Educational Progress Recovery Report Form
Please complete this form to report and track a student's progress recovery, interventions, and outcomes.
Student Full Name
*
First Name
Last Name
Student ID (if applicable)
Grade Level
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
Reporting Staff Name
*
First Name
Last Name
Date of Report
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Academic Area(s) of Concern
*
Mathematics
Reading
Writing
Science
Social Studies
Behavior
Attendance
Other
Describe the specific challenges or issues observed
*
Interventions or Strategies Implemented
*
Small group instruction
One-on-one support
Tutoring
Behavioral intervention
Parent/guardian meeting
Modified assignments
Other
Progress Assessment: Please rate the student's progress since intervention(s) were implemented.
*
No Progress
1
2
3
4
Excellent Progress
5
1 is No Progress, 5 is Excellent Progress
Supporting Evidence of Progress (e.g., assessment scores, work samples, observations)
Additional Comments or Recommendations
Parent/Guardian Contacted?
*
Yes
No
Next Steps / Follow-up Actions
Submit Report
Should be Empty: