Individualized Education Plan
Partial Example

for   Christine Hendricks    

Fill in the following information to construct an Individualized Education Plan:

Date of Meeting: 09/01/08

Presenting Problem 1:

Christine has trouble with short term memory. She forgets homework, especially Math, and she forgets to turn in homework she has completed.

(Who, What, When, How)

Objective 1:
Christine's mother, Ms Hendricks, will get a daily scheduler for her tonight. For the next month, Ms Elliott, her Math teacher, will initial Christine's entry in her scheduler at the end of each class involving an assignment or a turn in. Each day Ms Hendricks will check for the initials to ensure that homework is not forgotten. If this is successful, Ms Hendricks and Ms Elliott will meet with Christine and develop a schedule for reducing the frequency of checking. If this is not successful, the team will meet again.

Objective 2:...

Objective 3:...

Presenting Problem 2:...

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- Form Updated 01/01/16