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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
Passed
Did not pass
Passed
Did not pass
CAHSEE/Math date
CAHSEE/Math date
Score
Score
Passed
Did not pass
Passed
Did not pass
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
Yes
No
Yes
No
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