Summary Of The Student’s Academic Achievement And Functional Performance (26A)
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  Student's name ,
 
 
  Date of Summary Date of Summary Date of Summary Pick a date
 
 
Reason for Exit (check the ONE that applies):  
 

 
  Strengths/Interests/Learning Preferences: Strengths/Interests/Learning Preferences: Strengths/Interests/Learning Preferences:  
 
 
  Pre-Academic / Academic / Functional Skills Pre-Academic / Academic / Functional Skills Pre-Academic / Academic / Functional Skills  (Note results of any general State or district-wide assessments):  
 
 
  Cognitive Abilities: Cognitive Abilities: Cognitive Abilities:  
 
 
  Communication Skills: Communication Skills: Communication Skills:  
 
 
  Motor Skills (Fine/Gross): Motor Skills (Fine/Gross): Motor Skills (Fine/Gross):  
 
 
  Health: Health: Health:  
 
 
  Social/Emotional/Behavioral: Social/Emotional/Behavioral: Social/Emotional/Behavioral:  
 
 
  Self Help/Adaptive: Self Help/Adaptive: Self Help/Adaptive:  
 
 
  Pre-Vocational/Vocational: Pre-Vocational/Vocational: 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: Other Recommendations: Other Recommendations: