INDIVIDUALIZED EDUCATIONAL PLAN (IEP)

1. Name of Student: _________________ DOB: _________ Roll No: ___________

2. Name of School: __________________________________________________

3. School Year: (Current academic year) _________________________________

4. Group level: (Class) ________________________________________________

5. IEP Initiation: (Date when IEP is made) _________________________________

6. Disability: (Category) _______________________________________________

7. Health Issues: (Detail of allergies or seizures if any) _______________________

8. IEP Development Team:

Name: Team Member’s Signature: Position/ Title:

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

9. Parent’s name: _______________ Signature____________________________

10. Supplementary/ Related Services:

Service Provider: Hrs. / Week Location:

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

11. Areas of Strength: (State child’s abilities in measurable statements)

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
 ______________________________________________________________________
______________________________________________________________________

12. Areas of Need: (State long term goals for intervention)

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

13. Targeted Core Areas of Learning and Development: (State core areas of intervention
according to the curriculum book)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
__________________________________

14. Transition Plan:

a. Career Interest: (State specific talents if any) __________________________

_______________________________________________________________
b. Employment Outcome: (State child’s own and family’s vision for future gainful
existence) _____________________________________________________
________________________________________________________________
c. Community Linkages: (State contacts/ links that may facilitate future employment.
Both within the family and within the community) ____________

15. Checked by: ____________________ Principal Signature: ________________