BIDDEFORD SCHOOL DEPARTMENT Department of Special Education Individual Service Plan Student Name: Date of Birth: Telephone # Disability:

Parents: Address: ____ Private School ____Home Schooled

Services to be Provided:

Position Responsible

Location

Frequency

Duration Beginning/Ending Date

Specially Designed Instruction*** Occupational Therapy Speech and Language Social Work Other

Measurable Annual Goal

Form #24

*1,2,3,4 For Pre School only

How Goal will be Measured

Date sent to Parent/Guardian: ______________

**PROGRESS

Initials: _______