Copperas Cove ISD Student Profile
Copperas Cove ISD Student Profile Student Name:_________________________________________
Grade: ____________________
Name & Address of school the student last attended: _____________________________________________________ _____________________________________________________
Date of Withdrawal: __________________________ __________________________
Please indicate the following services previously received:
Yes
No
Gifted Education
Yes
No
Section 504 Services If yes, briefly explain: _____________________ ________________________________________________________________________ ________________________________________________________________________
Yes
No
Special Education Services If yes, briefly explain: _____________________ ________________________________________________________________________ ________________________________________________________________________
Yes
No
English as a Second Language Services
Yes
No
Dyslexia classes or programs
Yes
No
Homebound Services If yes, briefly explain: _____________________ ________________________________________________________________________ ________________________________________________________________________
Yes
No
Has the student previously attended a CCISD campus? If yes, please provide the campus name and school year attended. ______________________________________________ ___________________
Yes
No
Was the student enrolled in Home School, previously? provide the curriculum used and the school year(s). _____________________________________________
If yes, please
Did the student attend a Private School? The name of the school and the school year(s). ______________________________________________
If yes, please provide
Yes
Yes Yes
No
No No
Has the student ever been retained? 2 3 level(s) repeated. 1
If yes, what grade level? ___________________
___________________
__________________
If yes, please indicated the grade
4
5
6
7
8
Records provided?
____________________________________________________ Parent/Guardian Signature
_________________ Date
Copperas Cove ISD does not discriminate against any person because of race, color, religion, sex, national origin, disability, age, or any other basis prohibited by law. Copperas Cove ISD no discrimina contra ninguna persona por razón de raza, color, religión, sexo, origen nacional, discapacidad, edad, o cualquier otro prejuicio, prohibido por la ley.
Student Profile/17-18/Student Services/mr
Grade: ____________________
Name & Address of school the student last attended: _____________________________________________________ _____________________________________________________
Date of Withdrawal: __________________________ __________________________
Please indicate the following services previously received:
Yes
No
Gifted Education
Yes
No
Section 504 Services If yes, briefly explain: _____________________ ________________________________________________________________________ ________________________________________________________________________
Yes
No
Special Education Services If yes, briefly explain: _____________________ ________________________________________________________________________ ________________________________________________________________________
Yes
No
English as a Second Language Services
Yes
No
Dyslexia classes or programs
Yes
No
Homebound Services If yes, briefly explain: _____________________ ________________________________________________________________________ ________________________________________________________________________
Yes
No
Has the student previously attended a CCISD campus? If yes, please provide the campus name and school year attended. ______________________________________________ ___________________
Yes
No
Was the student enrolled in Home School, previously? provide the curriculum used and the school year(s). _____________________________________________
If yes, please
Did the student attend a Private School? The name of the school and the school year(s). ______________________________________________
If yes, please provide
Yes
Yes Yes
No
No No
Has the student ever been retained? 2 3 level(s) repeated. 1
If yes, what grade level? ___________________
___________________
__________________
If yes, please indicated the grade
4
5
6
7
8
Records provided?
____________________________________________________ Parent/Guardian Signature
_________________ Date
Copperas Cove ISD does not discriminate against any person because of race, color, religion, sex, national origin, disability, age, or any other basis prohibited by law. Copperas Cove ISD no discrimina contra ninguna persona por razón de raza, color, religión, sexo, origen nacional, discapacidad, edad, o cualquier otro prejuicio, prohibido por la ley.
Student Profile/17-18/Student Services/mr
