HALIFAX REGIONAL SCHOOL BOARD
Individual Program Plan
Student’s Name:
School Name:
School Year:
200
- 200
PERSONAL DATA
Student’s Name:
Date of Birth:
Address:
Telephone:
Parent(s)/Guardians:
Legal Guardian (if different from Above):
Emergency Contact Person and Number:
Teacher(s):
IMPORTANT INFORMATION RELATING
TO HEALTH AND SAFETY
Medications:
Warnings:
Special resources or support required (Vision, transportation, etc,):
RECORD OF RECENT ASSESSMENTS by teachers and other professionals
Date
Assessment
Examiner/Location of Assessment Results
TRANSITIONAL PLANNING: (Policy 2.7 Provincial Special Education Policy)
Factors to consider:
STUDENT PROFILE
Learning Style:
Physical Considerations:
Communication Ability:
Environmental Consideration:
Social/Emotional Consideration:
Other:
STRENGTHS
NEEDS
ANNUAL INDIVIDUALIZED OUTCOMES
(Developed by Program Planning Team)
Please number and list in order of priority. (Parents included in the process of selecting priority
outcomes)
Use this section to update information and to indicate progress. Please date.
Photocopy this page to accommodate the number of classroom/subject areas developing outcomes for the IPP
CLASSROOM/SUBJECT TEACHERS
Responsibility Area
Specific Individualized Outcomes (Developed from Annual Individualized Outcomes)
Outcome:
Outcomes
Material/Methods/Strategies Personnel
Deleted Specific Curriculum Outcomes:
Method(s) of Evaluation
Progress towards Achieving
Outcomes
Photocopy this page to accommodate the number of classroom/subject areas developing outcomes for the IPP
CLASSROOM/SUBJECT TEACHERS
Responsibility Area
Specific Individualized Outcomes (Developed from Annual Individualized Outcomes)
Outcome:
Outcomes
Material/Methods/Strategies Personnel
Deleted Specific Curriculum Outcomes:
Method(s) of Evaluation
Progress towards Achieving
Outcomes
Photocopy this page to accommodate the number of classroom/subject areas developing outcomes for the IPP
CLASSROOM/SUBJECT TEACHERS
Responsibility Area
Specific Individualized Outcomes (Developed from Annual Individualized Outcomes)
Outcome:
Outcomes
Material/Methods/Strategies Personnel
Deleted Specific Curriculum Outcomes:
Method(s) of Evaluation
Progress towards Achieving
Outcomes
Photocopy this page to accommodate the number of classroom/subject areas developing outcomes for the IPP
CLASSROOM/SUBJECT TEACHERS
Responsibility Area
Specific Individualized Outcomes (Developed from Annual Individualized Outcomes)
Outcome:
Outcomes
Material/Methods/Strategies Personnel
Deleted Specific Curriculum Outcomes:
Method(s) of Evaluation
Progress towards Achieving
Outcomes
Photocopy this page to accommodate the number of classroom/subject areas developing outcomes for the IPP
BEHAVIOUR PLAN
CLASSROOM/SUBJECT TEACHERS
Responsibility Area
Specific Individualized Outcomes (Developed from Annual Individualized Outcomes)
Target Behavioural Outcomes
Strategies
Personnel
Method(s) of Evaluation
Progress towards Achieving
Behavioural Outcomes
Persons Participating in Planning Process of IPP
Name
Position/Relationship to Student
Implementation Date:
Review Date:
SIGNATURES
I have participated in the planning process and agree with the outcomes in this IPP.
Parent(s)/Guardian(s):
Date:
Principal:
Date:
Parental Comments:
C:
Cum Card
Parent