SUMMARY OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE WHAT GOES WHERE? 8/13/2010
Student Name:
SUMMARY OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
Student Name:
Joe Shmow
District/School Name:
State College Area School District
Date Summary Issued to Student (mm/dd/yy):
Dear
School Age
Enter date
Joe Shmow
:
Now that you have graduated or are beyond school age, we are providing you with a Summary of Academic
Achievement and Functional Performance to assist you in planning for the future. This summary is divided
into four parts. Part 1 provides information we currently maintain about you. Part 2 summarizes your
academic achievement and functional performance in school. Part 3 provides recommendations for assistance
you may need to meet your postsecondary goals. Part 4, which is optional, gives you a chance to provide
information related to your achievement and performance.
Part 1: Student Information
Student Name:
Joe Shmow
Year of Graduation/Exit:
2009
Student Address:
111 Eleventh Street
City, State, Zip:
State College, PA 16801
Student Phone:
814-404--0000
Current School:
State College High School
Date of Birth:
6/5/1991
Current School Phone:
231-5020
Part 2: Summary of Student Performance
ACADEMIC ACHIEVEMENT
ACCOMMODATIONS
(if appropriate)
-summarize
student's academic
abilities, skills,
needs and
limitations in all
academic areas
where student
receives support
(reading, writing,
math)
Page 1 of 4
-list accommodations
that the student used
throughout high
school
RECOMMENDATIONS
-list accommodations
that student and
school personnel feel
student will benefit
from at postsecondary
school and/or on the
workplace
July 2008 Revisions
SUMMARY OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE WHAT GOES WHERE? 8/13/2010
Student Name:
FUNCTIONAL PERFORMANCE
(if appropriate)
Career/Vocational
-summarize the
student's
educational program
related to
functional
performance as they
relate to meeting
the student's
postsecondary goals
ACCOMMODATIONS
RECOMMENDATIONS
-list the effective
accommodations,
modifications,
assistive technology
and instructional
strategies utilized by
the student
-list accommodations
that student and school
personnel feel student
will benefit from at
postsecondary school
and/or on the workplace
-list the effective
accommodations,
modifications,
assistive technology
and instructional
strategies utilized by
the student
-list accommodations
that student and school
personnel feel student
will benefit from at
postsecondary school
and/or on the workplace
-list the effective
accommodations,
modifications,
assistive technology
and instructional
strategies utilized by
the student
-list accommodations
that student and school
personnel feel student
will benefit from at
postsecondary school
and/or on the workplace
Social Skills and Behavior
-summarize the
student's
educational program
related to
functional
performance as they
relate to meeting
the student's
postsecondary goals
Independent Living Skills
-summarize the
student's
educational program
related to
functional
performance as they
relate to meeting
the student's
postsecondary goals
If Social Skills/Behavior and/or Independent LIving Skills were not areas addressed in the student’s IEP and
support was not given in these areas, put NA.
Part 3: Recommendations to Assist Student in Meeting Postsecondary Goals
POSTSECONDARY
CONTACT
NEXT STEPS
OFFICE/AGENCY
GOALS
INFORMATION
Postsecondary
list
list specific
phone
Education and
suggestions for office/agencies number/email
Training:
REASON FOR
CONTACT
state the
reason
accommodations, that could help
address of
student would
State their
adaptive
the student
any agencies
need to
postsecondary
devices,
(OVR, ODS,
listed
contact this
goal/outcome
compensatory
etc.)
office/agency
as stated in
strategies,
the
assistive
Transition
technology or
Plan section
support
Page 2 of 4
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SUMMARY OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE WHAT GOES WHERE? 8/13/2010
Student Name:
in the IEP,
if there is
one. If not,
N/A
services
Employment:
list
list specific
phone
state the
State the
suggestions for office/agencies number/email
reason
student’s
accommodations,
such as OVR,
address of
student would
employment
adaptive
MHMR, etc.
those
need to
goal/outcome
devices,
agencies
contact this
as stated in
compensatory
office/agency
the
strategies,
Transition
assistive
Plan of IEP,
technology or
if there is
support
one. If not,
services
N/A
Independent Living:
list
list specific
phone
state the
State their
suggestions for office/agencies number/email
reason
independent
accommodations, that might help
address of
student would
living
adaptive
(OVR, MHMR,
the listed
need to
goal/outcome
devices,
HUD, etc)
agencies or
contact this
as stated in
compensatory
offices
office/agency
the
strategies,
transition
assistive
plan of the
technology or
IEP, if there
support
is one. If
services
not, N/A
Part 4: Student Perspective (Optional)
Please answer the following questions based upon your high school experiences:
In the past, what supports have
been tried by teachers or by you
to help you succeed in school
TO BE ANSWERED BY STUDENT – Get this information from the student and
(e.g., aids, adaptive equipment, enter it here
physical accommodations, other
services)?
Which of these accommodations
TO BE ANSWERED BY STUDENT – Get this information from the student and
and supports has worked best
enter it here
for you?
What strengths and needs
should professionals know about
TO BE ANSWERED BY STUDENT – Get this information from the student and
you as you enter the
enter it here
postsecondary education or
work environment?
We have enclosed a copy of this document for you to share with your parents. We also will place a copy in our
records. If you have questions concerning this document, please contact:
Enter your name
Name:
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July 2008 Revisions
SUMMARY OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE WHAT GOES WHERE? 8/13/2010
Student Name:
Phone:
Email Address:
Your school number and (814) 231-1072
Your email
For help in understanding this form, an annotated Summary of Academic Achievement and Functional
Performance is available at www.pattan.net Type “Annotated Forms” in the Search feature on the website.
If you do not have access to the Internet, you can request the annotated form by calling PaTTAN at
800-441-3215.
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July 2008 Revisions