• Start Time

  • End Time

  • School Personnel Involved

Site Visit Review Items for the Month

  • Site Visit Review Items

Comments and Documentation

  • Other Items Discussed

  • Stakeholder Data to be Collected

  • Stakeholder Interview(s)

  • Technical Assistance and Guidance Provided

  • Areas of strength for this month

Areas for Improvement Identified this Month

  • Area for Improvment

  • Action Steps Required

  • Timeframe for Completion

Follow-Up on Previously Identified Areas for Improvement

  • Area for Improvement

  • Progress of Action Steps Required

  • Timeframe for Completion

  • Improvement Progress

Summary of Findings

General Student File Review

Student Files

    Student File Checklist
  • Sign- In Sheet Included?

Biographical Information

  • Student Initials

  • Student ID Number

  • Grade Level

  • Birth Certificate with Proper Name/Spelling

  • Explanation

  • Proof of Residency

  • Explanation

Health Information

  • Signed Emergency Medical Release

  • Explanation

  • Immunization Chart

  • Immunizations Current

  • Explanation

  • Vision Screening

  • Vision Current? (K,1, 3, 5, 7, 9, New Student)

  • Explanation

  • Hearing Screening

  • Hearing Current? (K, 1, 3, 5, 9, 11, New Student)

  • Explanation

Academic Information

  • Most recent school grade report

  • Explanation

  • State Test Results

  • Explanation

  • Did the student transfer from a different school?

  • Records Release?

  • Explanation

  • Transcript from previous school

  • Number of Requests Documented

  • Date of most recent request

Overall Assessment

  • General Comments or Concerns

  • Student File - up Needed?

  • Follow up will take place

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