Step 1:  Teacher Reviews Existing Information (and IEP)

1. How old is the student?

2.  What is the student’s diagnosis?

3.  What is the student’s estimated developmental age?

4.  What is the student’s estimated receptive language age?

5.  What is the student’s estimated expressive language age?

6.  Does the child currently use an adaptive communication system?  If so, describe.

7.  Does the child exhibit problem behaviors that interfere with his/her learning?

8.  What are the results of the functional behavior assessment?

9.  What is the student’s current behavior plan?

10.  Does the student present with particular sensory preferences or strong dislikes?

11.  What are the student’s relative strengths?

12.  What are the student’s relative weaknesses?

13.  What activities does the student enjoy?


Step 2: Teacher Conducts Functional Assessments

1.  Which of the following areas need further assessment in the classroom? (check all that apply)

                ___ Social              ___ Communication            ___ Play/Leisure                  ___ Fine Motor

                ___ Gross Motor                  ___ Work Behaviors           ___ Pre-Academic               ___ Academic

                ___ Self-Care        ___ Pre-Vocational/Vocational         ___ Behavior        ___ Other


2.  How will you assess these areas?  (complete only for relevant areas)


Using criterion-referenced instrument

Using developmental checklists

Conducting a task analysis

Setting up structured observations

Observing unstructured situations






















Fine Motor







Gross Motor







Work Behaviors





















Pre-vocational/ Vocational





























3.  Who will you speak with to obtain information about how the child functions at home or in other educational/therapeutic settings?

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