Ironton City Schools

Proficiency Testing Program Documentation

for Handicapped Students

for School Year ___________ to ___________.

 

 

Student ______________________________ Age______ Birth Date ___________  Grade Level ________

 

 

Instructions

                This record can be used to document the student’s participation in the ninth-grade proficiency testing program for the school year recording above.  Use if student will be in grades 9, 10, 11, or 12 during the school year indicated above.

 

                Check Item A and Stop or Item B and Follow Instructions

 

_______A.  This student is exempted from high school proficiency testing because of a handicapping

                     condition as specified in Rule 3301-13-03 of the Administrative Code.

 

1.        Participate as follows (check one)

 

                _________Reading                            ______Mathematics

 

                _________Writing                             ______Citizenship

 

2.        In the following manner (check applicable items)

 

________ a.  Without modification

 

 

 

 

Parent(s)_________________________________________________ Date______________________

 

Student (18 & over)________________________________________ Date_____________________

 

School District Rep.________________________________________ Date_____________________