INDIVIDUALIZED EDUCATION PLAN (IEP)

STUDENT NAME:

Everett

DISABILITY CLASSIFICATION:

Other Health Impairment

SCHOOL YEAR: 1st Grade PROJECTED DATE OF ANNUAL REVIEW: End of Current School Year

PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS DOCUMENTATION OF STUDENT’S CURRENT PERFORMANCE AND ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS

ACADEMIC ACHIEVEMENT, FUNCTIONAL PERFORMANCE AND LEARNING CHARACTERISTICS

LEVELS OF KNOWLEDGE AND DEVELOPMENT IN SUBJECT AND SKILL AREAS INCLUDING ACTIVITIES OF DAILY LIVING, LEVEL OF INTELLECTUAL FUNCTIONING, ADAPTIVE BEHAVIOR, EXPECTED RATE OF PROGRESS IN ACQUIRING SKILLS AND INFORMATION, AND LEARNING STYLE:

Student Strengths, Preferences, Interests

Everett is a first grader. He currently receives Specialized Academic Instruction from the Special Education Teacher outside of the classroom as well as paraprofessionals within his classroom. Everett is very social and enjoys working with peers in the classroom, sitting with them in the cafeteria and playing with them at recess. At school, he prefers to do things independently before letting a teacher help him. He is motivated by interactive activities, role playing "horse" or sports games/actions, iPad games, music, playing at recess and listening to stories. Everett follows directions and participates in classroom activities with reminders to attend and stay on task. Structured tasks/schedules with visual prompts assist his understanding of directions. Everett loves to use sign language and is very receptive to imitating signs. He also uses a speech generating device (SGD) to communicate. Using aided language helps Everett attend to target vocabulary and build his expressive language. He can identify environmental sounds such as cars, trucks, dogs barking and birds if they are close by.

Present Levels of Educational Performance Summary Include results of initial or most recent evaluation, including, if appropriate, the results of any interventions, progress monitoring and gap analyses.

Classroom Behavior

Everett enjoys being in his classroom and participating in lessons. He follows routines, directions and cues from his peers. Everett’s bathroom and morning routines are completed independently once prompted to initiate them. He participates in all classroom activities with support from special education staff to assist with initiation of tasks, monitoring for safety, prompts to stay on task and

provide accommodations. Everett watches and listens to his classroom teacher during large and small group instruction with little prompting. He will usually insists on doing things independently before receiving help from others, however, he is more cooperative when peers assist with work tasks and prompt him for transitions than adults. Refusal behaviors sometimes occur when transitioning from a desired activity/location, however, he has made progress with this this year. Verbal cues such as "first ___, then ____" and/or a visual schedule are helpful in redirecting Everett’s behaviors. When sitting near his classmates at his desk or on the carpet, Everett often requires several prompts to keep his hands to himself and/or to attend to tasks.

Academics

Reading is a general area of strength for Everett. He is able to identify 25/26 letter sounds from a choice of 4 and will match letter to picture with same beginning sound with 80% accuracy. If given a picture representing a word, Everett will identify a rhyming picture from a choice of 4 with 80% accuracy. He is able to read 12 of 20 practiced words from the core vocabulary list. When given a list of CVC words, Everett is able to decode the word by saying each sound and blending the sounds to make the word with 75% accuracy after a model and structured prompts are given. To demonstrate reading comprehension, he will identify the character and setting of a story read aloud to him with 90% accuracy from a choice of 4 visuals by referring to pictures in the story. During writing tasks, Everett is able to write his name and will dictate further writing to an adult, they will scribe so he can trace. To continue making progress toward grade level standards, Everett needs to build onto his decoding skills and comprehension of informational text.

In math, Everett is able to count sets of up to 10 objects with 90% accuracy with reminders to count "6" (he often skips this number). He also demonstrates knowledge of number identification for numbers 0-10 by stating the name of the number when shown individually. To demonstrate understanding of place value, Everett will create a representation of 2-digit numbers using base-ten blocks with 75% accuracy after a model is given. Following step by step instructions after a model, Everett will count the amount of counters for each addend in an addition problem with sums to 20 with 80% accuracy and will solve the problem with 60% accuracy. Everett needs to continue building number sense and problem solving skills in order to continue making progress toward grade level standards in math.

Motor

Everett is currently a first grade student who receives 60 minutes a week of Occupational Therapy services outside the classroom to target fine and visual motor skills to support the writing process, functional skills, and self-management routines. Everett is a sweet and helpful student inside his classroom and enjoys his peers as well as basketball, football, gaga pit, music, and PE. He talks about spending time with his family and grandparents in Texas as well his love for ice cream and horses. Everett would love to own a farm and be the best cowboy. He has worked hard to meet his goals and continues to work on increasing independence throughout his school day.

Everett enjoys drawing and writing and is consistently demonstrating drawing 3-4 details and colors in pictures with some visual prompting in 80% of opportunities. He often enjoys drawing houses, cowboys, horses, lassos and outside activities to add to his scenes. He enjoys a visual model or break down of steps when learning a new picture to support his drawings with writing. He has made nice growth in this area and continues to work on drawing more complex pictures. Depending on the assignment or picture, he continues to work on flexibility to accept feedback or keep his picture as he often erases over it and wants to recreate the scene he drew multiple times in 50% of opportunities with 2 prompts. Prompts are provided to keep his original picture and let him add additional features without crossing over his work. During writing tasks, Everett wears glasses for close up and distance and is becoming more independent in putting them on for these assignments.

Everett is also becoming more familiar with copying letters and words from a model and benefits from visual boundaries such as lines or bigger boxes to put his words into or to write below the model in 40% of opportunities. He knows all the letters in his name and can write his name with correct casing in 80% of opportunities with 1 prompt, but can skip over one of the letter /e/ in his name before going back to insert it in the correct space. Everett is also working on writing his last name. He is consistently demonstrating tracing, however is working on segmenting words and copying them down word by word to increase independence and limit too many words at a time in 40-45% of opportunities. Everett also has weekly exposure to technology in the lab and his classroom. He is turning on/off his computer as well as navigating basic key functions.

Everett navigates the school building with distant supervision and knows his routines independently. He is able to manage his clothing and self-care routines with very minimal assistance. Prompts are provided when his backpack is heavy or some of his clothing items aren’t always part of his daily routines such as some snaps, zippers, and buttons. He is self-advocating and when needed asks " help me please". In the classroom, he is opening all of his school supplies and in the cafeteria he can manage all of his lunch items in 80% of opportunities.

Everett is an enthusiastic boy who loves to engage socially with others. He enjoys learning and is curious to navigate communication in the classroom. He both enjoys and is motivated by being in class with his same aged peers. Everett is very observant and benefits from strong peer role models in his general education classroom. Everett is a true multi-modal communicator. He uses a combination of sign, verbal speech, gestures and his speech generating device (with a dynamic display screen and 60 icons per page) to communicate wants, needs, interests and to provide information about himself and things around him. Everett wears glasses. He has two pairs of glasses, a near-sighted and a far sighted pair. He has also benefited from having amplification in the classroom. His areas of interest include sports like basketball and soccer. He also loves to dance. Everett works hard to follow classroom instructions. He uses information from his peer models, visual supports in the classroom and instructions from the paraprofessional working with him to help him. Everett’s communication skills have improved over the past year. He is attempting more verbalizations and has become increasingly more creative with communicating. He has expanded to using his speech generating communication device in addition to sign and

verbal speech. Everett frequently reads the words in the speech display bar and will imitate the device after it speaks. When engaged in an activity, Everett's comments and questions are typically on topic. He enjoys labeling items when he first sees them and then will provide more information upon the request of the communication partner. Most of Everett’s verbal speech is in 1-3 word phrases and primarily consists of nouns, however he is independently using significantly more verbs and adjectives than he was last year at this time. Everett is now combining verbal speech with the use of his communication device to create more complete phrases.

Everett’s progress over the past year is as follows: Everett has made excellent progress toward his speech-language and functional communication goals over the past year. Everett worked hard to produce the initial consonants of words and is now producing the initial consonant in words with 80 percent accuracy, however he continues to leave off the ending sounds of CVC words .The reversal of consonant order ("ops" for "soap") is a previously identified speech process which is no longer occurring in Everett's verbal speech. Everett has worked hard to pair two words on his SGD. He now pairs "want" with the name of an object to request in 88 percent of opportunities. Everett will pair two words to create a comment stating "look" or "see" _____ on his speech generating device in 82 percent of opportunities. Everett continues to require reminders to use his "no" page to negate in social situations. He now uses the word "not" paired with a verb or noun in 78 percent of opportunities to negate. Everett has been working to retell a personal event or story. Everett now tells the character and setting with up to 100 percent accuracy. The kick-off or "what happened" still requires extra prompting and is inconsistent. When he does provide information about the kick-off, he will tell the verb but usually not provide a complete cause and effect scenario (e.g. It was a regular old day when _____ happened.) Everett is repairing his communication breakdowns by finding the word which is misunderstood on his speech generating communication device in 75 percent of opportunities when provided verbal cue "I didn’t understand or "huh?" His desire to engage with others and to learn has been instrumental in his progress over the past year. Everett does continue to become frustrated when others don't understand him. He may push things away or yell "no" prior to using language to explain that he needs help or wants to do something different. Everett's verbal speech continues to be significantly unintelligible to the familiar and unfamiliar listener. He continues to benefit from the use of a speech generating device to augment his verbal speech and sign. Everett's verbal speech currently exhibits several phonological processes which include: syllable reduction- /hammer/ produced "muh", consonant cluster reduction- /blue/ produced "bu", deaffrication- /cheese/ produced "ti", lateralization of /s/ and /z/, assimilation- /cup/ produced "pup" and final consonant deletion- /five/ produced "fa". With speech sound production and speech intelligibility significantly below grade level Everett continues to need targeted intervention in this area.

For connected speech using his speech generating device, Everett is most proficient with labeling, commenting and requesting using 1-3 word phrases. Everett needs to continue to increase his expressive vocabulary and phrase/sentence complexity through a combination of verbal speech and use of his speech generating communication device. His speech generating device will serve as a

visual support to learn new vocabulary and more complex sentence structures. He would also benefit from utilizing communication strategies particularly on his speech generating device to improve his social participation skills. Everett needs to work on requesting, commenting, rejecting and engaging with peers in ways other than loud vocalizations and behavior. He would benefit from learning to repair his communication breakdowns, using pre-stored phrases on his speech generating communication device to augment his verbalizations and gestures.

Student Needs and Impact of Disability

How does the student’s disability affect his involvement and progress in the general curriculum and participation in appropriate activities?

Everett has been identified as a student with an Other Health Impairment (OHI) and has a diagnosis of Down Syndrome. He needs support to further develop age appropriate language and academic skills for successful participation within the classroom. Additionally, he demonstrates delays in his gross and fine motor skills which impact his participation in the general education curriculum without direct intervention and support.

In order to make progress toward grade level standards, Everett needs to develop skills in the following areas:

-Decoding and reading comprehension

-Number sense and mathematical operations

-Increase fine and motor skills to support the writing process

-Increase self-regulation skills related to flexibility during familiar/unfamiliar routines

-Increase functional communication skills

-Increase social communication skills

Parent/Student Input According to a parent questionnaire, Everett has shown progress with potty training, independence and writing letters and numbers. His parents shared that they have noticed him advocating for himself at home as well. They would like to see Everett be less rigid and have less outbursts as well as improve recognition of sight words, addition, speech articulation. They also shared that he is motivated by sports, balls, horses, cowboys and animals.

PHYSICAL DEVELOPMENT

THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT’S MOTOR AND SENSORY DEVELOPMENT, HEALTH, VITALITY AND PHYSICAL SKILLS OR LIMITATION WHICH PERTAIN TO THE LEARNING PROCESS:

Everett uses a high-tech speech generating device to communicate. Everett demonstrates delays in his gross and fine motor skills which impact his participation in the general education curriculum without direct intervention and support.

STUDENT STRENGTHS Everett enjoys being in his classroom and participating in lessons. He follows routines, directions and cues from his peers. Everett’s bathroom and morning routines are completed independently once prompted to initiate them. He participates in all classroom activities with support from special education staff to assist with initiation of tasks, monitoring for safety, prompts to stay on task and provide accommodations. Everett watches and listens to his classroom teacher during large and small group instruction with little prompting.

PHYSICAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT: Everett benefits from frequent breaks and visual supports to improve understanding. He also benefits from sitting with his back toward the source of bright light to lessen eye-strain.

MANAGEMENT NEEDS

THE NATURE (TYPE) AND DEGREE (EXTENT) TO WHICH ENVIRONMENTAL AND HUMAN AND MATERIAL RESOURCES ARE NEEDED TO ADDRESS NEEDS IDENTIFIED ABOVE:

-reminders and cues to follow the routines, especially during transition times

-structured tasks/schedules with visual prompts assist his understanding of directions

-benefits from role playing “horse” activities/games

EFFECT OF STUDENT NEEDS ON INVOLVEMENT AND PROCESS IN THE GENERAL EDUCATION CURRICULUM OR, FOR A PRESCHOOL STUDENT, EFFECT OF STUDENT NEEDS ON PARTICIPATION IN APPROPRIATE ACTIVITIES

LRE Setting: General education class at least 80% of the time

● Time in general education environment: 84.7%

● Time outside general education environment: 15.3%

STUDENT NEEDS RELATING TO SPECIAL FACTORS

BASED ON THE IDENTIFICATION OF THE STUDENT’S NEEDS, THE COMMITTEE MUST CONSIDER WHETHER THE STUDENT NEEDS A PARTICULAR DEVICE OR SERVICE TO ADDRESS THE SPECIAL FACTORS AS INDICATED BELOW, AND IF SO, THE APPROPRIATE SECTION OF THE IEP MUST IDENTIFY THE PARTICULAR DEVICE OR SERVICE(S) NEEDED:

Does the student need strategies, including positive behavior interventions, supports and other strategies to address behaviors that impeded the student’s learning or that of others?

☐Yes ☒No

Does the student need a behavioral intervention plan? ☐Yes ☒No

For a student with limited English proficiency, does he need a special education service to address his language needs as they related to the IEP? ☐Yes ☐No ☒Not Applicable

For a student who is blind or visually impaired, does he need instruction in Braille and the use of Braille? ☐Yes ☐No ☒Not Applicable

Does the student need a particular device or service to address his communication needs?  

☒Yes ☐No

Does the student need an assistive technology device and/or service? ☒Yes ☐No If yes , does the Committee recommend that the device(s) be used in the student’s home? ☒Yes ☐No

BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE STUDENT IS AGE 15 (AND AT A YOUNGER AGE IF DETERMINED APPROPRIATE)

MEASURABLE POSTSECONDARY GOALS

LONG-TERM GOALS FOR LIVING, WORKING AND LEARNING AS AN ADULT

EDUCATION/TRAINING: EMPLOYMENT: INDEPENDENT LIVING SKILLS (WHEN APPROPRIATE):

TRANSITION NEEDS

In consideration of present levels of performance, transition service needs of the student that focus on the student's courses of study, taking into account the student’s strengths, preferences and interests as they relate to transition from school to post-school activities:

MEASURABLE ANNUAL GOALS

THE FOLLOWING GOALS ARE RECOMMENDED TO ENABLE THE STUDENTS TO BE INVOLVED IN AND PROGRESS IN THE GENERAL EDUCATION CURRICULUM, ADDRESS

OTHER EDUCATIONAL NEEDS THAT RESULT FROM THE STUDENT’S DISABILITY, AND PREPARES THE STUDENT TO MEET HIS/HER POSTSECONDARY GOALS.

ANNUAL GOALS

WHAT THE STUDENT WILL BE

EXPECTED TO ACHIEVE BY THE

END OF THE YEAR IN WHICH THE IEP

IN EFFECT

CRITERIA

MEASURE TO DETERMINE IF

GOAL HAS BEEN ACHIEVED

METHOD

HOW PROGRESS WILL BE

MEASURED

SCHEDULE

WHEN PROGRESS WILL BE

MEASURED

Reading: When given 10 words individually containing CVC and beginning blends (wh-, sh-, ch-, th-), Everett will decode the words by blending the sounds with 80% accuracy in 2 out of 3 sessions.

Focused Assessments

80% accuracy

1 time per quarter

Reading: After having an informational text read aloud to him, Everett will identify the main idea and 2 details from the text with 75% accuracy in 4 out of 5 opportunities

Focused Assessments

75% accuracy

1 time per quarter

Mathematics: After a math story problem involving adding single digit numbers to 10 is read aloud to him, Everett will follow structured steps to draw/make

Focused Assessments

75% accuracy

1 time per quarter

the equation and solve the problem with 75% accuracy in 3 out of 4 trials.

Mathematics: Everett will demonstrate awareness of place value and number relationships by verbally skip counting by 5s, 10s, and 100s with 100% accuracy in 2 out of 3 opportunities.

Focused Assessments

100% accuracy

1 time per quarter

Physical Motor: In order to support the classroom writing process, Everett will print letters using a visual model or guide with no more than 2 prompts in 80% of opportunities during the following tasks:

a) Familiar words

b) Novel words

c) Last name

80% of recorded opportunities with no more than 2 prompts

Monitor and chart progress

1 time per quarter

Communication: Everett will improve his speech sound production through progress toward the following objectives. Everett will produce the final sound on CVC words in 80 percent of opportunities when

in 80 percent of opportunities when provided a gesture prompt.

Monitor and Chart Progress

1

time per quarter

provided a gesture prompt. Everett will produce the final sound of CVC words in a two word phrase in 80 percent of opportunities when provided a gesture prompt.

Communication: Everett will include more variable vocabulary in his phrases as demonstrated through the following objectives. Everett will independently produce (10) 2-3 word phrases which include a correct pronoun per session. Everett will produce (10) 2-3 word phrase which includes a question word per session.

10 times per session

Monitor and Chart Progress

1 time per quarter

Communication: Everett will improve his social language skills as demonstrated through the following objectives.

5 times during session

Monitor and Chart Progress

1 time per quarter

Everett will provide an opinion to contribute to a conversation (e.g. like, dislike, me too, etc.) 5 times during a session when provided a verbal cue.

Communication: Everett will improve his expressive vocabulary with an improved retell as demonstrated by the following objectives. a) Everett willprovide the characterand setting (e.g. Thisstory is about a ____in a ____.) in 80percent ofopportunities whenprovided a visual cue.b) Everett willprovide informationabout the story priorto the main event(e.g. In the beginning______.) in 80percent ofopportunities whenprovided a visual cue.c) Everett will

in 80 percent of opportunities when provided a visual cue.

Monitor and Chart Progress

1 time every quarter

provide information about the kick-off or main event (e.g. Until all of a sudden ______.) in 80 percent of opportunities when provided a visual cue.

Social\Emotional Wellness: Everett will demonstrate increased ability to participate in school activities and routines throughout the school day through the following objectives; a) Everett willcomply or participatein non-preferredactivities for 5minutes beforereceiving preferredactivity with less than3 prompts from staffin 4 out of 5occasions.

b) After a visualprompt is given,Everett will showflexibility within anactivity by using apre-taught strategy(i.e. saying "ok"instead of "no",requesting nextactivity or asking forhelp/break, etc.) withless than 3 prompts

less than 3 prompts Monitor and Chart Progress

1 time every quarter

from staff in 4 out of 5 occasions

REPORTING PROGRESS TO PARENTS

Identify when periodic reports on the student's progress toward meeting the annual goals will be provided to the student’s parents: at the same time school report cards are issued

RECOMMENDED SPECIAL EDUCATION PROGRAMS AND SERVICES

SPECIAL EDUCATION PROGRAM/SERVICES

SERVICE DELIVERY RECOMMENDATIONS*

FREQUENCY HOW OFTEN PROVIDED

DURATION LENGTH

OF SESSION

LOCATION WHERE SERVICE WILL BE

PROVIDED

PROJECTED BEGINNING/

SERVICE DATES

SPECIAL EDUCATION PROGRAM:

Special Education Teacher

Special Education Teacher

Direct

Indirect

2 time(s) per week

At least 1 time per month

60 minutes

30 minutes

Special Education Classroom

Special Education Classroom

1 year ago

1 year ago

RELATED SERVICES:

Speech-Language Therapy

Occupational Therapy

Direct

Direct

3 times per week

1 time per week

30 minutes

60 minutes

Outside General Education Classroom

Outside General

Education Classroom

1 year ago

1 year ago

Personal Care

Direct

daily

20 minutes

bathroom

1 year ago

SUPPLEMENTARY AIDS AND SERVICES/PROGRAM

MODIFICATIONS/ ACCOMOD ACTIONS:

● Preferential seating ● Sitting close to source

of instruction and away from distracting peers/materials

● Sitting with a clear, uninterrupted visual sweep of speaker and visuals

● Sit with his back towards the source of right light to enhance speech-reading opportunities and lessen eye strain

● Frequent checks for understanding

● Consistent access to a high-tech speech generating communications device across his day

● Adult and peer models on a speech generating device

● Provide language and social models utilizing the speech generating communication device

● Consistent access to his speech

daily

General education classroom

Special education classroom

1 year ago

● Redirection/prompts to maintain focus and tasks

● Shortened directions, repeated to ensure comprehension

● Frequent breaks, shortened assignments/tasks

● Visual supports to improve understanding of directions

● Frequent reinforcement to encourage expected behaviors

● Continued practice of sight word recognition during reading activities

● Adapted/modified homework to increase and compliance independence at home

ASSISTIVE TECHNOLOGY DEVICES AND/OR SERVICES:

Everett uses a high-tech speech generating device to communicate

daily

General Education Classroom

Special Education Classroom

Home

1 year ago

SUPPORTS FOR SCHOOL PERSONNEL ON BEHALF OF THE STUDENT: Paraprofessional

daily

General Education Classroom

1 year ago

*Identify, if applicable, class size (maximum student to staff ratio), language if other than English, group or individual services, direct and/or indirect consultant teacher services or other service delivery recommendations.

12-MONTH SERVICE AND/OR PROGRAM- Student eligible to receive special education services and/or program during July/August ☐Yes ☒No

If yes: ☐Student will receive the same special education program/services as recommended above.

☐ Student will receive the following special education program services:

SPECIAL EDUCATION PROGRAM/SERVICES

SERVICE DELIVERY RECOMMENDATIONS*

FREQUENCY

DURATION

LOCATION

PROJECTED BEGINNING/ SERVICE DATES

TESTING ACCOMMODATIONS (TO BE COMPLETED FOR PRESCHOOL CHILDREN ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL CHILDREN): INDIVIDUAL TESTING ACCOMMODATIONS, SPECIFIC TO THE STUDENT’S DISABILITY AND NEEDS, TO BE USED CONSISTENTLY BY THE STUDENT IN THE RECOMMENDED EDUCATIONAL PROGRAM AND IN THE ADMINISTRATION OF DISTRICT-WIDE ASSESSMENTS OF STUDENT ACHIEVEMENT AND, IN ACCORDANCE WITH DEPARTMENT POLICY, STATE ASSESSMENTS OF STUDENT ACHIEVEMENT.

TESTING ACCOMMODATIONS

CONDITIONS*

IMPLEMENTATION RECOMMENDATIONS**

☐None

● Auditory Presentation: Human Reader/Text-to Speech

● Assistive Technology (Provide specific detail in text box)

● Extended time (double time)

on all assessments

Double time

● Small Group Setting

● Human Scribe

*Conditions- Test Characteristics: Describe the type, length, purpose of the test upon which the use of testing accommodations is conditioned, if applicable. **Implementation Recommendations: Identify the amount of extended time, type of setting, etc., specific to the testing accommodations, if applicable.

BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE STUDENT IS AGE 15 (AND AT A YOUNGER AGE, IF DETERMINED APPROPRIATE).

COORDINATED SET OF TRANSITION ACTIVITIES

NEEDED ACTIVITIES TO FACILITATE THE

STUDENT’S MOVEMENT FROM SCHOOL TO POST-

SCHOOL ACTIVITIES

SERVICE/ACTIVITY

SCHOOL DISTRICT/AGENCY

RESPONSIBLE

Instruction

Related Services

Community Experiences

Development of Employment and Other Post-school Adult Living Objectives

Acquisition of Daily Living Skills (if applicable)

Functional Vocational Assessment (if applicable)

PARTICIPATE IN STATE AND DISTRICT-WIDE ASSESSMENTS (TO BE COMPLETED FOR PRESCHOOL STUDENTS ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR

NONDISABLED PRESCHOOL STUDENTS)

☐The student will participate in the same State and district-wide assessments of student achievement that are administered to general education students.

☒The student will participate in an alternate assessment on a particular State or district-wide assessment of student achievement.

PARTICIPATION WITH STUDENTS WITHOUT DISABILITIES

REMOVAL FROM THE GENERAL EDUCATION ENVIRONMENT OCCURS ONLY WHEN THE NATURE OR SEVERITY OF THE DISABILITY IS SUCH THAT, EVEN WITH THE USE OF SUPPLEMENTARY AIDS AND SERVICES, EDUCATION CANNOT BE SATISFACTORILY ACHIEVED.

FOR THE PRESCHOOL STUDENT:

Explain the extent, if any, to which the student will not participate in appropriate activities with age-appropriate nondisabled peers (e.g., percent of the school day and/or specify particular activities):

FOR THE SCHOOL-AGE STUDENT:

Explain the extent, if any, to which the student will not participate in regular class, extracurricular and other nonacademic activities (e.g. percent of the school day and/or specify particular activities): Speech therapy sessions

If student is not participating in a regular physical education program, identify the extent to which the student will participate in specifically-designed instruction in physical education, including adapted physical education:

EXEMPTION FROM LANGUAGE OTHER THAN ENGLISH DIPLOMA REQUIREMENT:

☒No ☐Yes – The Committee has determined that the student’s disability adversely affects his/her ability to learn a language and recommends the student be exempt from the language other than English requirement.

SPECIAL TRANSPORTATION

TRANSPORTATION RECOMMENDATION TO ADDRESS NEEDS OF THE STUDENT RELATING TO HIS/HER DISABILITY

☒ None. ☐Student needs special transportation accommodations/services as follows: ☐Student needs transportation to and from special classes or programs at another site:

ATTENDANCE PAGE

PLEASE NOTE THAT YOUR SIGNATURE REFLECTS YOUR PARTICIPATION AT THE CONFERENCE AND DOES NOT NECESSARILY INDICATE AGREEMENT WITH THE INDIVIDUALIZED EDUCATION PROGRAM.

ROLE (INDICATE IF BILINGUAL)

NAME SIGNATURE

Related Service Provider/ Special Education Teacher

General Education Teacher

Parent/Legal Guardian

District Representative

Speech Language Therapist