Iep Revision Form - South Bend Community School Corporation Special Education Department Page 6
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13South Bend Community School Corporation
Special Education Department
IEP Revision
Student: ______________________________ STN: ______________________ Revise IEP of ____________________
Effective Dates:
Begin date: _____________________________ End date: __________________________________
BIP Revision
Behaviors of Concern:
Participants:
1. What is the specific behavior of concern and how does it interfere with learning? (list only 1 behavior)
2. When, where and with whom does the behavior occur? Be specific.
3. How often does the behavior occur, and how long does it last?
4. What things seem to trigger the behavior?
5. What usually happens when this behavior occurs; reactions of peers/adults, consequences of the behavior?
Academic accommodations, environmental modifications, positive reinforcement and/or discipline.
6. What interventions have NOT been effective?
7. What interventions have helped improve behavior?
8. In what situations does the student behave most appropriately?
9. What reinforcers would the student prefer to support compliance in school?
Functions of Behavior:
1. Identify the predominant purpose/function the problem behavior appears to serve for the student:
Choose One:
To gain
To avoid
To communicate
Other
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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