Child Status Report

District Name: preprint

District ID: preprint PEELS

Child Status Report

Please update the information for each child listed. If information is unavailable because a child has moved out of your district, please provide whatever information is readily available.

Child’s PEELS ID: preprint

Child: First Name Last Initial

Date of Birth: preprint

1. Is this child’s family still living in your district? (Check one.)

Yes

No

Don’t know

2. Child’s current grade (check one).

Preschool Kindergarten

1st 2nd

3rd 4th

Ungraded Not in school

3. Name of child’s teacher:

________

____________________

_____________________________

Mr./Ms./Mrs./Dr.

First Name

Last Name

4. Name of person who knows child’s educational program best if different from teacher named above:

________

____________________

_____________________________

Mr./Ms./Mrs./Dr

First Name

Last Name

School/Preschool: preprint Wave 3 Primary school and address

5. School/Preschool if different from above:

Don’t know

Name: ___________________________________________________________________________________

Address: _________________________________________________________________________________

City: ___________________________________________________ State: _________ ZIP: ___________

Phone: ( )______________________________________________________________________________

Child’s PEELS ID: preprint

Child: First Name Last Initial

Date of Birth: preprint

1. Is this child’s family still living in your district? (Check one.)

Yes

No

Don’t know

2. Child’s current grade (check one).

Preschool Kindergarten

1st 2nd

3rd 4th

Ungraded Not in school

3. Name of child’s teacher:

________

____________________

_____________________________

Mr./Ms./Mrs./Dr.

First Name

Last Name

4. Name of person who knows child’s educational program best if different from teacher named above:

________

____________________

_____________________________

Mr./Ms./Mrs./Dr

First Name

Last Name

School/Preschool: preprint Wave 3 Primary school and address

5. School/Preschool if different from above:

Don’t know

Name: ___________________________________________________________________________________

Address: _________________________________________________________________________________

City: ___________________________________________________ State: _________ ZIP: ___________

Phone: ( )______________________________________________________________________________

1