mrpollastrini.weebly.com · Web viewSTUDENT NAME: Megan DATE OF MEETING: 09/29/16. ISBE 37-44O (11/14) Illinois State Board of Education, Special Education Services, 100 North First

STUDENT NAME: Megan DATE OF MEETING: 09/29/16

INDIVIDUALIZED EDUCATION PROGRAM (CONFERENCE SUMMARY REPORT)DATE OF MOST RECENT EVALUATION:______/______/______DATE OF NEXT REEVALUATION:______/______/_____

PURPOSE OF CONFERENCE (Check all that apply) Review of Existing Data Reevaluation 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)100 Green St..< Normal, IL 60565

STUDENT’S DATE OF BIRTH10/29/2004

SIS ID NUMBER85382956389

MALE

FEMALE

ETHNICITYWhite

LANGUAGE/MODE OF COMMUNICATION USED BY STUDENTEnglish

CURRENT GRADE LEVEL4rd

ANTICIPATED DATE OF HS GRADUATION2030

PLACEMENT(To be completed after placement determination)

YES NO Placement is in Resident School

DISABILITY(S)Other Health Impairment

MEDICAID NUMBER59230-

RESIDENT DISTRICTKaneville

SERVING DISTRICTDistrict 302

RESIDENT SCHOOLJohn Stewart Elementary

SERVING SCHOOLJohn Stewart Elementary

PARENT/GUARDIAN INFORMATION(1) PARENT’S NAME Educational Surrogate ParentJohn Smith

(2) PARENT’S NAME Educational Surrogate ParentKaren Murray

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

28 Blue St, Normal IL, 60565

(2) PARENT’S ADDRESS (Street, City, State, Zip Code)923 New York St, Normal IL, 60565

(1) PARENT’S TELEPHONE NUMBER (include Area Code)904-393-9938

(2) PARENT’S TELEPHONE NUMBER (Include Area Code)980-336-0990

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

Yes No Interpreter

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

Yes No Interpreter

PARTICIPANTSSignature 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 IEPELIG.

REVIEW IEPJohn Smith Parent School Social WorkerKaren Murray Parent Speech-Language PathologistMegan Murray Student Bilingual Specialist LEA Representative Interpreter

General Education Teacher Other (specify)Evyn Schaffer, Emma Rendek, Elise Romane, Kyle Pollastrini 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 September 29th, 2016

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STUDENT NAME: Megan DATE OF MEETING: 09/29/16____________________________________________________

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

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

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

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DOCUMENTATION OF EVALUATION RESULTS

Complete for initial evaluations, reevaluations, or a review of an independent or outside evaluation.Considering all available evaluation data, record the team’s analyses of the student’s functioning levels. Only those areas which were identified as relevant to the current evaluation must be completed. All other areas should be noted as “Not Applicable”. Evaluation data may include: parental input, teacher recommendations, physical condition, social or cultural background, adaptive behavior, record reviews, interviews, observations, testing etc. Describe the observed strengths and/or deficits in the student’s functioning in the following domains.Academic Achievement (Current or past academic achievement data pertinent to current educational performance)

Megan was administered the following tests: The Wechsler Intelligence Scale for Children-Revised (WISC-R), the Brigance e Diagnostic Inventory for Basic Skills (Brigance) and the Keymath-Revised (Keymath).

Megan scored a 113 on the WISC-R, which falls under the high average Full IQ range. Her score did show a 22 point discrepancy between her Verbal Scale IQ and her Performance Scale. Upon further analysis, in relation to her Performance Scale scores, Megan has excellent visual motor coordination and spatial order skills, but has difficulty distinguishing essential and nonessential details and sequencing timing of events. In relation to her Verbal Scale, she scored in the normal range for general knowledge and linguistic abilities, but struggled with problems related to defining words, identifying similarities between two words, using computational skills and reasoning and demonstrating social justice.

On the Keymath, Megan scored an overall grade equivalent of 3.1. Megan scored the highest in the geometry, measurement, time and money subtests. She was able to identify shapes, color, sizes and number patters as well as identity objects and estimate and measure the length and height of objects and lines. She was also able to interpret graphs and compute costs. Megan struggled with the multiplication, division, fraction and word problem subtests. She could not multiply more than one-digit numbers and could not perform multi-step division facts. In addition, she also had difficulty identifying fractions, putting fractions in order and converting fractions.

The Brigance was used to assess Megan’s reading skills. It was found that Megan has difficulty with word recognition, oral reading and comprehension. In terms of Word Recognition, Megan was able to read one and two syllable words, she could not read any words that had more than three syllables. In relation to Word Analysis, she had difficulty reading words that contained the long vowel and a silent “e”, but correctly read words with single initial consonant sounds as well as words with short vowel sounds. On the reading comprehension test, Megan struggled with passages that were written at a 3rd grade level. She has difficulty sounding out multi-syllabic words and relies on semantic or syntactic cues. It was found that she has increased difficulty with comprehension questions related to large amounts of information.

In terms of written language, Megan enjoys writing in many different genres. She does not use prewriting tools to organize her thoughts, and does not follow a chronological sequence of thoughts. Megan effectively uses a variety of sentence patterns, but does not include punctuation. Megan struggles with spelling, which in turn can make it difficult to distinguish the word intended.Functional Performance (Current or past functional performance data pertinent to current functional performance) Megan is frequently off task and has difficulty completing her assignments. She engages in off-task activities when she is supposed to be working on an assignment. She has a tendency to play with objects and/or leave her work area.

Cognitive Functioning (Data and other information regarding intellectual ability; how the student takes in information, understands information, and expresses information) Megan scored an IQ of 113 on the WISC-R. Megan learns best when is able to see something explained or is able to make something. Her classroom teacher noted that Megan enjoys working on the computer and performs better in writing tasks when she uses a talking processor. The student noted that she works best with others and like when she can use a computer.Communicative Status (Information regarding communicative abilities (language, articulation, voice, fluency) affecting educational performance)

Megan is highly verbal.

For ELL students explain ELL STATUS: Has Linguistic status Changed YES NO

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Health (Current or past medical difficulties affecting educational performance) To be completed by Nurse

Hearing/Vision (Auditory/visual problems that would interfere with testing or educational performance. Include dates and results of last hearing/vision test) To be completed by Nurse

Motor Abilities (Fine and gross motor coordination difficulties, functional mobility, or strength and endurance issues affecting educational performance) N/A

Social/Emotional Status/Social Functioning (Information regarding how the environment affects educational performance (life history, adaptive behavior, independent functioning, personal and social responsibility, cultural background)

Megan is very social able and has a lot of friends. Her classroom teacher reported that her classmates like her, but she is sometimes viewed as annoying by her peers.

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STUDENT NAME: Megan DATE OF MEETING: 09/29/16ELIGIBILITY DETERMINATION

(ALL DISABILITIES OTHER THAN SPECIFIC LEARNING DISABILITY)

DETERMINANT FACTORS

The determinant factor for the student’s suspected disability is:

Yes X No Lack of appropriate instruction in reading, including the essential components of reading instruction(Evidence Provided)_______________________________________________________________________

Yes X No Lack of appropriate instruction in math (Evidence Provided)________________________________________

Yes X No Limited English Proficiency (Evidence Provided):________________________________________________

If any of the above answers is “yes,” the student is not eligible for services under IDEA and the team must complete Step 1 and 4 below. If all of the answers are “no,” complete Steps 1-4.

COMPLETE FOR STUDENTS SUSPECTED OF HAVING A DISABILITY UNDER IDEA.STEP 1 - DISABILITY

No Disability Identified (Complete Step 4 and write “Not Eligible for Special Education Services” in the Disability section of the Conference Summary Report page.)

Disability IdentifiedBased on the team’s analysis, identify the disability(s):

Primary Secondary

□ Autism (O) □□ Cognitive Disability (A) □□ Deaf/Blindness (H) □□ Deafness (G) □□ Developmental Delay (3-9) (N) □□ Emotional Disability (K) □□ Hearing Impairment (F) □

Primary Secondary

□ Multiple Disabilities (M) □□ Orthopedic Impairment (C) □□ Other Health Impairment (L) □□ Speech or Language Impairment (I) □□ Traumatic Brain Injury (P) □□ Visual Impairment including Blindness (E) □

STEP 2 - ADVERSE EFFECTS

No Adverse Effect Identified(Complete Step 4 and write “Not Eligible for Special Education Services” in the Disability section of the Conference Summary Report page.)

Adverse Effect IdentifiedFor each disability identified, describe how the disability adversely affects the student’s educational performance

Other Health Impairment: Due to the student’s ADHD, she displays inconsistent performance in school. She frequently engages in off task activities such as playing with objects, leaving her work area, or seeking attention from her teacher or peers when she should be doing work. She is also displaying difficulty with math, reading and writing.

STEP 3 - EDUCATIONAL NEEDS

State to what extent the student requires special education and related services to address educational needs.

Yes, this child needs special education and related services to address educational needs. This child would benefit from pull out or push in services to address the areas of concern as well as behavioral interventions to increase her on-task behavior.

STEP 4 - ELIGIBILITY

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Based on the steps above, the student is entitled to special education and related services.

No (Not Eligible) Yes (Eligible)

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DOCUMENTATION OF INTERVENTION/EVALUATION RESULTS(SPECIFIC LEARNING DISABILITY)

(Required as of the 2010-2011 School Year)

Complete for initial evaluations, reevaluations, or a review of an independent or outside evaluation when a specific learning disability is suspected. As part of the evaluation process, relevant behavior noted during observation in the child’s age-appropriate learning environment, including the general education classroom setting for school-age children, and the relationship of that behavior to the child’s academic functioning and educationally relevant medical findings, if any, must be documented.PROBLEM IDENTIFICATION / STATEMENT OF PROBLEM:Using baseline data, please provide an initial performance discrepancy statement for all identified areas of concern in the relevant domains (academic performance; functional performance; cognitive functioning, communicative status (for ELL students includes an explanation of ELL status and any change in linguistic status); social/emotional status/functioning, motor abilities, health, hearing and vision) including information about the student’s performance discrepancy prior to intervention. Attach evidence.

PROBLEM ANALYSIS / STRENGTHS AND WEAKNESSES:Describe student’s skill strengths and weaknesses in the identified area(s) of concern within the relevant domains. Attach evidence, including evidence of skills deficit versus performance deficit.

PLAN DEVELOPMENT / INTERVENTION(S):Describe the previous and current intervention plans (core/Tier 1, supplemental/Tier 2, and intensive/Tier 3) including evidence that the intervention is scientifically based and was implemented with integrity. Attach plan/evidence.

PLAN EVALUATION / EDUCATIONAL PROGRESS:Provide documentation of student progress over time as a result of the intervention. Attach evidence/graphs.

PLAN EVALUATION / DISCREPANCY:State the current performance discrepancy after intervention, i.e., the difference between a student’s level of performance compared to the performance of peers or scientifically-based standards of expected performance. Attach evidence.

PLAN EVALUATION / INSTRUCTIONAL NEEDS:Summarize the student’s needs in the areas of curriculum, instruction, and environment. Include a statement of whether the student’s needs in terms of materials, planning, and personnel required for intervention implementation are significantly different from those of general education peers. Attach evidence.

ADDITIONAL INFORMATION NECESSARY FOR DECISION-MAKING (INCLUDE AS APPROPRIATE):Report any educationally relevant information necessary for decision-making, including information regarding eligibility exclusionary and inclusionary criteria. Attach evidence.

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ELIGIBILITY DETERMINATION(SPECIFIC LEARNING DISABILITY)

(Required as of the 2007-2008 School Year)

Complete for initial evaluations, reevaluations, or a review of an independent or outside evaluation when a specific learning disability is suspected.

DETERMINANT FACTORS

The determinant factor for the student’s suspected disability is:

Yes No Lack of appropriate instruction in reading, including the essential components of reading instruction(Evidence Provided)_______________________________________________________________________

Yes No Lack of appropriate instruction in math (Evidence Provided)________________________________________

Yes No Limited English Proficiency (Evidence Provided)_________________________________________________

If any of the above answers is “yes,” the student is not eligible for services under IDEA and the team must complete the Eligibility Determination section accordingly. If all of the answers are “no,” complete the following sections.

EXCLUSIONARY CRITERIAThe team determined that the following factors are the primary basis for the student’s learning difficulties. Document the source of evidence in each area:

Yes No A visual, hearing or motor disability:Yes No Cognitive Disability:Yes No Emotional disability:Yes No Cultural factors:Yes No Environmental or economic disadvantage:

If any of the boxes immediately above is checked “yes,” the student cannot have a primary eligibility of specific learning disability and the team must complete the Eligibility Determination section accordingly.

INCLUSIONARY CRITERIAEducational Progress (Over Time)Evidence in the Documentation of Evaluation Results should support the team’s answer to this question.

Is the student progressing at a significantly slower rate than is expected in any areas of concern?(Select One)

No Yes - The student is progressing at a significantly slower rate than expected Yes - The student is currently making an acceptable rate of progress but only because of the intensity of the intervention that is

being provided.

If yes, in which area(s)?

Discrepancy (At One Point in Time)Evidence in the Documentation of Evaluation Results should support the team’s answer to this question.

Is the student’s performance significantly below performance of peers or expected standards in any areas of concern?(Select One)

No Yes - The student’s performance is significantly discrepant. Yes - The student’s performance is not currently discrepant but only because of the intensity of the intervention that is being

provided.


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STUDENT NAME: Megan DATE OF MEETING: 09/29/16ELIGIBILITY DETERMINATION

(SPECIFIC LEARNING DISABILITY)(Required as of the 2007-2008 School Year)

Instructional NeedEvidence in the Documentation of Evaluation Results should support the team’s answer to this question.

Are this student’s needs in any areas of concern significantly different from the needs of typical peers and of an intensity or type that exceeds general education resources?(Select One)

No Yes - The student’s instructional needs are significantly different and exceed general education resources.


If any of the boxes in this section (Inclusionary Criteria) are marked “No”, the student does not have a Specific Learning Disability and the team must complete the Eligibility Determination section accordingly.

Optional CriteriaAfter determining that the criteria in the preceding section are met, the district may choose to use an IQ-achievement discrepancy model. If using this model, complete this section.

IQ-Achievement Discrepancy: Yes No NA Does a severe discrepancy exist between achievement and ability that is not correctable without special

education and related services? (Please refer to evidence in Documentation of Evaluation Results)


ELIGIBILITY DETERMINATION

Step 1: Disability Adversely Affecting Educational Performance

Yes No Based on the answers to the questions in the “Determinant Factors, Exclusionary Criteria,” and “Inclusionary Criteria,” sections, does the student have a specific learning disability?

If the answer is “no” the student is not eligible for special education services under the category of Specific Learning Disability and the team must complete Step 2 below.

If the answer is “yes,” indicate the area below and complete Step 2. Basic reading skills Reading fluency skills Reading comprehension

Mathematical calculation Mathematical problem solving Written expression

Oral expression Listening comprehension

Step 2: Special Education and Related Services

Specialized instruction is required in order for the student to make progress and reduce discrepancy (Eligible)

Specialized instruction is not required in order for the student to make progress and reduce discrepancy (Not Eligible)

Each team member must sign below to certify that the report reflects his/her conclusions for specific learning disability. Any participant who disagrees with the team’s decision must submit a separate statement presenting her/his conclusions.

Yes No Yes No

Yes No Yes No

Yes No Yes No

Yes No Yes No

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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

Megan is a highly verbal, very knowledgeable child. She enjoys working more hands on or working on a computer. Megan learns best when she is able to see something explained, or make something herself. She has excellent visual motor coordination and spatial orientation skills. She is very social able and has friends in school.

Parental Educational Concerns/Input

Megan’s parents are mostly concerned about her general lack of progress in school and poor performance in reading, writing and math. Her mother referred her for an evaluation. Her father does not agree.

Student’s Present Level of Academic Achievement (Include strengths and areas needing improvement)

Megan has a high average Full Scale IQ of 113. Her tests indicated that she has strong visual-motor coordination and spatial orientation, but has difficulty with distinguishing essential and nonessential details and sequencing the timing of a series of events. She is in the normal range of general knowledge and linguistic abilities. Megan would benefit from instruction related to defining words, identifying similarities between words and using computational skills and reasoning as well as demonstrating social justice. In relation to math, Megan scored an overall grade equivalent of 3.1. Megan’s strongest skill areas include her geometry, measurement, time, and money skills. She was able to identify shapes, sizes color, and number patterns. Megan displayed difficulty with multiplication, division, fractions and word problems, but was able to interpret graphs and compute costs. She would benefit from instruction on multiplication of more than one-digit numbers, as well as multi-step division problems. She also needs to improve on her ability to identify fractions, put fractions in order, and converting fractions to percentages. While Megan is able to read one and two syllable words, she has more difficultly and struggled to read words that contained more than three syllables. She can read words with initial constant sounds but showed difficulty reading words that contained the long vowel and silent “e”. Megan would benefit from instruction related to answering comprehension questions that pertain to large amounts of information and interpreting abstractions. In writing, Megan would benefit from using pre-writing tools such as semantic webs to help organize her thoughts and ideas. While she has many ideas to write about, and the ability to write in many different genres such as stories, poems and letters, Megan struggles with following a chronological sequence and tends to not fully develop the topic she is writing about.

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

Megan is frequently off task and has difficulty completing her assignments. She has shown that she tends to work on one assignment for a short period of time, and then works on another assignment. She tends to engage in off task behavior such as playing with objects, leaving her work area, or seeking attention from her teacher or peers. It appears that her behavior is influenced by other activities in the classroom. Megan stated that she loves to work with her hands. Megan would benefit from interventions and strategies that would help her stay on task and finish her work.

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).

Due to Megan’s disability, it makes it difficult for her to complete assignments. She has a tendency to work on one 10


assignment for a short period of time, and then go to a different assignment. She tends to demonstrate and produce inconsistence performance on her work. She engages in off task behavior during work time. Due to her disability and her inability to stay on task during work time, she is also experiencing difficulty in math, reading and writing, with an emphasis on reading and math. There are no severe functional implications of the student’s skills pertaining to the disability at this time.

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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 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.

Megan is frequently off task and has difficulty completing her assignments. She tends to engage in off task behavior such as playing with objects, leaving her work area, or seeking attention from her teacher or peers. She has shown that she tends to work on one assignment for a short period of time, and then works on another assignment. Megan would benefit from interventions and strategies that would help her stay on task and finish her work.

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 3

During social studies class, Megan will remain on task by having eyes orientated toward the task or speaker, and remain inher desk, unless given permission to leave seat, for 45 out of 50 minutes of the period for 5 consecutive periods bySeptember 2017.

Indicate Goal Area: Academic Functional Transition Illinois Learning Standard: #SEL 3B.2b

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

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal During independent work time, Megan will remain in her assigned area for 80% of the time for 7 consecutive trials.

EvaluationCriteria

EvaluationProcedures

Schedule forDetermining Progress

Dates Reviewed/Extent of Progress (Optional)

80% % Accuracy Observation Log Daily# of attempts X Data Charts WeeklyOther (specify) Tests X Quarterly

Other (specify) SemesterOther (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal When given an assignment, Megan will fully complete the assignment before going on to the next assignment with 100% accuracy for 7 consecutive assignments.

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EvaluationCriteria




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

Other (specify) Tests X QuarterlyOther (specify) Semester

Other (specify)

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Megan displayed difficulty with multiplication, division, fractions and word problems, but was able to interpret graphs andcompute costs. She would benefit from instruction on multiplication of more than one-digit numbers, as well as multi-stepdivision problems.


Goal Statement #2 of 3 Given a set of 20 single digit by two-digit multiplication problems, Megan will have 5 minutes to write the correct answer to20 out of 20 problems for three consecutive trials by September 2017.

Indicate Goal Area: Academic Functional Transition Illinois Learning Standard: # NIlS.4.OA.1Title(s) of Goal Implementer(s) Educational Team

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal Given a set of 20 single digits by two-digit multiplication problems, Megan will have 5 minutes to write the correct answer to 10 out of 20 problems for three consecutive trials by September 2017

EvaluationCriteria




% Accuracy Observation Log Daily / # of attempts X Data Charts WeeklyX Other (specify) Tests X Quarterly10 out of 20 problems correct

Other (specify) SemesterOther (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal Given a set of 20 single digit by two-digit multiplication problems, Megan will have 5 minutes to write the correct answer to 15 out of 20 problems for three consecutive trials by September 2017

Evaluation Evaluation Schedule for Dates Reviewed/14

STUDENT NAME: Megan DATE OF MEETING: 09/29/16Criteria Procedures Determining Progress Extent of Progress (Optional)

% Accuracy Observation Log Daily / # of attempts X Data Charts WeeklyX Other (specify) Tests X Quarterly15 out of 20 problems correct

Other (specify) Semester

Other (specify)






Megan is able to read one and two syllable words. She can read words with initial constant sounds but showed difficultyreading words that contained the long vowel and silent “e”. Megan would benefit from instruction related to identifying and reading vowel sounds.


Goal Statement #3 of 3

Given a reading passage at the 4th grade level, Megan will verbally pronounce the words in the passage with 95%accuracy for 3 out of 4 trials.

Indicate Goal Area: Academic Functional Transition Illinois Learning Standard: # NILS 4.R.F.3

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

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal Given a list of 10 words containing the following vowel blends (“ai,” “ae,” “ie,” “ou”), Megan will verbally pronounce 10 words with 80% accuracy for 5 consecutive trails

EvaluationCriteria






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STUDENT NAME: Megan DATE OF MEETING: 09/29/16Other (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal Given a list of 10 words containing a long vowel, Megan will verbally pronounce 10 words with 80% accuracy for 5 consecutive trials.

EvaluationCriteria






Other (specify)

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

TRANSITION

Yes No

NAConsideration 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 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 FACTORSCheck 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.

No assistive technology devices and services

No communication needs

No deaf/hard of hearing – languages and communication needs

No limited English proficiency – language needs

No blind/visually impaired – provision of Braille instruction

Yes

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 No The student requires accommodations for the IEP to meet her/his linguistic and cultural needs.

If yes, specify any needed accommodations:

Yes No Special education and related services will be provided in a language or mode of communication otherthan 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.

Proximity to teacher/ assigned seating Paraphrased directions Cues to staying on task Movement breaks Extended Time

Small group instruction Consistent structure with clear consequences Writing graphic organizer Break large projects into small chunks with

specific due dates

SUPPORTS FOR SCHOOL PERSONNEL 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.

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ISBE 37-44O (11/14) Illinois State Board of Education, Special Education Services, 100 North First Street, Springfield, Illinois 62777-0001


ASSESSMENT

Student will participate in classroom assessments with accommodations(s). (Complete Assessment Accommodations section on the IEP)

Student will:Participate in the entire district-wide assessment without accommodation(s).

Participate in the entire district-wide assessment with accommodation(s). (Complete Assessment Accommodations section on the IEP)

Participate in part(s) of the district-wide assessment (specify which part(s) and what, if any, accommodations are required). (Complete Assessment Accommodations section on the IEP).

Participate in the district-wide alternate assessment without accommodation(s).

Participate in the district-wide alternate assessment with accommodation(s). (Complete Assessment Accommodations section on the IEP)

Indicate below which state academic assessment(s) this student will take and, if applicable, if accessibility feature(s) and/or accommodation(s) are needed.

State academic assessments are not administered at this grade level:

1. Partnership for Assessment of Readiness for College and Careers (PARCC) (grades 3-8, and high school)

PARCC is provided for English Language Arts/Literacy and Mathematics at grades 3-8 and high school. For high school administration, a student currently enrolled in Integrated Math 3 or Algebra 2 will take the mathematics assessment and a student currently enrolled in English 3 will take the English Language Arts assessment.

The PARCC assessment is not appropriate. (Specify) (Go to #2)

Student will:Participate in PARCC with no accessibility features turned on in advance and no accommodation(s). Participate in PARCC assessment with accessibility features turned on in advance and/or accommodation(s). (Complete the PARCC Accessibility Features and Accommodations form and attach).

2. Dynamic Learning Maps (DLM) (Alternate assessment for grades 3-8, and 11) The DLM Participation Guidelines were met. (Complete the DLM Participation Guidelines and attach).

If met, the student will:Participate in DLM with no accessibility features/accommodation(s).

Participate in DLM with accessibility features/accommodation(s). (Complete the DLM Accessibility Features and Accommodations form and attach)

3. Illinois Science Assessment (grades 4, 7,& 11 only) Not administered at student’s current grade level.

Participate in science assessment with no accommodation(s).

Participate in science assessment with accommodation(s). (Complete Assessment Accommodations section of the IEP)

4. Other (optional by district). If applicable, list assessment to be given (e.g. ACT/Work Keys, KIDS) Participate in

Participate with no accommodation(s).

Student will participate in classroom assessments with no accommodation(s).CLASSROOM-BASED ASSESSMENTS

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

DISTRICT-WIDE ASSESSMENTS

STATE ACADEMIC ASSESSMENTSSTATE ACADEMIC ASSESSMENTS

Participate with accommodation(s). (Complete Assessment Accommodations section on the IEP)Participate with accommodation(s). (Complete Assessment Accommodations section on the IEP)



The State assessment of language proficiency Assessing Comprehension and Communication in English State to State (ACCESS) and theAlternate for English Access Learners (EL) in grades K-12 include:.

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

If yes, the Student will:Participate in the ACCESS with no accommodations

Participate in the ACCESS with accommodations (Complete Assessment Accommodations section of the IEP).

Participate in the alternate ACCESS with no accommodation(s).Participate in the alternate ACCESS with accommodation(s). (Complete Assessment Accommodations section of the IEP).

If the student will participate in assessments with accommodations, other than PARCC and DLM, document any needed

accommodations for the content area(s) in the section below.Classroom-Based Assessments

Proximity to teacher/ assigned seating Paraphrased directions Movement breaks Extended Time Graphic organizer for writing Break large tests into small chunks with specific due dates Directions read orally Passages read orally Directions repeated Eliminate answer choices

District-Based Assessments Movement breaks Extended Time Directions repeated Eliminate answer choices

Science Assessment Direction read orally Passages read orally Eliminate answer choices

Other Assessment (e.g. ACT/WORK KEYS, KIDS)

STATE ASSESSMENT OF LANGUAGE PROFICIENCY

ASSESSMENT ACCOMMODATIONSASSESSMENT ACCOMMODATIONS

STATE ASSESSMENT OF LANGUAGE PROFICIENCY


STUDENT NAME: Megan DATE OF MEETING: 09/29/16 N/A

ACCESS/Alternate ACCESS

N/A



EDUCATIONAL SERVICES AND PLACEMENT

Initiation Date09/29/2016 Duration Date: 09/29/17

PARTICIPATION IN GENERAL EDUCATION CLASSESThe 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)

Art Music PE Recess Any extra curricular activity

30 minutes 30 minutes 60 minutes 100

minutes TBD

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)

Science Social Studies

60 minutes 90 minutes

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

Pull out/push in services for Language Arts

Pull out/push in services for Math

100 minutes

150 minutes

PARTICIPATION IN SPECIAL EDUCATION CLASSES/SERVICESThe IEP must address all special education and related services.Special Education Services – Outside General Education Minutes Per Week

in SettingPull out/Push out Language Arts and math A.

250 Minutes

Related Services – Outside General Education Minutes Per Week in Setting

N/A B.0 Minutes

Educational Environment (EE) Calculation (Ages 3-5)_________ 1. Minutes spent in regular early childhood program

Educational Environment (EE) Calculation (Ages 6-21)1900____ 1. Total Bell to Bell Minutes


STUDENT NAME: Megan DATE OF MEETING: 09/29/16_________ 2. Minutes spent receiving special education and

related services outside regular early childhood (A+B)

250____ 2. Total Number of Minutes Outside of the General Education Setting (A+B)



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.

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:________________________________________________________________________________________________________

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:____________________________________________________________________________________________________

Yes NoWill attend the school he or she would attend if nondisabled?If no, explain:____________________________________________________________________________________________________

PLACEMENT CONSIDERATIONSWhen 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 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

All day General Education Placement Not enough support Yes No

General Education Placement with push in or pull out services

My limit students exposure to general education peers and

curriculum Yes No

Private Therapeutic Day Lack of exposure to typical peers Yes No

TRANSPORTATIONCheck all that apply

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

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

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

Please explain and/or detail transportation plan:

EXTENDED SCHOOL YEAR SERVICES Yes 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

Documents

mrpollastrini.weebly.com · Web viewSTUDENT NAME: Megan DATE OF MEETING: 09/29/16. ISBE 37-44O (11/14) Illinois State Board of Education, Special Education Services, 100 North First