Please fill out all below information in order to code a student into their perspective Special Program.Student InformationStudent ID* Student Name* First Last Please select a School*Jubilee BrownsvilleJubilee KingsvilleJubilee Lakeview University PrepJubilee Leadership AcademyJubilee LivingwayJubilee HarlingenJubilee Highland HillsJubilee Highland ParkJubilee San AntonioJubilee SenderoJubilee Wells BranchJubilee WestwoodGrade Level*Pre-KKindergarten1st2nd3rd4th5th6th7th8th9th10th11th12thProgram Entry or Exit* Entering Program Exit Program Status Change You can select both, if you need to input a Entry and Exit Date.Entering Program* MM slash DD slash YYYY Exit Program* MM slash DD slash YYYY Status Change Date* MM slash DD slash YYYY Does this student have a Home Language Survey?* Yes No What is the Home Language* English Spanish Other Other Home Language* What is the Student Language* English Spanish Other Other Student Language* Which Special Program will this student be entering?* ESL Bilingual Gifted and Talented 504 Dyslexia RTI Which special program will this student be changing to?* ESL Bilingual Gifted and Talented 504 Dyslexia RTI Which Special Program will this student be exiting?* ESL Bilingual Gifted and Talented 504 Dyslexia RTI Why was the change made?* Bilingual 1* 0 - Does not participate in Bilingual Program 2 - Transitional Bilingual/Early Exit 3 - Transitional Bilingual/Late Exit 4 - Dual Language Immersion/Two-Way 5 - Dual Language Immersion/One-Way ESL* 0 – Does not participate in ESL Program 2 – Content based 3 – Pull-out LEP Code* 0 – Non EB/English Proficient 1 – EB/EL F – Reclassified from EB/EL - Monitored 1 (M1) S – Reclassified from EB/EL - Monitored 2 (M2) 3 – Reclassified from EB/EL - Monitored 3 (M3) 4 – Reclassified from EB/EL - Monitored 4 (M4) 5 – Former EB/EL Student Parent Permission Code* 3 – Parent/Guardian Request Bilingual (non-LEP/EL Student) 7 – Parent/Guardian Did Not Respond 8 – Parent/Guardian Was Not Contacted A – Parent/Guardian Denied BIL, Approved ESL C – Parent/Guardian Denied LEP/EL Placement in ALL Language Program D – Parent/Guardian Approved BIL Placement E – Parent/Guardian Approved - Alt Lang Prog-BIL G – Parent/Guardian Approved reclassified BIL/ESL(non-LEP/EP Student) H – Requested Placement of Non-LEP Student in ESL J – Parent/Guard Approved-Alt Lang Prog-ESL K – Parent/Guardian Approved ESL Placement Leave Blank ( only use this if you are entering monitored) BIL/ESL Fund Code* BE : Standard Bilingual/ESL D1 : Dual Language Immersion/One-Way D2 : Dual Language Immersion/Two way Leave Blank ( only use this if you are entering monitored) Alt Lang Code* 00 : No Alternative Program 01 : Alternative Bilingual Language Program 02 : Alternative ESL Language Program Years in U.S SchoolPlease enter a number less than or equal to 25.Date HLS Admin MM slash DD slash YYYY OLPT English TestPlease select if any apply01 : Comprehensive English Language Learning (CELLA)02 : IPT I Forms G & H, Second Edition, 201604 : IPT I Online Forms G & H, Second Edition, 201606 : IPT II Forms E & F, Second Edition, 201608 : IPT II Online Forms E & F, Second Edition, 201610 : LAS Links Forms A & B, 201212 : LAS Links Online Forms A & B, 201214 : LAS Links Form C, 2012 Form D, 201316 : LAS Links Online Form C, 2012 Form D, 201318 : Pre IPT, Fifth Edition, 201619 : Pre IPT, Online, Fifth Edition, 201620: Pre LAS 2000 Forms C & D, 201122 : Texas English Language Proficiency Assessment (TELPAS)23 : Test of English Language Learning (TELL) Diagnostic, 201524: Woodcock-Munoz Language Survey III, 2016, Forms A & B26: Stanford ELPT 2nd Edition, Forms E & F Full Length, Forms E & F Abbreviated, 201298: Other English Assessment TestOLPT Spanish TestPlease select if any apply03 : IPT 1 Spanish, Fifth Edition, 201605 : IPT I Spanish, Online, Fifth Edition, 201607 : IPT Spanish, Fifth Edition, 201609 : IPT II Spanish, Online, Fifth Edition, 201611 : LAS Links Español, 201313 : LAS Links Español Online, 201315 : LAS Links Español, Second Edition, 201317 : LAS Links Español Online, Second Edition, 201318 : Pre IPT, Fifth Edition, 201619 : Pre IPT, Online, Fifth Edition, 201621 : Pre LAS 2000 Español Form C, 201125 : Woodcock-Muñoz Language Survey III, 2016, Spanish Form99 : Other Spanish Assessment TestOLPT English/Spanish Test Date MM slash DD slash YYYY OLPT English/Spanish Test Score Gifted and Talented*General Intellectual Ability (K-5th)Subject Matter Aptitude (6th-12th)Select reason for exiting* Exiting Program Exiting Program going into special education 504* Academic/Learning Auditory Impairment Behavioral/Emotional Health / Physical Temporary Impairment Visual Impairment Subject Matter Aptitude* Math Reading/ELA Science Social Studies Dyslexia Services* 01-Student receives services for dyslexia or a related disorder through IDEA or Section 504. (Section 504 Service) 02- Receiving instruction that meets applicable dyslexia program criteria established by the State Board of Education (SBOE) provided by a person with specific training in providing that instruction (See Chapter IV in the Dyslexia Handbook (2018) for program criteria) (SBEC/Trained Staff) 03- On the basis of having dyslexia or a related disorder, the student is permitted to use modifications in the classroom or accommodations in the administration of assessments under Section 39.023. (Section39.023 Mods) Please select the Tier the student qualifies Tier 1 (T1) Tier 2 (T2) Tier 3 (T3) Submitter's name:* First Last Your name here will also act as a signature. Submitter's Email Δ