Student Names
Case Manager _____________________
*** Copies to Receiving School and EC Department***
Receiving EC Teacher’s Signature ___________________ Date ______________
IEP Chair signature___________________________ Date______________
Report(s) of Progress
OT/PT/SLP Related Services Support( if
applicable)
Secondary Transition component (14 +)
Copy given/sent to Parent(s)
Record of IEP Participation
ESY (Addressed on IEP ,worksheet included
and addendum if needed)
LRE Justification Statement
Continuum of Alternative Educational
Placements
Nonacademic Services & Activities
Frequency and Location of Related Services
Frequency and Location of Special Ed
Alternate Assessment Justification
District-Wide Assessment Program
NC Assessment Program
Technical Assistance addressed
Implementation Specifications in regular
program
Aids, services, modification in regular program
LRE/General Education Program participation
Description of how Annual Goal will be
measured
Criteria for Mastery specified for Benchmarks
and Short Term Objectives
Benchmarks or Short Term Objectives
Measurable Annual Goals (academic or
functional) Assistive technology and integration
with related services addressed
Competency Goal–based on NCSCOS (n/a for
Extend 1 students)
Present Level of Academic & Functional
Performance (directly related to goals)
Consideration of Special Factors
(attachment HI only)
Consideration of Transitions
Student Profile
Area(s) of Eligibility
Current Reevaluation Due Date
DEC 6 (Consent for Placement)
VANCE COUNTY SCHOOLS
Department for Exceptional Children
INDIVIDUAL EDUCATION PLAN AUDIT and TRANSFER OF RECORDS FORM
Principal’s signature__________________________ Date_______________
Comments: ___________________________________________________________________________________