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Student:
Date:
EST:
Team Members:
When developing a student’s program plan, consideration of the following areas will provide the APSEA Service Delivery Team with information for the identification of learning priorities which are then supported through a tiered system of support. Appendix A: Program Planning Document will support the team’s identification of the student’s identified areas for development. This form provides a summary of data and decisions as they relate to the student’s program plan.
Comprehensive Assessment
Assessment Type:
(Pre- Instruction, Formative, Summative)
Date:
Assessor:
Data shared with:
Summary of Results/Date:
Identified Areas for Development
Areas for Development:
Date:
Assessment(s) Used To Support This Identification:
Team Members Supporting this Area:
Existing Practices that Support the Identified Areas for Development
Interventions:
(all 3 tiers)
Time (mins):
Frequency x/week:
Duration # of week:
Given by:
New Practices that Support the Identified Areas for Development
Interventions:
(all 3 tiers)
Time (mins):
Frequency x/week:
Duration # of week:
Given by:
Summary of Results/Data:
Post-Intervention Meeting
Date:
Meeting Type:
Outcome:
Actions/Notes:
Student/Family Present:
Comments:
Adapted from Guidelines and Standards: Educational Planning for Students with Diverse Learning Needs, New Brunswick Department of Education and Early Childhood Development, Spring 2019.