WVABE Intake Information
Student Name:
PERSONAL DATA
Age:
EMPLOYMENT STATUS
Educational Level:
Employed (Unsubsidized)
Full-time
Part-time
Marital Status:
Occupation/Employer:
Native Country/Language:
Unemployed:
Looking for unsubsidized work
Not in Labor Force:
Retired
Homemaker
# of Children:
Ages:
Subsidized employment
Volunteer
BARRIERS
LEARNING STYLES
SPECIAL NEEDS
PERSONAL GOALS/CAREER INTERESTS
Observable Physical Disabilities:
Vision:
Hearing:
Other Health Problems/Medications:
Learning Difficulties:
As a result of screening, should a referral be made?
As a result of screening, should class modifications be made?
SUPPORT SERVICES/REFERRALS NEEDED/MADE
Yes
Yes
No
No
POTENTIAL TESTING ACCOMMODATIONS NEEDED
(Put an asterisk * to indicate those that are verified by documentation)
STRICTLY CONFIDENTIAL INFORMATION PLACED IN CONFIDENTIAL FILE
Learning Needs Screening
Correspondence
Other
Referral
Documentation of Disabilities
ASSESSMENT RECORD FOR ACADEMIC STUDENT: Mark with asterisk * the score to be entered in AEMIS. Should student have an ABE or an ESL FFL in AEMIS? ____
Entry
Interim
Post-Assessment
Post-Assessment
Exit
Pre-Assessment
Date
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
# Contact
Hrs. on Test
Date
Exception?
Y/N
See Below
Assessment
TABE
CASAS
__ __ / __ __ / __ __ __ __
ESL / CASAS
BEST
BEST Plus
__ __ / __ __ / __ __ __ __
WorkKeys
__ __ / __ __ / __ __ __ __
TABE
CASAS
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
ESL / CASAS
BEST
BEST Plus
__ __ / __ __ / __ __ __ __
WorkKeys
__ __ / __ __ / __ __ __ __
TABE
CASAS
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
ESL / CASAS
BEST
BEST Plus
__ __ / __ __ / __ __ __ __
WorkKeys
Test Title
Level
(Indicate ONE)
LEMDA
LIT A B C D CIT None
LEMDA
LIT A B C D CIT None
LEMDA
LIT A B C D CIT None
LEMDA
LIT A B C D CIT None
LEMDA
LIT A B C D CIT None
LEMDA
LIT A B C D CIT None
LEMDA
LIT A B C D CIT None
LEMDA
LIT A B C D CIT None
LEMDA
LIT A B C D CIT None
LEMDA
LIT A B C D CIT None
LEMDA
LIT A B C D CIT None
LEMDA
LIT A B C D CIT None
Test
Form
Subject
Raw
Score
Scale
Score or
GLE
FFL
Math
Reading
Language
Listening/
Speaking
Math
Reading
Language
Listening/
Speaking
Math
Reading
Language
Listening/
Speaking
Waiver: Indicate if an exception was made to the established pre-/post-testing timeframes stated in the NRS Publisher’s Assessment Guidelines.
I certify that the student met ALL THREE of the following conditions:
 The student completed a minimum of 30 contact hours between assessments.
 The student demonstrated in classroom assessments (e.g. OPT, PLATO, KeyTrain, IGOs Benchmarks, etc.) that he or she had completed an FFL and was
ready to be post-tested.
 The student was recommended for post-assessment by his/her instructor.
In addition, AT LEAST ONE of the following exception(s) were also true (select all that apply):
 The student’s goal was to study and improve in only one skill area and was only pre- and post-tested in that skill area:
 This was a part-time or short-term course (up to 65 contact hours total for the course) that involved study outside of class hours, and the post-test (interim or
exit) was given at the end of the course. Special course:
 This was an intensive course that met more than 15 hours per week (e.g. SPOKES, HTGR, etc.), and the post-test (interim or exit) was given at the end of
an instructional period. Special course:
 The student had an entry level of FFL #5 or FFL #6, and had one or more of the following core goals (please indicate):
Enter Employment
Retain Employment
Obtain GED
Enter Post-secondary Education or Training.
 The student was leaving the program before the scheduled post-test time due to the following circumstances:
 The instructor believed the initial assessment (and placement) was inaccurate.
OPT
ASSESSMENT FOR SPECIAL STUDENTS
Date
Test Form
Reading
Writing
Math
Science
Social Studies
Total
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
Work-based Project
Assessment
Date
SPOKES Module
Pre-Test
Score
Percent
Contact Hrs. on
Post-Test Date
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
Computer
Literacy
Date
Date
Post-Test
Score
Percent
__ __ / __ __ / __ __ __ __
Computer Literacy Checklist
Pre-Test Level
Contact Hrs. on
Post-Test Date
Date
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
Post-Test Level
PROGRAM GOALS: Indicate how goals changed (or might change) after interim assessment.
Entry
Date
Pass?
Interim
Date
Entry
Date
Interim
Date
Improve basic literacy skills
Complete vocational/assessment testing
Pass the GED
Complete OPT (Official GED Practice Tests) ONLY
Enter post-secondary education or job training
Complete College Preparation Activity
Complete Career Exploration Activity
Obtain a job (unsubsidized)
Complete a short-term (12-30 hrs.) work-based project
Retain current job (unsubsidized)
Complete WVABE computer literacy program
Improve English language skills (non-native speaker)
Become a US Citizen
Prepare for the TOEFL (non-native speaker)
Increase involvement in child’s education
Increase involvement in community activities
Complete other personal goal, specify:
Register to vote or vote for first time
Improved?
PLAN OF STUDY
Program Goals
Improve basic literacy skills
WVABE Skills Checklist:
Specify FFL
Instructional Resources
Personal Development:
Self-Esteem
Goal Setting
Time Management
Money Management
Teaching Strategies for student learning style(s):
Small group instruction
Large group instruction
Independent study
ESL Skills:
Oral Communication:
Reading/Writing:
Employability Skills:
Communication with the Public
Decision Making/Coping with Change
Problem Solving
Stress & Health
Texts:
GED Skills:
Lang Arts Reading:
Lang Arts Writing:
Mathematics:
Science:
Social Studies:
Workplace Knowledge:
The 21st Century Company
Workplace Ethics
Workplace Professionalism and Diversity
Rights and Responsibilities
Learning Express Library at WVInfodepot.org:
Computer Skills
Workplace Skills Improvement
Occupation Practice Tests
Job and Career Accelerator
Ready to Work:
Maintaining Balance In Life and Work
Working Productively
Preparing for & Taking Employment Tests
Employment Portfolio
WIN Units:
Applied Mathematics
Locating Information
Reading for Information
Writing/Business Writing
Computer Literacy Skills
Daily Activities:
Job Readiness
Computer Applications—Word, Excel,
PowerPoint or equivalent applications
Email
Internet
GCFLearnFree.org:
Careers
Job Development
Everyday Life
Computers
Internet Basics
Complete GED Orientation
Personal Goals and
Electives:
Complete vocational/
assessment testing
Objectives:
SPOKES Customer Service Units:
Why Customer Service Matters
What Customers Want
Essential Customer Service Skills, Part I
Essential Customer Service Skills, Part II
Handling Complaints & Dealing with Angry People
Customer Service as Strategic Marketing Tool
Customer Service Teams
Improve English skills (nonnative students)
Pass the GED
Enter post-secondary
education or job training
Complete a College
Preparation Activity
ABE Skills:
Reading:
Writing/ Composition:
Short-Term (12-30 hrs.) Work-based
Projects (SPOKES Topic Areas)
Math:
Obtain a job (unsubsidized)
Retain current job
Complete Career
Exploration Activity
Increase involvement in
child’s education
Increase involvement in
child’s literacy activities
Improve citizenship skills
Increase involvement in
community activities
Complete WV ABE
computer literacy program
Complete a short-term (1230 hrs.) work-based project
Complete OPT (Official
GED Practice Tests) ONLY
Complete a personal goal
Register to vote or vote for
first time
Listening for Understanding
Dealing with Difficult Situations
Writing in the Workplace
Personal Accountability
Substance Abuse
Disaster Preparedness
Personality Choice for Employment and
Self Discovery
Core Abilities
Parenting
Literacy & Basic Level
PLATO Pathways:
GED Learning Path
Pre-GED level
Applied Technology
Listening
Observation
Teamwork
Work Habits
CFWV.com:
Career Planning
Off to Work/Get a Job
College Planning
Financial Aid Planning
Math FFL
One-on-one
Collaborative learning
Computer-assisted
GED &College Prep Level
GED Preparation
College Preparation
US Citizenship
ESL Online:
Rosetta Stone
USA Learns
Test Prep Online:
4Tests.com:
TestPrepPractice.net
March2success.com
Computer Lit:
This is the “On Button”
Curriculum
Inpics.net tutorials
baycongroup.com tutorials
Jegsworks.com
spclc.org/curricula/computer
Accuplacer
ACT
FastTrack to GED
CASAS Levels
Reading FFL
Writing FFL
Compass
CTLC LPN
SAT
STUDENT ACHIEVEMENTS
Select One:
Student Withdrew
Withdrawal Date: __ __/__ __/__ __ __ __
Student is continuing into the next Program Year (PY)
Check all achievements accomplished and documented as a result of the student’s participation in ABE.
Educational
Employment-Related
Increased at least .5 grade level, 3 points on CASAS Scale, Or 1 SPL In any assessment area
Obtained a better job or job promotion
Obtained / retained subsidized job
Increased at least one level in a learning management system in any assessment area (e.g., WIN,
PLATO, etc.)
Earned a Ready To Work Certificate
Completed entire vocational / assessment battery / test (i.e., LPN, TABE, CASAS, ACT, Work Keys)
Completed a worksite learning experience
Completed OPT (GED Official Practice Test)
Completed an approved job readiness program (i.e. SPOKES, Hit The Ground Running, LINKS)
Passed all Parts of the OPT (GED Official Practice Test)
Passed an employment or state licensing exam
Completed GED Orientation
Entered the military
Passed 1-4 of the GED Tests
Earned a Governor’s Career Readiness Certificate
Completed a Career Exploration Activity
Earned a Customer Service Certificate (i.e. SPOKES)
Completed a College Preparation Activity
Earned a Customer Service II Certificate (i.e. SPOKES)
Obtained Computer-based Testing (CBT) Skills
Earned an Achievement Certificate (i.e. SPOKES)
Other (Specify),______________
Earned a Microsoft Office Certificate (SPOKES Only)
Earned IC3 Certification (Must achieve all 3 credentials, SPOKES Only)
Further Education/Training
Earned IC3 Achievement Credential (Must achieve all 3 credentials, SPOKES Only)
Met requirements for entrance into technical training
Earned an Certificate
Met score requirements on entrance exam for college
Earned an Achievement Certificate (Select all that apply, SPOKES Only)
Enrolled in WV college/ university, specify: ______________
Computing Fundamentals
Living Online
Key Applications
Enrolled in out-of-state post-secondary/ job training, specify: ______________
Community
Enrolled in private/ local training outside of WV’s public school vocational system
Other (specify),______________
Enrolled in online post-secondary or CTE training, specify: ______________
Personal Goal
Enrolled in local CTE program
Obtained Computer Skills
Other (Specify),______________
Other Goal, Check One:
Educational
Personal Goal
Employment related
Family
Further ed/Training
Community
Family--Increased Involvement In Children’s Education
Helped children more frequently with school
Increased contact with children’s instructor
Increased involvement in children’s school activities
Family--Increased Involvement In Children’s Literacy Activities
Read to children more frequently
Visited library more frequently
Purchased books or magazines for children
Other (Specify),____________
Work-Based Project
Completed all project objectives
Completed objectives for a WVABE Computer Literacy program
Community
Increased involvement in community activities
Voted or registered to vote for first time
Institutional Education Only
Cognitive Skills
CTE
ABE/GED
College 101
Passed state-approved test of citizenship skills
Became a US citizen
Volunteered for community service