New Entrant Screening Summary

It is important to complete screening within 30 school days. Each person using this form should then return it to the principal who will track the routing.
**COUNSELORS/CLASSROOM TEACHERS: Please review records from prior school and indicate appropriate referral (if any) to reading or math specialists at bottom of page according to the following criteria:
     Reading:   Scored level 1 or 2 on Grade 4/8 ELA test or
                    Scored at or below 35%ile on a standardized reading test
     Math:       Scored level 1 or 2 on Grade 4/8 math test or
                    Scored at or below 35%ile on a standardized math test

Actions Taken
____ No follow-up warranted; screening suggests skills are within "normal" limits

____ Monitor speech/language development in the following areas:

____ **Referral to reading specialist due to review of prior reading scores:
            __________________________________________________

____ **Referral to math specialist due to review of prior math scores:
             __________________________________________________

____ Referral to speech/language for complete evaluation due to screening findings:
           ___________________________________________________

____ Referral for ESL evaluation

____ Referral to Building Child Study Team due to following screening findings:
          ___________________________________________________

____ Referral to CSE due to the following screening findings:
          ___________________________________________________

____ Referral to principal for evaluation in other areas based on the following screening findings:
          ____________________________________________________