PROGRESS REPORT FORM



Date:_____________________________         School:________________________________

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

Address:__________________________         Send to Attentionof:_____________________        
             __________________________                                        _____________________

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 school.                        Date:_______________
____Moved to another town.                                 Date:_______________
____Has been absent for more than 10 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:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________

DATE ADOPTED: July 1, 2003