WOODBRIDGE SCHOOL DISTRICT
TEACHER INPUT
Student_____________________________Teacher _______________________Date_____________
An IEP meeting is scheduled in the near future for this student. Your input is very important in planning the
student's educational program. The information requested on this form is necessary for making educational
decisions at the IEP meeting and allows you input regarding this student's performance in your class and your
recommendations for the coming year. This paper may become a part of the student's special education
eligibility folder. Please complete it and return it to ________________________________ by
_____________________
1. Competencies: List at least two competencies the student has in each subject you teach him/her.
Subject:__________________________________________________ Estimate current grade: _________
Competencies:
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Subject:__________________________________________________ Estimate current grade: _________
Competencies:
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Subject:__________________________________________________ Estimate current grade: _________
Competencies:
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Subject:__________________________________________________ Estimate current grade: _________
Competencies:
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2. Teacher observations: Please check all that apply.
 Attempts all work assigned
 Complies with teacher
requests
 Has a short attention span
 Has good attendance
 Seems disorganized
 Turns in assignments
 Work seems too hard
 Uses special ed. support
 Follows rules
available
 Is attentive
 Uses class time wisely
 Does poorly on tests
 Has a positive attitude
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Needs encouragement
Completes daily work
Is easily frustrated
Works cooperatively
Completes homework
Brings materials to class
Good rapport with peers
Participates in class
3. Testing scores(DIBELS, DAR, GATES, etc.)
4. Recommendations for next year:
a. Modifications: On the back or attached to this sheet is a list of modifications. Please take time to look at it
Carefully and mark the modifications that you believe are necessary for this student to be successful in your
class. This is very important since your recommendations are what the IEP team will consider in planning for
next year.
b. Setting recommendations: _______________________________________________________________
________________________________________________________________________________________
c. Other information: Any comments or other information you believe would help in planning his/her program
for next year: ____________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Form #404
What accommodations/modifications/supports/supplementary aids and services are necessary?
NAME __________________________________SCHOOL _____________________DATE_____________
These program modifications, accommodations, supports for school personnel, or supplementary aids and services are
necessary for the student to be involved and progress in the general curriculum and to attain the annual goals in the
I.E.P., to participate in extracurricular and nonacademic activities, and to be educated and participate with other students
with disabilities and non-disabied students.
 No modifications necessary
Discipline:
Yes  No
This student has a Behavior Intervention Plan.
For students in the mainstream setting with only classroom modifications, special education personnel will monitor
progress in the general curriculum each _______ weeks period by  teacher consultation  other:
_____________________________________
CLASS / COURSE NAMES
1. Modified Curriculum
2. MODIFIED TESTS:
a. Read test items to student
b. Replace the test with alternative assignments
c. Reduce the reading level of the test (paraphrase, simplify wording, etc.)
d. Reduce length of test or administer in smaller sections separately
e. Allow the student to refer to class notes/textbooks while taking the test.
f. Use objective test questions instead of essay/short answer
g. Limit multiple choice answer choices to
h. Present matching questions in groups of no more than
i. Allow the student to use a  calculator  computer  spell checker  other while
taking the test
j. Allow the student to have more time to complete the test.
k. Allow the student to  dictate,  tape record or  give oral responses to test items.
1. Allow the student to take the test alone or in the Content Mastery/resource class at
student request or when mastery level is below 70
m. Other:
3. MODIFIED ASSIGNMENTS AND GRADING:
a. Allow the student to dictate homework answers to parents or others to write the dictated
responses
b. Allow the student more time to complete pencil/paper assignments
c. Reduce the homework load (especially lengthy reading assignments)
d. Break assignment into shorter sections
e. Make sure the teacher or the student has written down the assignment
f. Allow the student choices for some assignments
g. Modify mastery criteria Specify:
h. Present reading assignments on cassette tapes
Form #404
3. MODIFIED ASSIGNMENTS AND GRADING continued:
i. Student should not be penalized for spelling errors except on ''spelling assignments''.
j. Student should not be penalized for handwriting errors except on “penmanship
assignments''.
k. Reversals and transpositions of letters and numbers should not be marked wrong.
l. Content Mastery/resource support at student request or when mastery level is below 70
m. Other:
4. ASSISTIVE TECHNOLOGY DEVICES OR SERVICES / ADAPTED MATERIALS
a. Provide tape recording of written materials
b. Underline or color code key words or concepts in textbooks or worksheets
c. Notetaking assistance
d. Allow the student to use a calculator
e. Provide specialized equipment: Specify:
f. Other:
5. INSTRUCTIONAL SUPPORT
a. Provide assistance in monitoring homework assignments
b. Oral directions: Repeat Rephrase Provide visual support
c. Peer tutoring / assigned buddy
d. Provide the student with preferential seating Specify:
e. Scheduled content mastery / resource support: Minimum time weekly:
Grade/Progress determined by General Ed. Special Ed. Joint
f. Content Mastery/resource support at student request or when mastery level is below 70
g. Helping teacher/paraprofessional
h. Co-teaching
i. Other:
6. SUPPORTS FOR PERSONNEL (ON BEHALF OF THE STUDENT)
a. Training/Staff Development in the area of:
b. Participation in ESC opportunities
c. Classroom visits to another campus/district
d. Consultation to general education personnel
f. None needed at this time
g. Other:
What services have been considered, tried or are being provided to this student?
General education
Special education
Speech therapy
Modifications/accommodations
Supplementary aids and services
Pre-K classroom
Related services
Dyslexia services
Other:_______________
______________________
Tutorials/academic remediation
Bilingual/ESL classes
List any specific accommodations that should occur for the student to participate in statewide and district-wide
assessments? ____________________________________________________________________________________
_________________________________________________________________________________________________
Form #404