Site Visit with Student File Review

• School Name

• Site Visit Date

  Date

• Prepared by

• Start Time

  Date

• School Personnel Involved

• Required Monthly Rubric Items

• Other Items Discussed

• Technical Assistance or Guidance Provided by Sponsor

• Areas of Strength

• Compliance Concerns or Suggestions

• Overall Assessment

• Items Requiring Follow-up

• End Time

  Date

Student Files

• Student File Checklist

Student File

• Sign-In Sheet Included?

  Yes

  No

  N/A

Biographical Information

• Student Initials

• Student ID Number

• Grade Level

• Birth Certificate with Proper Name/Spelling

  Yes

  No

  N/A

• Explanation

• Proof of Residency

  Yes

  No

  N/A

• Explanation

Health Information

• Signed Emergency Medical Release

  Yes

  No

  N/A

• Explanation

• Immunization Chart

  Yes

  No

  N/A

• Immunizations Current?

  Yes

  No

  N/A

• Explanation

• Explanation

• Vision Screening

  Yes

  No

  N/A

• Vision Current? (K, 1, 3, 5, 7, 9, new students)

  Yes

  No

  N/A

• Explanation

• Explanation

• Hearing Screening

  Yes

  No

  N/A

• Hearing Current? (K, 1, 3, 5, 9, new students)

  Yes

  No

  N/A

• Explanation

• Explanation

Academic Information

• Did student transfer from a different school?

  Yes

  No

  N/A

• Records Release

  Yes

  No

  N/A

• Explanation

• Transcript from Previous School

  Yes

  No

  N/A

• Number of Release Requests Documented

• Date of Most Recent Request

  Date

• Most Recent School Grade Report

  Yes

  No

  N/A

• Explanation

• State Test Results

  Yes

  No

  N/A

• Explanation

Overall Assessment

• General Comments or Concerns

• Student File Follow-up Needed?

  Yes

  No

  N/A