Triennial IEP Evaluation Checklist
Document and review key areas for the triennial IEP evaluation efficiently and clearly.
Student Name
*
First Name
Last Name
Date of Review
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Areas Evaluated
*
Academic Performance
Communication Skills
Social/Emotional Development
Behavior
Physical/Motor Skills
Other
Assessment Results
Rows
Meets Expectations
Needs Improvement
Not Assessed
Academic Performance
1
2
3
Communication Skills
4
5
6
Social/Emotional Development
7
8
9
Behavior
10
11
12
Physical/Motor Skills
13
14
15
Parent/Guardian Input Received?
*
Yes
No
Eligibility Determination
*
Continues to be Eligible
No Longer Eligible
Team Recommendations
Summary of Progress Since Last Evaluation
Next Steps / Follow-up Actions
IEP Team Members Present
Submit Evaluation
Should be Empty: