Fillable Printable Individual Education Plan (IEP): Template

Individual Education Plan (IEP): Template

Template Designed for electronic use

Individual Education Plan (IEP)

Child’s information

Family name Given name Date of birth

Days attending

kindergarten

Kindergarten

start date

/ /

Service information

Name of service

Address

Phone

Email address

IEP prepared by

Director/Teacher

signature

Date

Medical and support information for child

Diagnosis or disability

Medical notes

Support staff/agencies

Attendance at

Early Childhood

Development

Program

(ECDP)

Days and times

ECDP contact

details

Contributors to IEP

Name

Agency/Relation to

child

Contact number Signature

[Enter child’s name] Individual Education Plan Page 1 of 3

Template Designed for electronic use

Child’s profile

Parents/carers expectations

Health and safety information — including a copy of a health plan if applicable

Skills, strengths and interests for learning

Education adjustments and inclusive strategies

Adjustments Strategies for [Enter child’s first name]

Timing 



Scheduling 



Setting 



Presentation 



Response 



[Enter child’s name] Individual Education Plan Page 2 of 3

Template Designed for electronic use

Planning learning goals

QKLG learning

and development

areas

Key focus for [Enter child’s name]

Identity 



Connectedness 



Wellbeing 



Active learning 



Communication 



Specific learning goals

(highlight QKLG learning and

development areas as applicable)

Strategies and intentional

teaching practices

Evaluation and review

notes (dated)

[Enter goal]

Identity | Connectedness |

Wellbeing | Active learning |

Communicating

[Enter today’s date]

[Enter goal]

Identity | Connectedness |

Wellbeing | Active learning |

Communicating

[Enter today’s date]

[Enter goal]

Identity | Connectedness |

Wellbeing | Active learning |

Communicating

[Enter today’s date]

[Enter child’s name] Individual Education Plan Page 3 of 3