ELL Forms - New Student Referral Form

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New Student Referral Form
***BEFORE any testing or creating of forms or folders, ask the student or family if child has attended ANY of the Sheboygan Area School District schools before.

ID#:   Student's Name:

School Entering:   Grade:

Years of U.S. Education (K-12):   Years of non-U.S. Education:

Years of U.S. Pre-K:

Reading Instruction:





Math Instruction:




Handicap:

Birthdate:

Primary Language:   Other not listed:

Country of Origin:

Entry/Re-Entry Level:







Entry/Re-Entry Date:

Entering from (U.S. City and State OR Country if other than U.S.):

Immigrant: Yes No Definition:
  • are aged 3 through 21,
  • were not born in any state (includes children born in a U.S. territory or adopted by U.S. citizens or foreign exchange students), and
  • have not been attending one or more schools in any one or more states for more than three (3) full academic years.

Name of Intake Teacher(s):

Is student refusing ELL/Bilingual Services? Yes No

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