Pine Tree ISD: Form 36: Transfer Student Review
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Pine Tree Independent School District
Enrollment Date: ______________
LPAC Date: __________________
Parent Permission Date: _________
Bilingual Education / ESL Program
Placement Date: _____________
Student Name:
DOB:
Original HLS Date: ______________
Transfer Student Review
Parent Denial Date: ______________
Student ID:
Age:
Grade:
Campus:
The following documentation from the previous school district was reviewed by LPAC when considering student eligibility for
bilingual/ESL services (documentation on file in cumulative folder):
Student is transferring from (list school district):
Dates attended previous school:
From:
Until:
Program Participation:
Bilingual Program
ESL Program
Parent Denial
Special Education
§ 504
Other: _______________________________________________________________
Most recent LPAC minutes from sending school:
Date:
Student’s Primary Language:
Number of years in U.S. Schools:
Initial Assessment Scores:
Oral Language Proficiency Test:
English Score:
Date:
*Primary Language Score:
Norm Referenced Achievement Test (grades 2-12):
Reading:
STAAR scores
%ile
Language Arts:
TELPAS scores
Student History Worksheet
Date:
Date:
%ile
Transcript of grades
STAAR participation history
Evidence of Inadequate Foundation
Instructional Interventions
*This score is required in bilingual programs and it is encouraged in ESL programs
Attach all Documentation
Information from Parent: _____________________________________________________________________
__________________________________________________________________________________________
Information from Teacher: ____________________________________________________________________
__________________________________________________________________________________________
Pine Tree ISD: Form 36: Transfer Student Review
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IMMIGRANT STUDENT HISTORY
COMPLETE (if applicable):
Form 2: STAAR Immigrant Status
Form 3: Student History Worksheet (attach)
Form 5: Evidence of Inadequate Foundation (attach)
Form 8: Instructional Interventions (attach)
Forms 12-14: Insufficient Progress (attach)
Reminder: An LPAC meeting must be held in the semester of the
TAKS testing to make assessment decisions. Use the LPAC
Decision Making Process for the Texas Assessment Program
(Grades 3-12) Manual to guide LPAC through the decisionmaking process.
Comments: __________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
LPAC RECOMMENDATIONS
ENGLISH LANGUAGE CLASSIFICATION:
(Check the appropriate box)
LEP
Parent Notification of Placement:
Parent conference (if parent did not attend)
Form 9: Initial Parent Notification
Non LEP
LEVEL OF ENGLISH LANGUAGE PROFICIENCY BASED ON
TEST (S) ADMINISTERED:
_______________________________________________
LANGUAGE PROGRAM PLACEMENT:
Elementary Bilingual Education Program
Elementary English as a Second Language Program
Secondary English as a Second Language Program
Dual Language Program
Regular English Program
COMMENTS: ______________________________________
__________________________________________________
___________________________________________________
___________________________________________________
LPAC MEMBERSHIP
LPAC SIGNATURES: (all members must be LPAC trained)
Others Present at Meeting:
____________________________________________________
*Parent of Participating LEP Student
__________________________________________________
Parent of Student
____________________________________________________
Bilingual Education Teacher
__________________________________________________
Other
____________________________________________________
*English as a Second Language Teacher
___________________________________________________
Other
____________________________________________________
Transitional / Regular Education Teacher of LEP Student
___________________________________________________
____________________________________________________
Campus Administrator
___________________________________________________
* Indicates required ESL Program LPAC Membership