State Assessment and
Goal Setting/Attainment Policy for Adult Education

Effective Date – July 1, 2011
Revised April 1, 2011

Appendix D

Sample Literacy Screen Tool:

  1. Name:_________________________________________________________________
  2. Address: _______________________________________________________________
  3. Date of birth:____________________________________________________________
  4. Signature:______________________________________________________________
  5. Today’s date:___________________________________________________________

Table of Contents

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