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SAMPLE School District

English as a Second Language
Multiple Measures Exit Criteria for Grades 1-12
School Year: ____________

Date:_______________

Last Name:_______________________________

First Name:___________________________________

Current Grade:____
ESL Teacher:____________________________________________
Classroom Teacher: ________________________________________
I

Language Proficiency Scores
Test Name:________________
Score

Proficiency

Oral
Reading
Writing

Proficiency Level: _______________

Date: ________________

ACCESS for ELLs English Language Proficiency Test
Scale Score

Proficiency

Listening
Speaking
Reading
Writing
Comprehension

Overall Score: _______________

II

Classroom Grades
_______________________

___________________

Date: ________________

if applicable: ___________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ .___________________ ___________________ Date: ______________________ III ESL Teacher Recommendation Teacher:_____________________________________ Date: ___________ Observations: ___________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ I recommend that this student ____ remain in ESL ____ exit ESL Signature:_______________ Date:____________________ IV Classroom Teacher Recommendation Teacher:_____________________________________ Date: ___________ Observations: ___________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ I recommend that this student ____ remain in ESL ____ exit ESL Signature:_______________ Date:____________________ V IEP or basic skills concerns.

VI Achievement test scores: Math:________________ Rating:___________ Language Arts:_________________ Rating:____________ Reading level score:_____________________ VII Other Considerations _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ .