HALF HOLLOW HILLS CENTRAL SCHOOL DISTRICT Department of English as a Second Language
REQUEST FOR NYSESLAT/LAB-R SCORES Please complete this form if the student has been identified as an English Language Learner 1. Student’s Name:
4. If Yes, please list previous school(s):
2. Language(s) spoken by the student:
5. Did the previous district provide LAB-R or NYSESLAT scores? Yes / No (circle one) 6. If Yes, please provide the information in the chart below.
3. Date of entry to U.S. schools? Did the student enter your district as a LEP student? Yes / No (circle one) Last year in attendance
Grade Level
NYSESLAT Score L&S
R&W
Prof. Level
LAB-R Score
Years in Program
Prof. Level
A-7 (Part 154 Extension of Services Filed?) Yes / No Year
Please attach whatever supporting documents are needed so that we can have a complete history on the student. Please submit to the building requesting the information. Should you have any questions you may contact me at: Ms. Maria Alfano Coordinator of World Languages & English as a Second Language malfano@hhh.k12.ny.us Tel (631) 592-3189 Fax (631) 592-3927