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![School Name<br />Phone:<br />Fax:<br />Individual Education Plan<br />2010-2011<br />DATE OF IEP MEETING:<br />NAME OF STUDENT:<br />BIRTH DATE: AGE: GENDER:<br />MAILING ADDRESS:<br />GRADE: <br />PHONE:<br />PARENT/GUARDIAN: <br />STUDENT PROFILE<br />ASSESSMENT INFORMATION:Informal: Formal: <br />STRENGTHS:<br />DESCRIPTORS: <br />,[object Object],MEDICAL HISTORY:<br />SCHOOL HISTORY:<br />Areas of Need<br />Academic <br />Behavioural <br />Social/Emotional<br />Language Communication<br />Physical<br />Life skills<br />Long-term Goals/Dreams/Desires<br />What Do We Want to Accomplish This Year?<br />FOUR COLUMN GOAL CHART<br />NEED(From above list of areas)Goal for the StudentStrategy & Team ResponsibilitiesMeasurement of ProgressSocial-emotionalAcademic<br />NEED(From above list of areas)Goal for the StudentStrategy & Team ResponsibilitiesMeasurement of Progress<br />SUPPORT TEAM<br />RoleParticipant NameContact InformationParentTeacherPrincipalResource room teacher(add participants as needed)<br />SIGNATURES<br />________________________________________________<br />Parent/Guardian Date<br />_________________________________________________<br />Principal Date<br />Review Date: _____________________<br />](https://image.slidesharecdn.com/ieptemplate-100701143844-phpapp01/85/IEP-Template-1-320.jpg)
