Limited English Proficient (LEP) Student
Cumulative Folder Documentation Checklist
Student Name:
Date of Birth:
Initial Documentation
√
Form
Date
Home Language Survey
Oral Language Proficiency Test (OLPT) English
Oral Language Proficiency Test (OLPT) Spanish
LPAC Initial Placement/Recommendation
Notification of Placement
Parent Permission (same date as program placement)
Parent Denial
Annual Documentation
√
Documentation
Date
Date
Date
Date
Oral Language Proficiency Test (OLPT) English
Norm-Referenced Standardized Achievement Test(s)
TAKS Results
TELPAS Individual Student Profile
Other (district policy)
Notification of Exit
Parent Permission
Texas Education Agency Bilingual/ESL Unit 2010-2011
Student Alternatives Program, Inc. (06/2011)
ISD LPAC Initial Review
*Copy of complete form must be submitted for accurate PEIMS Coding.
Enrollment date:
Student name:
LPAC date:
Grade:
Home Language Survey date:
Academic year:
Identification
Oral Language Proficiency Test: English score:
Primary language score:
Norm-Referenced Standardized Achievement Test: Reading percentile:
Language Arts percentile:
Immigrant / New Student History
Immigrant Status according to PEIMS
Yes
No
Evidence of insufficient schooling outside U.S.
(Please attach documentation)
Periods of absence of schooling outside U.S.
Evidence of inadequate foundation of learning
New Student
Transfer from Texas District
Original Home Language Survey (HLS) Requested
Requested
Received on (date):
Home Language PEIMS Code: 01 Spanish
Other Language PEIMS Code: ____________
Transfer from out of state
Review previous records (when available)
Transfer from out of country
Review home country transcripts to grant possible
credit
Level of Academic Achievement
Subject
End-of-Year Grade
English/Language Arts
Math
Science
Social Studies
Other content areas
LPAC Signatures
Bilingual/ESL Educator: _________________________
Professional Transitional Educator: ________________
Campus Administrator: __________________________
Parent Representative: __________________________
Other (specify title): _____________________________
LPAC Recommendations
LEP (PEIMS LEP Indicator Code 1)
Parent permission date:
Parental Permission PEIMS Code:_________
Parent denial date:
Parental Denial PEIMS Code:_________
Non-LEP (PEIMS Non-LEP Indicator Code 0)
Enter Bilingual program
Transitional bilingual/early exit
Transitional bilingual/late exit
Dual language immersion/two-way
Dual language immersion/one-way
Enter ESL program
English as a second language/content-based
ESL/CB Program Type PEIMS Code: 2
English as a second language/pull-out
ESL/Pull-Out Program Type PEIMS Code: 3
Served in special program(s) (specify):
Other:
Texas Education Agency Bilingual/ESL Unit 2010-2011
Student Alternatives Program, Inc. (06/2011)
ISD LPAC Review
*Copy of complete form must be submitted for accurate PEIMS Coding.
Initial
Annual
Assessment determination
Other:
Student name:
Grade:
Academic year:
Enrollment date:
LPAC date:
Home Language Survey date:
Identification
Oral Language Proficiency test: English score:
Primary language score:
Norm-Referenced Standardized Achievement test: Reading percentile:
Language Arts percentile:
Academic Progress
TAKS Date:
Circle one:
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Score:
Reading/LAT
Writing
ELA/LAT
Science/LAT
Social Studies
Math/LAT
TPRI/Tejas Lee level:
Norm-Referenced Standardized Achievement date:
Test:
Reading percentile:
Language Arts percentile:
Level of Academic Achievement
Subject
English/Language Arts
Math
Science
Social Studies
Other content areas
End-of-Year Grade
LPAC Signatures
Bilingual/ESL Educator: ___________________________
Professional Transitional Educator: __________________
Campus Administrator: ____________________________
Parent Representative: ____________________________
ARD Committee Representative (if needed)*:
________________________________________________
Other (specify title): _______________________________
Texas Education Agency Bilingual/ESL Unit 2010-2011
TELPAS
Reading
Writing
Speaking
Composite score
Beg.
Beg.
Beg.
Beg.
Int.
Int.
Int.
Int.
Adv.
Adv.
Adv.
Adv.
Adv. High
Adv. High
Adv. High
Adv. High
Oral Language Proficiency Level end-of-year:
Other (specify):
LPAC Recommendations
LEP (PEIMS LEP Indicator Code 1)
Parent permission date:
Parental Permission PEIMS Code:_________
Parent denial date:
Parental Denial PEIMS Code:_________
Non-LEP(PEIMS Non-LEP Indicator Code 0)
Enter/Continue Bilingual Program
Transitional bilingual/early exit
Transitional bilingual/late exit
Dual language immersion/two-way
Dual language immersion/one-way
Enter/Continue ESL Program
English as a second language/content-based
ESL/CB Program Type PEIMS Code: 2
English as a second language/pull-out
ESL/Pull-Out Program Type PEIMS Code: 3
TAKS Assessment Determination (see attached documentation)
Served in Special Program(s) (specify):
Monitor Year 1 / Monitor Year 2
Re-enter ESL program as a result of monitoring
Exit Bilingual/ESL program (met criteria)
Other:
Student Alternatives Program, Inc. (06/2011)
ISD LPAC Monitoring of Exited/Reclassified Students
To Be Used in Conjunction with Annual End- of-Year Review Form
*Copy of complete form must be submitted for accurate PEIMS Coding.
First Year Monitor(LEP PEIMS Indicator Code: F) M1
Second Year Monitor(LEP PEIMS Indicator Code: S) M2
Student name:
Exit date:
Total years in BE/ESL program (if served):
Served in special program(s):
Enrollment date:
Grade:
Academic year:
Grading period:
Academic Progress
TAKS Date:
Circle one:
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Pass
Fail
Reading
Writing
ELA
Science
Social Studies
Math
Score:
Credits earned towards graduation (9-12):
Disciplinary actions taken against the student:
6th Grading
Period
5th Grading
Period
4th Grading
Period
3rd Grading
Period
2nd Grading
Period
1st Grading
Period
Level of Academic Achievement
Foundation
Subject
Other (specify):
Semester
Average
English/LA
Math
LPAC Evaluation
Re-enroll/Re-enter Bilingual program as a result of
monitoring
Transitional bilingual/early exit
Transitional bilingual/late exit
Dual language immersion/two-way
Dual language immersion/one-way
Re-enroll/Re-enter ESL program as a result of monitoring
English as a second language/content-based
Science
ESL/CB Program Type PEIMS Code: 2
English as a second language/pull-out
Social Studies
ESL/Pull-Out Program Type PEIMS Code: 3
Other Content
Areas
LEP(PEIMS LEP Indicator Code 1)
LPAC Signatures
Bilingual/ESL Educator: ___________________________________
Professional Transitional Educator: __________________________
Campus Administrator: ____________________________________
ARD Committee Representative (if needed)*:
________________________________________________________
Parent Representative: ____________________________________
Other (specify title): _______________________________________
Texas Education Agency Bilingual/ESL Unit 2010-2011
Parent Permission Date for Re-entry:
Parental Permission PEIMS Code:_________
Parent Denial Date for Re-entry:
Parental Denial PEIMS Code:_________
Require intensive instructional interventions: (specify)
Student Alternatives Program, Inc. (06/2011)