IEP Goal Progress Check-In/Check-Out Form
Use this form to record and assess a student’s IEP goal progress during each check-in and check-out session.
Student Name
*
First Name
Last Name
Date of Check-In/Check-Out
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Staff Member Name
*
First Name
Last Name
Session Type
*
Check-In
Check-Out
IEP Goal Area
*
Please Select
Academic
Behavior
Social Skills
Communication
Self-Management
Other
Progress Toward Goal
*
1
2
3
4
5
Observed Behaviors
On Task
Participated
Needed Redirection
Followed Directions
Demonstrated Self-Regulation
Other
Strategies or Supports Used
Visual Cues
Positive Reinforcement
Prompting
Breaks Provided
Peer Support
Other
Goal-Specific Performance (Likert Scale)
*
Rows
Never
Rarely
Sometimes
Often
Always
Followed Directions
1
2
3
4
5
Stayed On Task
6
7
8
9
10
Asked for Help Appropriately
11
12
13
14
15
Additional Comments or Notes
Submit Progress
Should be Empty: