Individual Migrant Plan (I.M.P.) and/or OSY Profile
Student
First Name
Last Name
STN
Date
/
Month
/
Day
Year
Date
Region:
Please Select
1
2
3
Grade Level/Age
Please Select
6
7
8
9
10
11
12
Drop Out
OSY
Home Language
Phone Number
Priority for Service (PFS)
Please Select
Yes
No
Student's Academic/Career Goal(s)
Student's Interests
English Learning Related Needs
Was student enrolled in school at the end of the spring school term (in IN or another state)?:
Yes
No
Does student plan to enroll in school after seasonal work is over (IN or another state)?:
Yes
No
Unsure
If the student answers "no" or "unsure" to the previous two questions, please complete the following:
Where did the student last attend school?
USA
Mexico
Guatemala
Other
Reason for leaving
Last year student attended school
What was the last grade the student attended?
Please Select
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Student did not attend school
High School Credit Accrual
High School Credit Accrual
Enrollment in Corporation Class(es)
Remediation
Enrichment
Mexico Coursework (enter which course)
Other
Preparation and Testing
STAAR/TAKS
Referral Form
Schedule Test Date
Schedule Test Administrator
Administered test (enter date)
Post-Secondary
College Application Process
SAT/ACT Preparation & Testing
Campus Visit(s) - Enter locations
Other
Career Awareness
iSOSY Resources - Career Exploration
Internships & Job Shadowing
Site Visits
Proteus or Work One
On-the-job Training
Other
Other
Life Skills
iSOSY Mini Lessons
Enter which lesson(s) you used above
iSOSY Academic Mini Lessons
Learn Math
Learn to Read
Learn to Write
Life Skills
Leadership Skills
Mentoring
Other
English Learning
Type a question
Bilingual Dictionary
iSOSY English lessons
WIDA Standards
Other
Miscellaneous options
Other
Note: this form is to be used with all secondary and OSY students who we expect will be receiving MEP services for 3 or more weeks.
After being enrolled for at least 3 weeks, to what extent did the student make progress on this plan, in accordance with individual objective set?
Did not meet objectives
Met objectives
Exceeded objectives
Staff Name
*
First Name
Last Name
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