Individualized Education Program/Plan (IEP)

Full Name of Student: ___________________________________

Age: __________ Date of Birth (dd/mm/yyyy): ______________________________

Current Grade Level: ___________ Area of Exceptionality: __________________________

Implementation Date of IEP (dd/mm/yyyy): ______________________________

Proposed Re-Evaluation Date of IEP (dd/mm/yyyy): _________________________

Unique educational needs,
characteristics, and measured
present levels of academic
achievement and functional
performance (PLOPs)
Note: Include how the
disability affects the student’s
ability to participate and
progress in the general
curriculum
Present Level:
Special education, related
services and supplemental aids
and services (based on research
and is practicable); assistive
technology and modifications
or personnel support
Note: include anticipated
starting date, frequency,
duration, and location for
each)
1.
Measurable annual goals and
short-term objectives
(benchmarks), including
academic and functional goals
to enable the student to be
involved in and make progress
in the general curriculum and to
meet other needs resulting from
the disability
Note: include progress
measurement method for each
goal
Goal:

Needs: Objectives
1.

IEP Team Members

Name of Team Member Title/Role Responsibility