see Dis 1

Data Collection & Goal Tracking System

___Huang Le_______ __Anytown School District ___________________ Student Resident District IEP Meeting Date __ Anytown School District ___________________ Gender: _X_ M ___ F Grade: _____

Attending District Annual IEP Review Date

___xx/xx/xx_________ __ Anytown School ___________ ____________________ Date of Birth (mm/dd/yy) Attending School Amendment Date __111-111-111_____ ____________________________ ___________________ Secure Student Identifier (SSID) Case Manager Most Recent (re)Evaluation

Date

AU Autism Spectrum Disorder _SI Speech/Language Impairment ____________________

Primary Disability Code & Category Secondary Disability Code & Category – OPTIONAL

Re-Evaluation Due Date

Domain Goal Data Progress? Language/communication Huang will initiate communicative

interactions with others by asking questions 4/5 opportunities to do so.

Average rate: 3/5 Progressing

Social/behavioral skills Huang will work cooperatively with peers in small group settings (ie. Share materials, allow peers to share different thoughts) 4/5 opportunities to do so.

Average rate: 4/5 Mastered

Classroom management skills

Huang will raise their hand and wait to be called on before talking aloud in group settings 4/5 opportunities to do so.

Average rate: 2/5 Progressing

Mathematics Huang will identify what the characters and mathematical operation within a math story problem 4/5 opportunities to do so.

Average rate: 5/5 Mastered

Literacy Huang will state the main idea of the story, video or situation 4/5 opportunities to do so.

Average rate: 3/5 Progressing

Self-help skills Huang will transition appropriately from tasks and activities and school environments 80% of the time given visual and verbal prompts.

Average rate: 20% Not progressing; change of intervention and strategy needed