INDIVIDUAL SUPPORT PLAN
(CONFIDENTIAL)
Date: _____________
Learner’s Name: ________________________________ Date of Birth: _______________ Educator: _____________________ Class: ____________
LSEN Nr: _____________________________
1. Background information on learner: Family and home situation, parents understanding of child, social problems, contextual factors, and early childhood
developmental problems.
1. Ask Questions relating to home circumstances.
Stressful events – divorce, death, violence, accidents, abuse, etc.
Financial situation – Who is working? Is there food?
With whom or where is the child staying.
Developmental problems – Thing that might have influenced the child when he/she was small.
Comment on appearance of child - neat, neglected, etc
Personality – introverted, extrovert, withdrawn, friendly, etc
Behaviour at home… Friends
Attach evidence.
2. Nature of disability if any: Describe in terms of mobility, self care, vision, hearing, behaviour, cognition, allergies, medication, health care needs, developmental
delays. Please attach any relevant medical reports.
1. Ask questions about birth and health.
Go through list
Were there any complications with the birth? Was the child born premature?
Ask about the learner’s development from birth onwards - behaviour, emotional, physical – sit, crawl, walk, talk, etc.
Has the eyes and ears been tested.
Other medical records
Sleep disturbances
Enuresis (bladder) and encopresis (bowls)
Attach evidence.
3. Barriers to learning and development: Within the school environment, learning, behavioural and social competence, and communication. Poverty, violence, physical
abuse, sexual abuse, substance abuse, neglect, poor parenting, absence of parental figure, health & wellness, trauma, etc.
1. Ask when the child started school and where?
Were there other problems in previous schools?
Ask for previous reports.
Language of previous school?
Number of failures?
When did, the child start at the school?
Where there ever any form of substance abuse?
2. Ask about behaviour or other problems at previous school. Also, include current information at our school that you know off.
Attach evidence.
4. Support strategies and intervention: Whole school development intervention, educator training and support, teaching methodology, curriculum differentiation,
classroom management, adapted assessment strategies, learning & teaching materials, LOLT, peer relationships,
therapy, emotional, health or social support, consultation with parents or caregivers, support provided by DBST, etc.
Area(s) in which Target to be Strategy of Intervention Responsible Time frame Review date Comment on progress
support is achieved person (to assess made in achieving
needed (If the learner needs concessions, or is achievement target(s)
an immigrant who needs exemptions, of the target)
use DBE124. If a medical condition
must be investigated by a medical or
other specialist, use DBE126)
Attach evidence.
Date: _______________________________ Educator signature: _______________________________
Review date: ______________________________ Parent Consent for scholastic assessment: _______________________________