county school district individual educational plan (iep ... › 3852926d › files...is the student...

Student:

PEER Downloadable Form (Rev. 07/13) of 13

County School DistrictIndividual Educational Plan (IEP)-

General InformationDate of IEP Meeting: School:

Student Name:

Address:

DOB:

Grade:

Primary Exceptionality:

Student Number:

Previously Amended:

Age:

Reevaluation Due Date:

Other Program and Service Areas:

Initiation Date of IEP:

Purpose of Meeting:

Review Due Date:

A copy of the IEP was provided to the parent:at the meetingother (describe):

Duration Date:

Parent/Guardian:

If there is not a FBA/BIP, describe positive behavioral interventions, strategies and supports considered in the development of this IEP.

Does the student's behavior impede his/her learning or the learning of others?

If yes, does the student have a functional behavior assessment (FBA) and/or behavior intervention plan (BIP)?

Yes No

Special ConsiderationsIn considering the following factors, if the IEP team determines that a student needs a particular device or service, including an intervention, accommodation, or program modification, the IEP must include a statement to that effect in the development of the IEP

Yes No

If yes, is instruction in Braille or the use of Braille appropriate?

Does the student have limited English proficiency?

Is the student blind or visually impaired?

Does the student have communication needs? If yes, those needs must be addressed in this IEP.

Is the student deaf or hard-of-hearing?

If yes, what opportunities for direct communication with peers and professionals in the student's language are needed?

Yes No

Yes No

Yes No

Yes No

Yes No

If yes, what opportunities for direct instruction in the student's language are needed?

Yes No

Yes No Does the student require instruction or the provision of information in the area of self-determination to be able to actively participate in IEP meetings and self-advocate?

Does the student need assistive technology devices or services?

If yes, describe how the student's language needs are being addressed.

N/A

Student:


Standard Diploma Special Diploma, Option 1 Special Diploma, Option 2

The student is pursuing a course of study leading to:

Diploma Option

DomainsThe student's needs that result from his or her disability are addressed through the following domains or transition service activities areas:

Transition Service Activity Areas:Curriculum and Learning Environment

Independant Functioning

Communication

Social/Emotional Behavior

Health Care

Instruction

Related Services

Community Experience

Employment

Post-School Adult Living

Daily Living, if appropriate

Functional Vocational Evaluation, if appropriate

Domains:

Parent input was obtained through:

N/A

Health concerns:

Results of statewide or districtwide assessments (e.g. Florida Comprehensive Achievement Test; Florida Alternate Assessment):

Results of the initial or most recent evaluation (district and/or independent):

General Factors and Assessment Data

Interagency responsibilities or linkages, if needed:

The parents' concerns for enhancing the education of the student:

Student:


Transition ComponentsHow was student input obtained?

What is/are the student's measurable postsecondary goal(s) related to postsecondary education and/or training?

What is/are the student's measurable postsecondary goal(s) related to employment?

What is/are the student's measurable postsecondary goal(s) related to independent living (where appropriate)?

Describe the student's course of study (such as participation in advanced placement courses or a career and technical education program):

At least one year prior to the student's eighteenth birthday, the student was informed of his or her rights under Part B of the Individuals with Disabilities Education Act (IDEA 2004) that will transfer from the parent to the student on reaching the age of majority, which is eighteen years of age.

Transfer of Rights

A separate and distinct notice of the transfer of rights was provided closer to the time of the student's eighteenth birthday.

Yes NA

Yes NA

Additional information as appropriate (e.g. date of receipt; initials documenting receipt)

Student:


Information on transition needs and/or self-determination is included here as appropriate. Present Level of Academic Achievement and Functional Performance

Describe the strengths of the student.Domain / Transition Service:

Describe the levels of achievement and functioning based on classroom data, including observations, work samples, and age appropriate transition assessments (if appropriate).

Describe how the student's disability affects the student's involvement and progress in the general curriculum.

Annual Goals and Short-Term Objectives or BenchmarksGoal:

Graded Work Sample

Mastery Criteria:

Assessment Procedures:

Progress Reports will be sent every:

% Accuracy; ofFor minutes(s); opportunities; Other:

Teacher Developed Checklist or Chart

Test(s): Teacher and/or Standardized

Student Work Product

Interview with:

Curriculum Based Assessments

Documented Observation

Other:

Short-term Objective or Benchmark:




Number of Additional Goal Pages:

Student:


Assessment

For Students Participating in Alternate Assessments

Does the student have a significant cognitive disability? Is the student unable to master the grade-level general state content standards, pursuant to Rule 6A-1.09401, F.A.C., even with appropriate and allowable instructional accommodations, assistive technology, or accessible instructional materials?

Does the student require direct instruction academics based on access points, pursuant to Rule 6A-1.09401, F.A.C., in order to acquire, generalize, and transfer skills across settings?

For Students Participating in Assessments with Accommodations

Yes No

Yes No

Yes No

Yes No

Is the student participating in a curriculum based on the state standards access points, pursuant to Rule 6A-1.09401, F.A.C., for all academic areas?

Describe why the Florida Alternate Assessment and/or the alternate district assessment(s) is/are appropriate.

The IEP team is responsible for determining whether a student with a disability will be assessed with the general statewide assessment or with the Florida Alternate Assessment. The decision is based on the criteria found in Rule 6A-1.0943(4), F.A.C.. The team may only determine that an alternate assessment is appropriate if the statements below accurately characterize the student’s current educational situation. If the decision of the IEP team is to assess the student through alternate assessment, the parent must be notified of the implications of that decision, including that the student cannot earn a standard diploma. In accordance with rule 6A-1.0943(4), F.A.C., an IEP team may only select the Florida Alternate Assessment for a student if the answers to the following statements are "yes" (Y).

Assessment accommodations may be used only if they do not alter the underlying content that is being measured by the assessment or negatively affect the assessment's reliability or validity. Only accommodations allowed by individual test administration manuals may be implemented on standardized tests. In accordance with Rule 6A-1.0943, Florida Administrative Code, the need for any unique accommodationsfor use on state assessments must be approved by the Commissioner of Education.

N/A for student's current grade

The student will participate in the General Statewide Assessment and/or End of Course assessment(s) without accommodations.

The student will participate in the General Statewide Assessment and/or End of Course assessment(s) with accommodations.

The student will participate in the Florida Alternate Assessment

Each student must participate in the general statewide assessment (GSA) and/or course-specific end of course (EOC) assessment(s), without accommodations, unless determined otherwise by the IEP team in accordance with Rule 6A-1.0943, F.A.C. Based on the nature and impact of this student's disability and educational program, the following has been determined:

If known, the GSA and/or EOC assessment the student will take:

A parent has provided consent for classroom/instructional accommodations not allowed on statewide assessment. Yes N/A

The IEP Team has made the decision to assess this student using the state standards access points. By receipt of the IEP, the parent has been notified that the implication of this decision is that the student will not be eligible for a standard high school diploma.

Yes No

All students must be afforded the opportunity to participate in districtwide assessment. Identify below the alternate district assessment(s) to be administered to this student. If none will be administered, indicate with "N/A."

Assessment AccommodationsPlease identify which accommodation(s), if any, will also used as an assessment accommodation. Please refer to the most current test administration manual. Be sure to check the accommodations the student is currently using. (Check all that apply.)Presentation

Signed presentation of directionsSigned presentation of items and answer choicesOral presentation of directionsOral presentation of items and answer choicesDirections repeated, clarifiedStudent to demonstrate understanding of directions Verbal encouragement

Leveled booksNote-taking assistanceRecorded books and text recordingsSimplified or graphic directionsSelf instruction or self-questionsSample problems and tasksVerbal description of images or reading descriptive text provided

Student:


Word recognition and comprehension supports

Regular printLarge printBraille documentReading passage booklet

DescriptionPaper-based Presentation Options The student is eligible to receive paper-based accommodations if one

or more of the following is/are true:

Paper-based testing requirementThe student cannot access assessment on the computerThe student requires an accommodation that cannot be implemented in conjunction with a computer-based administration

The student is hospitalized/homebound

The student has a flexible scheduling/extended time accommodation that required testing one session over more than one day

Straightedge to maintain or enhance visual attention to test itemsPortions of the assignment masked to direct attention to uncovered itemPositioning tools such as a book stand or page holderColored transparencies or overlaysWorkbooks secured to the work areaHighlighter to mark key phrases or words in directions and passages

Computer-based Presentation OptionsLarge print fontColor contrastZoom

Screen readerColored plastic transparency filters placed over the computer screen; eyeglasses with colored lenses

Responding OptionsMouse, keyboard or assistive technology using either device to indicate answers

Written, signed or verbal responses by student entered on the computer by administrator or proctor

Indicate type of response

Computer switch, pointing device or other communication device to indicate answers

Indicate type of device

Indicate type of deviceAssistive devices to access the keyboard

Answers entered directly in the work booklet if a separate sheet is usedBraille responses on a separate answer sheetPencils, pencil grips, crayons, spacers or other handwriting supportsSlant boardPhysical support or positioningAlphabet stripsDictionaries and thesaurusesOrganizers, outlines, checklists and other writing supports

Periodic check by administrator to be sure student is entering answer choices correctly

Spelling and grammar checks

Mathematics grids/guides to organize mathematical computation

Scheduling Options

Specific sessions administered at specific time of dayDescription

Assignments administered over several brief sessions, allowing frequent breaks

Extended timeDescription

Time management tools like checklists, planners or visual schedulesEstablished timelines and/or predictable routines

Setting Options

Assignments or tests administered in a familiar place

Assignments or tests administered individually

Assignments or tests administered by a familiar person who has been appropriately trained

Assignments or tests administered in a small group setting of a size comparable to the normal instruction group size

Describe group size:Special lighting

Description

Adaptive or special furnitureDescription

Special acoustics, such as FM system or special roomDescription

Increased opportunity for movementDecreased opportunity for movementReduced stimuliWhite noise (sound machines) or approved music to reduce auditory distractions

DescriptionPhysical access

Preferential seatingCompartmentalized containers and binders

Other Assistive Device OptionsVisual magnification device

DescriptionAuditory amplification device

DescriptionReal coinsAbacus or product such as Graphic Aid for Mathematics, Math Window or geoboard (students with visual impairments only)

Description

English/sign language or sign language/English language dictionary; sign picture, word, synonyms, and index only; no definitions (students who use sign language as their primary means of communication only)

Other assistive technology typically used by the student in classroom instruction, provided the purpose of the assignment is not violated

Description

Light boxAdapted calculator, raised number line, or Braille ruler (students with visual impairments only)

Other

Other

Other

Other

Student:


Unique AccommodationsIn accordance with Rule 6A-1.0943, FAC, school districts may request unique accommodations for individual students with disabilities. Each unique accommodation must be approved by the Commissioner of Education prior to its use. Written requests for unique accommodations must be submitted by using the Unique Accommodations Request Form. Accommodation requests must be reviewed by district level staff before being sent to the FDOE. In addition, the signatures of both the district ESE coordinator and the district assessment coordinator are required.

The IEP teams is not requesting unique accommodations

The IEP team will submit a request for the following unique accommodation(s) to district level staff for consideration

Special Education Services

LocationFrequencyDurationInitiationSpecially Designed Instruction

Related Services The team considered the need to related services and determined none are needed at this time.

Supplementary Aids and Services The team considered the need to related services and determined none are needed at this time.

Extended School Year Services The team considered the need to related services and determined none are needed at this time.

Student:


The IEP team has considered the following guiding questions prior to the selection of the accommodations

Classroom/Instructional Accommodations

1. What instructional and assessment tasks are difficult for the student to do independently? Are these difficulties documented in the present level statement? 2. Why are these tasks difficult for the student? 3. What accommodations will allow the student to access the information and demonstrate performance of the tasks? 4. How will the IEP team know if the accommodations is effective?

PresentationSigned presentation of directionsSigned presentation of items and answer choicesOral presentation of directionsOral presentation of items and answer choicesDirections repeated, clarifiedStudent to demonstrate understanding of directions Verbal encouragementLeveled booksNote-taking assistanceRecorded books and text recordingsSimplified or graphic directionsSelf instruction or self-questionsSample problems and tasksVerbal description of images or reading descriptive text providedWord recognition and comprehension supports

Description

LocationFrequencyDurationInitiation

Regular printLarge printBraille documentReading passage booklet

Paper-based Presentation Options

Straightedge to maintain or enhance visual attention to test itemsPortions of the assignment masked to direct attention to uncovered itemPositioning tools such as a book stand or page holderColored transparencies or overlaysWorkbooks secured to the work areaHighlighter to mark key phrases or words in directions, items and passages

Computer-based Presentation OptionsLarge print fontColor contrastZoomScreen readerColored plastic transparency filters placed over the computer screen; eyeglasses with colored lenses



Responding OptionsMouse, keyboard or assistive technology using either device to indicate answers

Written, signed or verbal responses by student entered on the computer by administrator or proctor

Indicate type of response

Computer switch, pointing device or other communication device to indicate answers

Indicate type of device

Indicate type of deviceAssistive devices to access the keyboard

Answers entered directly in the work booklet if a separate sheet is usedBraille responses on a separate answer sheetPencils, pencil grips, crayons, spacers or other handwriting supportsSlant boardPhysical support or positioningAlphabet stripsDictionaries and thesaurusesOrganizers, outlines, checklists and other writing supports

Periodic check by administrator to be sure student is entering answer choices correctly

Spelling and grammar checks

Mathematics grids/guides to organize mathematical computation


Student:


Scheduling Options

Specific sessions administered at specific time of dayDescription

Assignments administered over several brief sessions, allowing frequent breaks

Extended timeDescription

Time management tools like checklists, assignment planners or visual schedulesEstablished timelines and/or predictable routines


Setting OptionsAssignments or tests administered in a familiar place

Assignments or tests administered individually

Assignments or tests administered by a familiar person who has been appropriately trained

Assignments or tests administered in a small group setting of a size comparable to the normal instruction group size

Describe group size:Special lighting

DescriptionAdaptive or special furniture

DescriptionSpecial acoustics, such as FM system or special room

DescriptionIncreased opportunity for movementDecreased opportunity for movementReduced stimuliWhite noise (sound machines) or approved music to reduce distractions

DescriptionPhysical accessPreferential seatingCompartmentalized containers and binders


Other Assistive Device OptionsVisual magnification device

DescriptionAuditory amplification device

DescriptionReal coinsAbacus or product such as Graphic Aid for Mathematics, Math Window or geoboard (students with visual impairments only)

Description

English/sign language or sign language/English language dictionary; sign picture, word, synonyms, and index only; no definitions (students who use sign language as their primary means of communication only)

Other assistive technology typically used by the student in classroom instruction, provided the purpose of the assignment is not violated

DescriptionLight boxAdapted calculator, raised number line, or Braille ruler (students with visual impairments only)


Other

Other

Other

Other

Other

Other


Student:


Least Restrictive EnvironmentSome IEPs are developed to include more than one placement. For example, adding or deleting an ESE course as the student moves from one semester or school year to the next may change time with nondisabled peers enough to cause a change in placement. If the IEP team knows that a change in placement will occur during the duration of the IEP being developed, an explanation for each of the placements should be included. Add an additional least restrictive environment (LRE) page if the student's placement will change during this IEP.

(Supports required for the student to advance appropriately toward attaining goals, be involved and progress in the general education curriculum, and to be educated and participate with other students.)

Supports for school personnel (describe):

Person responsible for transition services follow-up (can be identified by title):

Explain the extent, if any, to which the student will not participate with nondisabled students in the general education class, extra-curricular and non-academic activities:

Initiation Date

Duration Date

LRE for children ages 3 through 5:The child receives minutes of special education and related services per week.

Does the child ever attend any regular early childhood program (at least 50% nondisabled children)? Examples include, but are not limited to, Head Start; public or private kindergarten; public or private preschool programs, including Voluntary Prekindergarten (VPK); child development centers; and group child care centers.

Yes No

Are the majority of the child’s special education and related services provided inside or outside the regular early childhood program setting? (Skip this question if the child attends an early childhood exceptional student education (ESE) program.)

Inside (K) Outside (M)

Yes, the child attends an early childhood exceptional student education (ESE) program at a regular school campus or community based setting (L)

Yes, the child attends an early childhood exceptional student education (ESE) program in a separate school designed specifically for children with disabilities (S)

Yes, the child attends an early childhood exceptional student education (ESE) program in a residential school or residential medical facility on an inpatient basis (B)

No, the child does not attend an early childhood exceptional student education (ESE) program and receives all of his or her special education and related services at home (principal residence of the child’s parents or caregivers), including children who receive services both at home and in a service provider location (A) No, the child does not attend an early childhood exceptional student education (ESE) program and receives all of his or her special education and related services at a service provider, including but not limited to a private clinician’s office, a clinician’s office located in a school building, a hospital facility on an outpatient basis, library or other public location (J)

Does the child attend an early childhood exceptional student education (ESE) program? (Skip this question if the child attends a regular early childhood program.)

Student:


Accessibility and ImplementationYes The IEP is accessible to each of the student's teachers who are responsible for implementation and each teacher of the student has

been informed of the specific responsibilities related to implementing the IEP.

Transfer of Rights

At least one year prior to the student's eighteenth birthday, the student was informed of his or her rights under Part B of the Individuals with Disabilities Education Act (IDEA 2004) that will transfer from the parent to the student on reaching the age of majority, which is eighteen years of age.A separate and distinct notice of the transfer of rights was provided closer to the time of the student's eighteenth birthday.

Yes N/A

N/AYes

Number of Additional LRE Pages:

LRE for students ages 6 through 21:The student's time in total school week is minutes. Time is bell to bell and includes time in on-the-job training (OJT) programs.

The student's time with nondisabled peer is minutes. Include class time, lunch, recess, time between classes and for OJT, time with work place peers if this time is spent with nondisabled peers.

Inside the regular class 80% or more of the day (regular level)

Inside the regular class no more than 79% of day and no less than 40% of the day (resource level)

Inside regular class less than 40% of the day (separate level)

___%

___%

___%

The student receives his or her educational services in a:

Regular public school, including traditional, magnet, or charter school (Z)

Correction facility (C)

Separate school (D)

Residential facility (F)

Home/hospital (H)

Private school (P)

None of the above (Z)If none of the above, describe the setting/location here (e.g., IAES provided in a public library, school district office, school building after hours, etc.):

Student:


Conference Notes:

Student:


Meeting Participants

Student Name:

Purpose of Meeting:

Student ID:

Date of Meeting:

The signatures below represent individuals who were in attendance at the meeting and participated in the development of the IEP. Pre-printed names alone represent individuals who participated in the meeting via conference phone call, video conferencing, or other off-site participation. Hand-printed names with the statement “written input” represent individuals who provided written input to the team regarding the student.

Parent/Guardian Signature Date

General Education Teacher Signature Date

Special Education Teacher / ESE Service Provider/ Teacher of the Gifted

Signature Date

LEA Representative Signature Date

Interpreter of Instructional Implications ofEvaluation Results

Signature Date

Administrator Signature Date

Other Agency Representative Signature Date

Other Signature Date




Student Signature required if 14 years or older Date

Describe how a copy of the IEP was provided to the parent:

county school district individual educational plan (iep ... › 3852926d › files...is the student...

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