IEPReviewForm

___________________________
SchoolDistrict

SSID#

DateofBirth

IEPDate

EvaluationDate

________________________

________________________

______________________

__________________

1. PresentLevelsofAcademicAchievementandFunctionalPerformanceWAC392172A0309003110
YN
DoestheIEPincludeawrittenstatementofthestudentspresentlevelsofacademicachievementand
functionalperformance,includinghowthestudentsdisabilityaffectsthestudentsinvolvementand
progressinthegeneraleducationcurriculum(thesamecurriculumasfornondisabledstudents)?
YNNA Forapreschoolchild,doestheIEPincludeawrittenstatementofthestudentspresentlevelsof
academicachievementandfunctionalperformance,includingasappropriate,howthedisabilityaffects
thechildsparticipationinappropriateactivities?
2. MeasurableAnnualGoalsWAC392172A0309003110
YN
DoestheIEPincludeastatementof
measurableannualgoals
*
,includingacademicandfunctionalgoals
designedto:
a. meetthestudentsneedsthatresultfromthestudentsdisabilitytoenablethestudenttobe
involvedinandmakeprogressinthegeneraleducationcurriculumand
b. meeteachofthestudentsothereducationalneedsthatresultfromthestudentsdisabilityand
c. forstudentstakingalternateassessmentsalignedtoalternateachievementstandards(e.g.,
WAAS),doestheIEPincludeadescriptionofbenchmarksorshorttermobjectives?
AreaofService
MAG
Comments

Reading
YNNA
Written
Language

YNNA

Math

YNNA

Behavior/Social

YNNA

StudySkills

YNNA

Life
skills/adaptive

YNNA

**
SLP

YNNA

**
OT

YNNA

**
PT

YNNA

**
Vision

YNNA

Other

YNNA

Other

YNNA

Other

YNNA

*
AlthoughthetermmeasurableisnotdefinedinWACorIDEA,thesafetynetcommitteehasadoptedthefollowing
professionaljudgmentstandardfortheterm
measurableannualgoal
:Inordertobeconsideredmeasurable,eachannual
goalshouldhavea
baseline
,target,anda
common
unitofmeasure.
**
MAGneededonlyifserviceisprovidedasspeciallydesignedinstruction.
3. ProgresstowardMeetingGoalsWAC392172A0309003110
YN
DoestheIEPincludeadescriptionof:
i. howthedistrictwillmeasurethestudentsprogresstowardmeetingtheannualgoalsand
ii. whenthedistrictwillprovideperiodicreportsontheprogressthestudentismakingtoward
meetingtheannualgoals?
4. LeastRestrictiveEnvironmentWAC392172A0205003090

1 IEPReviewFormRevisedJanuary2016

YN

DoestheIEPcontainanexplanationoftheextent,ifany,towhichthestudentwillnotparticipatewith
nondisabledstudentsinthegeneraleducationclassroomandextracurricularandnonacademic
activities?

YNNA

YNNA

YN

YN

YNNA
YNNA
YNNA

5. AssessmentWAC392172A03090
IftheIEPteamdeterminesthatanalternateassessmentinsteadofaregularstateordistrictwide
assessmentofstudentachievementisappropriate,doestheIEPindicatetheassessmentselected
andstatementofwhy:
i. thestudentcannotparticipateintheregularassessmentand
ii. theparticularalternateassessmentselectedisappropriateforthestudent?
b. IftheIEPteamdeterminesthatanyindividualaccommodationsarenecessarytomeasurethe
academicachievementandfunctionalperformanceofthestudentonstateanddistrictwide
assessments,arethoseaccommodationsstatedintheIEP?
6. ServicesProvidedbyIEPWAC392172A0118502020030900311003135
a. DoestheIEPcontainastatementofthespecialeducationandrelatedservicesandsupplementary
aidsandservices,basedonpeerreviewedresearchtotheextentpracticable,tobeprovidedtothe
student,oronbehalfofthestudent,andastatementofprogrammodificationsorsupportsforschool
personnelthatwillbeprovidedtoenablethestudent:
i. Toadvanceappropriatelytowardattainingthegoals
ii. Tobeinvolvedinandmakeprogressinthegeneraleducationcurriculum,andtoparticipatein
extracurricularandothernonacademicactivitiesand
iii. Tobeeducatedandparticipatewithotherstudentsincludingnondisabledstudentsinthe
servicesdescribed?
b. DoestheIEPstateaprojecteddateforthebeginningofspecialeducationandrelatedservices,
supplementaryaidsandservices,andprogrammodificationsorsupportsforschoolpersonneland
theanticipatedfrequency,location,anddurationofthoseservicesandmodifications?
c. DoestheIEPcontainastatementofextendedschoolyear(ESY)servicesperWAC
392172A02020ifdeterminednecessarybytheIEPteamforthestudenttoreceiveFAPE?
d. IfaBehavioralInterventionPlanisdeterminednecessarybytheIEPteaminordertoprovideFAPE
tothestudent,doestheplancontaintherequiredinformationperWAC392172A01031?
e. IfanEmergencyResponseProtocolisdeterminednecessarybytheIEPteaminordertoprovide
FAPEtothestudent,doestheIEPincludetherequiredinformationperWAC392172A02105?
7. TransitionActivitiesWAC392172A030900309503110
a.

TransitionactivitiesandservicesbeginningnotlaterthanthefirstIEPtobeineffectwhenthestudentturnssixteen,or
youngerifdeterminedappropriatebytheIEPteam,andupdatedannually,thereafter.

YN

a.

YN
YN
YNNA
YN

b.

YN

a.

YNNA

b.

c.

Isthereevidencethatthemeasurablepostsecondarygoal(s)werebasedonageappropriate
transitionassessmentsrelatedtotrainingeducation,employment,and,whereappropriate,
independentlivingskills?
DoestheIEPcontainappropriatemeasurablepostsecondarygoal(s)thataddress:
education/training(requiredforallstudents),
employment(requiredforallstudents),and,
independentliving(ifappropriateforthestudent)?
DoestheIEPcontaintransitionservicesperWAC392172A01190includingcoursesofstudythat
areneededtoassistthestudentinreachingthepostsecondarygoals?
8. IEPTeamWAC392172A0309503110
DidtheIEPTeamincludetherequiredIEPteammembership[i.e.,parent,generaleducation
teacher,specialeducationprovider,student(wheneverappropriate),districtrepresentative,etc.]?
Ifrequiredpersonneldidnotattend,istherewrittenevidence
***
oftheparentsanddistricts:
i. agreement(ifareaofcurriculumisnotbeingdiscussed)theattendanceofthememberisnot
necessary,or
ii. consent(ifthemembersareaofcurriculumwillbediscussed)toexcusethemember(s)?

2 IEPReviewFormRevisedJanuary2016

YNNA

YNNA

YNNA

(
***
NOTE:MustincludewithIEPsubmittedforSafetyNetIndividualHighNeedsapplication.)
c. IsthereevidencethatthestudentwasinvitedtoparticipateintheIEPmeetingwhenthepurposeof
themeetingwillbetheconsiderationofthepostsecondarygoalsforthestudentandthetransition
servicesneededtoassistthestudentinreachingthosegoals?
d. IftransitionservicesdescribedintheIEParelikelytobeprovidedorpaidforbyotheragencies,is
thereevidencethat,withparent/adultstudentconsent,representativesoftheagency(ies)were
invitedtoparticipateintheIEPmeeting?
9. TransferofRightsWAC392172A03090
Beginningnotlaterthanoneyearbeforethestudentreachestheageofeighteen,doestheIEPincludea
statementthatthestudenthasbeeninformedofthestudentsrights,ifany,thatwilltransfertothe
studentonreachingtheageofmajority?

3 IEPReviewFormRevisedJanuary2016