Student Exit Summary
HARRY S TRUMAN HIGH SCHOOL
Part 1 - Background Information
Date Completed:
MM
/
DD
/
YYYY
Student Name:
Your answer
OSIS#:
Your answer
Date of Birth:
Your answer
Date of Graduation / Exit:
MM
/
DD
/
YYYY
Reason for Exit:
Individual Completing Form:
Name:
Your answer
Title:
Your answer
Phone #:
Your answer
Part 2 - Summary of Present Levels of Performance
Academic or Functional Area: Reading
(e.g., basic reading/decoding and reading comprehension)
Your answer
Academic or Functional Area: Math
(e.g., calculation skills, problem solving, quantitative reasoning)
Your answer
Academic or Functional Area: Languages
(e.g., written expression, speaking, spelling)
Your answer
Academic or Functional Area: Learning Characteristics
(e.g., classroom participation, note-taking, homework and time management; study skills)
Your answer
Academic or Functional Area: Social and Behavioral Development
(e.g., interaction with teachers/peers; responsiveness to services and accommodations; degree of involvement in extra-curricular activities; emotional or behavioral issues related to learning and attention)
Your answer
Academic or Functional Area: Physical Development and Medical Conditions
Your answer
Part 3 - Accommodations and Supports
Indicate whether the student currently requires accommodations, including but not limited to assistive technology, and environmental or material resources or modifications.
Part 3 - Accommodations and Supports
Your answer
Part 4 - Student's Postsecondary Goals
Identify the post-school environment the student intends to transition upon completion of his/her high school education and draft goals accordingly.
Education and/or Career Training:
Your answer
Employment:
Your answer
Independent Living:
Your answer
Part 5 - Recommendations that may assist the student in reaching postsecondary goals:
Provide a brief narrative that would assist the student in meeting goals in the areas of education and/or career training; employment; and independent living (if appropriate).
Part 5 - Recommendations:
Your answer
Part 6 - Identify organizations or agencies to provide linkage support (as appropriate):
Provide specific contact information for individuals and/or agencies, if available
Part 6 - Organizations
Your answer
Final Instructions:
After printing this form, you MUST have the student initial each page. Also, write the student's name and OSIS# at the top of every page.
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