IEP Review
Teacher ________________________
Student _________________________
DOB___________________
ARC Notice Date:
School _______________________
IEP begin/ end dates____________
Age / Grade ___________________
8/10
Date __________________
Disability _______________
Notes:
(must be dated 7 calendar days before date
of scheduled meeting)
Scheduled ARC Meeting Date:
Transition Planning addressed
(see notes * regarding ages for
when this should be completed)
Notes:
Communication
(Must be completed for SLI and
DD- Communication, AUT)
Notes:
Addressed by age 14 (* Age 13 if student will turn 14 before next annual review)
Yes No N/A
Notes:
 IGP/ILP included
 Multi-Year Course of Study completed through exiting year of school
 Statement of Transition needs a (use template – must talk about independent living, etc.)
Addressed by age 16 (* Age 15 if student will turn 16 before next annual review)
Yes No N/A
 IGP/ILP and Multi-Year Course of Study completed through exiting year of school
 Statement of Transition Needs & Services (as described in the Transition PLAAFP)
 Services provided by district
 Interagency/Needed linkages included (if appropriate)
 Post Secondary Goals included – based on information gathered (student emphasis)
 Training/Education  Vocational  Independent Living
 N/A (documented)
Yes No N/A
 Summary of student’s communication skills in areas that apply
 Summary includes current evaluation/monitoring data
 Summary includes what the student is currently able to do
 Summary includes what the student is currently unable to do
 Summary includes “affect statement” for involvement and progress within general
curriculum-preschool participation in appropriate activities
Academic
(Must be completed for SLD,
MMD, FMD)
Notes:
Yes No N/A
 Summary of student’s academic achievement and functional performance in areas that apply
 Summary includes current evaluation/monitoring data
 Summary includes what the student is currently able to do
 Summary includes what the student is currently unable to do
 Summary includes “affect statement” for involvement and progress within general
curriculum-preschool participation in appropriate activities
Health, Vision, Hearing,
Motor Ability
(Must be completed for OHI, HI,
VI, OI, DD-Motor, TBI)
Notes:
Yes No N/A
 Summary of student’s health needs and functional performance in areas that apply to include
pertinent medical diagnoses, conditions and /or precautions
 Summary includes current evaluation/monitoring data
 List of medications (if applicable)
 Summary includes “affect statement” for involvement and progress within general
curriculum-preschool participation in appropriate activities
Yes No N/A
 Summary of student’s social/emotional skills and functional performance in areas that apply
 Summary includes current evaluation/monitoring data
 Summary includes what the student is currently able to do
 Summary includes what the student is currently unable to do
 Summary includes “affect statement” for involvement and progress within general
curriculum-preschool participation in appropriate activities
Social/Emotional
(Must be completed for EBD,
AUT, OHI, MMD, FMD, DDself-help/ adaptive, DD-socialemotional)
Notes:
General Intelligence
(Must be completed for MMD,
FMD, DD-Cognitive, TBI)
Notes:
Yes No N/A
 Summary of student’s intellectual ability and functional performance in areas that apply
 Summary includes current evaluation/monitoring data
 Summary includes “affect statement” for involvement and progress within general
curriculum-preschool participation in appropriate activities
Functional Vision/learning
Media Assessment
(Must be completed for VI)
Notes:
Special Factors
Notes:
Yes No N/A
 Summary of student’s visual needs and functional performance in areas that apply
 Summary includes current evaluation/monitoring data
 Summary includes “affect statement” for involvement and progress within general
curriculum-preschool participation in appropriate activities
Behavior – Yes No N/A
Limited English Proficiency – Yes No N/A
Blind/Visual Impairment – Yes No N/A
Communication - Yes No N/A
Deaf/Hard of Hearing – Yes No N/A
Assistive Technology – Yes No N/A
Annual Goals
Benchmarks/Objectives
Notes:
Yes No
 Relate directly to PLAAFP (formerly PLEP)
 Instructional area refers to Core Content/Program of Studies needed by a student to
successfully progress in the general curriculum
 Address skills and content related to disability (aligns with PLAAFP) student needs to learn
 Measurable
 Benchmarks/objectives relate to annual goal
Special Designed Instruction
Notes:
Documentation of what the teacher will do to…
 Adapt content and/or
 Adapt methodology and/or
 Adapt delivery of instruction
Monitoring Student Progress –
Guides Implementation of IEP and
Instruction
Notes:
 Method (tool/type):
 Summary of how parents will be informed extent of sufficient progress to achieve Annual
Goal
Supplementary Aids and Services
Notes:
 A description includes specific materials, resources, aids, and / or strategies to gain access to
the general curriculum
Accommodations for
Administration of State
Assessments and Assessments in
the Classroom
Notes:
 Documentation shows accommodations are based on regulation requirements (Inclusion of
Special Populations in the State-Required Assessment and Accountability Programs)
 Documentation shown in PLAAFP, Goals & Objectives AND
 Accommodations Determination form is completed
OR
 N/A
Program Modification & Support
for School Personnel
Notes:
 Determined on behalf of the student
 Description of type of modifications/support is included
 Description of how the student’s program is modified and/ or describes supports for school
personnel
 List of classes and nonacademic activities student will participate within the resource or
special class setting
 Amount of time
 Anticipated frequency
 Amount of time
 Begin/End date
 Location
 Dates correlate with the dates on the front page of the IEP
 IEP supports need for service (assists the student to benefit from Special Education services)
 Documentation includes how often student will receive service.
 N/A
 Yes: Monitoring Documentation Attached AND Explanation included on IEP
 No: Explanation included on IEP
 More data needed to make determination
LRE: Participation
Notes:
LRE: Special Education
Services
Notes:
LRE: Related Services
Notes:
ESY
Notes: