Present Levels of Academic Achievement and Functional Performance
IEP Date
Student Name
1. Concerns of parent/adult student relevant to educational progress
2. Academic/Functional Academic Skills
Reading
Math
Written Language
3. Communication Skills
Speech
Receptive Language
Expressive Language
Other
4. Psychomotor Skills (Fine/Gross Motor)
5. Self-Help/Daily Living Skills
6. Prevocational/Career/Study Skills
7. Social Adaptation/Social Emotional
8. Community Based Instruction
9. Recreation/Leisure Activities
10. Intellectual Functioning
10. Health Data
Vision
Hearing
Health Concerns
Medication