Request to Extend Bilingual Instructional Support

This form must be completed by the Center Director and Site Staff, in collaboration with the Classroom Teacher. Complete a separate request form for each GOLD objective checkpoint.

Request Date: Center/Site:

Teacher: Best Way to Contact: ☐Phone ☐Email

Phone Number: Email:

Language Needed: Number of Children Who Speak This Language:

Name of Assigned BIA:

After meeting with your BIA and reviewing the Child Evaluation Form(s), please provide the following information:

Number of children at each level on MyTeachingStrategies Objective 37 (Demonstrates progress in listening and understanding English):

Level 2-Beginning: Level 4-Progressing:

Level 6-Increasing: Level 8-Advancing:

Number of children at each level on MyTeachingStrategies Objective 38 (Demonstrates progress in speaking English):

Level 2-Beginning: Level 4-Progressing:

Level 6-Increasing: Level 8-Advancing:

What is your plan for intentionally using your BIA until the next GOLD checkpoint?

Which day(s) and time(s) will you be meeting with the BIA for weekly planning? (Reminder: BIAs have up to one hour per week to plan with each teaching team.)

Which schedule will best serve the children in your classroom per class? ☐1 day a week, 2 hrs. a day ☐3 days a week, 2 hrs. a day*☐2 days a week, 2 hrs. a day ☐4 days a week, 2 hrs. a day*

Complete a Request to Extend Bilingual Instructional Support form five days after every MyTeachingStrategies GOLD checkpoint date. This will allow time to determine continued BIA language support.

Email completed form to Joanna Williams-Diggs (jdiggs@psesd.org)

PSESD ONLY

Assigned BIA: Next Review Date:

Schedule: Date Teacher is contacted with info:

Revised 04/02/2019

01.018.12

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