IEP at A Glance

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BASIC INFO:

Students Name _________________________


Grade / D.o.b. ___________________________
Case Mgr. ________________________________

HEALTH INFO:
Diagnosis _________________________________ Secondary _________________________
Allergies yes / no ________________ Seizures yes / no
Medication _______________________________ Other _______________________________

SUPPORTS (attach behavior plan):


Communication/AAC______________________ Behavior plan yes / no
Accommodations _________________________ Modifications ______________________
Suppl. aids _______________________________ Other _______________________________

RELATED SERVICES (list frequency/duration/location):

Ot_________________________________________

Pt ___________________________________

Resource ________________________________ Other _______________________________

IEP GOALS OVERVIEW (attach complete IEP):


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2013 www.chartnc.com

Speech ___________________________________ Adaptive p.e. _______________________

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