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