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Teacher_Present_Levels_Form
Student Name: ______________ Evaluators Name: ____________________ Date Completed: ____________ Grade Level: _______ Rm No. ___________
Sources of information utilized to develop an IEP Input from all mandated IEP participants is critical. Therefore, in preparation for the IEP meeting, parents, current teachers, related service providers, and others who know the student should complete an IEP Planner to ensure that a wellrounded picture of the whole student is available at the IEP meeting. In addition, class work, homework, projects, teacher-made tests, district assessments, state wide assessments, quarterly report cards, attendance records, and other cumulative records are all connected to the students participation and progress in the general education curriculum and program.

Area of Reading Score What is the students oral reading uency? What is the students independent reading grade level? What is the students reading comprehension test average? Student Strengths, Additional Information:

Grade Level? Y/N

Area of Writing What is the students writing rubric average? Please answer yes/no by checking the appropriate box. Does the student write in complete sentences? Does the student use appropriate punctuation? Does the student utilize age-appropriate spelling?

Score

Grade Level? Y/N No

Yes

Please provide more information about the students writing below: Student Strengths, Additional Information:

2 Area of Math
if n/a please indicate

Score

Grade Level? Y/N

What is the students addition facts percentage? What is the students subtraction facts percentage? What is the students multiplication facts percentage? What is the students division facts percentage? What is the students math test average score? Student Strengths, Additional Information:

Area of Communication Please check as appropriate

In the classroom setting, does the student. Understand and use age-appropriate vocabulary accurately? Understand basic concepts (on/under/over/color/shape/etc) when given verbal directions? Follow simple (1-2 step) verbal directions easily? Use appropriate word structure (irregular and regular plurals, possessive nouns, auxiliary verbs, verb tenses) as appropriate for age and/or dialect? Maintain topics appropriately? Speak clearly and concisely? Stumble over words frequently? Formulate logical sentences or ideas about a classroom story or activity? Accurately answer "wh" (who, what, when, where, why) questions related to a classroom story or activity? Exhibit frustration when communicating with peers or teachers in the classroom? Communication in the Classroom

Yes

No

What communication/speech errors do you hear most often, if any? How do you feel this impairs him/her in the classroom? Any additional comments related to communication:

Area of Gross/Fine Motor

Use upper and lowercase letters? Write legibly? Hold a pencil correctly? Color within the lines? Run? Bounce a ball? Kick a ball?

Please check as appropriate In the classroom or playground setting, does the student.

Yes

No

3 Area of Behavior/Social/Emotional
classroom or playground setting, does the student. Please check as appropriate. In the

Yes

No

Does the student respect property and others? Does the student follow classroom and playground rules? Does the student have friends at school? Does the student have appropriate social skills? Has the student had any referrals this school year?

Vocational & Adaptive Behaviors

Please answer the questions below.

Is class work/homework completed in the appropriate time frame? If not, please describe below:

Are there any signicant issues (absences, tardiness, etc.) that have not been discussed previously on these present levels? Please feel free to list additional student strengths or celebrations in this area, as well.

Thank you for your input. Your perspective is very valuable as we develop a plan to target your students goals!