Case Conference Committee Report
_______________
Case Conference Committee Report
School:
Date of Report: ___________
Individual Education Program
Effective Dates:_____________________________________
File Date: ______________________
Student: ___________________________
STN:____________________
Date of Birth: ___________________
Age: ____
Current Grade: ____ Gender: ____
Guardian Information
Relation:
Relation:
Name:
Name:
Business Phone:
Business Phone:
Home Phone:
Home Phone:
Mobile Phone:
Mobile Phone:
Address:
Address:
Purposes of Conference
Case Conference Meeting Scheduled
Date: ________________
Time: ____________
Place:______________________________
Evaluation Information and Student Data
Strengths of the student: _______________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Response to instructional strategies and research-based interventions:
Progress Monitoring Data:
Educational Evaluation Report:
Present Level of academic and functional performance:
___________________________________________________________________________________
__________________________________________________________________________________
Student Name: ________________________________
Conference Date: __________________