CASEMIS/Action Plan |
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Student |
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DOB |
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Gender |
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Grade |
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SSID |
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IEP date |
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School of
residence |
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District of
residence |
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School of
attendance |
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Federal school setting |
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Federal preschool setting |
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Eligibility (P=Primary, S=Secondary) |
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210 ID |
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220 HH |
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230 Deaf* |
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240 SLI |
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250 VI* |
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260 ED |
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270 OI* |
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280 OHI |
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290 SLD |
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300 DB* |
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310 MD |
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320 AUT |
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330 TBI |
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281 Est. Med. Dis. (0-5) |
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Services |
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[DNR]
[Primary]
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-
/wk
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G
I
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- |
- |
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Case manager |
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% OUTSIDE Gen Ed |
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% IN Gen Ed |
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Testing: Test |
Accommodations/modifications |
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CASHEE |
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Math |
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Science |
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ELA |
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History |
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Writing |
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Transition Questions |
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1 |
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2 |
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3 |
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4 |
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5 |
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6 |
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7 |
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8 |
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Initial referral (for assessment) |
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Referral date |
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Referred by |
- |
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Parent consent date received |
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Coordinated early intervening services |
Yes
No
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Initial evaluation date |
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