APPENDIX D.

SAMPLE FORM 1

INDIVIDUAL PROGRAM PLAN (TRANSITION)

GENERAL (LONG-TERM) OUTCOMES AND SPECIFIC (SHORT-TERM) OUTCOMES

STUDENT’S NAME: DIANNE MARIE C. BANZON BIRTH DATE: DECEMBER 26, 1998

PROVINCIAL STUDENT IDENTIFICATION NUMBER: 120012587 DATE: JUNE 30, 2020

LIVING ARGUMENTS

GENERAL OUTCOME

RESPONSIBLE PERSON’S /ORGANIZATION

PROJECT DATE OF COMPLETION

Understanding of, and respect for issues of race, religion, ethnicity, culture, language and
sexuality.

PARENTS/ TEACHERS

JANUARY 15, 2022

SPECIFIC OUTCOME

RESPONSIBLE PERSON’S /ORGANIZATION

PROJECT DATE OF COMPLETION

 Clearly assign roles and responsibility.

PARENTS/ TEACHERS.

JANUARY 15, 2022

PERSONAL MANAGEMENT
GENERAL OUTCOME

RESPONSIBLE PERSON’S /ORGANIZATION

PROJECT DATE OF COMPLETION

Early identification and assessment

Each individual

APRIL 28, 2025

SPECIFIC OUTCOME

RESPONSIBLE PERSON’S /ORGANIZATION

PROJECT DATE OF COMPLETION

Individualized program planning.

Each individual

APRIL 28, 2025