Assessment Data/Special Factors
(This form can generate more than one printed page)
Name   IEP Date

 
    Level   Score  
 
CA Standards Tests ELA    
 
  Math    
 
  Science    
 
  History    
 
  Writing    
 

 
(The following items no longer appear on Form 3b, and do not print. They are listed for archival reference.)
 
CAT-6 ELA Mathematics Other Other    
 

 
CMA ELA Mathematics Science History Writing
 
CAPA ELA Mathematics Science Other    
 
CELDT Listening Speaking Reading Writing    
 
Other Assessment Data
(e.g., curriculum assessment, other district assessment)
 

 
Does student require assistive technology devices and/or services?
    If yes, specify:
 
Does student require low incidence services, equipment and/or materials to meet educational goals?
    If yes, specify:
 
Considerations if the student is blind or visually impaired
  Student not visually impaired
 
Considerations if the student is deaf or hard of hearing
  Student not hearing impaired
 
If the child is an English Learner, consider the language needs of the child as those needs relate to the IEP
 
Does student's behavior impede learning of self or others?
    (If yes, describe)
 
  If yes, specify positive behavior interventions, strategies, and supports
 
Behavior Goals Behavior Support Plan (BSP) attached Behavior Intervention Plan (BIP) attached
 
Areas of need to be addressed in goals for the student to receive educational benefit