Contents of Data Collection Charts and Feedback Forms

IEP Goal Trackers

Page 1

Math IEP Goals Tracker

Page 2

Weekly Student IEP Behavior

Goal Tracker
Class Data Collection Forms

Page 3

Class Seating Chart: Full Class

Data Collection
IEP Data Collection Forms

Page 4-6

Teacher Input Form for IEPS

Page 7

Link to Online Google Forms

Version of Teacher Input

Page 8-11

Parent Input
Communication

Page 12-13

Weekly Communication Sheet

Page 14

Special Educators
Communication & Paperwork
Log

Page 15

Communication Plan

Page 16-17

Data Collection and Feedback

Narrative

6th Grade Math IEP Goals Tracker

Tally the number of opportunities and the correct occurrences for the following IEP
goals. For example, if Anthony correctly solves a problem that requires addition,
subtraction, division, or multiplication, you would put a tally under opportunity and
occurrence. If he answers incorrectly, only put a tally under opportunity. If you are
tracking data for the same scholar on two different dates, clearly indicate which
data is from which date.

Class 6BMath
Scholar

Goal

Date

Opportunity

Occurrence % Correct

Anthony

Represent and solve

problems involving
the four operations.

tally correct

Que

Represent and solve

problems involving
the four operations.

tally correct

tally correct

Opportunity

Occurrence % Correct

Class 6AMath

Represent and solve

problems involving
the four operations.

Scholar

Goal

Dayla

1. Solve double-digit
addition problems
that require

regrouping.

tally correct

2. Solve double-digit
subtraction
problems that
require regrouping.

tally correct

Christian

Date

Ques Weekly IEP Behavior Goals Chart

Goal: Given clear,
precise directions,
Que will follow 3
out of 4
directions.

Goal: Que will

handle his
frustrations in a
socially
acceptable
manner by writing
in his journal or
asking to go to
the safe space 4
out of 5 times.

Monday
Additional
directions
followed:
Tuesday
Additional
directions
followed:
Wednesday
Additional
directions
followed:
Thursday
Additional
directions
followed:
Friday

= demonstratedAdditional
goal behavior
directions
= opportunity present,
but didnt demonstrate
followed:
goal behavior
= opportunity not present

Additional
Behavior
Notes

Peyton
N

Zaki
N

Omari
N

Christian
M

Amauri
N

Antonio

Justin
M

Kevin

Avian

Dymir
N

Mubarak

Rick

Isaiah
M

Eric

Khaleem
N

Daniel
M

Caleb

Que
M

Terrance

Kingsley
M

Rashad

Khiree
N

Tyrese

Gabriel
N

Jimmy

Zion
N

Anthony
N

Mastery Level
(circle corresponding
letter)

Key
B = Took a break
X = Absent
+ = Positive Liveschool
- = Negative Liveschool
Circle = Call home (+/-)
Front of Room

N= needs further
instruction
A= almost, on the way
M= mastered

Teacher IEP Input Form

Scholar Name ________________________ Grade ___________
Teacher Name ________________________ Subject ___________
Time of Day Scholar has Class _____________________
Current grade in the class by percentage _____

ACADEMICS
Answer the following questions based on what you observe while working with
the scholar:
1. Areas of Strengths (at least 2):
2. Grow(s) for academics (at least 2):
3. What standard(s) are the scholars peers working towards currently?
4. Is the scholar working towards the same standard(s) as his/her classmates? If
no, what standard(s) is he/she working towards?
5. What skill(s) does the scholar need to gain in order to master this standard?
6. What grade level is the scholar able to complete independently in your class?
(i.e. 4.8 reading level, 3.1 level math, etc)
7. What types of learning does your scholar struggle with? X all that apply.

Lecture/Demonstration
Competency Worksheets
Laboratory Training
Independent Study
Group Investigation
Learning Centers
Discovery
Role Playing
Drill and Practice
Discussion
Stimulation
Peer Tutoring
Other:

BEHAVIOR
Answer the following questions based on what you observe while working with
the scholar:
1. Areas of Strengths (at least 2):
2. Grow(s) for academics (at least 2):
3. What positive behaviors does the scholar exhibit at an equal level to his/ her
peers? (i.e. raising hand, using a pencil, greeting teacher or peers, social talking
during breaks, etc)
4. What positive behaviors does the scholar NOT yet exhibit that his/her peers
do?
Following directions
Transitions
Parallel Play
Unstructured times
5. Participating
X any areas the
scholar
could
grow
in
and
star Interaction
or asterisk * any that the
during small group instruction
Peer
scholar
does well
with.a large group activity Adult Interaction
Participating
during
Participating during one on one instructionLoud Noises
Participating during centers
Starting a conversation

6. If it applies, list grows and glows for the scholars use of speech and language
skills.
Check all testing
accommodations/modifications
7. If it applies, list grows and glows based
provided
to the scholar. Star or asterisk
goals.
* the ones that have been the most
effective in your opinion.

Extended Time
Oral Testing (Read Aloud Test Items)
Teacher Repeats directions one at a
time
Scholar repeats directions verbatim
Use of Calculator
Modified grading scale
Additional Time
Modify Format (multiple choice, short
answer)
Abbreviated Concepts
Modified Assessments (the end result
for this scholar is different)

Check all of the classroom

modifications
accommodations
on
the scholarsand
occupational
therapy
you use to assist this scholar. Star or
asterisk * the ones that have been
the most effective in your opinion.
Preferential Seating
Provide Copies of Material to be
Copied from Book to Board
Provide Copies of Notes (from
another student)
Peer Tutoring
Behavior/Performance Contracting
Highlighted Textbook
Taped Materials
Other:

Check all testing

accommodations/modifications
provided to the scholar. Star or asterisk
* the ones that have been the most
effective in your opinion.

Check all of the classroom

modifications and accommodations
you use to assist this scholar. Star or
asterisk * the ones that have been
the most effective in your opinion.

Extended Time
Oral Testing (Read Aloud Test Items)
Teacher Repeats directions one at a
time
Scholar repeats directions verbatim
Use of Calculator
Modified grading scale
Additional Time
Modify Format (multiple choice, short
answer)
Abbreviated Concepts
Modified Assessments (the end result
for this scholar is different)

Preferential Seating
Provide Copies of Material to be
Copied from Book to Board
Provide Copies of Notes (from
another student)
Peer Tutoring
Behavior/Performance Contracting
Highlighted Textbook
Taped Materials
Other:

Comments or concerns about academics?

Comments or concerns about behavior?

Please sign here indicating that you have completed this

form to the best of your ability and understand that, as a
member of the scholars IEP team, your input will help
formulate the legal Individualized Education Plan document.

X ____________________________

Date ___________________________

Link to Google Forms

Version of Teacher
Input
https://goo.gl/forms/1qaaX6v5rlz87JRf2

4601 Girard Avenue. Philadelphia, PA 19131

267-295-5700(P)| 267-295-5701 (F)| www.glacharter.org

PARENT INPUT FORM

Department of Special Services

Demographics:
Scholar Name
Date: _________________
Parent/Guardians Name (person completing form):_______________________________________
Current Address: __________________________________________________________________
Current Phone Number: ________________________________________________________________
Do you have an email address: Yes No
If yes please list preferred email:__________________________________________________________
Check one: Completed by parent/guardian Personal Interview Telephone Interview
If interviewed, conducted by _____________________ Date______________________________

Scholar lives with (circle one): parents mother father grandparents other?
Pleaseanswer thefollowingquestions regardingyour scholar.
1. Does your scholar wear glasses? Yes No
2. Does your scholar wear hearing aid(s)? Yes No
3. Does your scholar have an FM Device? Yes No
4. Did your scholar receive early intervention services? Yes No
If yes, which program was your scholar participating in: ____________________________________________
(Please attach any related documents if applicable)

5. If your scholar is new to GLA were they receiving services at their previous school? Yes No
If yes, please list services provided______________________________________________________________
____________________________________________ ______________________________________________
__________________________________________________________________________________________
(Please attach any related documents if applicable)

6. What academic strengths does your scholar possess?

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
________________________________________________________________________ __________________
__________________________________________________________________________________________
7. What non-academic strengths does your scholar possess?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
________________________________________________________________________ __________________
__________________________________________________________________________________________
8. What does you scholar enjoy? What motivates your scholar?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

9. Describe any current concerns you have about your scholars academic achievement:

_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
________________________________________________________________________ __________________
__________________________________________________________________________________________
10. Describe any current concerns you have about your scholars behavior:
_________________________________________________________________________ ________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_______________________________________________________ ___________________________________
__________________________________________________________________________________________
11.

What goals do you have for your scholar? Is the school system helping your scholar meet these goals?
_______________________ __________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
12. Have you seen improvement in your scholars academic performance, behavior and/or speech/language
this past year? Yes No
Please describe _____________________________________________________________________________
_______________________________ ___________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
13. Have there been any recent changes in your scholars behavior or school performance? Yes No
If yes, please describe________________________________________________________________________
_________________________________________________________________________ ___________________________________
____________________________________________________________________________________________________________
_________________________________________________________________________________________________________

14. Has your scholar had any serious medical or psychological problems that have occurred that may impact
special services being provided? Yes No
If yes, please describe________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
______________________________________________________ ___________________________________________________

15. Has your scholar received a psychological or educational evaluation from another agency or private
practitioner? Yes No
If yes, please complete the following:
Agency/School District: _____________________________________________________________________
Reevaluation Summary Report09/2013

Date Completed: ___________________________________________________________________________

Outcome/Findings:__________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
_________________________________________________________________________________________ _
(Please attach any related documents if applicable)

16. Is your scholar currently taking any prescribed medications? Yes No

If yes, please describe the medication and the condition for which it was prescribed: ______________________
__________________________________________________________________________________________
__________________________________________________________________________________________
____________________________________________________________________________ ______________
Does the scholar need to take this medication during school hours? Yes No
(If yes is selected additional paperwork must be submitted to the school nurse)

17. Have there been any significant changes that have occurred or currently occurring in your home or family
relationships during the last year? Yes No
If yes, please describe________________________________________________________________________
_______________________________________________________________________________________ _____________________
____________________________________________________________________________________________________________
_________________________________________________________________________________________________________

18. Is there any additional information about your scholar that you think is relevant to your scholars special
services paperwork? Yes No
If yes, please describe________________________________________________________________________
______________________________________ ______________________________________________________________________
____________________________________________________________________________________________________________
______________________________________________________________________________ ___________________________

19. Do you have any suggestions for improving the special education services being provided for your scholar?
Yes No
If yes, please describe________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
______________________________________________ ___________________________________________________________

20. How would you describe your scholars relationship with his/her same age peers?
__________________________________________________________________________________________
______________________ ____________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
21. Any other comments or concerns?
__________________________________________________________________________________________
__________________________________________________________________________________________

Reevaluation SummaryReport09/2013

_________________________________ _________________________________________________________
_________________________________________________________________________________________
______________________________
Parent/Guardian Signature

___________________________
Date

Please attach any additional information you feel might help meet your scholars educational needs.
Please feel free to contact the Special Services Department if you have any questions.

Please return this form to Ms. Solomon at Global Leadership Academy by the end of the week. Feel free to contact me at (530)5593297 or ssolomon@glacharter.org with any questions or concerns.

Please sign here indicating that you have completed this

form to the best of your ability and understand that, as a
member of the scholars IEP team, your input will help
formulate the legal Individualized Education Plan document.

X ____________________________

Date ___________________________
Reevaluation SummaryReport09/2013

Weekly Communicator
Scholar _____________________ Date _____
Teacher:
Updates

This Weeks Positives

1.
2.
3.

This Weeks Struggles

1.
2.
3.

Action Steps for Next

Week

This Weeks Struggles

1.
2.
3.

Action Steps for Next

Week

This Weeks Struggles

1.
2.
3.

Action Steps for Next

Week

Questions

Teacher:
Updates

This Weeks Positives

1.
2.
3.
Questions

Teacher:
Updates

This Weeks Positives

1.
2.
3.
Questions

Teacher:
Updates

This Weeks Positives

1.
2.
3.

This Weeks Struggles

1.
2.
3.

Action Steps for Next

Week

Questions

Please return the bottom part of this sheet to Ms.

Solomon. She will disperse copies to all teachers.
Parent:
Updates

This Weeks Positives

1.
2.
3.

This Weeks Struggles

1.
2.
3.

Action Steps for Next

Week

Questions

Answers to Teacher Questions

Scholar _____________________

Date _____

Communication/Paperwork Tracker
Scholar/ Who
communicatio
n was with

Date/Time

Form of
Communicatio
n (i.e. phone,
email,
paperwork)

Notes

Paper
work
Returne
d Date

Communication Plan
Special Education Teacher to and from General Education Teachers
On a daily basis, communication between the special education teacher
and general education teachers is completed via text message and phone
calls to the prospective classroom. In addition, the entire 5 th and 6th grade
team meet for check-ins during prep period three times a week on Monday,
Wednesday, and Friday at 2PM. Lastly, mini-conferences take place
afterschool when trying new behavioral plans or testing out potential
specially designed instructional strategies. At this min-conferences, data is
exchanged as well as updates on whether the new strategies seem to be
helpful.
For IEPs, teacher-input forms are emailed out to teachers two weeks in
advance before the special education teacher plans on editing the IEP. Three
days before the deadline, a reminder email is sent out and the general
education teachers are reminded in person. The day before the deadline the
teachers are reminded in person again and the online Google forms link is
sent out as well. This form is a slightly abbreviated version of the form that is
used to try to collect input quickly. If the information is not received by the
deadline, the special education teacher collects input verbally from the
general education teachers or by text message if the general education
teacher is not at school.
Special Education Teacher to and from Parent
The special education teacher communicates with parents via the
classroom phone, cell phone, text message, email, and sending paperwork
home via the scholar. For scholars that have historically unsuccessfully
transported paperwork home to their parents, paperwork is certified mailed.
Two positive phone calls are made per day to parents. If negative behavior
phone calls are made, they are always framed with positives and serve as a
problem solving conversation between the parent and teacher. We discuss
potential strategies to help the scholar meet behavioral expectations and
potential reasons for the scholars misbehavior during the day. These
conversations are meant to be positive team building sessions. All forms of
conversation are logged on the tracker including when paperwork is sent
home. If paperwork is sent home, the parent is always informed of what is
being sent home and whether it needs to be signed and returned or not.
Parents typically reach out to the special education teacher via phone
calls and emails. In addition, scholars will often inform the special education
teacher that their parent wanted to talk and the special education teacher will
give them a phone call. Any communication through the scholar (such as
sending paperwork home) must be monitored to make sure the transfer of
information has been completed. When paperwork is returned, it is marked on
the communication log to note when it was returned.

Data Collection and Feedback Narrative

Currently
For monitoring academic goals, I progress monitor by giving short assessments every
few weeks when I have scholars for intervention. I track their goals on an excel document
where I can plot their progress to document in their official progress monitoring forms once a
trimester.
For behavior goals, I have sent out fill in the blank statements for number of
occurrences or accuracy based on the scholars goals. I average out the scores given across
different classes and note any significant differences. For some goals that teachers are not
confident reporting on, I monitored the scholars goal in the special education classroom.
For feedback forms from parents, documents are sent out 2 weeks before the IEP will be
edited either in paper form via the scholar or via email if the parent requests it. Currently,
parents only return the input forms 1 out of 5 times, so their input is typically added during
the IEP meeting. Teachers receive the form via email 2 weeks before the IEP will be edited as
well. If they dont return the form after a 3 day reminder, 1 day warning, a same day
emergency shortened online form, and an attempt at retrieving the information in person or
via text message, the teacher input will be added during the IEP meeting as well.

What is working
For monitoring academic goals , the most effective strategy I have used so far is
tracking their progress on an excel document. This allows me to look at one document per
scholar as I am writing their progress monitoring documents. In addition, it has been effective
to keep a supply of different worksheets for different goals so that when a lesson finishes
early or a majority of the class is absent, I can pull out progress monitoring tools last minute
and make the use of time.
For monitoring behavior goals, the only effective strategy for collecting useful data so
far has been doing observations when pushing into classes. This gives me a good overview
look at how my scholars are doing behaviorally. However, this does not help determine
percentages and level of accuracy.
For feedback forms from parents and teachers, adding information to IEPs during IEP
meetings has resulted in every IEP team members input being included. However, the lack of
responses does make planning goals and writing a majority of the IEP very difficult ahead of
time. This often results in a lot of work post-IEP meeting to make sure everyones input has
effected goals, SDIs, etc.

What isnt working

For monitoring academic goals, the main issues that I have been encountering are
collecting data for scholars that I dont pull out for intervention classes, having time for all of
my scholars to monitor all of their goals during one short intervention session, and having my
scholars with writing goals have enough time to write the necessary length pieces for data
tracking.
For monitoring behavior goals, having the teachers report on the scholars behaviors
without a formal, written tracking sheet throughout the trimester seems very unreliable. In
addition, behaviors do not always occur when in the special education classroom or when I
am observing in the general education classroom. I am currently struggling with having
reliable data on scholars behaviors if I am not their to witness it.
For feedback forms from parents and teachers, I am struggling to get input forms
returned before I intend on editing the IEP. I would like to feel more prepared going into an IEP
meeting by having goals and SDIs that the general education teachers believe would be
feasible in their classrooms. A majority of my scholars are in the general education classroom
for more than 80% of the day, so general education teachers input is especially important.
Unfortunately, they have not been reliably turning in their input by a set deadline or
sometimes at all.

Plan for moving forward

The following are different strategies I plan on trying upon return from winter
break in January.
For monitoring academic goals
Writing goals for longer writing pieces will be monitored by general education
teachers via a rubric provided by the special education teacher.
Math goals will be monitored on a biweekly basis via the STAR test that will
self-score.
Reading level will be monitored on a biweekly basis via the STAR test on the
weeks that math is not tested.
Scholars will track math and reading grade level scores on a chart to increase
motivation and prevent scores from being ignored until progress monitoring
needs to be reported.
A bulletin board chart will be present in the classroom so that students can
monitor their growth. Every time a scholar moves up .2 grade level, they will
receive a paper marker to add to the wall chart.
For monitoring behavior goals
I dont have too many scholars that have behavior goals. I will form two
groups of scholars that have behavioral goals. Teachers will be asked to
complete a daily behavior chart tracking behaviors every other week for
scholars. For example, one week the teachers will monitor group 1s goals,
and the following week group 2s goals will be monitored. These sheets will
be collected each week on Friday afternoon and tracked on the same excel
document as the academic goals.
At the beginning of the trimester, behavior goals will be reviewed with each
scholar and a reminder will be placed in their binder that they carry around to
each class. This is an attempt to increase the scholars motivation and sense
of agency.
For feedback forms from parents and teachers
Parents will be given the option to complete an input form or host a short
phone-conference to obtain the information. These will be scheduled at least
2 weeks before the actual IEP meeting. This will prevent IEP meetings from
running over time and include the parents throughout more of the IEP writing
process.
A teacher tracker will be posted outside of the vice principals office. This will
be presented as a race. Every teacher that turns in paperwork by deadline
will receive a mark on the race chart. I am working with the vice principal to
create a reward system for the teacher that has the most forms turned in on
time at the end of each month.