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West Clermont School District

Summary of Performance

Student Name Birth Date Student ID #

Year of Graduation/Exit: School of Attendance

Anticipated Exit Date/deferring? (mm/dd/yy) Disability Diagnosis

Address City State Zip Code

Telephone Number: Primary Language:

Date of most recent IEP or most recent 504 plan: Date of last MFE

Date this summary was completed:

Summary of Student’s Academic Achievement and Functional Performance

Post – Secondary Goals What does the student plan on doing after graduating?

West Clermont Summary of Performance 10/23/08 - 1 - Recommendations What recommendations would you make to assist the student in reaching his/her post-secondary goals (adaptive equipment, accommodations, services and/or other agencies)?

Transition Options

**Option #1 - Upon meeting graduation requirements, I will accept my diploma and understand that my special education services through West Clermont Schools will be terminated.

Student ______

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**Option #2 – I wish to continue with public education through West Clermont Schools and defer my diploma at this time. I will be participating in the following school age program______

Student ______

Team Signatures

Participants:

Name ______Title ______Date ______

Name ______Title ______Date ______

Name ______Title ______Date ______

Name ______Title ______Date ______

Name ______Title ______Date ______

West Clermont Summary of Performance 10/23/08 - 2 -

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