Fillable Student Study Team

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Student Study Team

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Student Study Team
Student name: __________________________________________________ Date: ________________________
Student ID: __________________________________________________ Grade: ________________________
Parents name(s)/address: _______________________________________________________________________________
Parent(s) telephone: ___________________________________________ Referring person: ________________
Information reviewed:
• Modifications or accommodations attempted in the classroom
• Student’s current grades
• Medical/health/vision/hearing information
• Attached referral
• Teacher observations
• Parent observations/information
• Past special education records
• School records
• Other (specify) _________________________________________________________________________________
SST’s decision/plan/roles assigned:
Signatures of attendees: Role:
____________________________________________________ School Psychologist
____________________________________________________ Special Education Teacher
____________________________________________________ Regular Education Teacher
____________________________________________________ LEA Representative
____________________________________________________ Speech/Language Therapist
____________________________________________________ Occupational Therapist
____________________________________________________ Physical Therapist
____________________________________________________ Parent
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Student Study Team

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Completed 26 May 2021

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