INDIVIDUAL LEARNING PLAN
SCHOOL
Student Name: _______________(initial) __________
Homeroom Teacher: __________(initial)__________
Homeroom Teacher II: _________(initial)_________
Previous School: ____________________________
Parish of Previous school: _____________________
JIRMS#:__________
DOB: ___/___/___
Facility Entry Date: ___/___/___
Age: _____
Grade Completed: _____ School Year Last Attended: _____
ILP Date: ___/___/___
Release Date: ___/___/___
SCHOOL PROGRAM(S): Basic Skills I □ Basic Skills II □ Pre-GED □ GED □ Carnegie Credits □ Special Education □ Vocational □
EDUCATIONAL NEEDS: Check any which apply
____ Academy/ Cognitive
____ Behavior
____ Motor
____ Self-Help
____Vocational
____ Communication
____ Social
____ Other
MEDICAL CONCERNS: Check any which apply
____ Respiratory
____ Visual
____ Auditory
____ Medication
____ Other
STUDENT MULTI-REFFERENCED REPORT – TABE RESULTS
st
STUDENT MULTI-REFFERENCED REPORT – TABE RESULTS
nd
1 Test Date: __________
Reading: _____________ E M D A
Total Math: ________
E M D A
Language: _________
E M D A
2 Test Date: __________
Reading: ___________
E M D A
Total Math: __________ E M D A
Language: ______________ E M D A
Use the following codes to indicate mastery level of the skill
Date Mastered = Mastery
P = Partially Mastered
– = Not Mastered
NT = Not Tested at This Level
READING SKILLS
_____ Construct Meaning
_____ Interpret Graphics
_____ Evaluate/Extend
_____ Words in Context
_____ Recall Information
Meaning
Use the following codes to indicate mastery level of the skill
Date Mastered = Mastery
P = Partially Mastered
– = Not Mastered
NT = Not Tested at This Level
READING SKILLS
_____ Construct Meaning
_____ Interpret Graphics
_____ Evaluate/Extend
_____ Words in Context
_____ Recall Information
Meaning
MATH SKILLS
_____ Add Whole Numbers
_____ Numeration
_____ Number Theory
_____ Subtract Whole
_____ Data Interpretation
Numbers
_____ Pre-Algebra/Algebra
_____ Multiply Whole
_____ Measurement
Numbers
_____ Geometry
_____ Divide Whole
_____ Computation in
Numbers
Context
_____ Decimals
_____ Fractions
_____ Integers
_____ Percents
_____ Algebraic Operation
LANGUAGE SKILLS
_____ Usage
_____ Capitalization
_____ Punctuation
_____ Sentence Formation
_____ Paragraph
_____ Writing Conventions
Development
MATH SKILLS
_____ Numeration
_____ Add Whole Numbers
_____ Number Theory
_____ Subtract Whole
_____ Data Interpretation
Numbers
_____ Pre-Algebra/Algebra
_____ Multiply Whole
_____ Measurement
Numbers
_____ Geometry
_____ Divide Whole
_____ Computation in
Numbers
Context
_____ Decimals
_____ Fractions
_____ Integers
_____ Percents
_____ Algebraic Operation
LANGUAGE SKILLS
_____ Usage
_____ Capitalization
_____ Punctuation
_____ Sentence Formation
_____ Paragraph
_____ Writing Conventions
Development
Homeroom Teacher 3: ________________ (initial) ________
Homeroom Teacher 4: ________________ (initial) ________
Homeroom Teacher 5: ________________ (initial) _______
Homeroom Teacher 6: ________________ (initial) ________
ILP-1 (To be completed by homeroom teacher within four (4) calendar days)
INDIVIDUAL LEARNING PLAN
SCHOOL
Student Name: _______________(initial) __________
Homeroom Teacher: __________(initial)__________
Homeroom Teacher II: _________(initial)_________
Previous School: ____________________________
Parish of Previous school: _____________________
JIRMS#:__________
Facility Entry Date: ___/___/___
DOB: ___/___/___
Age: _____
Grade Completed: _____
Facility Entry
School Year Last Attended: _____
Date: ___/___/___
Release Date: ___/___/___
SCHOOL PROGRAM(S): Basic Skills I □ Basic Skills II □ Pre-GED □ GED □ Carnegie Credits □ Special Education □ Vocational □
EDUCATIONAL NEEDS: Check any which apply
____ Academy/ Cognitive
____ Behavior
____ Motor
____ Self-Help
____Vocational
____ Communication
____ Social
____ Other
MEDICAL CONCERNS: Check any which apply
____ Respiratory
____ Visual
____ Auditory
____ Medication
____ Other
STUDENT MULTI-REFFERENCED REPORT
TABE RESULTS
Test Date: _______ Reading: ______ E M D A
Total Math: ______ E D M A
Language: _____ E M D A
READING SKILLS
NOT MASTERED
_____________________________________________________
PARTIALLY MASTERED
___________________________________________________
_____________________________________________________
___________________________________________________
_____________________________________________________
___________________________________________________
MATH SKILLS
NOT MASTERED
_____________________________________________________
PARTIALLY MASTERED
___________________________________________________
_____________________________________________________
___________________________________________________
_____________________________________________________
___________________________________________________
LANGUAGE SKILLS
NOT MASTERED
_____________________________________________________
PARTIALLY MASTERED
___________________________________________________
_____________________________________________________
___________________________________________________
_____________________________________________________
___________________________________________________
STUDENT’S STRENGHTS: (Based on TABE Results)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
ILP-1 (To be completed by homeroom teacher within four (4) calendar days)
DATE DUE: ___/___/___
Student Name: ______________________
INDIVIDUAL LEARNING PLAN
Facility Entry Date: ___/___/___
Teacher: _______________________
Homeroom Teacher: _____________
READING GOAL: ______________________________________________________________________________________________
____________________________________________________________________________________________________________
TARGETED READING INSTRUCTIONAL SKILLS
________________________________
________________________________
________________________________
________________________________
MASTERY DATE: (BASED ON TABE SCORES)
_______________________
_______________________
_______________________
_______________________
BENCHMARKS:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
STRATEGIES FOR MODIFICATION/RESOURCES: (Use Modification Checklist for Assistance)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
CLASSROOM BEHAVIOR/MODIFICATION:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
REVISIONS TO ILP DUE TO RE-TESTING:
TARGETED READING INSTRUCTIONAL SKILLS
________________________________
________________________________
________________________________
________________________________
DATE: ___/___/___
MASTERY DATE: (BASED ON TABE SCORES)
_______________________
_______________________
_______________________
_______________________
BENCHMARKS:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
ILP-2R (To be completed by reading teacher within seven (7) calendar days)
DATE DUE: ___/___/___
Student Name: ______________________
INDIVIDUAL LEARNING PLAN
Facility Entry Date: ___/___/___
Teacher: _______________________
Homeroom Teacher: _____________
MATH GOAL: _________________________________________________________________________________________________
____________________________________________________________________________________________________________
TARGETED MATH INSTRUCTIONAL SKILLS
________________________________
________________________________
________________________________
________________________________
MASTERY DATE: (BASED ON TABE SCORES)
_______________________
_______________________
_______________________
_______________________
BENCHMARKS:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
STRATEGIES FOR MODIFICATION/RESOURCES: (Use Modification Checklist for Assistance)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
CLASSROOM BEHAVIOR/MODIFICATION:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
REVISIONS TO ILP DUE TO RE-TESTING:
TARGETED MATH INSTRUCTIONAL SKILLS
________________________________
________________________________
________________________________
________________________________
DATE: ___/___/___
MASTERY DATE: (BASED ON TABE SCORES)
_______________________
_______________________
_______________________
_______________________
BENCHMARKS:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
ILP-2M (To be completed by math teacher within seven (7) calendar days)
DATE DUE: ___/___/___
Student Name: ______________________
INDIVIDUAL LEARNING PLAN
Facility Entry Date: ___/___/___
Teacher: _______________________
Homeroom Teacher: _____________
LANGUAGE ARTS GOAL: ________________________________________________________________________________________
____________________________________________________________________________________________________________
TARGETED LANGUAGE ARTS INSTRUCTIONAL SKILLS
________________________________
________________________________
________________________________
________________________________
MASTERY DATE: (BASED ON TABE SCORES)
_______________________
_______________________
_______________________
_______________________
BENCHMARKS:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
STRATEGIES FOR MODIFICATION/RESOURCES: (Use Modification Checklist for Assistance)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
CLASSROOM BEHAVIOR/MODIFICATION:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
REVISIONS TO ILP DUE TO RE-TESTING:
TARGETED LANGUAGE ARTS INSTRUCTIONAL SKILLS
________________________________
________________________________
________________________________
________________________________
DATE: ___/___/___
MASTERY DATE: (BASED ON TABE SCORES)
_______________________
_______________________
_______________________
_______________________
BENCHMARKS:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
ILP-2LA (To be completed by language arts teacher within seven (7) calendar days)
DATE DUE: ___/___/___
Student Name: ______________________
PROGRAM: ________________________
INDIVIDUAL LEARNING PLAN
Facility Entry Date: ___/___/___
Teacher: _______________________
Homeroom Teacher: _____________
VOCATIONAL GOAL: ___________________________________________________________________________________________
____________________________________________________________________________________________________________
TARGETED VOCATIONAL INSTRUCTIONAL SKILLS:
MASTERY DATE
(Based on Student Competency Record and Curriculum Guide)
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
STRATEGIES FOR MODIFICATION/RESOURCES: (Use Modification Checklist for Assistance)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
CLASSROOM BEHAVIOR/MODIFICATION:
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
REVISIONS TO ILP DUE TO MASTERY:
TARGETED VOCATIONAL INSTRUCTIONAL SKILLS:
DATE: ___/___/___
MASTERY DATE
(Based on Student Competency Record and Curriculum Guide)
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
ILP-2V (To be completed by vocational teacher within seven (7) days)
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
INDIVIDUAL LEARNING PLAN PROGRESS REPORT SUBJECT __________________ SCHOOL YEAR
________
Student _______________________ Riverside □ Scenic
□
Southside
□
Westside □
Homeroom Teacher
Subject Teacher
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
___________________
ACHIEVEMENT CODES:
Date Achieved – Mastery
N – Not Yet Addressed
O – Ongoing
PERFORMANCE CODES:
A –Above Satisfactory
S – Satisfactory
U – Unsatisfactory
Date
Benchmark Numbers
(found on ILP 2)
FOCUS of Benchmark
(found on ILP 2)
Achievement/Date
1st
2nd
3rd
4th
Performance
S
1st
2nd
3rd
4th
S
Comments:________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Attach to report card