SPECIAL EDUCATION SECTION

INDIVIDUALIZED TRANSITION PROGRAM

EDUCATIONAL PERFORMANCE AND LONG RANGE PLANNING

Student’s Name : ___ Date of Birth:

School _PASAY CITY SPECIAL EDUCATION CENTER__ Place of Birth:
Previous School/Agency ____________________________ Home Address ____________________________________
Category of Special Education Needs _- Grade Level TRANS-PRE-VOC
 Committee/Team Parental Approval School Authority/Approval
Signature Date
1)I acknowledge that I was properly oriented On behalf of (school) ______________________
__________________________ _______ on the ITP of my child and that I fully
Parent/Guardian understand about the program. ________________________________________
2)I agree/disagree (cross out one) with this ITP I approve this ITP
__________________________ _______ 3)I received a copy of the ITP
Principal 4)I approve of the education placement

__________________________ _______
SPED Teacher _____________________________________ ____________________________ ________
Parent/Guardian Principal Date
__________________________ _______
Regular Teacher ___________________________
Date ____________________________ ________
__________________________ _______ Unless otherwise indicated all services are Assistant Principal Date
Speech Therapist/Teacher provided on an academic year basis. This
ITP was received by
__________________________ _______ ____________________________ ________
Counselor ______________________________________ Supervisor Date
ITP Timeline Time in Regular Parental Agreement with Annual Year Re-evaluation
Date Class Program major modification
Date ___________
Program Entry ________________ __________ ______________
Initials Date
Review ______________________ __________ ______________ Date of termination of Special Education
Services
Review ______________________ __________ ______________ _______________ ________
________________________________________
Review ______________________ __________ ______________ _______________ ________

Annual Review Parent/Guardian

SPECIAL EDUCATION PROGRAM

PRESENT LEVEL OF PERFORMANCE
SUMMARY OF ASSESSMENT RESULTS AND FUNCTIONAL LEVELS

Areas Date Performance

1. Motor (Fine and Gross) o

2. Language and Communication o

3. Socialization o

4. Self-Help Skills o

5. Functional Academics o

SPECIAL EDUCATION SECTION

INDIVIDUALIZED EDUCATION PROGRAM

1 2 3 4
Benchmark Evaluation Projected Dates
Annual Goal
Instructional Objectives Procedures/Methods Begins Ends
 o

INDIVIDUALIZED EDUCATION PROGRAM

RELATED SERVICES/PROGRAMS

Areas Service Provider Time in Program/Service