Summary Of The Student’s Academic
Achievement And Functional Performance (B)

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  Student's name ,
 
  Date of Summary Date of Summary
 
(These accommodations have been documented on IEP)
Recommendations Of Accommodations, Supports And Resources Continued:

Related to Support: Response to Materials & Instruction
 

 

 
 


 
 
 
 
 

 
 
 

 
Settings:
 
 

 
 

 


   


Related to Health Concerns: Timing/Scheduling of Tasks/Assignments/tests:
 

 
 


 
 

 
Presentation of Materials & Instructions
For Additional Information such as however not limited to; last cognitive assessment results (psycho-educational report), academic/functional assessment results, Individual Educational Program Packet, or other K-12 schooling documentation, contact:



Name of School District:


School District's phone number:


Title of Contact Person:


Best if contact is made no later than _____/_____/_____