Individualized Education Program
IEP Date
Student Name
Coordination of Services
Coordination of Services
(Specify if other:)
Specialized/Supplemental equipment, materials, services
Physical Education Option
(Specify if other:)
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
Electives:
Extracurricular Activities
Lunch, Recess, Passing Periods
Community Based Instruction
Other:
Other than as indicated above, due to the student's unique needs identified in the present levels and goals, student will not participate in the general education environment. Rationale:
Classroom 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:
Home/School Communication:
Parent Conferences
Parent Conferences
Other:
Other: