IEP Summary
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IEP Date
Student Name
Purpose:
IEP summary page
Addendum to IEP
IEP summary page
Addendum to IEP
dated
dated
See summary notes
See summary notes
Notifications
Notice has been provided to student/parent that completion of the requirements for graduation is projected at the end of the
Upon graduation and issuance of a diploma, special education services from the district will be terminated and as a result, graduation will constitute a change of placement.
Parent Initials
Yes
No
_____
_____
1. Parent rights/student rights were mailed with IEP invitation and reviewed at the IEP
_____
_____
2. I agree with the Individualized Education Program (goals and objectives).
_____
_____
3. I agree with the Special Education Program Placement and Services:
_____
_____
4. A continuum of program options has been discussed by IEP team.
_____
_____
5. Promotion/high school graduation requirements were reviewed with parent and student including the California High School Exit Exam (CAHSEE).
_____
_____
6. I agree with the Individual Transition Plan (16 years or older).
_____
_____
7. Rights were reviewed with student age 17 and older.
_____
_____
8. I agree my child does not meet the eligibility criteria for Special Education Services.
Parent/Guardian
Date
Administrator/Designee
Date
Parent/Guardian
Date
Teacher
Date
Student
Date
Special Education Teacher
Date
Psychologist
Date
Speech and Language Specialist
Date
Interpreter
Date
Adapted Physical Education Teacher
Date
Other
Date
Other ____________________
Date
Other
Date
Other ____________________
Date
PARENT NOT PRESENT. Attempts to contact the parents include documentation of:
Telephone calls
Telephone calls
Home visits
Home visits
Copies of correspondence
Copies of correspondence
Parent/teacher conference
Parent/teacher conference
Transitions:
Beginning at age 16 (or younger if determined appropriate), describe transition service needs of student related to courses of study:
Beginning at age 16 (or younger if determined appropriate), see attached Individual Transition Plan (ITP) dated
Beginning at age 16 (or younger if determined appropriate), see attached Individual Transition Plan (ITP) dated
On or before the student's 17th birthday, he/she has been advised of rights at age of majority (age 18)
Advised:
Date
Date
(by Whom)
Dissenting Opinion Attached
Dissenting Opinion Attached
Summary notes
(when printed, notes appear on separate page(s)