Iep Revision Form - South Bend Community School Corporation Special Education Department Page 4

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South Bend Community School Corporation
Special Education Department
IEP Revision
Student: ______________________________ STN: ______________________ Revise IEP of ____________________
Effective Dates:
Begin date: _____________________________ End date: __________________________________
Date of Conference: ________________________________ Location: ________________________________________
Purpose of the conference:
Revise
MDC
Other
Comments:
Additional Supplemental Present Level Information
Include only pertinent information that is not already in the current/future IEP.
General Introductory Statement:
Pertinent Information:
School Skills and Work Habits:
Social, Behavioral and Functional Skills:
Academic Progress:
Cognitive Functioning, Speech, Language:
How does the student's disability affect learning and progress in the general education curriculum?
This form is only to be used when an IEP has been finalized for future dates, and a revision is required for the currently
valid IEP. It is not to be used when there are questions of eligibility or state assessment.

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