Student Last Name

Student First Name

Student Middle Initial

12-digit BEDs Code for District of Residence

010100010000–689000000000

School Academic Year (Spring of Academic Year)

“2006” for 2005–06

Student ID Assigned by District

(000000001–999999999)

Student Birth Date

YYYYMMDD

Student Gender

F = Female
M = Male

Student Ethnicity

I = American Indian/Alaska Native

B = Black (not Hispanic origin)

A = Asian

H = Hispanic

W = White (not Hispanic origin)
P = Native Hawaiian/Other Pacific Islander

Disability Status of Student on the FIRST Day of Testing

A = Autistic
B = Emotionally Disturbed
C = Learning Disabled
D = Mentally Retarded
E = Deaf
F = Hard of Hearing
G = Speech Impaired
H = Visually Impaired (Includes Blind)
I = Orthopedically Impaired
J = Other Health Impaired
K = Multiple Disabilities
L = Deaf and Blind
M = Traumatic Brain Injury

12-digit Service Provider BEDs Code (Complete ONLY if service provider is not in the district of residence. Leave blank if service provider is in the district of residence.)

010100010000–689000000000

Student's Equivalent Grade Level

3 = grade 3 equivalent (Birth Date between July 1, 1995 and June 30, 1996)

4 = grade 4 equivalent (Birth Date between July 1, 1994 and June 30, 1995)

5 = grade 5 equivalent (Birth Date between July 1, 1993 and June 30, 1994)

6 = grade 6 equivalent (Birth Date between July 1, 1992 and June 30, 1993)

7 = grade 7 equivalent (Birth Date between July 1, 1991 and June 30, 1992)

8 = grade 8 equivalent (Birth Date between July 1, 1990 and June 30, 1991)

9 = high school equivalent (Birth Date between July 1, 1987 and June 30, 1988)

LEP Codes

1 = Student NEVER identified as limited English proficient
4 = Student formerly identified as limited English proficient
5 = Student currently identified as limited English proficient and scored below a State-designated level of proficiency on the Language Assessment Battery-Revised (LAB-R) or the New York State English as a Second Language Achievement Test (NYSESLAT)