Early Childhood Student Roster
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12/6/2024
147
File Last Updated:
First Name:
Middle:
Last Name:
SSN:
SSID:
Site:
CC Dupree
CC Faysville
CC Frost1
CC Frost2
CC Hardin
CC Pettus
CC Pine Harbor
CC Withdraw
MV Prosper A
MV Prosper B
MV Prosper C
MV Strive A
DOB:
Current Age:
15 Years 1 Months
Age as of 8/1:
14 Years
Gender:
Female
Male
Teacher:
Andrea Boyd
Angel Green
Beth Blue
Betsy Clapper
Carla Stewart
CC Withdraw
Linda Smith
Linda Smith 2
Melissa Frank
Race/Ethnicity:
White(non Hispanic)
Black
Hispanic
Asian or Pacific Islander
American Indian or Alaskan Native
Multiracial
Economic Status
Private
1-100%
101-125%
126-150%
151-175%
176-185%
186-200%
201-250%
251-300%
301+%
IEP:
No Disability
01-Multiple Disabilities (other than Deaf-Blind)
02-Deaf-Blindness
03-Deafness(Hearing Impairment)
04-Visual Impairments
05-Speech and Language Impairments
06-Orthopedic Impairments
08-Emotional Disturbance(SBH)
09-Cognitive Disabilities
10-Specific Learning Disabilities
12-Autism
13-Traumatic Brain Injury(TBI)
14-Other Health Impaired(Major)
15-Other Health Impaired(Minor)
16-Developmental Delay
Native Language:
Birth City:
Mother's Maiden Name:
District of Residence:
Cimarron
Clovis
Flagstaff
Melrose
Pine Hills
Shiprock
Wagon
District Attending:
Cimarron
Flagstaff
Melrose
Pine Hills
Clovis
Shiprock
Wagon
Head Start Partner:
ECE Enroll Date:
Withdrawal Date:
How Received:
ECE
Federal Head Start
ESC Providing services
Related services only
ELI
Other funding
Autism Scholarship:
SpEd Enroll Date:
Exit Special Ed:
Grade Level Next Year:
PreSchool
Kindergarten
Itinerant:
Bentley
Combs
Debbie Kern
Gibby Charles
Hindel
Krause
Lawson
Mullinnex
Randi Barnes
Shannon
Shoemaker
1st ECO Test Date:
ECO E Score:
ECO K Score:
ECO T Score:
Parent/Guardian Information
1.
Parent 1st Name:
Parent Last Name:
Phone:
Cell:
Mail
Street Address:
City:
State:
Zip Code:
2.
Same as above
Parent 1st Name:
Parent Last Name:
Phone:
Cell:
Mail
Street Address:
City:
State:
Zip Code:
3.
Parent 1st Name:
Parent Last Name:
Phone:
Cell:
Mail
Street Address:
City:
State:
Zip Code:
Parent Roster Form?
Yes
No
Permission to Share:
All
None
Name and Address
Name and Phone
Name Only