1.

Date *

Example: January 7, 2019

2. Your Name

Reading Goal

3. Given specialized instruction and practice, STUDENT will read grade-level passages with comprehension levels of 70% or higher, measured by classroom
assessments and or grade level probes.

Mark only one oval.

Level 1 - Low (scores lower than 50%, far below grade level expectations)

Level 2 - Emerging (scores between 50% - 69%, just below grade level expectations)

Level 3 - Proficient (scores between 70% - 89%, meeting grade level expectations)

Level 4 - Exceeds (scores 90% or higher, exceeding grade level expectations)

4. Comments on Reading Goal

Please include any commentary on observed reading abilities you have seen in class or working with the student, as well an any recommended areas of focus for improvement.

Writing Goal

5. Given specialized instruction, graphic organizers, editing checklists, and an opportunity to practice, STUDENT will write a writing sample that includes an
introduction, supporting details and a conclusion, scoring a 3 out of 4 on the following 4 point scale, as measured by classroom assessments.

Mark only one oval.

Level 1 - Low (scores lower than 50%, far below grade level expectations)

Level 2 - Emerging (scores between 50% - 69%, just below grade level expectations)

Level 3 - Proficient (scores between 70% - 89%, meeting grade level expectations)

Level 4 - Exceeds (scores 90% or higher, exceeding grade level expectations)

6. Comments on Writing Goal
Please include any commentary on observed writing abilities you have seen in class or working with the student, as well an any recommended areas of focus for improvement.

Math

7. Given five word problems with one variable, STUDENT will write an equation to represent the word problem and solve for the value of the variable with 80%
accuracy for two out of three problem sets by January 2022.

Mark only one oval.

Level 1 - Low (average scores lower than 50%, far below grade level expectations)

Level 2 - Emerging (average scores between 50% - 69%, just below grade level expectations)

Level 3 - Proficient (average scores between 70% - 89%, meeting grade level expectations)

Level 4 - Exceeds (average scores 90% or higher, exceeding grade level expectations)

8. Comments on Math Goal

Please include any commentary on observed math abilities you have seen in class or working with the student, as well an any recommended areas of focus for improvement.

Self-Advocacy

9. By January 2022, given instruction and support, STUDENT will advocate for her needs in class; including asking for help when needed, speaking with the
teacher if she is frustrated, asking for clarification of directions and asking what to do next, scoring 3 or higher on the following scale, measured by staff
observation.

Mark only one oval.

Level 1 - Low (advocates for support, help or to express frustration 0% - 39% of the time)

Level 2 - Emerging (advocates for support, help or to express frustration 40% - 69% of the time)

Level 3 - Proficient (advocates for support, help or to express frustration 70% - 89% of the time)

Level 4 - Exceeds (advocates for support, help or to express frustration 90% - 100% of the time)

10. Comments on Self-Advocacy Goal

Please include any commentary on observed self-advocacy abilities you have seen in class or working with the student, as well an any recommended areas of focus for improvement.

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