Student information



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SERVICE PLAN COMPONENTS

[Completed for Chapter 193 and IDEA students]


STUDENT INFORMATION

A section may be added at the beginning of the Services Plan format to include pertinent student information as determined necessary by the school district of attendance.





SERVICE PLAN PARTICIPANTS

Please sign in the appropriate space. A signature in this section of the Services Plan documents participation in the meeting and does not mean agreement with the Plan.



Student, if appropriate or required



Date

Parent


Date


General Education Teacher



Date

Special Education Teacher or Special Education Provider


Date


Child Study Team Member



Date


Case Manager (May be the CST member above.)



Date


Public School Representative (May be the CST member or other appropriate public school personnel.)



Date


Specialist



Date


Other


Date




PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

[Completed for Chapter 193 and IDEA students]


Consider relevant data. List sources of information used to develop the Services Plan.

Describe the present levels of academic achievement and functional performance including how the child’s disability affects his or her involvement and progress in the general education curriculum. For preschool children*, as appropriate, describe how the disability affects the child’s participation in appropriate activities.

Include other educational needs that result from the student’s disability.

* IDEA only



STATEMENT OF TRANSITION SERVICE NEEDS

[IDEA students only. Completed if the district of attendance determines that services will be provided.]

Beginning at age 14, or younger if appropriate, develop the long-range educational plan for the student’s future. Review annually.
Statement of the student’s interests and preferences :

PostSecondary GOALS Outcomes (vision for the future)

[Idea students only. Completed if the district of attendance determines that services will be provided.]

Post Secondary Education: (Including but not limited to, college, vocational training and continuing and adult education)

Employment/Career:

Community Participation: (Including but not limited to, recreation and leisure activities, and participation in community organizations)

Daily Living:
COURSES OF STUDY

[IDEA students only. Completed if the district of attendance determines that services will be provided. ]

Considering the student's strengths, interests, preferences, and desired post secondary goals, list the specific courses of study for the next school year. When appropriate, identify the courses of study projected for future years.

Grade___ Courses of Study (List course names):


Grade___ Projected Courses of Study (List course names):


Grade___ Projected Courses of Study (List course names):


Grade___ Projected Courses of Study (List course names):




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