SPECIAL EDUCATION UNIT - Albuquerque Public Schools



ALBUQUERQUE PUBLIC SCHOOLS

Language Usage Data

Student: _____________________________ ID #: __________________ School ___________________ Grade: _______

|Sections A, B, C, D, and E must be completed before making a referral to SAT for a student that is classified as PHLOTE and that scored less than ‘FEP’ on the first |

|administration of the LAS or less than ‘Advanced’ on the first administration of the NMELPA Screening Assessment or less than ‘Bridging’ on W-APT and has not yet been |

|re-classified as FEP-E. |

A. Family Information. Complete and attach parent/guardian interview form.

B. Language Proficiency Information. Attach ACCESS for ELLs data (Synergy or AIMS)

and Spanish LAS data as appropriate (Synergy or AIMS)

C. Student’s School Language. Does this student have the opportunity at school to speak the language other than English

that is indicated in any box on the HLS on the back of the registration card or Synergy? ( Yes ( No

Indicate the language(s) the student chooses to speak in the following situations. Place an ‘X’ in the appropriate boxes.

| |Only |Mostly |Equal |Mostly Language |Only Language |

| |English |English |Mixture |Other Than English |Other Than English |

|Informal with adults (hallways, cafeteria, etc.) | | | | | |

|Formal with peers (classroom, lab, library, etc.) | | | | | |

|Formal with adults (classroom, lab, library, etc.) | | | | | |

|With others that speak his/her home language. | | | | | |

Rate the student’s oral language usage. Place an “X” along the continuum.

|English |Language of Instruction if other than English |

|(instructional) |(instructional) |

|good average poor |good average poor |

|((non-instructional) |((non-instructional) |

|good average poor |good average poor |

Indicate percentage of subject currently taught in English and in any language other than English.

|Subject |% taught in English |% taught in a language other than English |

|Reading/Literature | | |

|Written Language/Language Arts | | |

|Math | | |

|Science | | |

|Social Studies | | |

Additional areas and/or additional comments: _________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

D. Present Program/Curriculum. Provide information about ALS services presently being provided. Please use additional pages if necessary.(Synergy or AIMS)

|Alternative Language Services (ALS): check the ALS services that the student currently receives: |

|English as a Second Language (ESL) and sheltered instruction |

|Maintenance Bilingual Education |

|Dual Language |

|Transitional Bilingual Education |

|Adaptations for Cultural Differences. Describe the adaptations made to address cultural differences. |

|_____________________________________________________________________________________________________ |

|_____________________________________________________________________________________________________ |

|_____________________________________________________________________________________________________ |

|_____________________________________________________________________________________________________ |

Instructional Management for Language Differences. Complete and attach Menu for Effective Sheltered Instruction.____________________________________________________________________________________________

E. Narrative from each certified teacher providing Alternative Language Services (ALS). A narrative from each certified teacher that provides ALS to this student (Bilingual, ESL, Sheltered Content) must be completed to include the following:

• A detailed description of the student’s language skills in comparison to the other students with a similar cultural and language background.

• A detailed description of the student’s academic progress in comparison to the other students with a similar cultural and language background.

• Please date the narrative and attach additional narrative pages if there is insufficient room on this page.

← ESL Teacher (if ESL is provided):

|Comparison of English language skills: ____________________________________________________________________________ |

|_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________|

|________________________________________________________________________________________________________________________________________________________________________________________________________ |

|Comparison of academic progress: _______________________________________________________________________________ |

|_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________|

|_______________________________________________________________________________________________________________________________________________________________________________________________________ |

|Signature: Date: / / |

| |

← Bilingual Teacher (if bilingual is provided):

|Comparison of English language skills: ___________________________________________________________________________ |

|_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________|

|_______________________________________ |

|Comparison of home language skills: _____________________________________________________________________________ |

|_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________|

|_______________________________________ |

|Comparison of academic progress (English & home language): _________________________________________________________ |

|_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________|

|________________________________________________________________________________________________________________________________________________________________________________________________________ |

|Signature: Date: / / |

← Teacher providing Sheltered Content (regular education teacher – preferably the referring teacher):

|Comparison of English language skills: ____________________________________________________________________________ |

|_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________|

|_______________________________________ |

|Comparison of academic progress: _______________________________________________________________________________ |

|_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________|

|_______________________________________ |

|Signature: Date: / / |

F. History of Programs and Services. Indicate what programs and/or services this student has received for each grade level. Use Synergy or AIMS and/or the cumulative file to assist in completing this section.

• For each year of bilingual services indicated, report what type if known: transitional, maintenance, dual language (if dual language, indicate model: 50/50, 90/10, etc.) and/or subjects taught in home language if known (language arts, etc).

• For each service indicated, report amount per day if known (i.e., 45 minutes per day for ESL).

• If it is not possible to access information regarding previously provided services/programs indicate (i.e. “unobtainable”).

• Please use additional pages if there is insufficient room on this chart,

|Grade |School(s) |Dates |Bilingual |ESL |ELD/Sheltered Content |Title 1 |

|Example |Whittier |8/02-11/02 |Maintenance = 45 min |45 min |4 hr |Schoolwide |

| |Sandia Base |11/02-5/03 | |45 min |5 hr | |

|Kinder | | | | | | |

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Completed by: ____________________________________________ __________/_____/_____________

Classroom Teacher (signature is required) Date

|THE INFORMATION ON THIS FORM AND ALL SUPPORTING DOCUMENTATION SHOULD BE KEPT CONFIDENTIAL. |

Revised 07/25/2011

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