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Student Name ______________________________________ IEP Date _______________________________
Reviewer __________________________________________ Review Date ____________________________
Purpose _____ Annual Review
_____ Revision
_____ IEP Approved for Submission
_____ Reevaluation
_____ Other _________________
______ IEP Returned for Correction
_____ CORRECTED IEP
PLEASANTS COUNTY SCHOOLS CHECKLIST FOR IEP REVIEW
GENERAL CHECKLIST:
 IEP date matches meeting notice
 Meeting Notice is attached to IEP – Parent has indicated attendance option
 If 8 day notice was not provided, parent has checked appropriate box (waiving 8 day notice)
 All IEP pages are dated and dates are same on each page
 All IEP pages are numbered and all pages are included
 IEP is signed by Special educator, regular educator, and chairperson (minimally) – If no, include Excusal Form
 All forms are included (Meeting notice, IEP, meeting summary, PWN, Medicaid Consent, WVEIS page, ESY Doc.)
 WVEIS page is completed accurately
 Procedural safeguards were provided (must be indicated on meeting notice)
 Within 1 year of previous IEP
 Parent Participation
 Consideration of ESY – if yes, must include ESY Consideration Document - NEW
 Considerations are indicated
 Transition page completed for students 16 and older (or student turning 16 during the course of the IEP), if applicable
 Agency Invited to transition meeting (documented by signature or on meeting notice), if applicable
PRESENT LEVELS CHECKLIST:
 Grade Level Expectations are included (each area, each related service area) For PK – Developmental Expectations
 Present Levels are reflective of gaps in learning from G.L. Expectations (each area, each related service area)
 Impact Statement included (each area, each related service area)
 Targeted NxG Standard included (Reading and Math) or ELSF Standard (pre-k) or Essential Element (Alternate
assessment Reading and Math)
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GOALS CHECKLIST:
 Goals have appropriate time frame
 Goals are connected to Present Levels
 Goals have appropriate condition
 Goals have behavior that is measurable and observable
 Goals have criteria for mastery that is appropriate to the behavior being measured
 Goals have an evaluation procedure that is easy to document and related to the criteria
 Have at least one critical skill indicated
 Identify HOW and WHEN progress will be reported to the parent
SERVICES-Part A:
 Only list general education settings (not SEE)
 List specific general education settings
 List extent/frequency that is descriptive (do not say “as needed”)
 Have an initiation date that is at least five days after the IEP date and written in three parts (If no, must explain why)
 Have a duration date that does not exceed one year from the initiation date
 Have a foundation in the present levels, supporting the rationale for including them.
 Are specific
SERVICES-Part B:
 Are in place for EVERY goal area; goals in place for every service
 List/clarify area for instruction, NOT disability area
 List the goal area and the content area (if appropriate) that the service will be provided in
 Indicate D for all services that will be provided face-to-face by a special educator to a student
 Indicate I for consultative services ONLY
 Indicate GEE or SEE
 Indicate extent/frequency expressed appropriately in minutes per week or per month
 Indicate Initiation date that is at least five days beyond the IEP date; written in 3 parts (If no, must explain why)
 Indicate a duration date that does not exceed one year from initiation date; written in 2 parts
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SERVICES-Part C:
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List all related services student requires
Have documentation in the present levels
Have goals
Have included transportation , if appropriate (need must be documented in PLPs)
Have documented direct (d) or indirect (i)
Have indicated the appropriate setting (SEE, GEE, other)
Have an initiation date that is at least five days beyond the IEP date; written in 3 parts
Have a duration date that does not exceed one year from the initiation date; written in 2 parts
PLACEMENT:
 Smarter Balanced Assessment is appropriately documented and all accommodations are selected in alignment with IEP
 If alternate assessment, provides justification
 Documents Placement – NOT BLANK
 Percentage of Time is accurate and in correct place
 Placement option (LRE code) is accurate
 If Initial, parent consent
ADDITIONAL REQUIREMENTS – UPDATED MARCH 2015:
 General Educator(s) have read and understand IEP – VERIFY ONLY, no submission required
 ESY Considerations page completed at meeting where ESY is discussed – SUBMIT WITH IEP, if appropriate
 Modification/Accommodation Calendar provided to all general educators responsible for providing these services VERIFY ONLY, no submission required
***NOTE: Changes and updates as of March, 2015 are indicated in BOLD/italics.
COMMENTS/SUGGESTIONS/NOTES: _____________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Rev. 03 2015