DEPARTMENT OF EDUCATION EDUCATION ADJUSTMENT PLAN Name: Student UPN: Insert School Logo D.O.B. Year Level: EAP Meeting Date: Review Date: Parent/Caregiver: Class Teacher: Spec. Ed. Teacher: Insert Student Support Staff: Primary Diagnosis: Secondary Diagnosis: Address (optional): Phone Number(s) (optional): Moderated by Specialist Advisor and Date: Personal Care Movement Student Needs Hygiene Eating & Diet Health Care Motor & Mobility Fine Motor Profile Indicator/s Level: 0=No Adjustments, 1=Supplementary Participation (Minimal), 2= Supplementary (Moderate), 3=Substantial, 4=Extensive; Communication Student Needs Curriculum Behaviour Social Safety Communication Communication Profile Access Competence Access - Receptive Participation – Language Expressive Language Level Indicator/s Important Student Information (medical/allergy information, guardianship, e.g. Transition points if appropriate year 6 7, 9- 10, post school) –
EDUCATION ADJUSTMENT PLAN DEPARTMENT OF EDUCATION Name: Student UPN: D.O.B. Year Level: EAP Meeting Date: Review Date: Parent/Caregiver: Class Teacher: Spec. Ed. Teacher: Support Staff: Primary Diagnosis: Secondary Diagnosis: Address (optional): Phone Number(s) (optional): Moderated by Specialist Advisor and Date: Insert School Logo Insert Student Participation Communication Student Needs Profile Curriculum Access Behaviour Social Competence Safety Communication Access - Receptive Language Communication Participation – Expressive Language Level Indicator/s Personal Care Movement Student Needs Profile Hygiene Eating & Diet Health Care Motor & Mobility Fine Motor Indicator/s Level: 0=No Adjustments, 1=Supplementary (Minimal), 2= Supplementary (Moderate), 3=Substantial, 4=Extensive; Important Student Information (medical/allergy information, guardianship, e.g. Transition points if appropriate year 6 – 7, 9- 10, post school)
EAP-Template-Portrait.docx