EDUCATION CASE MANAGEMENT CHECKLIST TEMPLATE

Created by ChecklistGuro (https://checklistguro.com)


--- STUDENT INFORMATION & REFERRAL ---
[ ] Student Full Name
[ ] Student ID Number
[ ] Date of Referral
[ ] Referring Party (Teacher, Parent/Guardian, School Counselor, Outside Agency)
[ ] Reason for Referral (Brief Description)
[ ] Grade Level (K, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
[ ] Supporting Documents (Optional)

--- ASSESSMENT & PLANNING ---
[ ] Presenting Concerns & Referral Reason
[ ] Areas of Need (Select all that apply) (Academic, Behavioral/Emotional, Social Skills, Physical/Health, Family/Home Environment)
[ ] Age
[ ] Date of Assessment
[ ] Primary Diagnosis/Suspected Diagnosis (if applicable) (N/A, Learning Disability, Emotional/Behavioral Disorder, Autism Spectrum Disorder, Other (Specify))
[ ] Summary of Assessment Findings
[ ] Strength Identification (Academic, Behavioral, Social, Personal)

--- INTERVENTION IMPLEMENTATION ---
[ ] Intervention Start Date
[ ] Intervention Methods Used (Individual Counseling, Group Therapy, Behavioral Modification, Academic Support, Parent Training)
[ ] Details of Intervention Activities
[ ] Frequency of Interventions (e.g., sessions per week)
[ ] Next Intervention Date
[ ] Intervention Delivery Method (In-Person, Virtual)
[ ] Supporting Documentation (e.g., therapy notes)

--- PROGRESS MONITORING & EVALUATION ---
[ ] Academic Performance Score (e.g., GPA, Standardized Test)
[ ] Behavioral Observations - Level of Concern (Not Applicable, Minimal, Moderate, Significant)
[ ] Summary of Progress Towards Goals
[ ] Date of Last Progress Monitoring Review
[ ] Areas Where Progress is Below Expectations (Academic Performance, Behavioral Regulation, Social Skills, Emotional Regulation, Attendance)
[ ] Attendance Rate (%)

--- COLLABORATION & COMMUNICATION ---
[ ] Communication Method (Email, Phone Call, In-Person Meeting, Video Conference)
[ ] Last Communication Date
[ ] Summary of Communication
[ ] Communication Recipient Role (Parent/Guardian, Teacher, School Psychologist, Administrator, External Agency)
[ ] Contact Person Name
[ ] Frequency of Communication (per week)

--- DOCUMENTATION & REPORTING ---
[ ] Date of Documentation
[ ] Summary of Case Activities
[ ] Hours of Service Provided
[ ] Supporting Documents (e.g., assessment reports)
[ ] Report Type (Initial Assessment, Progress Report, Closure Report)
[ ] Staff Signature

--- CASE CLOSURE & TRANSITION ---
[ ] Case Closure Date
[ ] Summary of Case Progress & Outcomes
[ ] Reason for Case Closure (Student met goals, Student no longer requires services, Other (Specify))
[ ] If 'Other' - Please specify reason for closure
[ ] Transition Plan Type (Return to Regular Education, Specialized Program, Other)
[ ] Details of Transition Plan (e.g., specific supports, referrals)
[ ] Transition Documents (e.g., referral letters, IEP updates)

--- LEGAL AND COMPLIANCE ---
[ ] FERPA Consent Form Received Date
[ ] 504 Plan Compliance? (Yes, No, N/A)
[ ] IEP Compliance? (Yes, No, N/A)
[ ] Number of Documented IEP Meetings
[ ] Summary of Legal Consultation (if applicable)
[ ] Date of Last Legal Review

--- END OF TEMPLATE ---
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