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556 BOLESKINE ROAD, VICTORIA, BRITISH COLUMBIA V8Z 1E8Phone (250) 475-4157 Fax (250) 475-4238
Student Services ReportIndividual Education Plan
School YearIEP
IEP Date IEP Review Date
Student DemographicsName PEN No. Gender Grade Birth Date Case Manager Home School Teacher Ministry Designation
Parent/Guardian InformationName Home Phone Address Daytime Phone
Student Support TeamName Title/Position
Student HistoryBackground Information Diagnosis/Medical History Previous Assessments Considerations: The parent/guardian was offered the opportunity to be consulted on the preparation of the IEP.IEP meeting date:
Student ProfileStrengths and Interests Needs and Challenges Current Assessments Current Services
Adaptation
Adjudication
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Annual Goals and ObjectivesGoal 1 Goal Area Position Responsible Goal Statement Current Level of Performance Objective 1 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress Objective 2 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress Objective 3 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress Objective 4 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress
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Goal 2 Goal Area Position Responsible
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Goal Statement Current Level of Performance Objective 1 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress Objective 2 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress Objective 3 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress Objective 4 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress
Goal 3 Goal Area Position Responsible
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Goal Statement Current Level of Performance Objective 1 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress Objective 2 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress Objective 3 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress Objective 4 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress
Goal 4 Goal Area Position Responsible
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Goal Statement Current Level of Performance Objective 1 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress Objective 2 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress Objective 3 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress Objective 4 Position Responsible Strategies and Resources Current Level of Performance (in progress/achieved/not yet initiated) Method of Measuring Progress