Santa Rosa District Schools
SUMMARY OF PERFORMANCE TEMPLATE
Part 1: Background Information
Student Name:
Date of Birth:
Year of Graduation/Exit:
Address:
(Street)
(City, State)
Telephone Number:
Primary Language:
Current School:
City:
(Zip code)
Student’s primary exceptionality:
Other exceptionality(ies), if applicable:
If English is not the student’s primary language, what services were provided for this student as an
English language learner?
Date of most recent IEP:
Date this Summary was completed:
This form was completed by: Name:
Reviewed By: Kindra Hosman
School:
Gulf Breeze High School
E-mail: hosmank@mail.santarosa.k12.fl.us
Telephone number: (850) 916-4140
Revised 2/8/16
Part 2 – Student’s Postsecondary Goal(s) Information from your IEP (pg.4 or 5)
1. Post-secondary education/training goal:
2. Post-secondary employment goal:
3. Post-secondary living goal: OR “Age appropriate, independent living skills”
Part 3 – Student Input (Highly Recommended) Answer the following questions in your
own words. Be specific!!!!!!
SUMMARY OF PERFORMANCE: STUDENT PERSPECTIVE
A. How does your disability affect your schoolwork and school activities (such as grades,
relationships, assignments, projects, communication, time on tests, mobility, extra-curricular
activities)?
B. What accommodations and supports have worked best for you? Why do you think they
worked best?
C. What strengths and needs should professionals know about you as you enter the
postsecondary education or work environment?
D. What areas do you think you need to improve upon (communication, self-advocacy, study
skills, etc.)?
Revised 2/8/16
Part 4 – Summary of Performance
(Complete all that are relevant to the student)
Use FCAT, PERT, ACT, SAT scores or use scores on your IEP pg.2 Include the test name
ACADEMIC
CONTENT AREA
Present Level of Performance
Reading
Ex)
FCAT 2012 – score: 325
Pert 2012 – score 101
ACT 2012 – score 18
Essential accommodations or
(grade level, standard scores, strengths, modifications and/or assistive technology
needs)
utilized in high school, and why needed.
Math
Ex)
Extra time, small group setting
PERT Math scores or Alg EOC
scores
Ex)
Extra time, small group setting,
read test items, use of calculator
English scores
Writing scores
Ex)
Extra time, small group setting, use
of scribe or computer
Learning style from CITE
inventory.
Things that would help you study
using your learning style.
Present Level of Performance
Essential accommodations or
(strengths and needs)
modifications and/or assistive technology
utilized in high school and why needed.
List strengths and needs
OR
“Age appropriate skills”
List accommodations needed
OR
N/A
List strengths and needs
OR
“Age appropriate skills”
List accommodations needed
OR
N/A
List strengths and needs
OR
“Age appropriate skills”
List accommodations needed
OR
N/A
Written Language
Learning Skills
FUNCTIONAL
AREAS
Social Skills and
Behavior
Independent Living
Skills
Environmental
Access/Mobility
Revised 2/8/16
FUNCTIONAL
AREAS (continued)
Present Level of
Performance
(strengths and needs)
Self-Determination
Self-Advocacy Skills
IEP pg. 4 or 5
Self Determination Practice Opportunities
CareerPSC fieldtrip or visit to
Vocational/Transition/ Vocational program, LS
Employment
transition inventories, work
experience
Additional
Considerations
Do not leave blank…
List needs or write NONE
Essential accommodations or
modifications and/or assistive technology
utilized in high school and why needed.
What help do you need to
advocate for your needs?
Ex) meet with counselor each
month, talk with teachers before
or after class
What help will you need for
transition?
Ex) meet with teacher/counselor
to discuss transition plan, meet
with recruiter
List accommodations needed
OR
N/A
Part 5 – Recommendations to assist the student in meeting postsecondary goals
Suggestions for accommodations, adaptive devices, assistive services, compensatory strategies, and/or
collateral support services to enhance access in the following post-high school environments (only
complete those relevant to the student’s postsecondary goals).
Education or
Training
Complete application to college or vocational program
Register with Disability Support Services (ADA)
Identify yourself as having an IEP!!!!
Employment
Contact Vocational Rehabilitation counselor
Independent living
I have reviewed and agree with the content of this Summary of Performance.
Student Signature:______________________________________ Date:_________________________
Revised 2/8/16