EFFECTIVE LEARNING ENVIRONMENTS
Educational Benefit Review Focus Student Summary Sample
Case Management
Student Name:
Site:
District:
Go back two
years in IEP
file.
Identified
YEAR ____
Assessment Area
ACADEMIC
BEHAVIOR
COMMUNICATION
FINE MOTOR
GROSS MOTOR
SELF HELP
SOCIAL EMOTIONAL
TRANSITION PLAN
VOCATIONAL
Need
(Y/N)
Y
Y
Y
N
N
N
Y
N
N
Present
Performance
(Y/N)
Goals &
Objectives
(Y/N)
Placement
& Services
(Y/N)
Y
Y
Y
Y
N
N
N
Y
N
N
Y
N
N
N
Y
N
N
Y
N
N
N
Y
N
N
Use only Y or N. Do not use N/A. If there
N
is no identified
need,N
it is acceptableYto put
N in the remaining boxes.
Progress
(Y/N)
N
N
Y
N
N
N
Y
N
N
OTHER
OTHER
Go back one
year in IEP
file.
Identified
YEAR ____
Need
Assessment Area
(Y/N)
ACADEMIC
BEHAVIOR
COMMUNICATION
FINE MOTOR
GROSS MOTOR
SELF HELP
SOCIAL EMOTIONAL
TRANSITION PLAN
VOCATIONAL
Present
Performance
(Y/N)
Goals &
Objectives
(Y/N)
Placement
& Services
(Y/N)
Progress
(Y/N)
Y
Y
Y
N
N
N
Y
N
N
Y
Y
Y
N
N
N
Y
N
N
Y
Y
Y
N
N
N
Y
N
N
Y
Y
Y
N
N
N
Y
N
N
Y
Y
Y
N
N
N
Y
N
N
Identified
Need
(Y/N)
Present
Performance
(Y/N)
Goals &
Objectives
(Y/N)
Placement
& Services
(Y/N)
Progress
(Y/N)
OTHER
ACADEMIC
COMMUNICATION
FINE MOTOR
SELF HELP
SOCIAL EMOTIONAL
TRANSITION PLAN
VOCATIONAL
OTHER
identified as a need, but was not
addressed in the present levels for Year
1. This was changed in Year 2.)
3. Are all of the student’s educational
needs addressed by appropriate goals
and objectives?
____Y __X_N (Explain:
Goals were not t
4. Do the services support the goals and
objectives?
__X_Y ____N (Explain: ______________
__________________________________)
5. Did the student make yearly progress?
____Y __X_N (Explain: Student did not
make progress in academics or behavior
in Year 1.)
6. If the student did not make progress:
 Were the goals and objectives
changed in the next IEP to assist
the student to make progress?
__X_Y ____N (Explain: ______________
__________________________________)
 Were the services changed in the
next IEP to assist the student to
make If
progress?
student did not make
____Y __X_Nprogress,
(Explain:you
Theneed
services
to in
that for
youstudent
changed
IEP)
place were show
adequate
need
to benefit the student.
7. Were enough services provided to
ensure that the student would make
progress?
__X_Y ____N (Explain: ______________
________________________________)
BEHAVIOR
GROSS MOTOR
Any areas
markedinclude
“N”
2. Does the present
performance
need
an explanation.
all of the needs
identified
in the
assessment?
____Y __X_N (Explain: Behavior was
created in the area of behavior for Year 1
this was changed in Year 2)
OTHER
YEAR ____
Assessment Area
1. Is the assessment complete and identify
the student’s needs?
__X_Y ____N (Explain: ______________
___)
Use current
year IEP.
8. To assess for overall compliance –
Considering the answers to each of the
above, was the IEP reasonably
calculated to result in educational
benefit?
__X_Y ____N (Explain: IEP was changed
to help the student make progress.
OTHER
NECTEC LAS 2014.15 Effective Learning Environments Educational Benefit Review Focus Student Summary Sample
4