Taylor Swift Public Schools Referral to Determine Eligibility For Special Education And Related Services (Responses)

Timestamp

Parent/Guardian:

Address:

9/23/2015 13:55:56 Joseph Lorenz

Sara Lorenz

222 Middleneck Road Y 917-485-9035

9/23/2015 14:08:11 Jimmy

Name:

Stephanie Doran

3863 Drake Street

Telephone:

DOB:

Primary Language

Referred by:

7 2nd

English:

Lynette Drexel

12/14/2007

English:

9/24/2015 20:28:27 Lillian James

Lisa James

20 Blue Road

561-555-1234

10/10/2007

8 3rd

English:

9/25/2015 12:49:38 Kaitlyn Anderson

Kara Anderson

15 Beach Dr. Merrick N 516 958 2382

1/2/2006

9/25/2015 22:39:45 John Green

Paula Green

194 Maple Drive

9/25/2015 22:43:03 John Green

Paula Green

194 Maple Drive

212-881-1090

9/28/2015 20:52:20 Montana Wholey

Rebecca Wholey

9 Ocean Avenue

(516) 585-7476

5164453987

Age:
4/17/2008

Grade:

Referral Date:

Relationship to Child:
9/23/2015 Teacher

Area(s) of Concern:

Describe Specific Conce Describe Alternative Str Are you aware of any sp If Yes, describe the type, Other Relevant Informati Has the parent/guardian If Yes, method of Notific Date(s) parent/guardian Signed:

Academic

Joseph is struggling with We have tried having Jo No

Yes

Jimmy struggling in his a Moved his seat twice in No

Jimmy is struggling in hi Yes

email and telephone

9/16/2015 Lynette Drexel

Signature of School Administrator

Date Signed:
9/23/2015

called mom

9/3/2015 stephanie Doran

9/12/2015 stephanie doran

Parent-Teacher Meeting

9/1/2015 Kayla Gressen

9/24/2015 Robert Carter

Extra time in writing and

Teacher

9/24/2015 Teacher

Academic

Lacking in proficient writi Parents have been worki No

Nicole Romano

9/25/2015 Education teacher

Academic

Some things that can be

Kaitlyn is behind on her r consult with parents on No

Yes

Social/Emotional

John is depressed the m John has a one on one a No

Yes

Academic

Seems distracted during Tried working with speci No

10/14/2015 Teacher

Academic

Given a simpler version

Highlight words that are
Required over 60% assi Learning of words and m
Appear to have difficulty Discussions about text r
Appears to have difficult Introducing one word pe No

8/30/2015 Teacher

Behavior

Johnny struggles being

9/1/0015 Teacher

Behavior

Jenny blurts things out d I have previously tried re Yes

I would like School visiti I have documented all b Yes

phone, notices, and plan

CHOP-tubes in ears

Letter home, Parent-tea

9/17/2015 Emma Vaccaro

Tried to get her to read o

2/14/2006
11/25/2006

2/14/2005

9
9 3rd
9

English:
12 English:

Rebecca Gleeson

Bob Smart Snr

101 Awesome Street

516-010-0101

9/29/2015 16:24:11 Johnny

Mrs. Garcia

164 Whitehall road

(516) 850-2248

9/2/2003

5 1st

English:

Special Education teach

9/29/2015 16:56:05 Jenny Morghan

Mary and John Morghan 236 green street

(516)432-0989

4/12/2009

7 2nd

English:

Miss Piacente

My assistant and I have No

Telephone

8/20/2015 LS

Has not been classified Yes

E-mail

9/18/2015 Rebecca Gleeson

Parents are updated we Yes

Telephone and parent te

none.

Meeting at school.

Yes

10/10/2015 Y. Holli
9/20/2015 Mrs. Grace
9/9/2015 Miss Christine Piacente

9/24/2015 Christine McManus

9/2/2015 PA
9/28/2015 Nicholas Savino

10/16/2015 P.Body
9/30/2015 Mrs. Miller
9/29/2015 Principal-Mr. Meyerson

English:

Emma Vaccaro

9/29/2015 Teacher

Communication

10/31/2005

8 3rd

English:

Shelby Kravitz

10/5/2014 Teacher

Behavior

Acting out in class, hurti Multiple talks with the st No

Yes

Letter

9/20/2014 Shelby Kravitz

10/18/2014 John Anderson

4/15/2005

10 5th

English:

Hope Knudsen

9/29/2015 Teacher

Communication

Student has trouble artic Student tried to write fee No

Yes

Conference

8/29/2015 Hope Knudsen

9/29/2015 Hope Knudsen

Yes

phone call

He is great when it come Yes

17 Cherry Tree Lane

(135)-791-1131

9/14/2008

9/29/2015 20:56:38 Crystal Smith

John Smith

23 Mark Tree Street

(555)434-8790

9/29/2015 23:16:11 Fred Goldstein

Susan Goldstein

154 Cherry Lane, Hemp 516-264-9965

13479960719

9/28/2015 Teacher

Nicole Romano

7 Second

Mary Eimer-Smith

187-04 Ilion Avenue

Oprah Winfrey

8/4/2015 Uncle

low level of confidence a No

-Appears to read lips

-Cannot spell phoneticall -Hearing test- scored bel
-cannot hear when you s -one-on-one phonetic sp Yes

9/29/2015 18:45:13 Janie Smith

Delthia Forte

5 English:

Steve Smith

9/29/2015 10:25:56 Bob Smart Jr

9/30/2015 0:36:06 Amaris Forte

10

3 English:

6/21/1996

9/30/2015 10:42:51 Arnold Smith

Neil Smith and Anna Sm 123 Applewood Lane

(555) 928-3333

2/22/2008

9/30/2015 12:47:22 Emma Reilly

Elizabeth Reilly

124 Cedar Street

516-678-9090

7/21/2006

9/30/2015 14:48:12 Jane Smith

Mary Smith

1234 Abbey Lane

(516) 987-654

9/17/2005

12
9 3rd Grade
7 2nd
10

6 English:

Anita Ellis

English:

Joan Myers

English:

myself, Ms. Griffin

5 English:

9/30/2015 15:09:02 Thomas Jones

Dennis Jones

123 Education Drive

123-456-7899

6/11/2005

10

9/30/2015 15:47:51 Lawrence Philbin

Regis Philbin

One Hollywood Way

631-867-5309

2/14/2004

11 Sixth

9/30/2015 15:51:49 Kamran

Julie

1 Merry Lane

516 804 0445

10/6/2007

3 English:

Simran Hira

9/30/2015 15:52:20 Kamran

Julie

1 Merry Lane

516 804 0445

10/6/2007

3 English:

Simran Hira

9/30/2015 22:42:17 Veronica Alvarez

Adolfo Alvarez

19 Blueberry Ln

(516) 495-4978

6/6/2007

8 3rd

5 Other:

Mrs. Jones

English:

Other:

Mrs. Garutare
Dr. Klaus

Victoria Rodriguez

I believe the hearing dis Yes

Communication

Does not speak.

Placed in groups for gro
Does not participate in cl Asked direct questions... No

5/2/2015 Teacher

Behavior

Arnold has been speakin I have tried to have a on No

1/3/2014 Teacher

Academic

Emma is having problem I would like to put Emma No

Yes

9/30/2015 Teacher

Academic

Jane has trouble comple Jane could be allowed m No

Jane knows the informat Yes

Academic

struggles with picking up -provided vocab words

-reading analysis
outcome=40%
-pronunciation
-went through a reading
-defining terms
outcome=Still struggled No

Yes

counselor

12/10/2015 Primary Teacher

9/8/2009 Teacher

Activities

Lawrence has difficulty

Lawrence otherwise kno Yes

Cousin

Social/Emotional

Emotionally Disturbed.

We have taken kamran t No

Cousin

Social/Emotional

Emotionally Disturbed.

We have taken kamran t No

Academic

extra time
reading comprehension 30 minute in another roo Yes

9/30/2015 Teacher

ESL

Lawrence's first languag Yes

HELP!

No

HELP!

No

ESL Teacher and Speci Veronica came to the U. Yes

Notes home
Meeting with Parents
Phone conversation

phone
Phone Call

10/17/2007 Anita Ellis

3/22/2015 Joan Myers
12/29/2015 Ms. Samantha Griffin
9/20/2015 Mrs. Jones

11/20/2015 Mrs. Garutare

9/3/2015 Billy Bob Thorton

9/29/2015 Apple Peabody

12/1/2007 Anita Ellis

5/15/2015 Nancy Noble
1/11/2015 Mr. David Pensabene
9/30/2015 Mr. Fields

12/1/2015 Mr. Patricugee

11/11/2010 Kelly Ripa

SRIMA N
SIMRAN HIRA
In person

10/2/2015

9/30/2015 Simran Hira

10/3/2015