IHBAJ-E PROGRESS REPORT FORM

File: IHBAJ-E

PROGRESS REPORT FORM

Date: ________________________ High School: ___________________________

Student’s Town Responsible
Name: _______________________ for Student: ____________________________

Address: _____________________ Send to Attention of:
_____________________ ______________________________________

Fill Out Relevant Portion

A. January Progress _____ June Progress _____

____ No concerns at this point
____ The following concerns (academic/special) exist:

____________________________________________________________
____________________________________________________________
____________________________________________________________

Please attach a copy of this semester’s rank card.

B. Concerns with the student:

____ Transferred to another high school. Date: ________________
____ Moved to another town. Date: ________________
____ Has been absent for more than 10 school days. Dates of absence:
_______________________________________________________
____ Has been removed for disciplinary reasons. Date: ______________
____ Referred to an alternative program.
____ Referred to Student Assistance Team.
____ Has been referred by staff or parent/guardian for consideration as a
possible special needs student.
____ Other

Summary of action to be taken in response to concerns:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Adopted: May 3, 2007