<p> New Hanover County Schools Personalized Education Plan (K-8 PEP)</p><p>Name: Power School: Date of PEP: _ _/_ _/_ _ _ _ Date of Update: _ _/_ _/_ _ _ _ Date of Update: _ _/_ _/_ _ _ _ Date of Update: _ _/_ _/_ _ _ _</p><p>School: Name and Address of Parent/ Guardian:</p><p>Teacher: DOB: Grade: Retentions Grade Level</p><p>Attendance Date of Vision: EOG Reading Math Writing Science Pre K: ______Scores K: ______Passed ______Not Passed Grade Score Level Score Level Score Level Score Level 1: ______3rd Pretest 2: ______Date of Hearing: 3rd EOG 3: ______4th EOG 4: ______Passed ______Not Passed 5th EOG 5: ______6th EOG 6: ______7th EOG 7: ______8th EOG 8: ______Current Reading Performance Current Writing Performance Current Math Performance</p><p>Areas of Concern Language Arts Math Behavior Other ___ Phonemic Awareness ___ Basic Math Facts ___ Noncompliance ___ Medical ___ Word Identification ___ Computation ___ Motivation ___ Motor Skills ___ Sight Word Vocabulary ___ Problem-Solving ___ Attention Span ___ Speech/Language ___ Reading Comprehension ___ Word Problems ___ Peer Relationships ___ Mental Energy ___ Reading Fluency ___ Geometry ___ Withdrawn/ Moody ___Mental Effort ___ Written Expression ___ Measurement ___ Overactive ___Alertness ___ Writing Mechanics ___ Probability ___ Verbally Aggressive ___Time Management ___ Writing Conventions ___ Data Analysis ___ Physically Aggressive ___Organization ___ Vocabulary ___ Algebra ___ Task Avoidance ___Communication Skills ___Other ___ Other ___Other ___Receptive Language</p><p>Behavioral Concerns? Additional Comments/ Information? Observations? Outside Services:</p><p>Revised 8/29/11 Page 1 of 2 Name: Review Date: Review Date: Review Date: Describe Parental Concerns/ Involvement in Plan Development: Strengths:</p><p>Problem Definition for Target Area of Concern: Baseline Data for Target Skill: (What is the specific difficulty and what is it impacting?) (Give the name of the assessment and score) 1.</p><p>2.</p><p>Intervention Intervention Results How did the Interventions Work? Decision Information ACTIVITY/ TIME/ DAYS (Assessments and Scores) Explain Below</p><p>1. Decision Date: ______Continue: _____ Modify: _____ Discontinue: _____ Request for Intervention Assistance (Tier II): ___</p><p>2. Decision Date: ______Continue: _____ Modify: _____ Discontinue: _____ Request for Intervention Assistance (Tier II): ___</p><p>Meeting Notes/ Modified Interventions:</p><p>Reviewed: ______Date Parent Signature Teacher Signature</p><p>Reviewed: ______Date Parent Signature Teacher Signature</p><p>Reviewed: ______Date Parent Signature Teacher Signature</p>