Document date: 10/22/15

IEP Accommodations

Page of

Students Name: Alexander Jackson

District ID:

Native Lang: English

District: Madison

Ethnicity: Asian
Birth Date: 2/10/12
Age: 3
School: Jefferson Elementary, Kidz Corner

State ID:

Grade:
PK

Sex: M

3. BEHAVIORAL INTERVENTION PLANNING

A.
B.
C.
D.

Does behavior impede the students learning or that of others?..........................................[] Yes

If yes, have positive behavior supports been considered?..................................................[] Yes
The positive behavior supports, if needed, are incorporated in the IEP goals....................[] Yes
A behavior intervention plan (BIP), including positive supports, is included below or is
attached to this IEP............................................................................................................. [] Yes

[x] No
[] No
[] No
[] No

January 2007

Form 410e
Copy to the confidential folder, each service provider, and the parent or adult student.