Present Levels of Academic Achievement and Functional Performance

(This form can generate more than one printed page)
Name   IEP Date

   
  Strengths/Preferences/Interests
 
   
  Concerns of parent relevant to educational progress
 
 
Did the school district facilitate parent involvement as a means of improving services and results for your child?
 

 
Preacademic/
Academic/
Functional Skills
 
  Reading
 
  Written Expression
 
  Mathematics
 

 
  Communication Development
 
   
  Gross/Fine Motor Development
 
   
  Social/Emotional/Behavioral
 
   
 
Health ( Hearing Hearing   Vision Vision )
   
 
   
  Pre-vocational/Vocational
 
   
  Adaptive/Daily Living Skills