Vaia THE SCHOOL DISTRICT OF PALM BEACH COUNTY Elementary Student Transfer To Be Completed for All Transfers (Print or Type) Psychological on file Yes Li No Physical Exam on file Yes No Cl Date Sifq)q 3 Immunization Dates: ..54*DPT g'1410 MMRa - shq/93 Health Problems/High Risk Yes U Copy of form attached Yes O N/A EL. N/A "ant .41611Ge-x., Avezvviti • 64/- bag -Soh scimuTh ltesstedA-c-ts, teter-e-nAtit-ti-- PAximted - 6.1f-seznnix" 17-7.557 W. hiat. eii,a- EL .0 IA/. 12,412. -16truit As. _P5Of REGULAR INSTRUCTION PROGRAM INFORMATION Copp of Report Card Method Teacher Name(s). A 09. i)-itt r ename 4 Instructional Materials (indicated level) GRADE KG 1 2 3 5 PAGE Mathematics KG 1 2 3 rtiC. 5 Macmillan O Level Level Level Level LeveUeyfi l9 Level fiedfA ,,, Reading FOCUS O / I i i Teter . L. r iceekSu-5r4 r 9 .0r- i- % I.- Other ei / 8,14 Maid; e Student meeting Pupil Progression Standards Yes No O /Student currently repeating grade ... Yes O Pupil Progression Letter sent Yes O No Wei , School Patrol Yes O Letter signed Yes O No Ore Workbooks sent with student Yes O ILS Disk Yes O No OW SPECIAL INSTRUCTIONAL PROGRAM INFORMATION student is in special Program (drcle) Migrant Current-. Date 504 Staffing/Testing in Progress EH LAD Speech Alt. Ed. EMH SEH SOI ESOL Gifted SLD VE Chapter 1 OBLIGATIONS FULFILLED Textbooks returned Yes CV No O Library books etumed ....Yes No O TIAGEsts Ocnc'Eg. PEW 0938 (REV 8/99) alAtAvilh sluded vaLOwisen ng school office Other (name program) No a. No IL No N/A ta, ITCCAnd7e)(1 198 PiNKtcumdative folder CONFIDENTIAL MMUS-M LIL.A I A-UU0U /0 3501.135-025 Page 1 of 1 EFTA_00066395 EFTA01246761