Preschool to Kindergarten Transition Amendment

(This form can generate more than one printed page)
 
Name   Changes to IEP dated Changes to IEP dated   Meeting Date
 
  Birth date
 

 
  Current   Proposed  
 
 
 
 
School of Attendance  -     
 

 
  Services
  Current   Proposed  
 
 
 
 
(There are no services listed for this IEP. To add services, go to the Services tab.)
 

 
  Current   Proposed  
 
 
 
 
Extended School Year Yes No    
 
  Educational setting
 
Federal School Setting  -     
 
Services provided at Sch of Attd    
 
% OUTSIDE general ed environment    
 
% of time IN general ed environment    
 
Transportation Yes No    
 
Physical Education    
 
  Testing
 
Participation in State/Districtwide Assessments (STAR) DRDP:  Yes No
DRDP-Access:  Yes No
   
 

 
  Additional Changes
 
       
 
  Summary of Kindergarten Readiness/Functional Skills:
 
   
 
  Activities to Support Transition/Notes:
 
   
 
  Action Items:
 
   
 

 
  (initial)     I agree to the contents of the amendment to the IEP dated:  
   
     
 
 


 

Parent/Guardian/Surrogate Date   Parent/Guardian/Surrogate Date
 

 


 

Special Education Preschool Teacher/Provider Date   General Education Teacher Date
 


 

Additional Participant/Title Date   School District Representative Date
 


 

Additional Participant/Title Date   Additional Participant/Title Date
 
NCCSE 151