Based on Prince Charming’s included information and your knowledge of report writing: Craft an integrated psychoeducational report to include all pertinent information: – Rea

School District Identifying Information

Student Name:      

Date of Birth:       Local ID #:      

Disability Classification: FORMDROPDOWN

Projected date IEP is to be implemented:      

Projected date of annual review:      

PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS

Documentation of student's current performance and academic, developmental and functional needs

Evaluation Results (including for school-age students, performance on State and district-wide assessments)

Academic Achievement, Functional Performance and Learning Characteristics

Levels of knowledge and development in subject and skill areas including activities of daily living, level of intellectual functioning, adaptive behavior, expected rate of progress in acquiring skills and information, and learning style:

Student strengths, preferences, interests:

Academic, developmental and functional needs of the student, including consideration of student needs that are of concern to the parent:

Social Development

The degree (extent) and quality of the student's relationships with peers and adults; feelings about self; and social adjustment to school and community environments:

Student strengths:

Social development needs of the student, including consideration of student needs that are of concern to the parent:

Physical Development

The degree (extent) and quality of the student’s motor and sensory development, health, vitality and physical skills or limitations which pertain to the learning process:

Student strengths:

Physical development needs of the student, including consideration of student needs that are of concern to the parent:

Management Needs

The nature (type) and degree (extent) to which environmental and human or material resources are needed to address needs identified above:      

Effect of Student Needs on Involvement and Progress in the General Education Curriculum or, for a Preschool Student, Effect of Student Needs on Participation in Appropriate Activities

Student Needs Relating to Special Factors

Based on the identification of the student's needs, the Committee must consider whether the student needs a particular device or service to address the special factors as indicated below, and if so, the appropriate section of the IEP must identify the particular device or service(s) needed.

Does the student need strategies, including positive behavioral interventions, supports and other strategies to address behaviors that impede the student's learning or that of others? FORMCHECKBOX Yes FORMCHECKBOX No

Does the student need a behavioral intervention plan? FORMCHECKBOX No FORMCHECKBOX Yes:      

For a student with limited English proficiency, does he/she need a special education service to address his/her language needs as they relate to the IEP?

FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Not Applicable

For a student who is blind or visually impaired, does he/she need instruction in Braille and the use of Braille? FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Not Applicable

Does the student need a particular device or service to address his/her communication needs? FORMCHECKBOX Yes FORMCHECKBOX No

In the case of a student who is deaf or hard of hearing, does the student need a particular device or service in consideration of the student's language and communication needs, opportunities for direct communications with peers and professional personnel in the student's language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the student's language and communication mode?

FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Not Applicable

Does the student need an assistive technology device and/or service? FORMCHECKBOX Yes FORMCHECKBOX No

If yes, does the Committee recommend that the device(s) be used in the student's home? FORMCHECKBOX Yes FORMCHECKBOX No

Beginning not later than the first IEP to be in effect when the student is age 15 (and at a younger age if determined appropriate)

MEASURABLE POSTSECONDARY GOALS

long-term goals for living, working and learning as an adult

Education/Training:      

Employment:      

Independent Living Skills (when appropriate):      

TRANSITION NEEDS

In consideration of present levels of performance, transition service needs of the student that focus on the student's courses of study, taking into account the student’s strengths, preferences and interests as they relate to transition from school to post-school activities:      

MEASURABLE ANNUAL GOALS

The following goals are recommended to enable the student to be involved in and progress in the general education curriculum, address other educational needs that result from the student's disability, and prepare the student to meet his/her postsecondary goals.

Annual Goals

What the student will be expected to achieve by the end of the year in which the IEP is in effect

Criteria

Measure to determine if goal has been achieved

Method

How progress will be measured

Schedule

When progress will

be measured

REPORTING PROGRESS TO PARENTS

Identify when periodic reports on the student's progress toward meeting the annual goals will be provided to the student's parents:      

MEASURABLE ANNUAL GOALS

The following goals are recommended to enable the student to be involved in and progress in the general education curriculum or, for a preschool child, in appropriate activities, address other educational needs that result from the student's disability, and, for a school-age student, prepare the student to meet his/her postsecondary goals.

Annual Goal

What the student will be expected to achieve by the end of the year in which the IEP is in effect

Criteria

Measure to determine if goal has been achieved

Method

How progress will be measured

Schedule

When progress will

be measured

Short-term Instructional Objectives and/or Benchmarks (intermediate steps between the student’s present level of performance and the measurable annual goal):

Annual Goal

Criteria

Method

Schedule

Short-term Instructional Objectives and/or Benchmarks (intermediate steps between the student’s present level of performance and the measurable annual goal):

Annual Goal

Criteria

Method

Schedule

Short-term Instructional Objectives and/or Benchmarks (intermediate steps between the student’s present level of performance and the measurable annual goal):

(Duplicate table/rows as needed)

REPORTING PROGRESS TO PARENTS

Identify when periodic reports on the student's progress toward meeting the annual goals will be provided to the student's parents:      

RECOMMENDED SPECIAL EDUCATION PROGRAMS AND SERVICES

Special Education Program/Services

Service Delivery Recommendations*

Frequency

How often provided

Duration

Length of session

Location

Where service will be provided

Projected Beginning/ Service Date(s)

Special Education Program:

FORMDROPDOWN FORMDROPDOWN      

FORMDROPDOWN FORMDROPDOWN      

FORMDROPDOWN FORMDROPDOWN      

FORMDROPDOWN FORMDROPDOWN