Summary Of The Student’s Academic
Achievement And Functional Performance (B)
Name   Date of Birth      

NOTE: These accommodations have been documented on student's most recent IEP
 
Related to Support: Response to Materials & Instruction
   
Check for understanding Reduced/shortened tests/assignments/tasks:
   
Instructions/directions repeated/rephrased Extended time on in-class assignments/tests:
   
Present one task at a time Use of notes for tests/assignments
   
Preferential/assigned seating; explain:
Open book for tests/assignments
   
Use of assignment notebook or planner Spelling errors will not impact grade when no opportunity for editing assistance and/or spell-check is available
   
Provided with progress reports Special projects or alternate assignments in lieu of assignments given to non-disabled peers
   
Supervision during unstructured time Use of a calculator
   
Cues/prompts/reminders of rules/procedures Proof-reader and redo assignment or writing mechanics not graded
   
Offer choices Other:
   
Note taking assistance  
   
Access to computer on campus  
 
Use of a scribe/word processing Settings:
   
Use of a calculator Access to study carrel for task/assignments/tests
   
Peer tutor/staff assistance in:
Free from visual distractions
   
Prior Behavior Support Plan (BSP) Quiet environment - free from excessive noise
   
Home/job/school communication system; explain:
In a small group environment
   
Other:
Other:
   


Presentation of Materials & Instructions Related to Health Concerns:
   
Books on tape and/or CD Reminder to take medication(s)
   
Assignments/tests modified to address identified needs of learning styles:
Medication(s) given under supervision
   
Large print Other:
   
Closed caption  
   
English language development materials  
   
Manipulative/study aids for:
 
   
Test questions/assignments - given orally  
   
Tests/assignments directions - read orally  
   
Tests/assignments - shorten  
   
Questions on tests/assignments rephrased  
   
Preview of tests/assignments  
   
Tests/assignments given in smaller parts  
   
Visual aids: flash cards, maps, posters, clues, etc.  
   
Other:
 
   

Exit Summary Completed Exit Summary Completed   by: For additional information, please contact:
 
Name Position   District
 
School Telephone   Department
 
  School District Phone Number 

 
 
 
  Student Signature   Date