California High School Exit Examination 2008–2009 Answer Document 1 Student Name Use only a No. 2 pencil. Grade School District Signature 2 Date SCHOOL USE ONLY MI Math R R A A A A A A A A A A A A A A A A A A A A A S S B B B B B B B B B B B B B B B B B B B B B A A C C C C C C C C C C C C C C C C C C C C C E E D D D D D D D D D D D D D D D D D D D D D I I E E E E E E E E E E E E E E E E E E E E E Z Z F F F F F F F F F F F F F F F F F F F F F T T G G G G G G G G G G G G G G G G G G G G G M M H H H H H H H H H H H H H H H H H H H H H I I I I I I I I I I I I I I I I I I I I I J J J J J J J J J J J J J J J J J J J J J Jan. K K K K K K K K K K K K K K K K K K K K K Feb. L L L L L L L L L L L L L L L L L L L L L M M M M M M M M M M M M M M M M M M M M M Date of Birth Day Year PL Month E ELA 4 Gender 5 Male First Name 3 Score Code When a barcode is present in this box, this document can be used ONLY by the student whose name is printed here. Female Last Name Mar. 0 0 0 0 Apr. 1 May 2 1 1 1 N N N N N N N N N N N N N N N N N N N N N 2 2 2 O O O O O O O O O O O O O O O O O O O O O Jun. 3 19 3 3 3 P P P P P P P P P P P P P P P P P P P P P Jul. 4 4 4 Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Aug. 5 5 5 R R R R R R R R R R R R R R R R R R R R R Sep. 6 6 6 S S S S S S S S S S S S S S S S S S S S S Oct. 7 7 7 T T T T T T T T T T T T T T T T T T T T T Nov. 8 8 8 U U U U U U U U U U U U U U U U U U U U U Dec. 9 9 9 V V V V V V V V V V V V V V V V V V V V W W W W W W W W W W W W W W W W W W W W X X X X X X X X X X X X X X X X X X X X X Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y African American or Black (not of Hispanic origin) [600] Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z American Indian or Alaska Native Asian Chinese Japanese Korean Vietnamese Asian Indian Laotian Cambodian Other Asian Filipino Hispanic or Latino Pacific Islander Native Hawaiian Guamanian Samoan Tahitian Other Pacific Islander White (not of Hispanic origin) Declined to state [100] 8 Ethnicity M V W 6 7 Other Ethnicities Mark all that apply SA Primary Ethnicity Mark ONLY one Parent/Guardian Education Level Grid the response that describes the education level of your most educated parent/guardian with whom you live. [201] [202] Graduate school/post graduate training High school graduate [203] College graduate Not a high school graduate [204] Some college (includes AA degree) Declined to state or unknown [205] [206] 9 Local Student ID Number 10 Statewide Student Identifier (SSID) [207] [299] [400] 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 [500] 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 [301] 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 [302] 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 [303] 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 [304] 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 [399] 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 [700] 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 [999] 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 DO NOT WRITE IN THIS AREA SERIAL # Page 1 C C Information on this page must be completed only by school or district staff who have signed the Test Security form. COMPLETE FOR EACH STUDENT Use only a No. 2 pencil. County/District of Residence Enter County and District codes for student’s residence if residence is other than where student attends school/receives services. 12 Special Education Services a. If this student receives special education services under an IEP, grid the three-digit Primary Disability code from the IEP. Mark only one. — A 000 H 270 B 210 I 280 0 0 0 0 0 0 0 C 220 J 290 1 1 1 1 1 1 1 D 230 K 300 2 2 2 2 2 2 2 E 240 L 310 3 3 3 3 3 3 3 F 250 M 320 4 4 4 4 4 4 4 G 260 N 330 5 5 5 5 5 5 5 6 6 6 6 6 6 6 7 7 7 7 7 7 7 8 8 8 8 8 8 8 9 9 9 9 9 9 9 15 Purposes for AYP The signature below indicates that the student has access to the accommodations and/or modifications as specified in the student's IEP or 504 Plan. IEP This student receives special education services at a Nonpublic Nonsectarian (NPS) school. (Enter code in box c.) c. Complete only if this student was found to be no longer eligible to receive special education services within the last two school years. If yes in “b” above, grid the 7-digit NPS school code. Day Section 504 Plan b. Mark all Accommodation(s) and/or Modification(s) used during the administration by this student. See codes listed in the Directions for Administration manual. ELA Math A A B B C C 0 0 0 0 0 0 0 D D 1 1 1 1 1 1 1 E E 2 2 2 2 2 2 2 F F 3 3 3 3 3 3 3 G G 4 4 4 4 4 4 4 H H 5 5 5 5 5 5 5 I I 6 6 6 6 6 6 6 J J K Year 0 0 0 0 0 0 7 7 7 7 7 7 7 K 1 1 1 1 1 1 8 8 8 8 8 8 8 L L 2 2 2 2 2 9 9 9 9 9 9 9 M M 3 3 SA Note: The CAPA will not satisfy the CAHSEE requirement for purposes of obtaining a high school diploma. a. Yes Special Education Exit Date Month Complete only for a student who used accommodations or modifications in attempting the exam. Signature of Test Site Coordinator b. M Student assessed with CAPA (A valid disability code, other than 000, must also be gridded in the “Special Education Services” area.) Accommodations and Modifications PL 14 Participation 13 E 11 3 3 3 N N 4 4 4 4 O O 5 5 5 5 P P 6 6 6 6 Q Q 7 7 7 7 R R 8 8 8 8 S S 9 9 9 9 T T U U V V W W X X 99 For CDE Use Only A 1 B 2 C 3 D 4 Page 2 C C ENGLISH-LANGUAGE ARTS — SESSION 1 Use only a No. 2 pencil. Version Number Test Book Serial Number 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 8 8 8 8 8 8 8 8 9 9 9 9 9 9 9 9 9 9 9 9 9 1. 2. 3. 4. 5. A B C D B C D B C D A B C D A B C D A B C D A B C D A B C D A B C D 6. 7. 8. 9. 10. A A A B C D R1 R2 RT CS A B C D A B C D A B C D A B C D A B C D 16. 17. 18. 19. 20. A B C D A B C D A B C D A B C D A B C D 21. A B C D PL 11. 12. 13. 14. 15. ETS USE ONLY E 0 WRITING TASK SA M Use only a No. 2 pencil to write your response. PLEASE CONTINUE➔ DO NOT WRITE IN THIS AREA SERIAL # Page 3 C C ENGLISH-LANGUAGE ARTS — SESSION 1 SA M PL E Continue writing your response for the Writing Task. Page 4 C C ENGLISH-LANGUAGE ARTS — SESSION 1 SA M PL E Continue writing your response for the Writing Task. End of Writing Task DO NOT WRITE IN THIS AREA SERIAL # Page 5 C C ENGLISH-LANGUAGE ARTS — SESSION 2 Use only a No. 2 pencil. B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C A B C A B C A B C 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D D D D D A B C D A B C D A B C D A B C D Questionnaire A B C D E F A B C D E F A B C A B C D E F A B C D E A B C D E F A B C A B C D E F A B C A B C A B C A B C D A B C D E F A B C D E F A B C A B C D E F SA M 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 70. 71. 72. 73. 74. 75. 76. 77. 78. 79. A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D E A PL 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. ETS USE ONLY R2 Arts 2 End of English-Language 2 Session 2 Page 6 C C SA M PL E This page is for scratch work. It will NOT be scored. Page 7 C C SA M PL E This page is for scratch work. It will NOT be scored. DO NOT WRITE IN THIS AREA Page 8 SERIAL # C C MATHEMATICS Use only a No. 2 pencil. Version Number Test Book Serial Number Mathematics Classes Taken Grid the most recent grade in which you have taken or are taking each of the math classes listed below. If you haven’t taken the class, leave it blank. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 General Math 3 3 3 3 3 3 3 3 3 3 3 3 3 Pre-Algebra 4 4 4 4 4 4 4 4 4 4 4 4 4 Algebra 1 5 5 5 5 5 5 5 5 5 5 5 5 5 Geometry 6 6 6 6 6 6 6 6 6 6 6 6 6 Algebra 2 7 7 7 7 7 7 7 7 7 7 7 7 7 Integrated Mathematics Course I 8 8 8 8 8 8 8 8 8 8 8 8 8 9 9 9 9 9 9 9 9 9 9 9 9 9 8 9 10 11 12 E 7 Integrated Mathematics Course II Integrated Mathematics Course III PL Advanced Mathematics Courses MATHEMATICS — SESSION 1 B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D M A SA 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 1 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. ETS USE ONLY End of Mathematics Session 1 A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D R1 R2 41. 42. 43. 44. 45. 46. RT A B C D A B C D A B C D A B C D A B C D A B C D CS 1 Page 9 C C MATHEMATICS Use only a No. 2 pencil. MATHEMATICS — SESSION 2 B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D A B C D 67. 68. 69. 70. 71. 72. 73. 74. 75. 76. A B C D A B C D A B C D A B C D A B C D A B C D A B C A B C A B C A B C 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. A B C D A B C D A B C D A B C D A B C D A B C D 87. 88. 89. 90. 91. 92. D D D D A B C D A B C D A B C D A B C D Questionnaire A B C D E F A B C D E F A B C A B C D E F A B C D E A B C D E F A B C A B C D E F A B C A B C A B C A B C D A B C D E F A B C D E F A B C A B C D E F SA M 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 2 A B C D A B C D A B C D A B C D A B C D A B C D E A PL 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. End of Mathematics Session 2 ETS USE ONLY R2 2 DO NOT WRITE IN THIS AREA Page 10 SERIAL # C C SA M PL E This page is for scratch work. It will NOT be scored. Page 11 C C Information on this page must be completed only by school or district staff who have signed the Test Security form. COMPLETE FOR EACH STUDENT Use only a No. 2 pencil. 16 17 CBEDS Enrollment This student was counted in the last October CBEDS data collection and has been continuously enrolled since that date. 18 English Proficiency English Learner Test Variations Complete only for English Learners (EL) who used testing variations that are regularly used in the classroom or for assessment. English Only (EO) Initially Fluent English Proficient (I-FEP) English Learner (EL) School Yes No District Yes No Reclassified Fluent English Proficient (R-FEP) After the student was reclassified to RFEP, did the student score proficient or above for any three years on the ELA CST? Yes 19 Mark the EL Test Variation(s) used during the administration. See codes listed in Directions for Administration. No ASAM Schools Only 22 20 NSLP For an English Learner, enter the date first enrolled in school in the United States or its territories. 21 Primary Language 2-digits 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 MONTH DAY 26 ETS Use Only RFEP C D D YEAR MONTH DAY YEAR 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 24 3 3 3 3 3 3 3 3 4 4 4 4 4 4 Grid all the specially funded programs in which the student participated during this school year. 5 5 5 5 5 5 Migrant Education 6 6 6 6 6 6 American Indian Education 7 7 7 7 7 7 Gifted and Talented 8 8 8 8 8 8 8 8 EL in ELD 9 9 9 9 9 9 9 9 EL in ELD and SDAIE SA 25 B C For RFEP student, enter the date in which reclassified. 0 M No 0 A B PL Yes 23 EL Math A E Student enrolled in school less than 90 school days prior to testing. ELA 0 0 Program Participation EL in ELD with SDAIE and Primary Language Support EL in ELD and Academic Subjects through Primary Language Other EL Instructional Services No EL program participation 27 For Local Use 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 Grid Only One Post-Grade 12 Student This student has met all other graduation requirements and is enrolled for the sole purpose of taking the CAHSEE. Educational Testing Service Princeton, NJ 08541 Copyright © 2008 by the California Department of Education Mark Reflex® by NCS Pearson IM-178981-001:654321 ISD7401 Printed in U.S.A. DO NOT WRITE IN THIS AREA Page 12 SERIAL # C C