Summary Of The Student’s Academic
Achievement And Functional Performance (A)
Student's name
,
Date of Summary
Date of Summary
Reason for Exit (check the ONE that applies):
Strengths/Interests/Learning Preferences:
Pre-Academic / Academic / Functional Skills (Note results of any general State or district-wide assessments):
Cognitive Abilities:
Communication Skills:
Motor Skills (Fine/Gross):
Health:
Social/Emotional/Behavioral:
Self Help/Adaptive:
Pre-Vocational/Vocational:
Agency Linkages (check agencies known to be working with the individual or could be a resource to the individual)
Agency Contact Person and phone number, if known
Regional Center
California Children's Services (CCS)
Dept. of Social Services (DSS)
County Mental Health (CMH)
Employment Development Department
Department of Rehabilitation
Comm. College-University Disabled Student Services
Probation
Other:
Other Recommendations: