General Education Teacher IEP Input Form Student Name: ___________________________________ Behavior in Does the child’s behavior negatively impact Class: his/her learning? How?  Excellent _________________________________________________ _________________________________________________  Good _________________________________________________  Fair  Poor Work Habits Does the student: Follow Directions: Always Sometimes Usually Never Stay on Task: Always Sometimes Usually Never Work Independently: Always Sometimes Usually Never How is this student performing in your class? _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________

What are this student’s strengths? _______________________________________________________________ _______________________________________________________________ What are this student’s needs? _______________________________________________________________ _______________________________________________________________ What accommodations or modifications are needed for the child to be successful in your classroom? _______________________________________________________________ _______________________________________________________________ Teacher Name: ___________________________ Special Little Learners 2015©

Date: ___________