Student reporting form title I migrant education




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Wisconsin Department of Public Instruction

STUDENT REPORTING FORM

TITLE I MIGRANT EDUCATION

PI-1732 (Rev. 03-13)



INSTRUCTIONS: Submit within seven (7) days of withdrawal or term ending for each school-enrolled migratory child this term. A valid COE must exist and the child’s name must be listed on this term’s CER. Send to:

WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION
TITLE I MIGRANT EDUCATION PROGRAM


PO BOX 7841

MADISON, WI 53707-7841




If this student received Section 1304 Continuation of Services, check the appropriate number below to identify service authorization.




 1 = Eligibility ended this term

 2 = 1 additional year

 3 = Eligibility ended in secondary school


School Term

 Regular

 Summer








SCHOOL DISTRICT DATA







School District Name

     


School Building SSID Code Enter only one.




Regular Term = WI

 

 

 

 

Summer = WI

 

 

 

 




Name of Records Contact Person Completing This Form

     


Email Address of Records Contact Person

     


School Phone Area/No.

      Ext.     







STUDENT DATA







Unique Student ID (USID) Only as listed under NGS

     


Date of Birth Mo./Day/Yr.

     


Sex Check One

Male Female






Student’s Last Name

     


Student’s First Name Formal spelling

     


Middle Name

     





Birth City

     


State

  


Country Only if not USA

     





Homebase District

     


City

     


State

  


ZIP Code

     





Mother’s Last Name

     


Mother’s First Name

     


Father’s Last Name

     


Father’s First Name

     








EDUCATION DATA
Add to or close a child’s COE/CER reported enrollment for this term/history ID line.







Enrollment This Term Mo./Day/Yr.

     


Withdrawal This Term Mo./Day/Yr.

     


Education Interrupted




School Grade

  


Days Enrolled

   


Days Present

   


Graduated Mo./Day/Yr.

     





Teacher Observed English Language Oral Proficiency

 None  Limited  Fluent



Date Observed Mo./Day/Yr.

     


Medical Alerts

 Chronic  Acute

 None


Assessment Data Attached

 Yes  No



Immunization Records Attached

 Yes  No






Supplemental Programs Check services provided below that were in part or fully funded through the migrant education budget this term.




Instructional Services




 Bilingual

 Career Exploration

 Distance Learning

 ESL


 Financial Literacy

 GED / HEP



 Health Education

 Life Skills

 Literacy

 Math Instruction

 MathMATTERS

 Mini-PASS



 NovaNet

 Out of School Youth (OSY)

 PASS

 PLATO


 Post Secondary Prep

 Pre-GED



 Preschool

 Reading Instruction

 Science

 Social Studies

 Test Prep

 Tutorial Elementary



 Tutorial Middle/Secondary

 UT Austin

 Other





Supportive Services




 Clothing

 Counseling Service

 Health / Dental / Eye Care

 Homeless Support



 Materials

 Nutrition

 Out of School Youth (OSY)

 Parent Education



 Precollege Programs

 Referred Services

 School Supplies

 Social Work / Outreach / Advocacy



 Transfer Packet

 (Pupil) Transportation



 Other







SECONDARY SCHOOL COURSEWORK
Complete for students in grades 7-12, per semester
An “R” in a column means a required entry for grades 9-12.




Courses Requiring Immediate Attention (for evaluation by school of graduation)—See/use NGS state course list.




If Partial

If Final

Grade Level

Course Name
(formal name) or add your school’s course name to be added under NGS subject area

Course Type
See list, NGS, UT, PASS, Smart

Course Section
A / B If any

Course Subject

Term Type
Sem / Qtr

Term Name —Fall / Spring /
Summer


This Calendar Year of Term

Partial Grade in Percentage
Example: 91%

Course Hours Attended

Final Grade
as a Percentage
Example: 89%


Credit Granted
as a decimal
Example: .5


R

R

R




R

R

R

R













  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    

Use the second Reporting Form, below, if enrollment continues with uninterrupted attendance and courses in the second semester.

Date NGS Reported Mo./Day/Yr.      

Comments

     


For GED Completions, enter date received.      

If Partial

If Final

Grade Level

Course Name
(formal name) or add your school’s course name to be added under NGS subject area

Course Type
See list, NGS, UT, PASS, Smart

Course Section
A / B If any

Course Subject

Term Type
Sem / Qtr

Term Name —Fall / Spring /
Summer


This Calendar Year of Term

Partial Grade in Percentage
Example: 91%

Course Hours Attended

Final Grade
as a Percentage
Example: 89%


Credit Granted
as a decimal
Example:.5


R

R

R




R

R

R

R













  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    

  

     

     

  

     

   

    

    

    

   

    

    




Date NGS Reported Mo./Day/Yr.      

Comments

     





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