Brimer Community Unit School District 1
111 East Seame Street
Brimer, Illinois 62000
(618) 111-1111
CHILD REVIEW CONFERENCE SUMMARY REPORT
 Initial Evaluation
 Graduation
 Review of Existing Data
 Manifestation Determination
 IEP/Annual Review
 Transition
 Termination
 Triennial Reevaluation
 Initial IEP
 Eligibility Determination
 Behavior Intervention Plan
 Other
STUDENT IDENTIFICATION INFORMATION
Student’s Name ___________________________________________
Date of the IEP _______________________
Student’s Address ____________________________
Parents’ Address _______________________________
_____________________________________________
______________________________________________
Student’s Date of Birth ________________________
Parents’ Home Telephone Number ______________
Student’s Gender _____________________________
Father’s Work Telephone Number ______________
Language/Mode of Communication _____________
Mother’s Work Telephone Number _____________
Student’s ID Number __________________________
Residential School District _____________________
Serving School District _________________________
Student’s Home School _______________________
GENERAL COMMENTS
CRC Page _____ of _____
Brimer Community Unit School District 1
PRESENT LEVEL OF EDUCATIONAL PERFROMANCE
Academic Performance
 Age/Grade Appropriate  See below for description
Social/Emotional Status
 Age/Grade Appropriate  See below for description
General Intelligence
 Age/Grade Appropriate  See below for description
Independent Functioning Status
 Age/Grade Appropriate  See below for description
Communicative Status
 Age/Grade Appropriate  See below for description
Career/Vocational Status
 Age/Grade Appropriate  See below for description
Motor Status
 Age/Grade Appropriate  See below for description
Hearing/Vision
 Age/Grade Appropriate  See below for description
Other (Specify) _________________________
 Age/Grade Appropriate  See below for description
CRC Page _____ of _____
Brimer Community Unit School District 1
PRESENT LEVELS OF EDUCATIONAL PERFROMANCE (continued)
CRC Page _____ of _____
Brimer Community Unit School District 1
PRESENT LEVELS OF EDUCATIONAL PERFORMANCE (continued)
When completing this page, include all areas that impact the student’s disability; this may
include strengths; academic performance; social/emotional status; independent functioning;
career/vocational status; motor status; and speech/language communication.
Summary of the Student’s Strengths
Adverse Effects Identified in the Most Recent Evaluation
State how the disability, affects the student’s involvement and progress in the education
curriculum or for preschool children, as appropriate, how the disability affects the child’s
participation in appropriate activities. This may reflect some of the adverse effects identified
above as well as the data obtain in an eligibility determination.
CFR Page _____ of _____
Brimer Community Unit School District 1
ANNUAL GOALS AND INSTRUCTIONAL OBJECTIVES/BENCHMARKS
Person responsible for implementing the IEP (e.g., goals and objectives/benchmarks, accomodations, modifications, and supports) must be notified of his or her specific responsibilities.
Has that person been notified?
Yes  No If no, when will that person be notified? (specify)
Check the methods that will be used to notify parents of the student’s progress on annual goals
and if the progress is sufficient to achieve the goals by the end of the IEP year.
 report cards  progress reports  parent conference  other (specify)
Goal Number
Illinois Learning Standards Domain
Illinois Leaning Standard Goal Number
Goal Statement
Instructional Objective/Benchmark
Evaluation
Criteria
Evaluation
Procedures
Schedule for
Determining Achievement
 _____% of Accuracy
 Log of Observations
 Daily
 _____ of _____ Attempts
 Chart
 Weekly
 in __________ Minutes
 Tests
 Quarterly
 Other (specify)
 Other (specify)
 Semester
Date Review/
Extent of Progress
CRC Page _____ of _____
Brimer Community Unit School District 1
ANNUAL GOALS AND INSTRUCTIONAL OBJECTIVES/BENCHMARKS (continued)
Instructional Objective/Benchmark

Evaluation
Criteria
Evaluation
Procedures
Schedule for
Determining Achievement
 _____% of Accuracy
 Log of Observations
 Daily
 _____ of _____ Attempts
 Chart
 Weekly
 in __________ Minutes
 Tests
 Quarterly
 Other (specify)
 Other (specify)
 Semester
Date Review/
Extent of Progress
Instructional Objective/Benchmark
Evaluation
Criteria
Evaluation
Procedures
Schedule for
Determining Achievement
 _____% of Accuracy
 Log of Observations
 Daily
 _____ of _____ Attempts
 Chart
 Weekly
 in __________ Minutes
 Tests
 Quarterly
 Other (specify)
 Other (specify)
 Semester
Date Review/
Extent of Progress
Instructional Objective/Benchmark
Evaluation
Criteria
Evaluation
Procedures
Schedule for
Determining Achievement
 _____% of Accuracy
 Log of Observations
 Daily
 _____ of _____ Attempts
 Chart
 Weekly
 in __________ Minutes
 Tests
 Quarterly
 Other (specify)
 Other (specify)
 Semester
Date Review/
Extent of Progress
CRC Page _____ of _____
Brimer Community Unit School District 1
PARTICIPATION IN THE GENERAL EDUCATION PROGRAM
Subject
Grade
Level
Projected Date
of Initiation
Projected
Duration
TYPE OF SPECIAL EDUCATION PROGRAMMING
Primary
1. Autism
`
2. Emotional Disturbances
3. Hearing Impaired
4. Mental Retardation
5. Multiple Disabilities
6. Other Health Impaired
7. Orthopedic Impaired
8. Learning Disabilities
9. Speech/Language Impaired
10. Traumatic Brain Injured
11. Visually Impaired
12. Developmental Delay (Birth – 5 only)
Secondary
Tertiary
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RELATED SERVICES TO BE PROVIDED
Type of Service
Projected Date
of Initiation
Minutes per
week
Weeks per
year
Direct Indirect
Service Service
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CRC Page _____ of _____
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Brimer Community Unit School District 1
BEHAVIORAL STRATEGIES

Yes  No Does the student’s behavior negatively impact his or her education or
that of his or her classmates.
If yes, what techniques and procedures will be used to modify or neutralize his
or her behaviors? (Identify specific procedures or techniques.)
 Yes  No  N/A
If required, will an Individual Behavior Management Program be
completed at this meeting?
If required, when will an Individual Behavior Management Program be
completed?
LINGUISTIC AND CULTURAL ACCOMMODATIONS
 Yes  No The student requires accommodations for the IEP to meet his or her linguistic
and cultural needs. If yes, specify any needed accommodations.
 Yes  No Special education and related services will be provided in a language or mode of
communication other than or in addition to English. If yes, specify any needed
accommodations.
CRC Page _____ of _____
Brimer Community Unit School District 1
ASSISTIVE DEVICES AND SERVICES
Assistive Devices Considered (List all devices considered and the reasons for their acceptance or rejection.)
Device
Accepted Rejected
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Reasons for acceptance or rejection
Assistive Services Considered (List all services considered and indicate the reasons for their acceptance or rejection.)
Service
Accepted Rejected
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Reasons for acceptance or rejection,
EXTRACURRICULAR AND NONACADEMIC PARTICIPATION
Extracurricular and Nonacademic Activities Considered (List all eligible activities, sports, clubs and student
organizations and indicate the reasons for their acceptance or rejection.)
Extracurricular and Nonacademic Activities
Accepted Rejected
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Reasons for acceptance or rejection,
GRADUATION
Date the Student was originally scheduled to graduate.
Date the Student is projected to complete the requirements for graduation.
 Yes  No Graduation is applicable at this time.
CRC Page ____ of ____
Brimer Community Unit School District 1
TRANSPORTATION
 Yes  No
Special transportation is required to and from school and/or between schools.
 Yes  No
Special transportation is required in and around the school building(s).
 Yes  No
Specialized equipment (e.g., adapted buses, lifts, and ramps) is required.
(If yes, specify)
To arrive at school, the student will:
 walk
 regular school vehicle
 Parent
 special vehicle
 other (specify)
Date special transportation will begin
(NOTE: Transportation is a related service, but in this IEP it will be treated separately.)
EXTENDED SCHOOL YEAR
 Yes
 No
Student will experience significant regression during the summer. Documentation indicates that recoupment would exceed acceptable normal limits. If
necessary, the IEP must indicate and specify the type and amount of services to
be provided and duration of the services.
 Yes
 No
Documentation, goals and objectives for extended school year are attached.
 Yes  No
Extended school year deemed appropriate.
TRANSITION
 Yes  No Consideration of service needs, goals and support services is required by age 14.
The team must address transition service needs. If yes, complete the Transition
Service section of the CRC-IEP.
 Yes  No Consideration of the Home-Based Support Service Program for adolescents and
adults with mental retardation. If yes, complete the Transition Services section of
the CRC-IEP.
CRC Page _____ of _____
Brimer Community Unit School District 1
PARTICIPATION IN GENERAL EDUCATION AND OTHER EDUCATION-RELATED SERVICES
The placement shall be appropriate to the student’s needs and least restrictive of the student’s
interactions with children without disabilities based on the student’s CRC-IEP. It shall be located as close
as possible to the student’s home unless the CRC-IEP requires some other arrangement in the school he
or she would attend if not disabled and consistent with the findings of the case study evaluation. Provide
an explanation of the extent to which the student will be able to participate in the general education
settings. If rejected, justify, in detail, why is not acceptable.
General Education with NO supplementary aids and services
General Education with supplementary aids and services
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 Yes  No Participation in general education program is NOT appropriate at this time.
 Yes  No Participation in general education program is appropriate at this time.
If a placement is in a separate public or private facility:
A. Describe the nature and severity of the student’s disability which precludes placement in a
general education school building.
B. Explain why the student cannot be educated in the general education school building with supplementary aids and services and assistive devices and services.
CRC Page _____ of _____
Brimer Community Unit School District 1
PLACEMENTS OPTIONS CONSIDERED
 Yes
 No A special class, separate schooling or removal from the general education is required
because the nature and severity of the student’s disability. His or her disability is such
that education in the general education classes with the use of supplementary aids and
services cannot be achieved satisfactorily.
When determining placement, consider any potentially harmful effect either on the student’s part or on
the quality of services that he or she needs. After considering general education with and without
supplementary aids and services and assistive devices and services, complete the following section.
Remember you must first consider placement in the general education class with and without aids and
services. If placement is other than the general education class, then three other placements options must
be considered.
Placement Option #1: General Education without supplementary aids and services
Placement Option #2: General Education with supplementary aids and services
Placement Option #3:
CRC Page ____ of _____
Brimer Community Unit School District 1
PLACEMENTS OPTIONS CONSIDERED (continued)
Placement Option #4
Placement Option #5:
Placement Option Selected (and justification)
If the placement option selected is not the general education program with or without supplementary
aids and services, provide an explanation of the extent, if any, to which the student will not participate
with students without disabilities in the general education classes and activities.
TRANSFER OF RIGHTS
 Yes  No
 N/A
Seventeen-year-old students must be informed of his or her rights under IDEA
that will transfer to the student upon reaching age 18.
CRC Page_____ of ____
Brimer Community Unit School District 1
PARTICIPATION
Signature indicates attendance; it does not indicate agreement.
Mother _________________________________________
Principal _________________________________________
Father __________________________________________
Special education teacher__________________________
Student _________________________________________
General education teacher _________________________
LEA representative ______________________________
Behavioral interventionist __________________________
________________________________________________
Assistive device professional _______________________
________________________________________________
__________________________________________________
________________________________________________
__________________________________________________
 Yes  No
Receipt of the parent’s rights and procedural safeguards with the notice of conference.
 Yes  No
Receipt of the IEP.
 Yes  No
Receipt of ISBE 34-57F,Parent/Guardian Notification of Conference.
 Yes  No
Receipt Individual Behavioral Intervention Program and Functional Assessment
(if appropriate)
 Yes  No
Receipt of the eligibility determination summary report (if appropriate)
 Yes  No
Receipt of a copy of the school district’s behavior intervention policies and procedures.
__________________________________________________________________
Parent Signature
_____________________
Date
Yes
 No
Did any party disagree with the conclusions reached by the CRC-IEP team?
Yes
 No
Were the dissenting party or parties asked to complete a minority report?
Yes
 No
Was a minority report completed?
Yes
 No
Is the minority report attached to the IEP?
If appropriate, who completed the minority report
Name of person completing this CRC-IEP
CRC Page _____ of _____