Steve Mizera,
Director
Special Services
(707)528-5321
Fax: (707) 547-5889
Smizera@srcs.k12.ca.us
Administrator/Facilitator
IEP Meeting (Annual/Initial/Triennial) checklist/agenda
Student:______________________DOB:_______School:____________CaseCarrier:__________
Date Started: ____________Date Ended (Parent Consent): ______________________
Opening/Introductions
□ Agenda
□ Procedural Safeguards/Does the parent have questions about the Procedural Safeguards?
□ Signed Meeting Notice
□ Confirm Personal Data
□ Review the Purpose of Meeting
Present Levels of Performance
□ Case Manager to make a statement about the current placement and services
□ Assessment results shared with other team members to determine eligibility and to develop goals/obj
□ Parent Concerns
□ Special Education Teacher
□ General Education Teacher
□ Counselor
□ DIS/Related Services
□ Student Strengths
□ Certificate of Eligibility (Initials and Triennials)
□ Statement of how the disability affects involvement in general education
Special Factors
□ Assistive Technology
□ Low Incidence
□English Language Needs discussed including CELDT scores
□Student Behavior/(BIP if appropriate):
□ Standardized Testing Discussion on Alternative Assessment
Measurable Goals
□ Team reviews previous goals and share data on goals met or being modified
□ Present/develop measurable goals using ongoing data to revise goals including annual goals linked to ITP for students 15 and older)
□ English Language needs discussed including linguistically appropriate goals
□ Statement of how parents will be regularly informed of progress on goals
Services, Aids and Supports
□ Modifications/Accommodations and Supports: Document on service page
□ Services, including Frequency, duration, location, start and end date, provider and curricular area
□ If Transition Plan includes Transition services and activities
□ ESY to be considered
Education Setting
□ LRE statement
□ Transportation
□ Transition statement for Pre K, transition to elementary, middle or high school
Summary
□ Review meeting notes
□ Look at checklist to see that all parent concerns were addressed
□ Members sign IEP attendance ( if parent does not sign IEP a date is set to have parent return the IEP)
□ Parent sign IEP
Case Carrier: _______________________________________Date Submitted_____________________
Site Administrator and or Program Mgr: ____________________________ Date Received: __________Date Reviewed:____
211 RIDGWAY AVENUE  SANTA ROSA  CALIFORNIA 95401-4386
2/15/2016
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