iep

INDIVIDUALIZED EDUCATION PROGRAM (CONFERENCE SUMMARY REPORT)

DATE OF MOST RECENT EVALUATION: 12/10/12 DATE OF NEXT REEVALUATION: 3/6/2014

PURPOSE OF CONFERENCE (Check all that apply)

X Review of Existing Data Reevaluation X IEP Review/Revision Manifestation Determination Termination of Placement

Initial Eligibility Initial IEP Transition Graduation Other (e.g. FBA/BIP)________

STUDENT IDENTIFICATION INFORMATIONSTUDENT’S ADDRESS (Street, City, State, Zip Code) 123 DisneyWorld DriveOrlando, FL. 32801

STUDENT’S DATE OF BIRTH 7/27/1996

SIS ID NUMBER741-85-2963

X MALE

FEMALE

ETHNICITY14 - African American

LANGUAGE/MODE OF COMMUNICATION USED BY STUDENT000 - English

CURRENT GRADE LEVEL11

ANTICIPATED DATE OF HS GRADUATION6/2014

PLACEMENT(To be completed after placement determination)

X YES NO Placement is in Resident School

DISABILITY(S) Specific Learning Disability

MEDICAID NUMBER

RESIDENT DISTRICT SERVING DISTRICT WDS555

RESIDENT SCHOOL SERVING SCHOOL

DisneyWorld High

PARENT/GUARDIAN INFORMATION(1) PARENT’S NAME Educational Surrogate Parent Mickey Mouse

(2) PARENT’S NAME Educational Surrogate Parent

(1) PARENT’S ADDRESS (Street, City, State, Zip Code) 123 DisneyWorld DriveOrlando, FL. 32801

(2) PARENT’S ADDRESS (Street, City, State, Zip Code)

(1)PARENT’S TELEPHONE NUMBER (include Area Code)(800)4DISNEY

(2) PARENT’S TELEPHONE NUMBER (Include Area Code)

(1) LANGUAGE/MODE OF COMMUNICATION USED BY PARENT(S)

Yes XNo Interpreter

(2) LANGUAGE/MODE OF COMMUNICATION USED BY PARENT(S)

Yes No Interpreter

PARTICIPANTS

Signature indicates attendance. Check appropriate boxes to indicate which meetings were attended. Anyone serving in a dual role should indicate so on the following lines. If a required participant participates through written input or is excused from all or part of the IEP meeting, the required excusal and written report, as necessary, is attached.

ELIG.REVIEW IEP

ELIG.REVIEW IEP

X Mickey Mouse X Daisy Duck

Parent School Social Worker

X Minnie Mouse

Step Parent Speech-Language Pathologist

X MG

Student Bilingual Specialist

X GOOFY

LEA Representative Interpreter

X Pluto

General Education Teacher Other (specify)

X Gina Cernyar

Special Education Teacher Other (specify)

School Psychologist Other (specify)

If the parent(s) did not attend the IEP meeting, document the attempts to contact the parent(s) prior to the IEP meeting.

PROCEDURAL SAFEGUARDS

Explanation of Procedural Safeguards were provided to/reviewed with the parent(s) on 3/7/2013

Transfer of Rights - Seventeen-year old student informed of his/her rights that will transfer to the student upon reaching age 18. Yes X NA

Parent(s) were given a copy of the: Evaluation report and eligibility determination X IEP

District’s behavioral intervention policies District’s behavioral intervention procedures (initial IEP only)

PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Complete for initial IEPs and annual reviews.

When completing this page, include all areas from the following list that are impacted by the student’s disability: academic performance, social/emotional status, independent functioning, vocational, motor skills, and speech and language/communication. This may include strengths/weaknesses identified in the most recent evaluation.

Student’s Strengths 3/6/13 (Cernyar) - MG is sociable, kind, and thoughtful towards his teachers and peers alike. He enjoys communicating with others and discussing his successes and aspirations. He is a very driven student and has already thought about his future goals, such as improving his reading and becoming an actor. MG always puts forth his best effort and tries very hard in school and to reach his highest potential. He is a great self-advocate and is always willing to ask for help when something in unclear to him

Parental Educational Concerns/Input

TO BE FILLED IN AFTER MEETING

Student’s Present Level of Academic Achievement (Include strengths and areas needing improvement)According to the AIMs Web Assessment (conducted by content-area teacher):

3/6/13 (Goofy) - Being in the 11th grade, MG suffers with his fluency skills, scoring at the 17th percentile by reading 190 words correctly at the 6th grade level. MG also struggles in reading comprehension. He scored with 14 correct at the 6th grade level, putting him at the 6th percentile. MG is at the 8th grade level for writing mechanics with 34 total words written (at the 7th percentile) with 23 correct writing sequences (at the 4th percentile). In math application, MG is currently at the 1st percentile at the third grade level.

Student’s Present Levels of Functional Performance (Include strengths and areas needing improvement)

3/6/13 (Cernyar) - According to the Life Centered Career Education Assessment (LCCE) conducted by Gina Cernyar (Student Teacher): MG scored at a mastery level (8 out of 10 questions or better) for the following sub-categories; Food – preparation and grocer (80%); Interpersonal Skills (80%); Decision Making Skills (80%); and Physical/Manual Skills (100%).According to the Life Centered Career Education Assessment (LCCE) conducted by Gina Cernyar (Student Teacher):

MG struggles greatly in ‘home management’ skills, when answering 5 out of 10 questions correctly, with 8 out of 10 being considered mastery. He also struggles with ‘clothing’ skills, in which he answered 4 out of 10 questions correctly in regards to laundering and clothing combination skills (8 out of 10 considered mastery). MG answered 4 out of 10 questions correctly regarding self-awareness, which entail knowing about the human body and emotions (8 out of 10 being mastery). He also scored 5 out of 10 questions correctly under ‘occupational choices’, with 8 out of 10 questions correct is considered mastery.

Describe the effect of this individual’s disability on involvement and progress in the general education curriculum and the functional implications of the student’s skills.

For a preschool child, describe the effect of this individual’s disability on involvement in appropriate activities.

By age 14½, describe the effect of this individual’s disability on the pursuit of post-secondary expectations (living, learning, and working).

3/6/2013 (Cernyar) – MG struggles in the areas of Reading Fluency, Reading Comprehension, Written Expression, Math Concepts and Applications, and socialization skills. This requires him to receive instructional support in the general education curriculum through a self-contained setting.

SECONDARY TRANSITION

Complete for students age 14½ and older, and when appropriate for students younger than age 14½. Post-school outcomes should guide the development of the IEP for students age 14½ and older.

AGE-APPROPRIATE TRANSITION ASSESSMENTSTransition Assessments(Including student and family survey/interview)

Assessment Type

Responsible Agency/Person

Date Conducted

ReportAttached

Goal #

EMPLOYMENT None needed Life Centered Career Ed

G. Cernyar – SPED teacher

2/26-28/13 Yes 1, 2, 3

EDUCATION None needed

Transition Survey

D. Duck – Social Worker

2/26/13 Yes 1, 2, 3, 4, 5

TRAINING None needed Transition Survey

D. Duck – Social Worker

2/26/13 Yes 1, 2, 3

INDEPENDENT LIVING SKILLS None needed Life Centered Career Ed

G. Cernyar – SPED teacher

2/26-28/13 Yes 1, 2, 3, 4, 5

POST-SECONDARY OUTCOMES (address by age 14½ )

Indicate and project the desired appropriate measurable post-secondary outcomes/goals as identified by the student, parent and IEP team. Goals are based upon age appropriate transition assessments related to employment, education and/or training, and where appropriate, independent living skills.

Employment (e.g., competitive, supported shelter, non-paid employment as a volunteer or training capacity, military): AND

3/6/13 (Cernyar) – MG will receive full-time employment following high school/post-secondary education providing customer service at the job location of his choosing.

Post-Secondary Education (e.g., community college, 4-year university, technical/vocational/trade school): AND/OR

3/6/13 (Cernyar) – MG will receive training at a variety of at least three different sites in a vocational setting.

Post-Secondary Training (e.g., vocational or career field, vocational training program, independent living skills training, apprenticeship, OJT, job corps): AND

3/6/13 (Cernyar) – MG will receive additional training required for his occupation of choice following high school and post-secondary training.

IF APPLICABLE, Independent Living (e.g., independent living, health/safety, self-advocacy/future planning, transportation/mobility, social relationships, recreation/leisure, financial/income needs):

3/6/13 (Cernyar) – MG will learn independent living skills, such as laundering clothes as well as home safety and management skills. He will practice these skills and will be able to perform such skills with 85% accuracy.

3/6/13 (Cernyar) – MG will learn how to create a bus route to at least three different locations and navigate his way to those places with 100% accuracy, with two prompts or less.

COURSE OF STUDY (address by age 14½)Identify a course of study that is a long-range educational plan or multi-year description of the educational program that directly relates to the student's anticipated post-school goals, preferences and interests as described above.

Year 1 – Age 14/15 Year 2 – Age 15/16 Year 3 – Age 16/17 Year 4 – Age 17/18 Extended – Age 18-21

Comprehensive English I English Comp II American Literature Comp Lit/Rhetoric Vocational Training

Hist of the Ancient World World History/Studies US History Modern US History Laundering Skills

Earth Science Biology Chemistry Health Home Safety

Algebra I Plane Geometry Algebra II Senior Math Home Management

Computer Info Tech Financial Management Business FoodsOn-site, specific job

training

PE Treble Chorus Chorus Drama

PE PE PE

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TRANSITION SERVICES (address by age 141/2)Please include, if appropriate, needed linkages for outside agencies, (e.g., DMH, DRS, DSCC, PAS, SASS, SSI, WIC, DHCFS,

etc.)INSTRUCTION (e.g., tutoring, skills training, prep for college entrance exam, accommodations, adult basic ed.)

Accommodations within career planning

Provider Agency and Position DisneyWorld High

Goal #(s) if appropriate

Date/Year to be Addressed 2013-2014Date/Year Completed2014

RELATED SERVICES (e.g., transportation, social services, medical services, technology, support services)

Transportation (door-to-door)

Provider Agency and Position Dist 55 - DisneyWorld High


Date/Year to be Addressed 2013-2014Date/Year Completed2014

COMMUNITY EXPERIENCES (e.g., job shadow, work experiences, banking, shopping, transportation, tours of post-secondary settings)

On-the-job/transportation training, job shadowing/work exploration

Provider Agency and Position Dist 55 – DisneyWorld High

Goal #(s) if appropriate1, 2, 3, 5Date/Year to be Addressed

Date/Year Completed

DEVELOPMENT OF EMPLOYMENT AND OTHER POST-SCHOOL ADULT LIVING OBJECTIVES (e.g., career planning, guidance counseling, job try-outs, register to vote, adult benefits planning)

Career planning and Guidance Counseling


Goal #(s) if appropriate1, 2, 3Date/Year to be Addressed 2013-2014Date/Year Completed2014

APPROPRIATE ACQUISITION OF DAILY LIVING SKILLS AND/ORFUNCTIONAL VOCATIONAL EVALUATION (e.g., self-care, home repair, home health, money,

Independent living, / job and career interests, aptitudes and skills)


Goal #(s) if appropriate1, 2, 3, 4Date/Year to be Addressed 2013-2014Date/Year Completed2014

LINKAGES TO AFTER GRADUATION SUPPORTS/SERVICES (e.g. DRS, DMH, DSCC, PAS, SASS, SSI, WIC, DHCFS, CILs)

NONE

Provider Agency and Position


Date/Year to be Addressed

Date/Year Completed

HOME-BASED SUPPORT SERVICES PROGRAM

Yes X No The student has a developmental disability and may become eligible for the program after reaching age 18 and when no longer receiving special education services.

If yes, complete the following statements:Plans for determining the student’s eligibility for home-based services:

Plans for enrolling the student in the program of home-based services:

Plans for developing a plan for the student’s most effective use of home-based services after reaching age 18 and when no longer receiving special education services:

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GOALS AND OBJECTIVES/BENCHMARKS

Complete for initial IEPs and annual reviews. (Anyone responsible for implementing the IEP (e.g., goals and objectives/benchmarks, accommodations, modifications and supports) must be notified of her/his specific responsibilities.)

REPORTING ON GOALSThe progress on annual goals will be measured by the short-term objectives/benchmarks. Check the methods that will be used to notify parents of the student’s progress on annual goals and if the progress is sufficient to achieve the goals by the end of the IEP year:

Report cards X Progress reports Parent conference Other (specify) __________________________

CURRENT ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCEResults of the initial or most recent evaluation and results on district-wide assessments relevant to this goal; performance in comparison to general education peers and standards.

MG scored 5 out of 10 questions correctly about ‘occupational choices’ on the Life Centered Career Education

assessment with 8 out of 10 questions correct is considered mastery. He struggled with questions regarding what

different tasks certain occupations would perform.GOALS AND OBJECTIVES/BENCHMARKS

The goals and short-term objectives or benchmarks shall meet the student’s educational needs that result from the student’s disability, including involvement in and progress in the general curriculum, or for preschool students, participation in appropriate activities.

Goal Statement #__1__of__1___ MG will receive full-time employment following high school/post-secondary education providing customer service at the job location of his choosing.

Indicate Goal Area: Academic X Functional X Transition Illinois Learning Standard: #___________

Title(s) of Goal Implementer(s) IEP Team

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal

MG will receive training at a variety of at least three different sites in a vocational setting. He will be able to perform all duties of the position with 80% accuracy for 4 out of 5 trials without any assistance.

Evaluation Criteria

Evaluation Procedures

Schedule forDetermining Progress

Dates Reviewed/Extent of Progress (Optional)

80 % Accuracy Observation Log X Daily 4/5 # of attempts X Data Charts Weekly

Other (specify) Tests QuarterlyOther (specify) Semester

Other (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalMG will receive additional training required for his occupation of choice following high school and post-secondary training. He will be able to perform all duties of the position with 90% accuracy for 4 out of 5 trials without any assistance.

Evaluation Criteria




90 % Accuracy Observation Log X Daily 4/5 # of attempts X Data Charts Weekly


Other (specify)


Evaluation Criteria




% Accuracy Observation Log Daily / # of attempts Data Charts Weekly


Other (specify)






MG scored a 5 out of 10 in home management on the Life Centered Career Education assessment, struggling most with proper home care, what tools are used to fix various items and what it means for an item to be microwave safe.

GOALS AND OBJECTIVES/BENCHMARKSThe goals and short-term objectives or benchmarks shall meet the student’s educational needs that result from the student’s disability, including involvement in and progress in the general curriculum, or for preschool students, participation in appropriate activities.

Goal Statement #__1__of__1___ When given a performance battery through the Life Centered Career Education assessment on home management, MG will perform 8 out of 10 scenarios correctly, without any assistance.



Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalWhen given different scenarios, MG will identify which tools may be used to complete a household task, performing 5 consecutive scenarios with 90% accuracy.

Evaluation Criteria




90 % Accuracy X Observation Log Daily / # of attempts X Data Charts X Weekly5 in a row

Other (specify) Tests Quarterly

Other (specify) SemesterOther (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalWhen given a home-safety scenario, MG will identify how to safely perform the task given, answering 8 consecutive questions with 100% accuracy.

Evaluation Criteria




100 % Accuracy Observation Log Daily # of attempts X Data Charts X Weekly8 in a row

Other (specify) Tests Quarterly

Other (specify) SemesterOther (specify)


Evaluation Criteria






Other (specify)






MG scored 4 out of 10 points under the “clothing” category, which asked questions about laundry as well as clothing

choices during various seasons and what to pair with one another.


Goal Statement #__1__of__1___

MG will pick out weather-appropriate and situation-appropriate clothing independently with 100% accuracy.



Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalMG will pick out a weather-appropriate outfit for himself 9 out of 10 randomly selected days each week for ten weeks.

Evaluation Criteria




100 % Accuracy Observation Log Daily 9/10 # of attempts Data Charts X Weekly

Other (specify) Tests QuarterlyX Other (specify)

Naturally occurringSemester

Other (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalMG will pick out a situation-appropriate outfit for himself 9 out of 10 randomly selected days each week for ten weeks.

Evaluation Criteria




100 % Accuracy Observation Log Daily 9/10 # of attempts Data Charts X Weekly

Other (specify) Tests QuarterlyX Other (specify)

Naturally occurringSemester

Other (specify)


Evaluation Criteria






Other (specify)






On the Life Centered Career Education assessment, MG answered 4 out of 10 questions correctly regarding

self-awareness, which entail knowing about the human body and emotions (8 out of 10 being mastery).


Goal Statement #__1__of___1__

MG will increase his knowledge of self-awareness by answering 8 out of 10 self awareness questions on the

Life Centered Career Education assessment.



Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalMG will independently problem solve peer interactions for 4 out of 5 trials.

Evaluation Criteria




% Accuracy X Observation Log Daily 4/5 # of attempts Data Charts Weekly


Other (specify)Naturally occurring

Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalMG will refocus his peers, rather than joining them, when they are engaging in disruptive behaviors for 4 out of 5 trials.

Evaluation Criteria




% Accuracy X Observation Log Daily 4/5 # of attempts Data Charts Weekly




Evaluation Criteria






Other (specify)





MG answered two out of ten questions correctly in regards to moving about the community. He is unaware of how to

take public transportation throughout the community. He does not know how to navigate throughout the community.



When using the MTD bus system, MG will identify when to arrive to the stop, when to leave the community location, and

will pull the stop cord according to the scrolling marquee across 5 consecutive settings.



Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalWhen in the community or creating a bus schedule, MG will identify the time in which to get to the bus stop (5 minutes prior) across 5 consecutive trials.

Evaluation Criteria




% Accuracy Observation Log Daily 5/5 # of attempts X Data Charts Weekly

Other (specify) Tests X QuarterlyOther (specify) Semester


Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalWhen in the community or creating a bus schedule, MG will identify the time in which to leave for the bus stop from the community location across 5 consecutive trials.

Evaluation Criteria







Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalWhen on the MTD bus, MG will independently pull the stop cord using the scrolling marquee at 5 different stops across 5 consecutive trials.

Evaluation Criteria






Other (specify)






MG is currently at the 17th percentile by reading 120 words correctly at the 6th grade level when measured through

AIMs Web Reading Fluency.



MG will increase his reading fluency to 123 words read correctly at the 7th grade level when measured through

AIMs Web Reading Fluency, putting him at the 25th percentile.

Indicate Goal Area: X Academic X Functional X Transition Illinois Learning Standard: #____1A_______


Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalOn the AIMs Web Reading Fluency assessment, MG will read 140 words correctly on the 6th grade probe for 4 out of 5 trials.

Evaluation Criteria




% Accuracy Observation Log Daily 4/5 # of attempts Data Charts Weekly

Other (specify) X Tests X QuarterlyOther (specify) Semester

Other (specify)


Evaluation Criteria






Other (specify)


Evaluation Criteria






Other (specify)






In Reading Comprehension through AIMs Web, MG scored with 14 correct at the 6th grade level, putting him

at the 6th percentile.



MG will increase his Reading Comprehension to the 25th percentile at the 7th grade level.

Indicate Goal Area: X Academic X Functional X Transition Illinois Learning Standard: #____1A_______


Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalWhen assessed through AIMs Web, MG will score at the 25th percentile for Reading Comprehension at the 6th grade level for 4 out of 5 trials.

Evaluation Criteria






Other (specify)


Evaluation Criteria






Other (specify)


Evaluation Criteria






Other (specify)






MG is at the 8th grade level with 34 total words written (at the 7th percentile) with 23 correct writing sequences

(at the 4th percentile) for written expression.


Goal Statement #__1_of__1___

MG will increase his writing fluency to 60 total words and 55 correct writing sequences on 4 out of 5 trials.

Indicate Goal Area: X Academic X Functional X Transition Illinois Learning Standard: #__3A________


Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalOn the AIMs Webs written assessment, MG will write 43 total words and 30 correct writing sequences for 4 out of 5 trials.

Evaluation Criteria






Other (specify)


Evaluation Criteria






Other (specify)


Evaluation Criteria






Other (specify)






3/6/2013 (Cernyar) - MG is currently at the 1st percentile at the third grade level for Math Concepts and Applications.



MG will increase his MCAP score through AIMs Web to the 7th percentile at the 4th grade level.

Indicate Goal Area: X Academic X Functional X Transition Illinois Learning Standard: # 6B


Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalOn the MCAP assessment through AIMs Web, MG will score at the 10th percentile at the third grade level for 4 out of 5 trials.

Evaluation Criteria




% Accuracy Observation Log Daily4/5 # of attempts Data Charts Weekly


Other (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalOn the MCAP assessment through AIMs Web, MG will score at the 25th percentile at the third grade level for 4 out of 5 trials.

Evaluation Criteria






Other (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual GoalOn the MCAP assessment through AIMs Web, MG will score at the 7th percentile at the 4th grade level for 4 out of 5 trials.

Evaluation Criteria






Other (specify)

EDUCATIONAL ACCOMMODATIONS AND SUPPORTS

Complete for initial IEPs and annual reviews. (Anyone responsible for implementing the educational accommodations must be notified of her/his specific responsibilities).

TRANSITIONX Yes No

NA

Consideration of service needs, goals, and support/services is required (by age 14 ½ , the team must address transitionservice needs). If yes, complete the “Transition Services” section of the IEP.

Yes

No X NA Consideration of “Home-Based Support Services Program for Mentally Disabled Adults” for eighteen-year-old student isrequired. If yes, complete the “Home-Based Support Services Program” section of the IEP.

CONSIDERATION OF SPECIAL FACTORS

Check the boxes to indicate if the student requires any supplementary aids and/or services due to the following factors. For any box checked “yes,” specify the special factors in the “Supplementary Aids, Accommodations and Modifications” section listed below.

X No assistive technology devices and services

X No communication needs

X No deaf/hard of hearing – languages and communication needs

X No limited English proficiency – language needs

X No blind/visually impaired – provision of Braille instruction

Yes

X No behavior impedes student’s learning or that of others. If yes, the team must consider strategies, including positive behavioral interventions and supports to address behavior. This may include a Functional Behavioral Assessment and/or a Behavioral Intervention Plan. If, so attach any completed forms.

LINGUISTIC AND CULTURAL ACCOMMODATIONS

Yes X No The student requires accommodations for the IEP to meet her/his linguistic and cultural needs. If yes, specify any needed accommodations:

Yes X No Special education and related services will be provided in a language or mode of communication other than or in addition to English. If yes, specify any needed accommodations:

SUPPLEMENTARY AIDS, ACCOMMODATIONS, AND MODIFICATIONSSpecify what aids, accommodations, and modifications are needed for the child to make progress toward annual goals, to progress in the general education curriculum, participate in extracurricular and other non-academic activities, and to be educated and participate with other children with disabilities and/or nondisabled children (e.g., accommodations for daily work, environmental accommodations, moving from class to class, etc.). Supplementary aids, accommodations, and modifications must be based upon peer-review research to the extent practicable.

Given verbal directions in clearly stated steps Allow Calculator Check for understanding (student summarizing) Test one concept or performance indicator per standard at a timeProvide extra examples when learning vocabulary Test questions to be read aloudLonger time to process information Ask student to repeat directions back for understandingExtended time: 1.5 Guided notes or provided notesExplain directions and give concrete examples Alternative setting with fewer distractionsCheck for accuracy during test

SUPPORTS FOR SCHOOL PERSONNELX Yes No Program trainings and/or supports for school personnel are needed for the student to advance appropriately toward attaining

the annual goals, participate in the general curriculum, and be educated and participate with other students in educational activities. If yes, specify what trainings and/or supports are needed, including when appropriate, the information that clarifies when the trainings and/or supports will be provided, by whom, in what location, etc.

All accommodations will be provided to classroom teachers and support staff.

ASSESSMENT

CLASSROOM-BASED ASSESSMENTS

X Yes No Student requires accommodations to participate in classroom-based assessments.

Yes X No Student requires alternate assessment/methods to participate in classroom-based assessments

DISTRICT-WIDE ASSESSMENTS

District does not administer district-wide assessments

District does not administer district-wide assessments at this grade level: _________

Student will:

Participate in the entire district-wide assessment with no accommodations

X Participate in the entire district-wide assessment with accommodations

Participate in part(s) of the district wide assessment (specify)

Participate in the district-wide alternate assessment

STATE ACADEMIC ASSESSMENTS

The State academic assessments are the Illinois Standards Achievement Test (ISAT) at grades 3-8 and the Prairie State Achievement Exam (PSAE) at grade 11, Illinois Measure of Annual Growth in English (IMAGE) in grades 3-8 and 11 (for English Language Learner (ELL) students), and Illinois alternate Assessment (IAA) in grades 3-8 and 11.

State academic assessments are not administered at this grade level __________

Student will:

Participate in the ISAT/PSAE/IMAGE with no accommodations

X Participate in the ISAT/PSAE/IMAGE with accommodations

Participate in the IAA

If the student will participate in the IAA, the following were met:

The ISAT/PSAE/IMAGE is not appropriate (specify)

The IAA participation guidelines were met

The alternate assessment selected is appropriate for the student (explain)

STATE ASSESSMENT OF LANGUAGE PROFICIENCY

The State assessment of language proficiency is Assessing Comprehension and Communication in English State to State (ACCESS) in grades K-12

Yes X No ENGLISH LANGUAGE LEARNER (ELL). If “NO”, skip to next section

Student will:

participate in the ACCESS with no accommodations

participate in the ACCESS with accommodations

ASSESSMENT ACCOMMODATIONS

If the student is participating in any of the above assessment(s) with accommodations, specify the needed accommodations (e.g., extended time, alternate setting, auditory testing) necessary to measure the student’s academic achievement and functional performance. The accommodations should be appropriate for that particular assessment and reflective of those already identified for the student in the Supplementary Aids, Accommodations, and Modifications section.

Given verbal directions in clearly stated steps Allow Calculator Check for understanding (student summarizing) Test one concept or performance indicator per standard at a timeProvide extra examples when learning vocabulary Test questions to be read aloudLonger time to process information Ask student to repeat directions back for understandingExtended time: 1.5 Guided notes or provided notesExplain directions and give concrete examples Alternative setting with fewer distractionsCheck for accuracy during test

EDUCATIONAL SERVICES AND PLACEMENT

Initiation Date: 3/7/2013 Duration Date: 3/6/2014

PARTICIPATION IN GENERAL EDUCATION CLASSES

The IEP must address all content areas, classes, and specify if the student will participate in general physical education.

General Education with No Supplementary Aids(Specify content areas, classes, whether or not the child will participate in general physical education, and extracurricular and other nonacademic activities.)

Minutes Per Week in Setting(Optional)

N/A

General Education with Supplementary Aids (as specified in the Supplementary Aids section)(Specify content areas, classes, whether or not the child will participate in general physical education, and extracurricular and other nonacademic activities with supports, if applicable.)

Minutes Per Week in Setting(Optional)

PE and Electives (Drama in August 2014)

Special Education and Related Services within the General Education Classroom(Specify content areas and classes in which the child will participate with the provision of special education and related services. List each special education and related service that will be provided during each class. )

Minutes Per Week in Setting

0

PARTICIPATION IN SPECIAL EDUCATION CLASSES/SERVICES

The IEP must address all special education and related services.

Special Education Services – Outside General Education Minutes Per Week in Setting (A)

MathSocial StudiesReadingEnglishWork Training

250250250250250

Related Services – Outside General Education Minutes Per Week in Setting (B)

25 – Transportation (Special)28 – Behavior Intervention Plan32 – Supported Employment

Educational Environment (EE) Calculation (Ages 3-5)_________ 1. Minutes spent in regular early childhood program_________ 2. Minutes spent receiving special education and

related services outside regular early childhood (A+B)

Educational Environment (EE) Calculation (Ages 6-21)2100 1. Total Bell to Bell Minutes1250 2. Total Number of Minutes Outside of the

General Education Setting (A+B)

03 EE Code 41 % Percent Inside General Education 59 % Percent Inside Special Education

EDUCATIONAL SERVICES AND PLACEMENT

EDUCATIONAL ENVIRONMENT CONSIDERATIONSTo the maximum extent appropriate, all students shall be educated and participate with students who are non-disabled. Provide an explanation of the extent, if any, to which the student will not participate in general education classes and activities.

X

Yes NoSpecial education classes, separate schooling, or removal from the regular education environment is required because the nature or severity of the student’s disability is such that education in general classes with the use of supplementary aids and services cannot be achieved satisfactorily.

Explain:________________________________________________________________________________________________________

X

Yes NoWill participate in nonacademic activities with nondisabled peers and have the same opportunity to participate in extracurricular activities as nondisabled peers?

If no, explain:____________________________________________________________________________________________________

X

Yes NoWill attend the school he or she would attend if nondisabled?

If no, explain:____________________________________________________________________________________________________

PLACEMENT CONSIDERATIONS

When determining the placement, consider any potentially harmful effect either on the student or the quality of services that he/she needs. After determining the student’s placement, complete the “Placement” section on this cover sheet.

Yes X NA For a child who is deaf, hard or hearing, blind or visually impaired, parents have been informed of existence of the Illinois School for the Deaf or the Illinois School for the Visually Impaired, and other local schools that provide similar services.

PLACEMENT OPTIONS CONSIDERED POTENTIALLY HARMFUL EFFECT/ REASONS REJECTED

TEAM ACCEPTS PLACEMENT

02 – Inside general classroom 40-79% of the day

This placement does not adequately meet Donald’s needs Yes X No

03 – Inside general classroom less than 40% of the day

Though restrictive, this placement meets Donald’s instructional needs X Yes No

01 – Inside general classroom 80% or more of the day

This placement does not adequately meet Donald’s instructional needs Yes No

TRANSPORTATION

Check all that apply

X Yes No Special transportation is required to and from schools and/or between schools.

Yes X No Special transportation is required in and around school buildings.

Yes X No Specialized equipment (such as special or adapted buses, lifts, and ramps) is required.

Please explain and/or detail transportation plan:

Activity on the bus must be monitored. MG must always be seated near an adult and never with any female students.

EXTENDED SCHOOL YEAR SERVICES Yes X No Extended school year services are needed. The IEP team must document the consideration of the need for extended

school year services and the basis for the determination.

If yes, the IEP must indicate the type, amount and duration of services to be provided. SPECIAL EDUCATION

SERVICE(S)LOCATION AMOUNT/FREQUENCY

OF SERVICESINITIATION

OF SERVICES

DURATION OF SERVICES

GOAL(S) ADDRESSED

iep

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