PROFILE FOR SUBMISSION / STUDENTS MEETING CRITERIA FOR STUDENT ASSISTANT ALLOCATION

SCHOOL:  NUMBER____________________NAME_______________________                                       PRINCIPAL_______________________DATE________________________________

 

Student Name & MCP#
D.O.B.
Y/M/D
Exp.
Grade
Next
Sept.
ISSP in Place
Is receiving
criteria C,
D, E, F, G
support
(Specify)
Has severe cognitive delay

 

 
Has severe physical disability
Hard of Hearing/ Deaf
or
Blind/
Visually
Impaired
Has sever behavior disorder; is injurious to
self/others; and therefore needs constant
adult supervision

 

 
Has
few
or no
verbal
skills		 Has
severe
mobility
disability
and
requires
assist-
ance		 Requires
toileting
help		 Has
few or
no self
help
skills 		Requires
constant
adult
attention
to function
physically
in the
classroom		 Requires
toileting help		 Requires
portering/
lifting 		On Prescribed Curriculum using ASL or
Braille		 Date of last injury Injury was to
self/other




 Does Run Away Date of last running Behavior Manage-
ment component in ISSP and signed by team
                                       
                                       
                                       
                                       
                                       

Special Education Teaching Units:     C____    D____    E____   F____   G____  Non-Categorical____
(Specify # of Units)
       Other Student Support Services         SLP____  Guidance____   Ed. Psych____  Visual Itinerant____  Hearing Itinerant____
       
       Indicate:  0 - Available on a regular basis    1 - Available when required   2 - Not available   3 - Not Required                  
                       

SIGNATURES:     Principal______________________________________    Assistant Director (Programs)_______________________________   Program Specialist (SSS)______________________________________