Fcps Form Is 677 PDF Details

If you are a parent or guardian of a Fairfax County Public Schools student, then you will need to fill out the FCPS Form 677. This form is used to update your contact information and other important details. Make sure to fill out the form completely and accurately, so that we can reach you in case of an emergency. You can download the FCPS Form 677 from our website, or pick one up at your child's school. Don't forget to submit the form! Thank you for your help in keeping our students safe.

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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1. The Fcps Form Is 677 usually requires certain information to be typed in. Make sure the following blank fields are completed:

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

It's easy to make an error when completing your Phone, for that reason be sure to look again before you decide to send it in.

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