Fcps Form Is 677 PDF Details

The FCPS IS 677 form, known as the Dual Language Assessment Request Form, serves as a critical document within the Fairfax County Public Schools system, facilitating the assessment needs of students who are dual-language learners. This comprehensive form requires detailed information about the student, including name, ID number, sex, grade, date of birth, place of birth, home language(s), and both US entry date and FCPS entry date, providing a holistic view of the student's background and schooling history. It also dives into specifics such as years of schooling in the home language, retention in the home country, and any instances of interrupted education, which are crucial for understanding the educational journey of each student. The form further involves parental or guardian input, capturing details about the parent or guardian, including their home country and contact information, which reinforces the collaborative effort between the school system and families. Areas of concern are plainly addressed, allowing for a clear depiction of the student's needs, while previous interventions, DLA consultations, and special education services are queried to furnish a complete educational picture. Importantly, the form also acknowledges physical conditions that might impact assessment administration, emphasizing the individualized approach taken to meet each student's unique requirements. Sent alongside a Home Language Survey and any pertinent documentation, this form is directed to the Office of Language Acquisition and Title I Dual Language Assessment Service, illustrating the structured yet personalized framework designed to support dual language learners within the FCPS system.

QuestionAnswer
Form NameFcps Form Is 677
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesis677 fcps dla form

Form Preview Example

Dual Language Assessment Request Form

Student Name

 

 

 

 

 

 

 

 

 

ID Number

 

 

 

 

Sex

 

 

Male

Female Grade

 

 

 

DOB

 

 

Place of Birth

 

 

 

 

 

 

 

 

Home Language(s)

 

 

 

 

 

 

Entry Date U.S.

 

 

 

 

 

 

 

 

 

 

Entry Date FCPS

 

 

 

 

 

 

 

 

 

 

 

Years of U.S. Schooling

 

 

 

 

 

Years of Schooling in Home Language

 

 

 

 

 

 

Retention in Home Country?

Yes

No

 

 

Interrupted Education?

Yes

No

 

 

Parent or Guardian Name

 

 

 

 

 

 

 

 

Parent or Guardian Home Country

 

 

 

 

 

Home Phone

 

 

 

 

 

 

 

Work Phone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Describe the area of concern.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Submission

 

Name of DLA consultant (if applicable)

 

 

Referring Source

 

 

Title

 

 

 

 

 

Date

 

 

 

School

 

Cluster

 

Phone

 

 

 

Local Screening Chairperson

 

 

 

 

Phone

 

ESOL Dept. Chairperson/Leader Teacher

 

 

 

Phone

School Counselor

 

 

 

 

 

(for MS and HS only)

Phone

 

 

 

 

 

 

 

 

 

Student's current WIDA English Language Proficiency Level

 

 

 

1-Entering

2-Emerging

3-Developing

4-Expanding

 

5-Bridging

(Level 6-Reaching is considered English proficient. Dominant language assessments are neither required, nor appropriate for English proficient students.)

Have ongoing interventions targeted to the specific area of concern been implemented?

Yes

No

 

 

(Please attach documentation, including dates and results of interventions.)

 

 

 

 

 

 

 

Has there been a previous DLA Consultation?

Yes

No

 

 

 

 

 

 

 

 

If not, is the DLA needed for reevaluation?

Yes

No

If Yes, Date

 

 

 

 

 

Is student currently receiving special education services?

Yes

No

 

Area of Disability

 

 

 

Has there been a previous Dual Language Assessment?

Yes

No

If Yes, Date

 

 

 

 

If there is a physical condition that may affect the administration of assessments, please describe:

The student wears or uses

IS-677 (8/12)

Glasses

Hearing Aids

Other (specify)

Please email to DLA@fcps.edu along with a scanned copy of the

Home Language Survey and supporting documentation.

Office of Language Acquisition and Title I

Dual Language Assessment Service

Leis Administrative Center

(703) 208-7801

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How one can fill out Fcps Form Is 677 portion 1

2. Right after this array of blank fields is done, go on to type in the applicable information in all these: School, Local Screening Chairperson, ESOL Dept ChairpersonLeader Teacher, Cluster, Phone, Phone, Phone, School Counselor, for MS and HS only, Phone, Students current WIDA English, Entering, Emerging, Developing, and Expanding.

Ways to complete Fcps Form Is 677 part 2

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