Individual Catholic Educational Plan (Icep) Draft
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7Individual Catholic Educational Plan (ICEP) Draft
An ICEP is used to provide a student with accommodations and any one or more of
the following: specialized academic instruction, modification of curriculum,
modification of assessments.
Student name__________________________________
D.O.B.___________
Last
First
School_________________________________________
Date:____________
Grade_______ Homeroom teacher__________________________________________
Supporting information: (Give date of assessment or evaluation)
________Medical
______Psycho-educational evaluation
_______ Speech & Language Evaluation
_______ Other Professional Assessment (specify) _______________________________
The student has documentation supporting the following:__________________________
________________________________________________________________________
________________________________________________________________________
Persons having input into this plan:
Check one:
I. The following plan DID include the input of professional(s) with training in
writing specific educational or therapeutic goals for children with special needs:
____________________ ________________________ _____________________
Name
Title
Degree or training
____________________ ________________________ _____________________
Name
Title
Degree or training
Others involved in creating this plan:
Parent(s):
Name and title:
________________________________
_______________________________
Name and title:
Name and title:
___________________________
_______________________________
II. The follow plan did NOT include the input of professional(s) with training
in writing specific educational or therapeutic goals for children with special needs.
In this case, please contact the Catholic Schools Office for further information.
Parent(s):
Name and title:
________________________________
_______________________________
Name and title:
Name and title:
___________________________
_______________________________
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