Professional Documents
Culture Documents
Department of Education
School ID # 131534
Middle Name
Surname
PWD School
ID
Previous
School
Gender
Enrolment Date
Exceptionalit
y
CUSTODIAL DETAILS
Parent/Guardian Name:
Date of birth
Residential Address:
DATE
Consent for Initial
Evaluation
Photo of the
Learner
Mobile Number:
Vision
Hearing Screening
Recommended Placement
Program
Recommendation
School Placement
School Address
Grade level and class
Teacher
Name
Notice
Provided to
IEP ATTENDANCE
Position
Signature
Teacher
Evaluator
Parent
From
Date
Date
Method
PUPILS STRENGTHS
___No
COGNITIVE ABILITIES
LANGUAGE ARTS
VISION
COMPENSATORY
FINE MOTORS
TRANSVOCATIONAL SKILLS
How does this students performance differ from same person?
Strengths
Needs
AREA
School Assessment
Asses1
Assess2
SCHOOL ASSESSMENT
The IEP team has determined this student will assessed as follows:
AREA
Reading
Math
Writing
Social Studies
Science
TYPE OF ASSESSMENT
ACCOMODATIONS
Accommodations will be used in general education and special education
settings when state assessments are administered. Accommodations will be
used in the special and general education classroom settings.
Reading
0 Separate, quiet, or individual setting
provide
3 large print edition of the assessment
provided
4 Visual magnification is used by the
student
Math
0 Separate, quiet, or individual setting
provide
3 large print edition of the assessment
provided
4 Visual magnification is used by the
student
Writing
0 Separate, quiet, or individual setting
provide
3 large print edition of the assessment
provided
4 Visual magnification is used by the
student
Social Studies
0 Separate, quiet, or individual setting
provide
3 large print edition of the assessment
provided
4 Visual magnification is used by the
student
Science
0 Separate, quiet, or individual setting
provide
3 large print edition of the assessment
provided
4 Visual magnification is used by the
student
GENERAL EDUCATION / LEAST RESTRICTIVE ENVIRONMENT
How does this students exceptionality affect his/her involvement and
progress in the general education curriculum (K-12) or developmentally
appropriate activities for preschool children?
Answer 1
Provide an explanation of the extent, if any, to which this student will not
participate in the general education classes and the general education
curriculum.
Answer 2
Answer 3
Answer 4