Individualized Education Program (IEP) Evaluation
Student Information
Student Name:
Date of Birth:
School:
Grade:
IEP Meeting Date:
Evaluation Summary
Evaluation Date:
Evaluation Team Members:
Purpose of Evaluation:
Present Levels of Performance
Academic:
Social/Emotional:
Physical:
Other:
Assessment Results
Area Assessed
Instrument/Method
Results
Interpretation
Eligibility Determination
Disability Category:
Eligibility Justification:
Recommendations
Recommended Special Education Services:
Related Services:
Accommodations/Modifications:
Additional Comments