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Name   IEP Date
  (this form prints to one page only)

 
CAHSEE (California High School Exit Exam)
 
CAHSEE/ELA date CAHSEE/ELA date Score Score
 
CAHSEE/Math date CAHSEE/Math date Score Score
 

 
Test modifications/accommodations:
 
  (Describe test accommodations/modifications:)   
 
If not taking the CAHSEE, check appropriate box:
To participate in California Alternate Performance Assessment (CAPA)
Outside of testing group (grades 10 through 12 and age 15 and older and ‘ungraded’)
 

 
On or before the student's 17th birthday, he/she has been advised of rights at age of majority (age 18).
 
   By whom By whom       Date Date   
 
When you reach the age of 18, the age of majority, you have the right to receive all information about your educational program and make all decisions related to your education. This includes the right to represent yourself at an IEP meeting and sign the IEP in place of your parent or guardian.
         
 
 
 
  Student signature   Parent/Guardian signature  
 

 
Passed Algebra 1 Passed Algebra 1       Date Date      
Student working towards Certificate of Completion
 
Credits required for graduation Credits required for graduation    Credits earned Credits earned    Credits needed Credits needed   
Transcript attached
 
  Required courses to be completed Required courses to be completed Additional courses of study Additional courses of study