New Hanover County Schools Personalized Education Plan (K-8 PEP)

Name: Power School: Date of PEP: _ _/_ _/_ _ _ _ Date of Update: _ _/_ _/_ _ _ _ Date of Update: _ _/_ _/_ _ _ _ Date of Update: _ _/_ _/_ _ _ _

School: Name and Address of Parent/ Guardian:

Teacher: DOB: Grade: Retentions Grade Level

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

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Reading Comprehension ___ Word Problems ___ Peer Relationships ___ Mental Energy ___ Reading Fluency ___ Geometry ___ Withdrawn/ Moody ___Mental Effort ___ Written Expression ___ Measurement ___ Overactive ___Alertness ___ Writing Mechanics ___ Probability ___ Verbally Aggressive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

Behavioral Concerns? Additional Comments/ Information? Observations? Outside Services:

Revised 8/29/11 Page 1 of 2 Name: Review Date: Review Date: Review Date: Describe Parental Concerns/ Involvement in Plan Development: Strengths:

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.

2.

Intervention Intervention Results How did the Interventions Work? Decision Information ACTIVITY/ TIME/ DAYS (Assessments and Scores) Explain Below

1. Decision Date: ______Continue: _____ Modify: _____ Discontinue: _____ Request for Intervention Assistance (Tier II): ___

2. Decision Date: ______Continue: _____ Modify: _____ Discontinue: _____ Request for Intervention Assistance (Tier II): ___

Meeting Notes/ Modified Interventions:

Reviewed: ______Date Parent Signature Teacher Signature

Reviewed: ______Date Parent Signature Teacher Signature

Reviewed: ______Date Parent Signature Teacher Signature