ADULT INDIVIDUAL EDUCATION PLAN (AIEP) ADULT EDUCATION

CONFERENCE DATE

AIEP OWNER

NAME OFSTUDENT DOB

SOC. SEC.NUMBER DISABILITY

SCHOOL CLASS LOC.

VERIFICATION DOCUMENTATION: OTHERMEDICALSCHOOL DISTRICTVRDCF PSYCHOLOGICAL

PARTICIPATING CENTER FM-4577 Rev. (07-03)

SERVICES TO BE INITIATED ON (Date)

(Date) (Date)

SPECIALIZED EDUCATIONAL OR VOCATIONAL TRAININGSERVICES, AIDS, OR EQUIPMENT TO BE PROVIDED BY THE ADULT CENTER

SUPPORT SERVICE PROVIDERS/SERVICE(S)

EXPECTED PROGRAM OUTCOME(S): LIFELONG LEARNINGQUALITY OF LIFE

WORKFORCE PREPARATION

(Following conference date)

INTERIM REVIEW HELD ON

ASSESSMENT INSTRUMENT DATE SCORES

DCF

VR

DBS

OTHER

PRESENT LEVEL OF PERFORMANCE - The student is currently able to

SIGNATURES OF PERSONS DEVELOPING THIS AIEP

STUDENT PARENT/GUARDIAN (If applicable)

PRINCIPAL OR DESIGNEE TEACHER

FLEXIBLE SETTING FLEXIBLE SCHEDULING FLEXIBLE RESPONDING FLEXIBLE PRESENTATION FLEXIBLE TIMING

ACCOMMODATIONS OR MODIFICATIONS ARE REQUIRED FOR THE ASSESSMENT PROCESS. YES NO IF YES, SELECT THE NEEDED TEST ACCOMMODATIONS.

AIEP GOALS AND OBJECTIVES CLASS LOC. _____________________________

NAME OF SOC. SEC.STUDENT ________________________________ NUMBER _________________ SCHOOL ________________________ TEACHER

FM-4577 Rev. (07-03)

ANNUAL GOALS SHORT TERM INSTRUCTIONAL OBJECTIVES EVALUATIVE CRITERIAAND TIMELINES

OBJECTIVEMET DATE