School-Based Music Therapy Session Note (IEP-Linked)

Student Name: [Student name]

Student ID: [Student ID]

Date of Service: [MM/DD/YYYY]

Session Type: [Individual / Group / Co-treatment / Consult / Make-up / No session]

Location: [Location]

Service Minutes: [Planned minutes] planned; [Delivered minutes] delivered

Provider: [Provider name, credentials]

Session Status

Status: [Provided as scheduled / Provided partially / Not provided]

If not provided or student absent: [Reason for missed or partial session] (Do not document interventions or data for sessions that did not occur.)

Follow-up Actions: [Actions taken to address missed session]

Make-up Planned: [Yes / No / Pending] — [Planned date or window if known]

IEP Linkage

Objectives Targeted This Session:

• Objective: [Objective text or reference ID]

  Mastery Criterion: [Criterion for mastery]

  Measurement Method: [Measurement method per IEP]

  Status: [Addressed / Planned but not addressed]

  Rationale if Not Addressed: [Brief reason] (Only include if not addressed.)

• (Repeat for each objective targeted.)

IEP Accommodations Used: [Accommodations utilized this session]

Session Supports (non-IEP): [Session-specific supports not in IEP] (Only include if applicable.)

Session Summary

[Session focus statement linking planned focus to IEP objective(s); note immediate factors such as schedule changes, fatigue, or peer dynamics] (1–3 sentences.)

• Objective: [Objective text or ID]

  Intervention(s): [Music therapy method; materials/instruments; prompting level; adaptations]

  Student Response: [Observable engagement, communication, regulation, and skill performance; supports required; generalization observations if probed] (Include brief direct quotes only if clarifying motivation, refusal, or distress.)

• (Repeat for each objective addressed.)

Progress Data

• Objective: [Objective text or ID]

  Opportunities/Trials: [Number]

  Correct/Independent Responses: [Number] ([Percentage]%)

  Prompt Level Distribution: [Independent: #; Gesture: #; Verbal: #; Model: #; Physical: #] (Include only levels used.)

  Duration/Latency: [Value and units] (Only include if relevant to objective.)

  Data Integrity Notes: [Interrupted trials, environmental disruptions] (Only include if applicable.)

  If quantitative probes not feasible: No formal probes collected — [Rationale]. Qualitative indicators observed: [Observable indicators].

• (Repeat for each targeted objective. Do not leave this section blank.)

Plan

Targets for Next Session: [Objective(s) to prioritize]

Intervention Adjustments: [Planned changes to materials, prompting, pacing, or supports]

Measurement Plan: [What will be measured and method]

Preparation/Coordination: [Materials to prepare; team coordination items] (Only include if applicable.)

Signature

Provider Signature: [Signature]

Credentials: [Credentials]

Date Signed: [MM/DD/YYYY]