STUDENT NAME

IEP Goal Monitoring

DATETEACHER

Goal # 1: Did Student complete classroom/sensory/social activities using provided

mini-visual system? (4/5 opportunities)

*Oct: Student did not meet criteria for goal # 1

012345

Yes No Yes No

September October

Goal # 2: Did Student independently request a break (break box/sensory) when he needed time away from

an activity (4/5 opportunities)

*Sept & Oct: Student did not meet criteria for goal # 2

0

0.5

1

1.5

2

2.5

3

3.5

Yes No Yes No

September October

Goal # 3: Did Student identify and use appropriate “personal space” when interacting and communicating with peers and

adults. (4/5 opportunities)

* Sept & Oct: Student did not meet criteria for goal # 3

00.5

11.5

22.5

33.5

44.5

Yes No Yes No

September October

Goal # 3 Additional Information

• September & October teacher reports: Student had particular difficulty during carpet time - he nearly always touches others during this time.

• “crushing hugs” in the classroom

Goal # 4: Did Student initiate play with peers by using social language phrases and questions to engage others. (4/5 opportunities)

*Student met criteria for goal # 4 in October which was an improvement from September

0

1

2

3

4

5

6

Yes No Yes No

September October

Goal # 5: Did Student understand “losing is ok” by following game rules and by using appropriate social phrases / nonverbal

communication during game play (4/5 opportunities)

* Sept & Oct: Student did not meet criteria for goal # 5

0

0.5

1

1.5

2

2.5

3

3.5

Yes No Yes No

September October

Overall- October goals

• Student did not meet criteria for goals #1, 2, 3 & 5

• Student met criteria for goal # 4 in October which was an improvement from September