Personalized Education Plan (PEP) K-8 by 5PNNCbZv

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									                                                     Personalized Education Plan (PEP) / Tier I: Third Grade
Student:                                          School:                    Year:                      Teacher:
Diagnosed Medical Concern:                          Has the child been retained?    Yes         No    Year(s) retained     ,
Current Services Received:           EC        Speech     Reading Recovery         RTI: Tier II      RTI: Tier III    Counseling       Physical Therapy   Occupational Therapy          ELL

Check the appropriate area(s) if the child is not meeting grade level expectations based on grade level assessments and NCSCOS:               Reading     Writing      Math

                          Data Used for PEP             NCSCOS Strengths in This         NCSCOS Needs in This Area          Targeted Skill and Strategy       Data to Be Used for
                            Development                   Area (Two Required)                (Two Required)                                                      PEP Review
          Initial      Check all that apply:          NCSCOS Objective Choose One        NCSCOS Objective Choose One       Skill/Goal:                      Check all that apply:
                         DRA2 Assessment                                                                                                                      DRA2 Assessment
          Conference     Ongoing Running Records      NCSCOS Objective Choose One        NCSCOS Objective Choose One                                          Ongoing Running Records
          Date:          Conference Notes                                                                                                                     Conference Notes
                                                                                                                           Strategy:
                         Guided Reading Notes         NCSCOS Objective Choose One        NCSCOS Objective Choose One                                          Guided Reading Notes
                         Other:                                                                                                                               Other:
Reading




          Review                                      NCSCOS Objective Choose One        NCSCOS Objective Choose One       Skill/Goal:                      Check all that apply:
                                                                                                                                                              DRA2 Assessment
          Conference                                  NCSCOS Objective Choose One        NCSCOS Objective Choose One                                          Ongoing Running Records
          Date:                                                                                                                                               Conference Notes
                                                                                                                           Strategy:
                                                      NCSCOS Objective Choose One        NCSCOS Objective Choose One                                          Guided Reading Notes
                                                                                                                                                              Other:

          Final                                       NCSCOS Objective Choose One        NCSCOS Objective Choose One       Recommendations for next year:
          Conference                                  NCSCOS Objective Choose One        NCSCOS Objective Choose One
          Date:
                                                      NCSCOS Objective Choose One        NCSCOS Objective Choose One

          Initial      Check all that apply:          NCSCOS Objective Choose One        NCSCOS Objective Choose One       Skill/Goal:                      Check all that apply:
                         Assessments/Cold Writes                                                                                                              Assessments/Cold Writes
          Conference     Conference Notes             NCSCOS Objective Choose One        NCSCOS Objective Choose One                                          Conference Notes
          Date:          Work Samples                                                                                                                         Work Samples
                                                                                                                           Strategy:
                         Other:                       NCSCOS Objective Choose One        NCSCOS Objective Choose One                                          Other:
Writing




          Review                                      NCSCOS Objective Choose One        NCSCOS Objective Choose One       Skill/Goal:                      Check all that apply:
                                                                                                                                                              Assessments/Cold Writes
          Conference                                  NCSCOS Objective Choose One        NCSCOS Objective Choose One                                          Conference Notes
          Date:                                                                                                                                               Work Samples
                                                                                                                           Strategy:
                                                      NCSCOS Objective Choose One        NCSCOS Objective Choose One                                          Other:

          Final                                       NCSCOS Objective Choose One        NCSCOS Objective Choose One       Recommendations for next year:
          Conference                                  NCSCOS Objective Choose One        NCSCOS Objective Choose One
          Date:
                                                      NCSCOS Objective Choose One        NCSCOS Objective Choose One

          Initial      Check all that apply:          NCSCOS Objective Choose One        NCSCOS Objective Choose One       Skill/Goal:                      Check all that apply:
                         Assessments                                                                                                                          Assessments
          Conference     Observation Notes            NCSCOS Objective Choose One        NCSCOS Objective Choose One                                          Observation Notes
          Date:          Work Samples                                                                                                                         Work Samples
                                                                                                                           Strategy:
                         Other:                       NCSCOS Objective Choose One        NCSCOS Objective Choose One                                          Other:

          Review                                      NCSCOS Objective Choose One        NCSCOS Objective Choose One       Skill/Goal:                      Check all that apply:
Math




                                                                                                                                                              Assessments
          Conference                                  NCSCOS Objective Choose One        NCSCOS Objective Choose One                                          Observation Notes
          Date:                                                                                                                                               Work Samples
                                                                                                                           Strategy:
                                                      NCSCOS Objective Choose One        NCSCOS Objective Choose One                                          Other:

          Final                                       NCSCOS Objective Choose One        NCSCOS Objective Choose One       Recommendations for next year:
          Conference                                  NCSCOS Objective Choose One        NCSCOS Objective Choose One
          Date:
                                                      NCSCOS Objective Choose One        NCSCOS Objective Choose One


                                                                                                                                                  Union County Public Schools, 2008
                          Data Used for PEP             Strengths in This Area                  Needs in This Area                  Targeted Behavior and              Data to Be Used for
                            Development                                                                                                  Intervention                     PEP Review
           Initial                                                                                                             Behavior:                             Check all that apply:
                                                                                                                                                                       Observation Notes
           Conference   Weekly Observation                                                                                     Intervention:                           Individual Behavior Plan
           Date:        Notes                                                                                                                                          Behavior Report Card
                                                                                                                                                                       Other:
Behavior

                                                                                                                               Goal:
           Review                                                                                                              Behavior:                             Check all that apply:
                                                                                                                                                                       Observation Notes
           Conference                                                                                                          Intervention:                           Individual Behavior Plan
           Date:                                                                                                                                                       Behavior Report Card
                                                                                                                               Goal:                                   Other:

           Final                                                                                                               Recommendations for next year:
           Conference
           Date:

List the 2 most significant behaviors in observable terms that are interfering with student academic success. The Guidance Counselor, Psychologist, Curriculum Coordinator, or an administrator
must observe the student before a Behavior PEP is written.



Initial Conference                      Date:__________________
                                                                                                                    Parent PEP Contacts:
Teacher:_____________________________                     Parent:___________________________________                Date:________         Telephone       Letter      Other
Teacher:_____________________________                     Student (Grades 6-8):_________________________            Date:________         Telephone        Letter     Other
Teacher:_____________________________                                                                               Date:________         Telephone        Letter      Other



Review Conference                       Date:__________________
                                                                                                                    Parent PEP Contacts:
Teacher:_____________________________                     Parent:___________________________________                Date:________         Telephone       Letter      Other
Teacher:_____________________________                     Student (Grades 6-8):_________________________            Date:________         Telephone        Letter     Other
Teacher:_____________________________                                                                               Date:________         Telephone        Letter      Other



Final Conference                        Date:__________________
                                                                                                                    Parent PEP Contacts:
Teacher:_____________________________                     Parent:___________________________________                Date:________         Telephone       Letter      Other
Teacher:_____________________________                     Student (Grades 6-8):_________________________            Date:________         Telephone        Letter     Other
Teacher:_____________________________                                                                               Date:________         Telephone        Letter      Other

PEP to be continued?             Yes          No

To be completed at the end of the year:                                                                          To be completed before moving to Tier II:
Attendance: Days Absent _______          Days Tardy _______        Attendance Concern?          Yes      No       Vision Results: Near_____ Far_____Hearing Results:  Pass   Fail
                                                                                                                      Date:________________            Date:__________________

Once the initial PEP is written, it must be reviewed at midterm and at the end of the year. Parental signature is required at each conference.
                                                                                                                                                        Union County Public Schools, 2008

								
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