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

(This form can generate more than one printed page)
Date of Summary Date of Summary
Name   Date of Birth   Date of most recent IEP

 
Primary Disability Primary Disability   Primary language Primary language
 
Reason for Exit (check the ONE that applies):  
Graduated per District's requirements/policy, and completion of California High School Exit Exam (CAHSEE) earning a regular high school diploma
Reached the maximum age for special eduction services
 

SUMMARY OF THE STUDENT'S ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
 
Strengths/Interests/Learning Preference:

Pre-Academic / Academic / Functional Skills (Note results of any general State or district-wide assessments):

Cognitive Abilities:

Communications Skills:

Motor Skills Fine/Gross:

Health:

Social/Emotional/Behavioral:

Self Help/Adaptive:

Pre-Vocational/Vocational:
 
Agency Linkages (check agencies known to be working with 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: