Individualized Education Program
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IEP Date
Student Name
PLACEMENT RATIONALE / REASON FOR DECISION
Considered
Rationale
General Education
General Education
Accept
Reject
Accept
Reject
Designated Instruction
Designated Instruction
Accept
Reject
Accept
Reject
Resource Specialist
Resource Specialist
Accept
Reject
Accept
Reject
Special Day Class
Special Day Class
Accept
Reject
Accept
Reject
Non-Public School
Non-Public School
Accept
Reject
Accept
Reject
Other:
Other:
Accept
Reject
Accept
Reject
Tests, evaluation, information relied upon:
Current Assessment
Current Assessment
Classroom Documentation
Classroom Documentation
Agency Report
Agency Report
Independent Assessment
Independent Assessment
Academic, developmental, and functional needs of child
Academic, developmental, and functional needs of child
Other Relevant Factors:
Other Relevant Factors:
GENERAL EDUCATION PARTICIPATION
Academic Subjects:
Assemblies, Field Trips, School Activities
Assemblies, Field Trips, School Activities
Electives:
Extracurricular Activities
Extracurricular Activities
Lunch, Recess, Passing Periods
Lunch, Recess, Passing Periods
Community Based Instruction
Community Based Instruction
Other:
General Education Accommodation/Modifications
Provision for Transition to General Education
BEHAVIOR:
Student's behavior
does
does not
does
does not
impede learning of self or others (describe)
See IEP goals/benchmarks
See IEP goals/benchmarks
See attached Behavior Support Plan (BSP)
See attached Behavior Support Plan (BSP)
See attached Hughes Bill Behavior Intervention Plan (BIP)
See attached Hughes Bill Behavior Intervention Plan (BIP)
PARENT COMMUNICATION/REPORTING SCHEDULE:
Annual IEP
Annual IEP
Report Cards - Concurrent with issuance of General Education Report Cards
Progress Reports
Progress Reports
Home/School Communication:
Parent Conferences
Parent Conferences
Other: