Student’s Name: [Last, First] District Student ID Number: Date of Birth (month/day/year): [ ###### ] [mm,dd,yyyy] School: [School] Grade Level: [K-12] School Year: [yyyy -yyyy] Language Reported by Parent/Guardian: [DPI Reporting Case Manager: Lang.]

MADISON METROPOLITAN SCHOOL DISTRICT Individual Plan of English as a Second Language /Bilingual Services Parent Permission Form

Your child has been identified as an English Language Learner (ELL). Identification was based on the information you provided on your child's language background during the online enrollment process in conjunction with some academic performance data. Your child was given an English language proficiency assessment and scored at the English proficiency level listed above. This assessment gives us information regarding your child's needs for English language instruction in the following language domains:Listening, Speaking, Reading, and Writing.

LANGUAGE PROFICIENCY Overall English Language Proficiency Date Administered: Test Administered: [Score] [test date] [W-APT or ACCESS]

Proficiency Level Description of English Language Proficiency Levels 1 - Entering The student knows and uses minimal social/academic language with visual support. 2 - Beginning The student knows and uses some social English and general academic language with visual support. 3 - Developing The student knows and uses social English and some specific academic language with visual support. 4 - Expanding The student knows and uses social English and some technical academic language. 5 - Bridging The student knows and uses social and academic language working with grade level material. 6 - Fully-English The student reads, writes, speaks and comprehends English within academic classroom settings. Proficient

ELL IPS –High v. 3-15-2017 ENGLISH LANGUAGE LEARNER SUPPORT SERVICES Based on assessments of English language proficiency and academic content knowledge, the student will receive the following services, with your consent.

Service Subject Area Frequency times /wk Student will receive instruction co-planned and co- English ⍔ 1,2,3,4,5 taught by ESL/Bilingual Resource Teacher and Math classes per week General Education Teacher. Science Social Studies Student will receive instruction from ESL or Bilingual English Resource Teacher who is also certified in the general Math education subject area. Science Social Studies Student will receive instruction from General English Education Teacher who consults with ESL or Bilingual Math Resource Teacher to integrate appropriate language Science instruction into curriculum. Social Studies Student will receive subject area and English English language development instruction by ESL /Bilingual Math Resource Teacher who is also certified in the general Science education subject area in a sheltered environment. Social Studies Student will receive instruction in English and Spanish Language Arts or Hmong within a Dual Language Immersion or Social Studies Developmental Bilingual Program. Student will receive in-class support in home language English provided by Bilingual Resource Specialist under the Math guidance of certified teaching staff. Science Social Studies Student will receive pre-teaching and re-teaching of English vocabulary and subject area concepts by ESL or Math Bilingual Resource Teacher in a resource setting. Science Social Studies Student will receive instruction from elective teacher in Health consultation with ESL/ Bilingual Resource Teacher Physical Education and/or Bilingual Resource Specialist to meet the AVID learning needs of bilingual students. other elective(s) Student will receive course selection and post-secondary planning guidance from a bilingual counselor. Student with an IEP (Individual Education Plan) will have a tailored plan to meet both the language development and academic learning needs of the student.

ELL IPS –High v. 3-15-2017 WHY DO WE HAVE ENGLISH AS A SECOND LANGUAGE / BILINGUAL PROGRAMS? The purpose of the ESL and Bilingual programs in the Madison Metropolitan School District is to serve students who are English Language Learners (ELLs) to become proficient in academic English and prepare for their continuing education and career readiness goals. In the 2014-2015 school year, MMSD served over 7000 ELL students. While Spanish is the largest language group and Hmong is the next largest language in MMSD, there are over 95 identified spoken languages by our students. Our ESL services are required under Federal and State laws including the No Child Left Behind legislation [NCLB 2001].

PROGRAMS OFFERED English Language Development is a component of ALL program types. English as a Second Language (ESL) This type of service delivery is offered to students who are English language learners at all grade levels and all levels of English language proficiency. Students receive subject area and language development instruction in a variety of educational settings and may include native language support. This service helps students understand and develop grade level content, skills, vocabulary, and academic discourse. Bilingual Programs Developmental Bilingual Education (DBE) DBE classrooms give access to learning academic concepts and skills in Spanish and English. Through this service delivery model, students develop literacy and language skills in both languages. Key concepts taught in one language are reinforced in the other language throughout the curriculum and over time. Dual Language Immersion (DLI) In DLI classrooms, native Spanish speakers and native English speakers maintain and develop their first language while acquiring native-like communication and literacy skills in a second language. Academic content is taught and assessed in two languages over an extended period of time. Having speakers of both English and Spanish, as well as students from different cultural backgrounds, provides authentic opportunities for students to learn with and from each other. Research has shown that students perform at or above grade level on standardized tests within five to seven years of experience in DLI programs.

MMSD EXIT CRITERIA Grades 4-8 – Overall composite score of 5.7 or better on the ACCESS for ELLs English language proficiency assessment AND student achieves a level of Proficient or Advanced on the Reading section of the state-mandated academic achievement assessment.

Grades 9-12 – Overall composite score of 5.7 or better on the ACCESS for ELLs English language proficiency assessment AND student is not credit deficient toward graduation.

ESL STUDENTS WITH DISABILITIES An English language learner who qualifies for special education services will have an Individualized Education Plan (IEP) that describes the appropriate combination of ESL and special education services for the student. In these instances, ongoing collaboration between ESL/bilingual staff and special education staff is recommended.

ELL IPS –High v. 3-15-2017 ACCEPTANCE OF SERVICES

● The ESL/ Bilingual programs available through the Madison School District have been fully explained to me and I give permission for my child to receive ESL/Bilingual services. ● My son/daughter will receive help to develop English Language proficiency and academic achievement ● I understand that my child must take an annual federally required English language proficiency assessment and I will receive updated information based on the results of the assessment ● As parent or guardian, I have the right to have my child immediately removed from this program after contacting the school and having a meeting with the ELL Case Manager.

Parent Signature (indicates approval of programming): Date Signed:

ELL Case Manager: Date Signed:

Principal: Date Signed:

ELL IPS –High v. 3-15-2017 PARENT REFUSAL OF ESL/BILINGUAL SERVICES The ESL/bilingual programs available through Madison School District have been fully explained to me. I am requesting that (name of student)______not receive additional support in the acquisition of English through the District’s ESL/bilingual program. I understand: ● I can enroll/re-enroll my child by contacting the principal or ELL Case Manager at the school my child attends. ● My child must continue to take an annual federally mandated English language proficiency assessment and I will receive updated information based on the results of the assessment. ● I authorize the District to retain records related to ESL services consistent with the requirements of federal law. Parent Signature (indicates refusal of programming): Date Signed:

ELL Case Manager: Date Signed:

Principal: Date Signed:

NOTICE OF APPEAL A parent or legal guardian may appeal the School Board’s failure to place a pupil in the bilingual-bicultural education program. A parent or legal guardian who wishes to appeal must contact the Office of Multilingual and Global Education within 10 days after the school term begins. The office of Multilingual and Global Education is located at 545 West Dayton Street, Room 216, Madison, Wisconsin 53703

To be completed by ELL Case Manager

Was interpretation provided? Yes No Name of person who provided translation and/or interpretation Briefly, list strategies to explain programs available, reason for refusal, and any additional information pertinent to the parent’s decision to refuse.

ELL IPS –High v. 3-15-2017