Teacher IEP Input Form 

Date: ______________________

To be completed by (General Education Teacher): ___________________________________________

In reference to (Student): ______________________________________________ Grade _________________________

It is time to evaluate progress for this year and to begin the planning process for the year ahead.  Your input is very important in developing a plan that is right for our student.  Using your responses and information from the child and the parents, a rough draft of the IEP will be created for use as a basis for discussion at the IEP meeting.

Please complete this form and return it to _______________________________________ by  _______________________.

1. What do you see as the student’s successes this year? 

2.  What are the student’s academic strengths and other special skills or abilities?

 3. What are the areas of weakness that you have noted?  

4.  Are there other concerns, such as social skills, adaptive behavior or behavioral issues? 

5.  Date and list most recent scores from assessments performed this year. This can include state assessments as well as classroom-based assessments.

6.  List any classroom modifications or accommodations that seem helpful to the student.

7.  Attendance: (i.e. excellent, good, fair)

8. Additional comments: (i.e. growth made in reading comprehension, needs math support, sleeps during class)

9. How many parent/teacher conferences have you had this year?

10. What is the parent's concerns as a result of the conferences?