Title 1 Student Selection Form


The Student Selection Form used to determine the students to receive Title 1 services.

 

 

John Stark Regional High School Title 1 Student Selection Form

Reading/Math 2014 2015

Student’s Name: _________________________________________ Date: _________________

Please use the following point system to determine whether this student qualifies for Title 1 Services.

History of reading/math difficulties based on past performance on NWEA assessment?

2 points

What is the student’s performance on the NWEA spring assessment?

≤40%ile >40%ile

5 points

2 points

What is the student’s performance level on the annual state assessment? (as appropriate to grade) Substantially Below Proficient Partially Proficient Proficient Proficient with Distinction

5 points

3 points

1 point

0 points

The student is receiving other services that adequately address reading/math needs.

Yes No

3 points

5 points

The student is homeless. (Automatically qualifies for Title I)

12 points

The student is from a migrant family.

5 points

A student new to the SAU who scores < 40%tile, but receives no special education services, automatically qualifies for Title I services.

 

12 points

Teacher recommendation for services based on observation of student’s ability to make typical growth in the regular classroom without supplemental services.

Unlikely Possible Most likely

5 points

3 points

1 point

Score of 12 qualifies for Title I

_______ Total

Was the student selected to receive Title 1 services? _____ yes ____ no Rationale:

9/3/2014