NEW JERSEY DEPARTMENT OF EDUCATION PORTFOLIO APPEAL EDUCATION PROFICIENCY PLAN

Student Name: NEW JERSEY DEPARTMENT OF EDUCATION PORTFOLIO APPEAL EDUCATION PROFICIENCY PLAN CDS Code: District Name: School Name: In order to earn a New Jersey high school diploma a student must demonstrate proficiency in both mathematics and English Language Arts. A student may do this in the following ways: English Language Arts (ELA) PARCC ELA Grade 9 750 (Level 4) or PARCC ELA Grade 10 750 (Level 4) or PARCC ELA Grade 11 725 (Level 3) or SAT Critical Reading (taken before 3/1/16) 400 or SAT Evidence-Based Reading and Writing Section (taken 3/1/16 or later) 450 or SAT Reading Test (taken 3/1/16 or later) 22 or ACT Reading or ACT PLAN Reading* 16 or Accuplacer Write Placer 6 or Accuplacer Write Placer ESL 4 or PSAT10 Reading or PSAT/NMSQT Reading (taken before 10/1/15) 40 or PSAT10 Reading or PSAT/NMSQT Reading (taken10/1/15 or later) 22 or ACT Aspire Reading* 422 or ASVAB-AFQT Composite 31 or Meet the criteria of the NJDOE Portfolio Appeal Mathematics PARCC Algebra I 750 (Level 4) or PARCC Geometry 725 (Level 3) or PARCC Algebra II 725 (Level 3) or SAT Math (taken before 3/1/16) 400 or SAT Math Section (taken 3/1/16 or later) 440 or SAT Math Test (taken 3/1/16 or later) 22 or ACT Math or ACT PLAN Math* 16 or Accuplacer Elementary Algebra 76 or PSAT10 Math or PSAT/NMSQT Math (taken before 10/1/15) 40 or PSAT10 Math or PSAT/NMSQT Math (taken 10/1/15 later) 22 or ACT Aspire Math* 422 or ASVAB-AFQT Composite 31 or Meet the criteria of the NJDOE Portfolio Appeal * Indicates test is no longer administered but can be used for the graduating year. Note: The symbol means a score greater than or equal to.

Part I. Student Courses and Assessment Information Student Name: This Educational Proficiency Plan is for this/these content area(s) check those that apply: English Language Arts/Literacy Mathematics Both Please fill out the following table and list any scores the student achieved on the assessments listed below. If the student did not take a specific assessment, please leave the box blank. English Language Arts (ELA) Student Score Pass? Y/N PARCC ELA Grade 9 750 (Level 4) or PARCC ELA Grade 10 750 (Level 4) or PARCC ELA Grade 11 725 (Level 3) or SAT Critical Reading (taken before 3/1/16) 400 or SAT Evidence-Based Reading and Writing Section (taken 3/1/16 or later) 450 or SAT Reading Test (taken 3/1/16 or later) 22 or ACT Reading or ACT PLAN Reading* 16 or Accuplacer Write Placer 6 or Accuplacer Write Placer ESL 4 or PSAT10 Reading or PSAT/NMSQT Reading (taken before 10/1/15) 40 or PSAT10 Reading or PSAT/NMSQT Reading (taken10/1/15 or later) 22 or ACT Aspire Reading* 422 or ASVAB-AFQT Composite 31 or Meet the criteria of the NJDOE Portfolio Appeal

Student Name: Please fill out the following table and list any scores the student achieved on the assessments listed below. If the student did not take a specific assessment, please leave the box blank. PARCC Algebra I 750 (Level 4) or PARCC Geometry 725 (Level 3) or PARCC Algebra II 725 (Level 3) or SAT Math (taken before 3/1/16) 400 or SAT Math Section (taken 3/1/16 or later) 440 or SAT Math Test (taken 3/1/16 or later) 22 or ACT Math or ACT PLAN Math* 16 or Accuplacer Elementary Algebra 76 or PSAT10 Math or PSAT/NMSQT Math (taken before 10/1/15) 40 or PSAT10 Math or PSAT/NMSQT Math (taken 10/1/15 later) 22 or ACT Aspire Math* 422 or ASVAB-AFQT Composite 31 or Meet the criteria of the NJDOE Portfolio Appeal Mathematics Student Score Pass? Y/N

Student Name: English Language Arts/Literacy (ELA/L) Information* ELA/L Courses Taken Grade Obtained Areas of Strength Areas Which Need Improvement *Please include a copy of the student s transcript with the appeal.

Student Name: Mathematics Information* Mathematics Courses Taken Grade Obtained Areas of Strength Areas Which Need Improvement *Please include a copy of the student s transcript with the appeal.

English Language Arts/Literacy (ELA/L) Proficiency Plan Student Name: ELA/L Topic Describe Interventions Describe Evidence to be Collected to Determine Proficiency in the Topic Targeted Date for Completion

Mathematics Proficiency Plan Student Name: Mathematics Topic Describe Interventions Describe Evidence to be Collected to Determine Proficiency in the Topic Targeted Date for Completion

Plan Agreement Student Name: Guidance or School Advisor Signature: Teacher Signature: Advisor Contact Name: Advisor Phone: Advisor e-mail: Education Proficiency Plan Completion Verification Section (required): This student has completed all requirements of his/her plan: Principal or designee name (printed): Principal or designee signature: Date: