Vermont Department of Vermont
Individualized Education Program
Present Levels of Educational Performance*
Identify the student’s present levels of educational performance including the student’s functional performance,
abilities, acquired skills and strengths; and how the disability affects the student’s involvement and progress in the
general curriculum. For preschool children, identify how the disability affects the child’s participation in activities
appropriate for the child.
Student Name: _______________________________________________ Date: ___ -_____________
*if applicable, include transition needs (age 14)
Page ___ of ___
Form 5
September 21, 2005
Individualized Education Program (IEP)
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