Sample ILP Instrument

TOOL 1: Sample ILP Instrument

Date Updated

1)Student Personal Information

2)Parent/Guardian/Other Caring Adult Information

3)Other Student Plans

Check off the other types of student plans that are in place, and provide the date of the most recent version for each applicable plan.

4)Student Identified Strengths

Provide an overview of your self-identified strengths in the personal/social, academic, and workplace readiness domains.

5)Student Identified Barriers to Success

Check all boxes that apply to you and identify any steps to be taken to reduce barriers.

6)State Agency Involvement

List any involvement with state agencies. Examples include Department of Youth Services, Department of Transitional Assistance, Department of Children and Families, and Department of Mental Health.

7)Career Interests

List your career interests (this may include results from interest inventories), career opportunities associated with the career interest area, and the education or training necessary to obtain that career. Create a separate row for each potential career opportunity – so one career interest area may have several rows with different career opportunities.

8)Short Term Student Goals

Provide at least one short term (1-2 month) goal for each domain (academic, personal/social, and workplace readiness). For each short-term goal, include action steps to reach this goal, including the description of activities, supports that will be needed or provided, and the timeline. Retain prior short-term goals for student review and reflection.

9)Long Term Student Goals

Provide at least one long term (post-secondary) goal related to future education, career, and personal/life goals. For each long-term goal, include some immediate action steps to reach this goal, including the description of activities, supports that will be needed or provided, and the timeline. Retain prior long-term goals for student review and reflection.

10) Middle School Courses Information

Provide an overview of the middle school courses taken and the associated grades.

11) High School Courses Information

Provide an overview of the courses taken, including the course titles, course grade (GR), and course credits earned (CR). Note in the course title if the course is taken for dual credit, is an AP course, etc.

12) High School Roadmap

For each subject area, provide the total number of credits required for graduation, the total applicable credits earned to date, and the total credits remaining to be earned in the subject area. If applicable, provide a short description of the course(s) options to fulfill the required credits. This table can be used a simple roadmap to graduation for students, families, and staff.

13) Tier 2 and Tier 3 Supports or Interventions

Document the Tier 2 and Tier 3 supports and interventions (academic and non-academic) that you are participating in (or in which you previously participated). Tier 2 interventions and supports are moderately intensive and are targeted toward small groups of students with similar needs who would benefit from similar interventions or supports. Tier 3 interventions and supports are the most intensive and are provided to individual students with the highest levels of need.

Check off the grade levels in which you participated in that intervention or support.

14) Assessment Results

Provide an overview of your results on state, local, and other assessment results.

15) Extracurricular Activities

Document the extracurricular activities in which you are engaged, including those provided in school, and well as those offered out of school.

16) Career Development Education Activities

Career Development Education encompasses three stages – Awareness, Exploration, and Immersion – thathelp students move from the cognitive to the experiential. Document your participation in activities and/or courses that provide career awareness, exploration, or immersion opportunities.

• Awareness stage examples include: career interest inventories, exploring labor market information through websites and publications, listening to career speakers, and/or participation in career days or fairs.
• Exploration stage examples include participation in workshops or classes with a career focus, “job shadowing,” informational interviews with local professionals, and/or producing a career-related research or capstone project.
• Immersion stage examples include internships, entrepreneurial enterprises, or other work-based learning opportunities.

17) Reflections

Reflections from the student, parent/guardian, and school should happen at the beginning and at the end of the school year. The reflection at the beginning of the year focuses all parties on the work and the specific goals for the upcoming year. The year-end reflection is an honest assessment of successes and challenges encountered throughout the school year. The end-of-year reflection may identify action steps for the next year.

TOOL 1: Sample ILP Instrument, excerpt from the Massachusetts Guide for Implementing Individual Learning Plans published by the MA Department of Elementary and Secondary Education