Individual student checklist


This checklist will assist with collating the necessary data relating to individual students and will allow the principal to
verify the evidence being used to support a student’s inclusion.
Schools can print as many copies as required.
Nationally Consistent Collection of Data on School
Students with Disability
Individual student checklist for school use only (Information
shaded in grey will be entered into the data collection tool)
1.
2.
Student name:
Student key:
3. Tick to confirm
 Evidence has been identified to support the students inclusion
(see opposite site of checklist)
 Consultation has been undertaken with parent/carer
 Consent has been obtained
4.
Indicate the level of adjustment (tick one only)
 0. No adjustment at this time
 1. Supplementary
 2. Substantial
 3. Extensive
5.
Broad category of disability (tick one only)
Evidence (tick any that apply):
 documentation about classroom curriculum-based
assessments and extra-curricular activities
 documentation from a recognised medical
professional, therapist or paraprofessional
 evidence of collaborative planning with the student,
parents/carers
 student individual learning plan
 other evidence that adjustments have been provided
 other evidence showing the adjustments has been
regularly monitored and adapted
 reports that detail the adjustments being made for
the student in areas such as health or personal care
and social development, including adjustments to
the environment and infrastructure
 any other relevant supporting documents (staff
timetables, professional learning, support for staff)
Notes:
 Physical
 Cognitive
 Social/Emotional
 Sensory
Individual student checklist


This checklist will assist with collating the necessary data relating to individual students and will allow the principal to
verify the evidence being used to support a student’s inclusion.
Schools can print as many copies as required.
Nationally Consistent Collection of Data on School
Students with Disability
Individual student checklist for school use only (Information
shaded in grey will be entered into the data collection tool)
1.
2.
Student name:
Student key:
3. Tick to confirm
 Evidence has been identified to support the students inclusion
(see opposite site of checklist)
 Consultation has been undertaken with parent/carer
 Consent has been obtained
4.
Indicate the level of adjustment (tick one only)
 0. No adjustment at this time
 1. Supplementary
 2. Substantial
 3. Extensive
5.
Broad category of disability (tick one only)
 Physical
 Cognitive
 Social/Emotional
 Sensory
Evidence (tick any that apply):
 documentation about classroom curriculum-based
assessments and extra-curricular activities
 documentation from a recognised medical
professional, therapist or paraprofessional
 evidence of collaborative planning with the student,
parents/carers
 student individual learning plan
 other evidence that adjustments have been provided
 other evidence showing the adjustments has been
regularly monitored and adapted
 reports that detail the adjustments being made for
the student in areas such as health or personal care
and social development, including adjustments to
the environment and infrastructure
 any other relevant supporting documents (staff
timetables, professional learning, support for staff)
Notes: