomebodyWanted, Hot Seat, Look Again Strategy It Says, I Say, and So, Inferences Through Ads, The Sherlock Method, Plot Diagram, Look Again Strategy SomebodyWanted, TicTac-Toe, Paired Passage Process Strategy Reporter’s Formula, Hot Seat, Read and Retell Strategy Reporter’s Formula, Hot Seat, Read and Retell Date 6/4/15 Complete Parent / Guardian Contact Person Contacted Time 2:30 PM Admin. Initials DJ DJ DJ DJ DJ DJ DJ Printed Name Debra Jones Jane Doe (mother) Summary of Discussion Discussed results and how we will address the student’s needs until the end of the year. Summer School application has been signed. Attached Documentation Please check the complete box to indicate any documentation included and initial to verify that you have included the documentation. Form R.3 (Notification of Student Performance-Did not meet passing standard, Second Administration)/ Form R.3 Spanish (Notification of Student Performance-Did not meet passing standard, Second Administration) Form R.4 (Confirmation of Participation in the GPC Meeting-Second Administration)/ Form R.4 Spanish (Confirmation of Participation in the GPC Meeting-Second Administration) Form R.5 (GPC Meeting Minutes Second Administration)/Form R.5 Spanish (GPC Meeting Minutes Second Administration) Form R.6 (Parent Notification of GPC decision- Second Administration)/ Form R.6 Spanish (Parent Notification of GPC decision- Second Administration) Form R.7 (Parent Waives Right to Third Administration)/ Form R.7 Spanish (Parent Waives Right to Third Administration) If Applicable CSR (Confidential Student Report) Summer School Application Other Grade Placement Committee Members: Relationship Principal/Principal Designee Signature Debra Jones Date 6/1/15 Jane Doe Parent/Guardian Jane Doe 6/1/15 Juan Doe Parent/Guardian Juan Doe 6/1/15 Melanie Wilson Reading Teacher Melanie Wilson 6/1/15 Other (must be original signatures ) Other It is the policy of San Antonio ISD not to discriminate on the basis of race, color, national origin, age, sex or handicap in its vocational programs, services or activities as required by Title VI of the Civil Rights Act of 1964, as amended; Title IX of the Education Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended. Es norma del distrito de San Antonio no discriminar por motivos de raza, color, origen nacional, edad, sexo o impedimento, en sus programas, servicios o actividades vocacionales, tal como lo requieren el Título VI de la Ley de Deprechos Civiles de 1964, según enmienda; el Título IX de las Emmiendas en la Educación, de 1972, y la Sección 504 de la Ley de Rehabilitación de 1973, según enmienda Revised ELAR Department April 2015 GPC Form D: Accelerated Instruction Plan after 3rd Administration: First Six Weeks of School – Grade 5 Name: Jane Q. Student 3rd Administration Area of Acceleration ID Number: 00000001 Total Correct Category 1 Category 2 Category 3 29 of 46 8 of 10 12 of 19 9 of 17 Duration Daily during _____ day(s) period to implement a targeted Accelerated Instruction Plan. Daily instruction will be 1 hour per day 2 hours per day 3 hours per day 6 hours per day Other: 45 minutes per day Intervention Plan Accelerated Instruction Plan: First Six Weeks of School (AIP) Week 1 Assessment Results Assessment Results Assessment Results 5.6B, 5.8A TEK Focus Week 4 Fig. 19D, Fig.19E TEK Focus Week 5 Week 6 Assessment Results 5.10A, 5.11A, 5.11B TEK Focus Week 3 Assessment Results 5.2B, 5.3C TEK Focus Week 2 Assessment Results 5.12A, 5.12B, 5.14C TEK Focus Fig. 19D, Fig. 19E TEK Focus Parent/Guardian Contact Date Time Person Contacted Summary of Discussion 7/21/15 3:30 PM Jane Doe Discussed the results and invitation to GPC Attached Documentation Complete Admin. Initials DJ DJ DJ DJ DJ DJ Please check the complete box to indicate any documentation included and initial to verify that you have included the documentation. Form R.8 (Notification of Student Performance-Did not meet passing standard, Third Administration)/ R.8 Spanish (Notification of Student Performance-Did not meet passing standard, Third Administration) Form R.9 (Confirmation of Participation in the GPC Meeting-Second Administration)/ Form R.9 Spanish (Confirmation of Participation in the GPC Meeting-Third Administration) Form R.10 (GPC Meeting Minutes Third Administration)/Form R.10 Spanish (GPC Meeting Minutes Third Administration) Form R.11 (Parent Notification of GPC decision- Third Administration)/ Form R.11 Spanish (Parent Notification of GPC decisionThird Administration) CSR (Confidential Student Report) Other: Work Samples It is the policy of San Antonio ISD not to discriminate on the basis of race, color, national origin, age, sex or handicap in its vocational programs, services or activities as required by Title VI of the Civil Rights Act of 1964, as amended; Title IX of the Education Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended. Es norma del distrito de San Antonio no discriminar por motivos de raza, color, origen nacional, edad, sexo o impedimento, en sus programas, servicios o actividades vocacionales, tal como lo requieren el Título VI de la Ley de Deprechos Civiles de 1964, según enmienda; el Título IX de las Emmiendas en la Educación, de 1972, y la Sección 504 de la Ley de Rehabilitación de 1973, según enmienda Revised ELAR Department April 2015 Page 1 of 2 Printed Name Debra Jones Grade Placement Committee Signature Relationship Jane Doe Juan Doe Melanie Wilson Principal / Principal Designee Debra Jones Date 7/11/15 Parent / Guardian Jane Doe 7/11/15 Parent / Guardian Juan Doe 7/11/15 Reading Teacher Melanie Wilson 7/11/15 Agree Disagree (must be original signatures ) Other Other Review of AIP by Receiving Campus Printed Name Role Signature Date Walter Winchell 7/11/15 Assigned Teacher Johnny Rocket 7/11/15 Other Counselor John Grisham 7/11/15 Walter Winchell Principal / Designee Johnny Rocket John Grisham Other (must be original signatures ) It is the policy of San Antonio ISD not to discriminate on the basis of race, color, national origin, age, sex or handicap in its vocational programs, services or activities as required by Title VI of the Civil Rights Act of 1964, as amended; Title IX of the Education Amendments of 1972; and Section 504 of the Rehabilitation Act of 1973, as amended. Es norma del distrito de San Antonio no discriminar por motivos de raza, color, origen nacional, edad, sexo o impedimento, en sus programas, servicios o actividades vocacionales, tal como lo requieren el Título VI de la Ley de Deprechos Civiles de 1964, según enmienda; el Título IX de las Emmiendas en la Educación, de 1972, y la Sección 504 de la Ley de Rehabilitación de 1973, según enmienda Revised ELAR Department April 2015 Page 2 of 2
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