TEACHER IEP INFORMATION

Please return to:

Student Name:

By: __________________________
_____________

Date/Time/Location of IEP

Teacher:__________________

______________________________

Thank you for taking the time to complete this form. It will assist in the development of
appropriate IEP goals, objectives and accommodations for the student.
Please check the appropriate comment and provide detail if rated poor.
Area
Attendance
Classroom Behavior
On Task Behavior
Homework Completion
Classwork Completion
Test Performance
Quiz Performance

Good

Fair

Poor

Detail

Accommodations These are the accommodations that the student currently has on
his/her IEP. Please underline or highlight the accommodations that you use on a regular
basis, and which are most successful
Setting Accommodations
Reduce Distractions to the Student

Strengths Please list at least two specific areas in which youve seen success. Avoid
statements such as a pleasure to have in class. Provide information that is specific
(Student is a pleasure to have in class because he/she helps his/her neighbors remain
focused during small-group assignment):
1.
2.

3.
Needs Please list at least two specific areas in which you see a need for improvement,
or for which you have concerns regarding the student. Avoid statements that are due to
the students disability (a student with ADHD will of course have trouble remaining
focused and on-task). Give information that is specific (Student struggles to pay
attention during Direct Whole-Group Instruction when presented in a lecture-format).
1.
2.
3.
Are you modifying the curriculum requirements or grading scale on the student? If so,
please describe how.
Please attach any work samples that can demonstrate the students strengths, weaknesses
and progress.

A substitute will be provided so that you will be able to attend this meeting.
**** If this statement is highlighted, you are being asked to provide
information to assist in the development of the students IEP, but are NOT
expected to attend the IEP meeting.****