Sample IEP H - OSPI

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:J IIesigned to clearly c-0mmunicate to the parents, the student, and providers the type and amount ofspecial education and any necessary related services or supports thatthe student. The most recent evaluation report is used to develop the IEP. The IEP is individualized to reflect the unique needs of the student and how these needsit the student to be included and progress in the eneral education curriculum.INDIVIDUALIZED EDUCATION PROGRAM, Student ID: - - - - - OSPI State ID:Age: 19Grade: 12Date of IEP meeting: -'-'.;.c. .:c.c. :1/10/2012;.Eligibility cat egory: Intellectual OisabiliRace/Ethnicity:MultipleIBP Review date:--'-'1/.:;.9 /2 0.:.13 --------- Placement School:Primary language: - lish n Most Recent Evaluation:-"'-01.:. f.:.:. 14.:.:/ 2- 01.:.;0::;.R esident School:- -- - - - - - Paren t/Guardian name(s):No1nitiaI IEP?Surrogate parent: No.- -- Case manager name:T itle: Sp Ed Teacherl'OL'ffS TO CONSIDER: IEP team membership is described inOther participants (Name/fitle):WAC 392-172A-03095. School district must i;ive prior written notice whenproposing oc refusing to initiate or change theidentification, evaluation, educational placement, orL.L:l LI U:l.l kt. :.: .!e.!c:!u.:.:t'1. 'f'i/) provision of FAPE.COMMENTS: NOTE: Please use this space if clarification ofsections ofthe IEP is required. Also, sbould there be any aspects ofthis IEP where IEP participants are in disagreement. list concern,possible solutions and expected date by which the issue(s) will be resolved through another IEP meeting.As per State law,has notified the parent and the child that all rights accorded to parents under the Individuals with Disabilities EducationAct transfer to the child upon reaching age 18, (except for a child with a disability who has been detennined to be incompetent under State law).IIDIIII IIIIIHIIUIIIIIIIIDIUIIIIHIR,,m . m;o' 1

TRANSITION PLANPURPOSE: The purpose of transition planning is to develop a coordinated set of activities designed within aresul oriented process that is focused on improving the ac.1demic achievement and functional perfonnanceofthe student in order to facilitate the student's movement from school to post-scltool activities, includingpostsecondary education/training, employment, and if appropriate, independent living skills.,oi3Graduation Year: AgeofMajority: 02/09/2010,.;:.;;.Q.;.:.:.J.i.:.:.,.: .;.,: .:.:; .:;:.;;; ; ; .,;.:.; :; ----------.-------------.------------ '---,Interests/PreferencesAreas ofStrengthLimitations/NeedsWork/Community ademic:C, '11 MC 4tri,J (p&h,vi(t.! f1tkfCtw'2.C (\tM ' I Rt,it t) s tvft.If Jo:: .;tftt1\A/t\1"1 r.J L,UJC P6s;-h11 : s ,oth,tm : mroedkm"fl1 DI;;DtSlu.S ;" ,cv1&5p(:.{1,.50,.:f'l&-vl) itt'S wl#W Nt1-0f1 Suv("lGo' -b '\\L l ill/ ,0 1f.SCeo '")·.Kivu,.;.,,J nc.' pt5How was this information obtained?,s,r( ,')IJt.ft'"n"' b: l)tl,i1. v,,tdl-en pfhco . 1 AA w b ,. \1.· { & ( nits'c ii,. ; gc.c:,;.P"' Tci·Gvt,,( .,' 'i"'4,'*")C t t '51,J p,icv c. S\ t(,\C., v - bt1 s·- C . . ( .\.u ;·.1.(.Sa J (,,w-J 5NStaff/Records/AssessmelllS DCareer Center/WOIS Olnventory Surveys D0bservationsDOther:List the assessments, inventories, and/or surve s administtred:Measurable Postsecondary Goals - Statements for education/training and employment and independent living (as appropriate) must bewritten to ro ·ect be ond hi hschool. Statements must be observable, and must be based on assessment in ormation.A. Postsecondary Education (college degree, community/technical college, vocational training, employment, other):yment (tompetitive, supported, military, psthway to employment):Transition Services - Statements that describe services, sorts, and activities neededto acilitate movement toInstruction, Related Services, Community Experientes, Development of Adult Living ObjectivesA.Eduratiowl'raillJlct .1"""'1 O it,l'W lt-S () N ' c l \.vi21ltTIWb J Sfc.n l,o," tsR1J,t -h,Jsoal.POJNTS TOCONSIDER:· Secondary transitionmust be addressed in thefirst JEP to be in effectwhen the student turns16, or younger ifdetermined appropriateby the IEP team., andupdated annually. Measurablepostsecondary goals,based upon age appropriate transitionassessment results, mustbe included in the areasof education/training,employment, and (ifappropriate) independentliving skills. Transition servicesshould be based on theindividual student' sneeds, taking intoaccount the student'sstrengths, preferences,and interests, and mayinclude instruction,related services,community experiences,the development ofemployment and otherpostschool adult livingobjectives, and ifappropriate, theacquisition ofdailyliving skills andprovision ofa functionalvocational evaluation.

POINTS TO CONSlDER Representatives of any agencies that are likely to be responsible for providing or par ing for transitionservices to the student should be invited to the IEP meeting, with parent consent A course of study is "a multi-year de.wription of coursework to achieve the student's desired post-schoolgoals, from the student's current to anticipated exit year." (NSTTAC, 1JX 7).Coordinated Services with Adult A eociesDivision of Developmental Disabilities (ODD) Employment/Residential OpportunitiesWork Source - Em lo 1 ment Ortwtities & Trainin ServicesBenefits Spe ialists Financial Planning, Plan to Work, Working while on SSI or SSD1Disability Support Servites (DSS) - Accommodations at colleges and universitiesSocial Security Admiaistnitioo BenefitsMenta l Health Mental Health NeedsWrite Recommended Adult A encies:D Passed 10th Grade State Assessment or Alternativelir'Completed Culminating ProjectCOURSE OF STUDY PLANNING SHEETWriJe substitutions next lo the reQuired courses. complete electives. check /he box if the course has been comoletedYear 4 / Grade 12Year 1 / Grade 9Year 2 / Grade 10Year 3 / Grade 11Semester l substitutionsSemester IsubstirutionsSemester 1 substirutionsSemester 1 substitutionsD English: Functional AcademicsD English: Functional AcademicsD English: Functional AcademicsD English: Functional AcademicsD Math: Independent LivingD Math: Personal Choic D CWA/Econ: Personal ChoicesD Math: Independent LivingD World History: RelationshipsD Science: Occupational GuidanceD American Studies: Career ChoicesD Career Focus (OJT)0 Career Focus (Off)OD Science: Occupational Guidance0 Fitness: Foods/ Nutritiono oD Fitness/Health: Foods /Nutrition0 Career Focus (OJT)D Career Focus (OIT)0 WAAS PortfolioD0Semester 2 substitutionsSemester 2 substitutionsSemester 2 substitutionsSemester 2 substitutionsD English: Functional AcademicsD English: Functional AcademicsD English: Functional AcademicsD English: Functional Academics0 Math: Personal ChoicesD Math: Independent Livi ngD Math: Independent LivingD CWA/Econ: Personal ChoicesD American Studies: Career ChoicesD World History: RelationshipsD Career Focus (OJ1)D Science: Occupational GuidanceD Career Focus (OJT)OD Science: Occupational GuidanceD Fitness: Foods / NutritionDO0 Fitness/Health: Foods / NutritionD Career Focus (OJT)D Career Focus (OJT)0 WAAS PortfolioDDYearsYear6COMl\fENTS: Explain credit andcourse modljkations and subsJitutions.Semester 1Semester 1D Career Focus (OJT)D Pi,.D f 9'1. D c.f'E;D CJGD r --' Semester. 2D Career Fo (OJnD,l tZ-Att,l9, 12 v ,Jo00- -- - - - - -- - - - 0Semester 2D Careei Focus (OJT)D Career Focus (OJT)0 DD0--------. - ---- 0o0- - - - -------- . ,JI /1o - - - - - - - r -"--tl Jt - - - - - - DD&:trt:CJ AS:S"'" t. -Cm ltd 1S, .r, ck -k

PURPOSE: The following is a summary of services, when will begin. where they will be provided, wh owill be responsible for providing them, and when they will end.Student Name - ID:Case Manager:SUMMARY OF SERVICES MATRIXDURATION: Start Date I 1/1 111. IEnd Date -- Goal(s) &RelatedFrequency(i.e. minutes per week)282282282282minminminminLine #1Location of Sen·ice(See Below)ONE letter per lineSpEd Staff: Design, Supervise,Monitor & EvaluateStaff Responsible for DeliveringServiceEd TeacherCCCd TeacherCd Teacher Total building instructional minutes per week (excluding lunch time):: Total minutes per week student is served in a special education sett.tng %of time spent in general education setting (Line # 1 minus Line #2 divided by Line # 1)An explanation ofthe extent, if any, to which the student will not participate with nondisabled students in the general education class, and in nonacademic and extracurricularactivities, including a description of any adaptations needed for participation in physical education: Due to significant delays in educational performance, the student requiresecially designed instruction and/or related services within a special education class. Adapted PE- None required.PLACEMENT OPTIONS CONSIDERID- LOCATION OF SERVICES:Based on current evaluation results and recommendations, with consideration of any potential harmful effect on the student or on the quality of services which the student needs, the followingplacement options were sequentially coMidered by the IEP team in order to determine the most appropriate program placement to meet student's IEP goals and objectives:A. General education setting (NO SPECIAL EDUCATION)B. General education setting \vith Special Education instruction &/or Related SeivicesD. Home instructionE. Hospiial instruction0 . OtherC. Special education settingF. Residential schoolX. ALL SETTINGS - lAflnterpreter/Nurse time ONLYPOINTS TO CONSIDER:If the position responsible for delivering the specially designed instruction is anyone other than a certificated special education teacher or related service provider, then thecertificated special education teacher/related service provider must design and supervise the instruction, and monitor and evaluate the student's progress.

PURPOSE: The following 'Nill inform the parents and the student of the student's progress towardmeeting the measurable annual goal(s) and to specify how the parents will be informed.Supplementary services and program support will be listed if required by the student.Student Name - ID:Case Manager:--'---------1- REPORT OF STUDENT PROGRESS: (Parents are to be informed at least as often as p »'ents of nondisabled students.jState how the parents will be regularly infonned ofstudent's progress toward meeting the annual goal(s) concurrent with the issuance of report cards (such as through the use ofquarterly or other periodic reports):Annual IEP and quarterly notices of progress to the parent/guardian.SUPPLEMENTARY AIDS AND SERVICES: (lnservice, training. elC that a/laws student to be educated with non-disabled peers)InitiationServiceFrequencyLocation of ServiceDurationDatePROGRAM MODIFICATIONS OR SUPPORT FOR SCHOOL PERSONNEL:Staff Responsible forDeliverine Service(current infom1aJion listed- write in d1anges as needed)Student is in a self-contained special education program. Program modifications and supports within general education will be discussed when transition into regular, education is recommended.!iP nor· IEPOTHER CONSIDERATIONS :1. Does this student require specialtransportation?2. Extended School Year (ESY) services?NoNo3. Does the student's behavior negativelyimpact his/her learning or the learning ofothers'?4 . Does this student require the use of aversiveinterventions?NoNo5 . Are there any other factors not alreadyaddressed (such as medical concerns or otherissues), or other adaptations needed?Mka e ChaneesN otesJfyes, review the current Special Transportation form0IEP team determinedIf ESY is determined by the IEP team to be necessary.complete and attac h the ESY addendum.Ifyes, consider the s tudent's needfor positive behavioralsupports/ interventions, a Functional Behavioral Assessment,and/or a Behavioral Intervention Plan.Jfyes, complete and attach the Aversive Intervention Planaddendum.

PURPOSE: IEPs must include a statement o f measurable annual goals. including academic andfunctional goals, designed to meet each of the student's educational needs that result from the disabilityto enable the student to be involved and make progress in the general education curriculum. In order tobe measurable, the goal should include a baseline ("from"), a target ("to"), and a unit of measure.SchoolJ.ra n,.sjt,.jo.,n.,.Be,.h.,.a.,y.,.jor : MEASURABLE ANNUAL GOAL AREA WITH SHORT TERM OBJECT IVES/BENCHMARKSIMPACT STATEMENT - Effect of the disability on involvemeoUprogress in general education curriculum/appropriate activities:.s a 12th grade student with a documented Intellectual Disability wh ich significantly affects her behavior progress. She will .Strate an ability to predictuences by accurately stating at least two possible consequences when presented with hypothetical situations by the teacher.perfonns well below that ofher 12th grade peers, who are able to demonstrate an ability to predict consequences by accurately stating at leastsible consequences when presented withequires specially designed instruction for herhypothetical situations by the teacher. With or w ith out extensive accommodations including one-to -one support,Behavior needs.PRESENT LEVELSdemonstrate an ability to predict consequences by accurately stating at least two possible consequences when presented with hypothetical situations by theteacher with 25% accuracy.lllcanACHIEVEMENT INDICATORS4 - Al on Staadard At Tbis Time: consistently demonstrates exceptional skills and knowledgeat gtade level expec!Atioos.3 - Mttting Staadard Al TIils Time: consistently demonstraies grade level skills andknowledge.Measurable Annual Goal(with baseline or from .10) r t to PostsecondaQ' Goal:· ducation/Training[ ] EmploymentLJ Independent Living will demonstrate an ability to predictconsequences by accurately stating at least twopossible consequences when presented w ithhypothetica l situations by the teacher increasingfrom 25% to 80% accuracy. The behavior will bemonitored by assigned school personnel andrecorded in the student's progress notes/datasheets over each grading period.Method/Criteriafor EvaluatingProgress2 - Appruchiag S1J11M1ard At T his Time: is making progTess toward meeting grade level expeciations. sometimes showingevidence of meeting the standards, at other times showing lack of widefstanding or ability to apply the concept or skiUs.1 - 8qiDoi91 Work Toward StaAdard At This TimeX - 1'"ot Graded At T his TiiaeAnticipatedCompletionDateData CollectiondaJeI progress[as measured by:(\,\e \. \-sCc,4 s\,U\f,o I POINTS TO CONSIDER: Results of the most current evaluation., and the academic, developmental, and functional needs of the student.Measurable annual goals stem from tile recommendations for specially designed instruction in the evaluation report.Measurable annual goals must relate to the general education curriculum or, for preschool students, participation in appropriate activities.Mcasurnble annual goals must also address other educational needs that result from the student's disability.'1011!.f

PURPOSE: IEPs must include a statement ofmeasurable annual goals. including academic andfunctional goals, designed to meet each of the student's educational needs that result from the disabilityto enable the student to be involved and make progress in the general education curriculum. In order tobe measurable, the goal should include a baseline (" from"), a target ("to"), and a unit of measure.1,T.u,ra,.nl ilsji.w.tiow.io.,M1.1o1a,11,lhi.,. :School:MEASURABLE ANNUAL GOAL AREA WITH SHORT TERM OBJECTIVES/BENCHMARKSIMPACT STATEMENT - Effect of the disability on iovolvement/progress in general education curriculum/appropriate activities:. is a 12th grade student with a Intellectual disability which significantly affects her ability to justify mathematical functions to solve daily math problems,cally the use and exchange of money. The average 12th grade student is able to select and justify functions and equations to model and solve problems and havean understandin of the use and exchange ofm oney She is unable to participate in general education classes even with extensive accommodations including one toone support.requires specially designed instruction to learn to select and j ustify functions and equations to model and solve daily math problems.PRESENT LEVELSlllllisable to make coin exchanges in a variety of ways up to 10.00 with 60% accuracy and 4 prompts .ACHIEVEMENT INDICATORS f Abo e Standard At This Time: consistently demonstta excep1io11al skills and knowledgeat g,adc level expectations.l - Meding S1a11dar4 At Tbis Tillle: coosis1cntly demonstrates grade level skills andknowledge.Measurable Annual GoaltJr2r!{with baseline orfrom . to)tQ PQS econd!IQ'. Goal:ducation/TrainingU EmploymentLJ Independent Living.will improve her ability to make coinexc anges in a variety ofways up toMethod/Criteriafor EvaluatingProgress2 - Approacbillg Stan41ard At This Time: is making progress toward meeting grade level expectations, sometimes showingevidence of meeting the standards, at other times showing lack of undemanding or ability to apply the concept or skills.AnticipatedCompletionDateData CollectiondaleI progress Ias measured by: \X - Net Graded At Tlai!I Timel - nlag Work Toward Staadud At Tllis Time,/to/ i3r 10.00 from 60% to 80% accuracy with no morethan 2 prompts, over 3 out of 4 trials as evaluatedby teacher created data probes.POINTS TO CONSIDER: Results of the most current evaluation, and the academic. developmental, and functional needs of the student. Measurable annual goals stem from the recommendations for speciall designed instruction in the evaluation repon. Measurable annual goals must relate to the general education curriculum or, for preschool students., participation in appropriate activities. Measurable annual goals must also address other educational needs that result ftom the student's disability.notes

Student Name ID:PURPOSE: rEPs must include a statement of measurable annual goals. including academic andfunctional goals, designed to meet each of the student's educational needs that result from the disabilityto enable the student to be involved and make progress in the general education curriculum. In order tobe measurable, the goal should include a baseline ("from"), a target ("to"), and a unit of measure.SchoolT.r a ns.jt jo n W.,.rj tjn.,g : MEASURABLE ANNUAL GOAL AREA WITH SHORT TERM OBJECTIVES/BENCHMARKSIMPACT STATEMENT - Effect of the disability on involvement/progress in general education curriculum/appropriate activities:. is a 12th grade student with a Intellectual Disability, which significantly affects her ability to write independently with confidence and proficiency. She hasculties completing functional . itten tasks. The average 12th grade student is able to write and complete a variety of written tasks such as applications,resumes, personal information etcis unable to participate in general education classes even with extensive accommodations including one to one support.requires specially designed instruc 10n o learn to complete functional daily written tasks.PRESENT LEVELS. is able to apply comprehension-monitoring strategies, with the use ofprior knowledge, make, confirm and revise predictions during and after reading at the fifthgrlevel with 75% accuracy with 5 or more prompts.ACHIEVEMENT JNDICATORS4 -A on Staadard Al This T im : consistendy demonstraaes e"ceptional skills and knowledgea t grade level expectations.J - Meetioc Staadanl At This TilD : consistently dcmoostrateS grade level skiUs andl - Approaclliag Slndard At This T IJlle: is making progress 10"'-a,d meeting grade level expectations, sometimes sbo"' ngevidence ofmeeting lhe standards, at other times bo"ing lack of underslanding or ability to apply the concept or skills.I - Beginaing Work Toward S1aa4ard At Tbis Timeknowledge.Measurable Annual Goal(with baseline or from . to) 1 1 to Posts oodan: Goal:EducationlfrainingLJ EmploymentLJ Independent Livinglalwillwrite important information on avanety of forms at the fifth grade level improvingMethod/Criteriafor EvaluatingProgressAnticipatedCompletionDateData CollectiondateIpr gressIas measured by:- 1MtX-Not Graded At T bis Time/10/ r from 70% to 80% accuracy with no more than 2prompts on 3 out of4 trials as evaluated byteacher created data probes.POINTS TO CONSIDER: Results of the most current evaluation. and the academic. developmental. and functional needs of the student. Measurable annual goals stem from the recommendations for specially designed instruction in the evaluation report. Measurable annual goals must relate 10 the general education curriculwn or, for preschool students, participation in appropriate activities. Measurable annual goals mUSl also address other educational needs that result from the student' s disability.notes

PURPOSE: IEPs must include a statement of measurable annual goals. including academic andfunctional goals, designed to meet each of the student's educational needs that result from the disabilityto enable the Student to be involved and make progress in the general education curriculum. In order tobe measurable, t.he goal should include a baseline ('' from"), a target (" to"), and a unit of measure.School-is.J.ra n,.s.jtio.o.B.e.a.d.jn,.g : MEASURABLE ANNUAL GOAL AREA WITH SHORT TERM OBJECTIVES/BENCHMARKSIMPACT STATEMENT - Effect of the disability on involvement/progress in general education curriculum/appropriate activities:a 12th grade student with a Intellectual Disability, which significantly affects her ability to use prior knowledge and text based information in making,confirming and revising predictions to improve her reading comprehension. The average 12th grade studen. e to apply comprehension monitoring strategies,eir understanding ofthe content.is unable to participate in general education classesanalyze and /or synthesize infonnation from multiple sources to dee.requires specially designed instruction to learn to analyz.e and /or synthesize informationeven with extensive accommodations including one to one support.from multiple sources to deepen her understanding. ENT LEVELSgrais able to apply comprehension-monitoring strategies, with the use ofprior knowledge, make, confirm and revise predictions during and after reading at the sixthlevel with 75% accuracy with 5 or more prompts.ACHIEVEMENT INDICATORS4 Above SUn4ard At This Tl8le: consist.ently demonstrates exceptional skills and knowledgeat grade level cxpeciation.s.3 - Meeting Scudar4 AC This Tiae: consistently demonstrates gra level skills andknowledge.Measurable Annual Goal(with ba3eline orfrom . to)Su ort to Postsecondarv Goal:WEducationffrainingU EmploymentLJ Independent Living- w i l l apply comprehension monitoringstrategies at the sixth grade level by making,confi nning and revising predictions based onprior knowledge and evidence in text, improvingfrom 75% to 90 % accuracy and from requiring 5or more prompts to requiring no more than 2prompts over 3 consecutive trials as evaluated byteacher created data probes.Method/Criteriafor EvaluatingProgress2- Approachin& Sta.ndard At nis Time: is making progress toward meeting grade level expectations, sometimes showingevidence of meeting the standards, at olher times showing tack of understanding or abilily to apply the concepi or skills.1 - Begi.aolag Work Toward Standard At This·TimeX - N"t Graded Al This TimeAnticipatedCompletionDateData CollectiondateI progressjas measured by:C t :i t 7,110/11POINTS TO CONSIDER: Results of the most current evaluation, and the academic, de velopmental, and functional needs of the S1Udent. Measurable annual goals stem from the recommendations for specially designed instruction in the evaluation report. Measurable annual goals must relat.e to the general education curricuhnn or. for preschool students, participation in appropriate activities. Measurable annual goals must also address o(her educational needs that result from the student's disability.notes

PURPOSE: The following is a listing of Accorrvnodations that may be required for the studentduring classroom activities and for State and District assessments.Student Name- ID:Case Manager:ACCOMMODATIONS AND ASSISTIVE TECHNOLOGYPOINTS TOUse large print/Braille/recorded booksAlter format ofmaterials (highlight, type, spacing, color-code ere.)Low-vision devices (magnifiers, Closed Circuit 11 etc.)Sign Language - ASL or SEEShortened assignmentsPreview test proceduresLimited multiple choiceRephrase test questions and/or directionsProvide test/quiz study guideSimplify test wordingRead class materials orally ("Reading " high sclu,ol only)Assign peer tutor/note ow use oft.ape recorderSpelling devices (Grammar not for Wrinng)Speech-to tel(t software (Dragon, etc)Hands-on assignmentsOther:,.' ;Prior notice oftests/quizzesExtra time to complete assignmentsModify student's schedule (describe below):NIA r,1 CONSIDER: !I.Ym ::afl The IEP team makesProvide individualized/small group instructionthe determination ofwhat individualRead class materials orallyProvide study outlines/guides/graphic organizersaccommodations areModify/repeat/model directionsnecessary for thestudent.Take test in separate location Copies of this pagePreferential seatingshould be providedOther:to the generaleducation teacher(s)or other staff whoUtilize oral responses to assignments/t.estswill be responsibleText-to-Speech (Kun:weil. WYNN. Text Help. etc.jfor making theseaccommodations.Allow dictation to a scribe AccommodationsAllow use ofa calculator (high school onMprovided on stateand districtwideassessments shouldbe those that areprovided as part ofthe regularinstructionalprogram.Provide desktop list of tasks Assistive----1--P ro-VI- .-de hom-ew.;;.or k l is-ts TechnologyBehavior plan/contractProvide daily assignment listModified gradingOther:Extra time on tests/quizzesAllow breaks (during work, between ta.,Jcs, dnring testing, e1c.)Other:*TESTING: Required State and District assessments1':I! ' ·1 3U · :;::''itifEfl .·J' fJl!i · , ''"/.1J ]'!N· I l t·- :.) -" \ "-·· . ' r&:"·!. m::c\ . . ·',.RJf' , ,IF-, -, '. Describe Current Assistive Technology:I Additional Assistive T echnolo2v Evaluation Needed (Describe Current Physical Therapy Equipment:.J yes)I Additional Phvsical Tberaov Eauipment Reauested (" yes)- )!:,,:· .

PURPOSE: The purpose of the participation in State and District assessments is to document theappropriate testing option for the student.Student Name - ID:Case Manager:PARTICIPATION IN STATE AND DISTRICTWIDE ASSESSMENTS OF STUDENT ACHIEVEMENTState Assessment - The student will participate in the following state assessment(s) this school year:Reading MathWritingSciencefr,rades 3-S and JO)lerades4. 7. JO)lnade. 5, 8. 10)DDDDDE orMEorMEorMEorMDDDDDDDDDDDRegular State Asse ssmentRegular State Assessment w ith Accommodations*Bas ic State Asses s ment - (Level 2)*DAPE - (11 th and 12th grade only, circle E or M)*WAAS Portfolio (alternate assessmem - requires benchmC11·kslohjsJ*Explain why the student cannot participate in the regular state assessment and why the selected assessment option isappropriate:Due to significantly low academic scores in the above areas, the alternative Sr-.tte testing was selected as the most appropriate assessment optio n.Based upon the student' s classroom perfonnance. previous state assessment scores, behavioral issues and current perfonnance levels, the IBP teamhas detem1ined that alternative State testing in the above areas is required.Due to the impact of the student' s disabling co ndition upon academic performance, the IEP team has determined that alternative State testing inthe above areas is required.Other:lift5/hl C i 1/U/hbvrDistrictwide Assessment- Toe student will participate in districtwide assessment(s) appropriate for their grade &/orfunctional performance level:Explain why the student is unable to participate in a regular districtwide assessment:Due to the impact or the student' s disabling condition upon academic performance, the IEP team has determined that alternative District testing isrequired.Other:PASJSCORESGradeOptionR"dingL"1 eMetPOINTS TO CONSIDER: 1be rEP team makes t.bedetennination of what typeof assessment the studentwill take and whatadministrativemodifications andindividualaccommodations arenecessary. Accommodations providedon state and districtwideassessments should bethose that are provided aspan of the regularinstructional p rogram. Parents and studentsshould be informed thatany assessment other thanthe regular stateassessment (with orwithout accommodations)lead to a C-enificate ofIndividual Achievement(CIA), rather than aCertificate of AcademicAchievement (CAA). For further information onthe state assessmen t.allowableaccommodations., andg raduation requiremen ts,please refer to OSPI'swebsite o ·ww,k 12.wa,11s ) .

.-J) ZDate: ) )/'-'bStudent Name:PARENT CONSENT TO INVITE TRANSITION AGENCY PERSONNELIf the district intends to invite representatives of any agency that is likely to be responsible for providing orpaying for secondary transition services to the IBP meeting, your consent is required.[2J I give my consent for the secondary transition agency representative(s) marked with an"*" on theinvitation to be invited to the IEP meeting.D I give my consent for the secondary transition agency representatives marked with an " *" on theinvitation to be invited to the IBP meeting, except for the following representative(s):Reason (optional):D I do not give consent for the secondary transition agency representative(s) marked with an"*"

: J I I esigned to clearly c-0mmunicate to the parents, the student, and providers the type and amount ofspecial education and any necessary related services or supports that the student. The most recent evaluation report is used to develop the IEP.The IEP is individualized to r

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