Special Education

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Teaching Students with Attention-Deficit/Hyperactivity Disorder

Appendix Three: Accommodation/Support Plan Form

Name:	Grade:
Date:	School:
Completed by:	Review Date:

1. Indicate the student's areas of strength:

Academics:	Personal Skills
___ Reading decoding	___ Computers/ technology
___ Reading comprehension	___ Interacting with peers
___ Written expression	___ Memory
___ Mathematics - recall of basic facts	___ Leadership Skills
___ Mathematics - conceptual understanding	___ Interacting with adults
___ Rich oral vocabulary	___ Requests help when needed
___ Ability to understand complex concepts	___ Sense of humour
___ Spelling	___ Responds well to praise
___ Other, please specify _________________________	___ Demonstrates enthusiasm
Areas of Interest	___ Other, please specify _________________________
___ Computers / video games	Comments:
___ Television / movies
___ Sports (specify) _________________________
___ Visual arts
___ Music (specify) _________________________
___ Volunteer activities (specify) _________________________
___ Other accomplishments _________________________

2. Indicate areas of concern that are significantly affecting the student's ability to learn and interact with others at school:

Academics:	Behaviour:
___ Memory	___ interacting with adults
___ Understanding and following instructions	___ motor activity detrimental to learning (describe) _________________________
___ Reading decoding	___ interrupting, blurting out, inappropriate verbalizations
___ Reading comprehension	___ interacting with peers in class
___ Written expression	___ interacting with peers at lunch and recess breaks
___ Mathematics - recall of basic facts	___ complying with staff requests
___ Mathematics - conceptual understanding	___ transitions between activities or classes
___ Limited oral vocabulary	___ behaviour during loosely structured activities (assemblies, field trips, etc.)
___ Ability to understand complex concepts	___ attendance
___ Spelling	___ Other, please specify _________________________
___ Other, please specify _________________________
Organization:
___ handing in assignments
___ keeping track of necessary materials
___ time management
___ completing tasks
___ getting started on assigned work
Comments:

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Goals/Person Responsible	Strategies	Progress Observed
1.		____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________
2.		____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________
3.		____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________

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