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NEPN/NSBA Code:
IHBAJ-E MSAD #37 PROGRESS REPORT FORM FOR SPECIAL
Date: __________________ School: ______________________ Student's Town Responsible Name: __________________ for Student: ____________________ Address: _____________________ Send to Attention of: ______________________ _________________________________
FILL OUT RELEVANT PORTION A. January Progress ___ June Progress ___ ____ No concerns at this point ____ The following concerns (academic/special) exist: ______________________________________________________ ______________________________________________________ ______________________________________________________ Please attach a copy of the most current rank card. B. Concerns with the student: ____ Transferred to another high school. Date: ____________ ____ Moved to another town. Date: _______________ ____ Has been absent for more than 10 school days. Dates of absence: ______________________________________________ ____ Has been removed for disciplinary reasons. Date: ______ ____ Referred to an alternative program ____ Referred to Student Assistance Team ____ Has been referred by staff or parent for consideration as a possible special needs student ____ Other Summary of action to be taken in response to concerns: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Adopted: April 24, 2002 |
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