School & Community Activities Assistant / &Parent Center (F.A.C.E)

SCHOOL &COMMUNITY ACTIVITIES ASSISTANT: In charge of Severe Attendance and School Events

Marisol Ante

AYUDANTE DE ACTIVIDADES ESCOLARES Y COMUNITARIAS: Encargo de Grave Asistencias de estudiantes y Eventos de la Escuela

B plaq teal Espanol

 FAMILY AND COMMUNITY ENGAGEMENT LIAISON (F.A.C.E): Stiern’s Parent Center

B plaq teal Ms. Martinez

ENLACE DE PARTICIPACION DE LA FAMILIA Y LA COMUNIDADE (F.A.C.E): Centro De Padres

B plaq teal Espanol

 

                                                                                                                                        

 

Behavior Specialist; Mrs. Leon and Mr. Cespedes

                                                                                     Especialista en comportamiento; Mrs. Leon y Mr. Cespedes

 


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Request for Assistance

Positive Behavior Intervention Support

Behavior Intervention Specialist

Student Name: ________________________________________        Grade: _________                                     

Date: ___________________________                             IEP (circle one)      Yes        No       

Teacher: _____________________________     School: _____________________________                     

1)  I am a (circle one):       Family Member      Student           Other

Name: ______________________________________

Relationship to student: _______________________________

2) Type of Concern:

____Academic only

____Behavior only

____Both Academic and Behavior

3) Briefly describe the reason for the request:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

For school use only:

Date parent/student was notified of request (response should occur within 3 days):        /         /

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Parent Questionnaire

Student Name: _______________________________      Grade: _________________

Parent Name: _______________________________        Date: __________________

1.     Family/Home:

What is the primary language spoken at home? _____________________________

Who does the child live with? __________________________________

If parents do not live together, does the child spend time at both homes? ___________________

Please describe:

____________________________________________________________________________________________________________________________________________________________

Are there any significant changes that have occurred in your child’s life that might be affecting school performance? ____________________________________________________________

2.     Educational History:

Have any past teachers raised concerns with reading, other academic areas, or behavior?

____________________________________________________________________________________________________________________________________________________________

Tell us about any schools your child has attended? _____________________________________

Do you have concerns about your child’s schooling? ____________________________________________________________________________________________________________________________________________________________

Has your child received any special help in or outside of school (tutoring, services from outside providers, etc.)? _________________________________________________________________________

3.     Relevant Medical and Developmental History:

Did your child have any problems with growth and development during the first few years (developmental milestones, birth history)?  ___________________________________________

Have there been any significant medical conditions (e.g., head injuries, surgery or other hospitalizations, frequent ear infections, vision problems)? ______________________________________________________________________________

______________________________________________________________________________

4. Social/Adaptive/Behavior:

Are there any behaviors that you are concerned about? ____________________________________________________________________________________________________________________________________________________________

When you have behavior problems at home, what do you find helpful?

____________________________________________________________________________________________________________________________________________________________

Do you feel your child needs more assistance with daily living tasks such as dressing, eating, taking care of belongings, than other children?  _______________________________________

Are there any cultural or racial factors that you feel are affecting your child in school?

____________________________________________________________________________________________________________________________________________________________

5. Strengths:______________________________________________________________________________

______________________________________________________________________________

6. Other Parent Concerns (check all that apply):

*Fidgeting

*Short Attention Span

*Organization

*Following Directions

*Noncompliance/behavior

*Sleep Problems

*Other (please describe):

Solicitud de Asistencia

 

Dirigido a: Secondary Systems Planning Team

(Equipo de Sistemas Secundarios de Planificación)

Nombre de Estudiante: _____________________________________       Grado: _________                                     

 

Fecha: _________________________                       IEP (encierre uno en círculo)               No       

 

Maestro(a): ____________________________      Escuela: _____________________________                     

1)  Yo soy (encierre uno en círculo):              Miembro de la familia      Estudiante         Otro

 

Nombre: __________________________________________

Relación con estudiante: _____________________________

 

2) Tipo de preocupación:

 

____Solo académica

____Solo de comportamiento

____Ambas académica y de comportamiento

3) Brevemente describa la razón para la solicitud:

 

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Cuestionario para los padres

Nombre de estudiante: ____________________________________   Grado: _______________

Nombre de padre/madre: __________________________________   Fecha: ________________

  1. Familia/Hogar:

 

¿Cuál es el idioma materno usado en el hogar? ____________________________________

¿Con quién vive el estudiante? ________________________________

Si los padres no viven juntos, ¿pasa el estudiante tiempo en ambos hogares?_________________

Favor de describir:

____________________________________________________________________________________________________________________________________________________________

Hay algún cambio significante que ha ocurrido en la vida de su hijo(a) que podría estar afectando su desempeño escolar? ___________________________________________________________

  1. Historial educativo:

¿Hay algún maestro del pasado que ha expresado preocupación referente a la lectura, otras áreas académicas o comportamiento?

____________________________________________________________________________________________________________________________________________________________

¿Cuéntenos de cualquier escuela a la que su hijo(a) haya asistido? ________________________

¿Tiene preocupación referente a la enseñanza de su hijo(a)?

____________________________________________________________________________________________________________________________________________________________

¿Ha recibido su hijo(a) ayuda especial dentro o fuera de la escuela (ayuda académica adicional, servicios de proveedores externos, etc.)? _____________________________________________

  1. Historial médico y de desarrollo relevante:

¿Tuvo su hijo(a) algún problema con el crecimiento o desarrollo durante los primeros años (etapas de desarrollo, historial de nacimiento)? _______________________________________

¿Ha habido alguna condición médica significativa (por ejemplo, lesiones en la cabeza, operaciones u otras hospitalizaciones, infecciones de oído frecuentes, problemas de visión)?

____________________________________________________________________________________________________________________________________________________________

 

  1. Social/Adaptivo/Comportamiento:

 

¿Hay algún comportamiento por el que está preocupada?

____________________________________________________________________________________________________________________________________________________________

¿Cuándo tiene problemas de comportamiento en el hogar, que ha encontrado útil?

____________________________________________________________________________________________________________________________________________________________

¿Opina usted que su hijo(a) necesita más asistencia con las tareas diarias tales como vestirse, comer, tomar cargo de sus pertenencias que otros niños? ________________________________

¿Hay algún factor cultural o racial que usted siente este afectando a su hijo(a) en la escuela?

____________________________________________________________________________________________________________________________________________________________

  1. Puntos fuertes:

______________________________________________________________________________

______________________________________________________________________________

 

  1. Otras preocupaciones como padre (marque todo lo que corresponda):

 

􀀀Inquietud

􀀀Despistado

􀀀Organización

􀀀Seguir instrucciones

􀀀Incumplimiento/Comportamiento

􀀀Problemas para dormir

􀀀Otro (por favor describir):

Otra información:

 

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Nondiscrimination Policy

Bakersfield City School District programs, activities, and practices shall be free from unlawful discrimination, including discriminatory harassment, intimidation, and bullying based on actual or perceived characteristics of race or ethnicity, color, ancestry, nationality, national origin, ethnic group identifications, age, religion, marital or parental status, physical or mental disability, sex, sexual orientation, gender, gender identity, gender expression, or genetic information or any other characteristic identified in Education Code 200 or 220, Penal code 422.55, or Government Code 11135, or based on association with a person or group with one or more of these actual or perceived characteristics. If you believe you have been subjected to discrimination, harassment, intimidation, or bullying, you should immediately contact the school site principal and/or the District’s Human Resource Administrator, at 661-631-4663, or at 1300 Baker Street, Bakersfield, California 93305. A copy of BCSD’s Uniform Complaint Procedures and Non-Discrimination policies are available by clicking here and/or upon request.