1. IEP Input Form
(Remember download form on desktop fill out the form save it, then reattach it to a email
addressed to me!)
Please return to me by: ____________ Special Education Teacher: ________________
Student Name: ___________________ Regular Teacher: _________________________
Grade: ______
Subject: ___________________
Date: __________________
The special services department would like to thank your in advance for you participation
and cooperation in completing the below information. Your input is valuable, and the
information you provide will be utilized to write our students IEPs.
1. Present levels of educational performance:
a. Please list the student’s present grades and performance in your subject class:
b. Describe the student’s preparedness for class.
c. Describe the student’s class work/ homework habits.
d. Please note any parental contact you have made.
e. Please name what types of modifications may be necessary to support the
student’s learning in your class.
f. To what extent is the student utilizing In-class support in your classroom?
g. To what extent is the student using extra help beyond the school day?
h. Any problems or concerns?
2. Please list any parental concerns:
3. Please list student’s strengths and weakness:
4. Please list any student behavior that is interfering with his/her learning:
5. Describe the student attendance patterns.
6. Please name any social/ emotional components: (Ex: Does the student work well with
others? get along with peers? is cooperative? has poor motivation? etc)
7. Recommendations for next school year:
a. Classes:
b. Academic program:
c. Standardized testing modifications:
d. Suggested aids/modifications for next year: