Form Dss 5245 - Child Education Status Component - North Carolina Division Of Social Services
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1North Carolina Division of Social Services
CHILD EDUCATION STATUS COMPONENT
Copy given to child’s caregiver ___________________________ on _______________
Completed by: ____________________________________ Today’s Date: __________
1.
Child’s Name ________________________________________ 2. Grade _____
3.
School Placement Prior to Foster Care:__________________________________
_______________________________________
Current School:
4.
Is it in the best interest of the child to remain in the same school in which he/she
was enrolled prior to placement? YES _____ NO _____ If not, why not? _____
__________________________________________________________________
_________________________________________________
_________________________________________________
If it is NOT in the best interest of the child to remain in the same school,
proceed to question 5.
a) Is there an appropriate placement in the proximity of the child’s original
school? Yes ___ No ___ Not applicable ___
b) Has the agency negotiated with the appropriate school agencies to ensure that
the child can remain in the same school? Yes ___ No ___
c) Will transportation assistance be needed to transport the child from his/her
placement to the original school? Yes ___ No ___
5.
If it is not in the best interest of the child to remain in the same school, has the
DSS and the local educational authority arranged for immediate and appropriate
enrollment in a new school and for immediate transfer of all educational records
to the new school? Yes ___ No ____ If not, describe actions to be taken:_______
_________________________________________________
6.
What are the child’s strengths? ______________________________________
________________________________________________
________________________________________________
7.
Is the child in a special class (e.g. BEH, LD, EMH, etc.) Yes ____ No _____
If so, indicate which type ____________________________________________
8.
Does the child have an IEP? Yes ____ No ____ Needed _______
9.
Is the child functioning below grade level in any subject(s)? Yes ____ No ____ If
so, what subject(s)? _________________________________________________
10.
Is the child receiving special resource assistance (e.g. tutoring, speech or language
therapy, etc.) Yes ___ No ___ If so, what type of assistance? ________________
_________________________________________________
11.
Additional school-related information: Use back of page as needed.
DSS 5245 (rev.3/10) Child Welfare Services
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