Individualized Education Program Assessment Questionnaire
Please complete the following assessment to help us better understand the student's educational strengths and support needs.
Student Full Name
*
First Name
Last Name
Current Grade Level
*
Please Select
Pre-K
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
Primary Area(s) of Concern
*
Reading
Writing
Mathematics
Social Skills
Behavior
Attention/Focus
Communication
Other
How would you rate the student's current academic performance?
*
Very Low
1
2
3
4
Excellent
5
1 is Very Low, 5 is Excellent
Please indicate the student's strengths and support needs in the following areas:
*
Rows
Strength
Needs Support
Reading
1
2
Writing
3
4
Mathematics
5
6
Social Skills
7
8
Behavior
9
10
Attention/Focus
11
12
Communication
13
14
What types of classroom support have been most effective for the student?
Small group instruction
One-on-one support
Visual aids
Assistive technology
Behavioral interventions
Flexible seating
Other
How does the student respond to new academic challenges?
*
Eager and persistent
Willing but needs encouragement
Reluctant or anxious
Avoids or withdraws
Please rate the student's level of independence in completing assignments.
*
Needs Full Assistance
1
2
3
4
Completely Independent
5
1 is Needs Full Assistance, 5 is Completely Independent
Are there specific strategies or accommodations that have been helpful?
Additional comments or observations
Submit Assessment
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