C:\Html\Forms\profile.htm

INDIVIDUAL STUDENT PROFILE FOR STUDENT ASSISTANT ALLOCATION / FOR SCHOOL USE ONLY

SCHOOL: NUMBER____________________NAME_______________________ PRINCIPAL_______________________DATE________________________________

Student Name & MCP#

D.O.B.
Y/M/D

Exp.
Grade
Next
Sept.

ISSP in Place

Is receiving
criteria C,
D, E, F, G
support
(Specify)

Has severe cognitive delay

Has severe physical disability

Hard of Hearing/ Deaf
or
Blind/
Visually
Impaired

Has sever behavior disorder; is injurious to
self/others; and therefore needs constant
adult supervision

Has
few
or no
verbal
skills

Has
severe
mobility
disability
and
requires
assist-
ance

Requires
toileting
help

Has
few or
no self
help
skills

Requires
constant
adult
attention
to function
physically
in the
classroom

Requires
toileting help

Requires
portering/
lifting

On Prescribed Curriculum using ASL or
Braille

Date of last injury

Injury was to
self/other

Does Run Away

Date of last running

Behavior Manage-
ment component in ISSP and signed by team

Individual Support Services Planning Team

Student__________________________ Special Education Teacher________________________

Parent___________________________ Homeroom Teacher_____________________________

Other Team Members

Name_______________________ Position_____________________