Well, going from what I assume she needs, this would be your regular lesson plan format, but you would include any accomodations needed. You would make the accomodations for below level, on level, and above level, as a basic guideline. Since she can't give you a format, I'd either use columns, or Just subhead each section to include your accomodations for each. I haven't done a formal lesson of this particular nature, but I have done them for special education, and for inclusive education, and this is as far as we're required to go.
EXAMPLE:
Below Level On Level Above Level
I.Focus/Warm-up
II.Statement of Objective(s)
III.Materials
IV. Vocabulary
V.Introduction and Developmental Activities
VI.Guided Practice
VII.Independent Practice
VIII.Assessment
IX.Closure
Or add a section that provides for accomodations for the lesson, after the activities.
Hope that helps some!. I'll PM you an actual sample
