Iep In The Philippines 1a1y3l
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STUDENT NAME: Jane Doe DATE OF BIRTH: 7/7/2000 LOCAL ID #: 5555555 PROJECTED DATE IEP IS TO BE IMPLEMENTED:02/13/2015 STUDENT NAME: Jane Doe
DISABILITY CLASSIFICATION: Learning Disability
PROJECTED DATE OF ANNUAL REVIEW:05/19/2016 NYC ID:5555555
PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS DOCUMENTATION OF STUDENT'S CURRENT PERFORMANCE AND ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS EVALUATION RESULTS (INCLUDING FOR SCHOOL-AGE STUDENTS, PERFORMANCE ON STATE AND DISTRICT-WIDE ASSESSMENTS) ELA State Exam 2014 Present Level 2 Proficiency Rating- 2.90 Growth Rate- 77% Scale Score 300 MATHEMATICS State Exam 2014 Present Level- 2 Proficiency Rating- 2.57 Growth Rate- 24% Scale Score- 324 ACADEMIC ACHIEVEMENT, FUNCTIONAL PERFORMANCE AND LEARNING CHARACTERISTICS LEVELS OF KNOWLEDGE AND DEVELOPMENT IN SUBJECT AND SKILL AREAS INCLUDING ACTIVITIES OF DAILY LIVING, LEVEL OF INTELLECTUAL FUNCTIONING, ADAPTIVE BEHAVIOR, EXPECTED RATE OF PROGRESS IN ACQUIRING SKILLS AND INFORMATION, AND LEARNING STYLE: In ELA, based on the Independent Reading Level Assessment Framework Jane Doe is reading on a 3rd grade level. This demonstrates that Jane Doe has mastered common core reading standards up to grade 3. She is currently struggling with skills that incorporate acquiring and using grade level academic language and word usage. When asked to use textual evidence to explain her ideas with a grade level text, Jane Doe demonstrates challenges to achieve this task on her own and requires s in the form of scaffolded questions and graphic organizers. In reading, Jane Doe demonstrates challenges with making inferences and drawing conclusions. In the ICT ELA classroom, often Jane Doe demonstrates a lack of focus. She is very easily distracted and requires frequent monitoring to complete classroom tasks. Jane Doe is able to work in small groups, but often requires re-direction to stay on task. When Jane Doe is focused she is able to form accurate conclusions after reading texts on her independent reading level and can respond to questions verbally and in written form. In writing Jane Doe struggles with structuring essays and short responses. Currently Jane Doe has shown progress using the R.A.C.E formula to respond to short assessment questions. Essay writing is still a challenge. Jane Doe benefits from using
PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS DOCUMENTATION OF STUDENT'S CURRENT PERFORMANCE AND ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS graphic organizers that outline where to place transition words, details and explanations within a paragraph. Jane Doe has trouble completing and turning in H.W. assignments and benefits from the reinforcement and monitoring of her school planner to stay organized and to build responsibility appropriate for middle school. MATHEMATICS Jane Doe is a 6th grade student who does not particularly enjoy Mathematics. Jane Doe has had difficulty grasping the grade level curriculum. Jane Doe has basic addition and subtraction skills. However, when subtracting numbers with regrouping, Jane Doe is more likely to make errors. Jane Doe still requires practice with her multiplication and division skills. Jane Doe was given flash cards to practice her multiplication and division skills. Therefore, Jane Doe was not able to master topics such as finding the GCF and LCM. Jane Doe is constantly distracted in class. Jane Doe had difficulty with fraction and decimal operations as well. Jane Doe was able to multiply simple fractions, however, when she was instructed to convert mixed numbers and improper fractions before multiplying, there were many errors. Jane Doe was able to follow the steps for dividing fractions and again, with simple fractions, she was able to display some success. Jane Doe is often distracted in class. Due to the constant lack of focus, Jane Doe struggles with task completion. Jane Doe is quite talkative in class and could show more progress if she would prioritize and stay focused. SCIENCE Jane Doe shows willingness to learn new concepts. She comes to science class prepared and ready to work. She greatly benefits from working one on one with a teacher or in small groups with a teacher. It is helpful for Jane Doe when instructions are broken down into clear and simple steps. Graphic organizers that chunk or section pieces of information help Jane Doe to understand complex material. Embedded questions in chunked reading material help Jane Doe to stay focused when reading. Jane Doe follows teacher instructions and explanation. Jane Doe is mostly well mannered and respectful; she remains on task with frequent teacher check-ins to ensure focus and understanding. Jane Doe benefits from additional time to complete her assignments. Jane Doe is able to comprehend scientific texts while using vocabulary reference sources like a textbook. She also benefits from diagrams and images that portray scientific ideas and concepts, as well as real world- science curriculum examples. STUDENT STRENGTHS, PREFERENCES, INTERESTS: Jane Doe enjoys school, she expresses a desire to learn and likes learning. Her favorite classes include, science, math, ELA and PE class. She feels like she enjoys the social aspect of school, she has many friends in her class. Jane Doe's extra curricular activities include dance and cheerleading. Jane Doe also enjoys spending time with her family and is looking forwards to this summer vacation as her family has planned trips. Jane Doe plays in the school orchestra and enjoys learning the viola. ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT:
PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS DOCUMENTATION OF STUDENT'S CURRENT PERFORMANCE AND ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS Mom is trying to make an appointment with a psychologist but is having difficulty finding someone. Mom needs a referral for an independent psychologist. 2013, Jane Doe saw a psychologist who recommender her to not be on medication ADHD, mom feels like Jane Doe would benefit from being on medication now. Did she receive a promotion in doubt for this year? Jane Doe would greatly benefit from a tutor outside of school. She requires some oneto-one instruction. Mom feels that Jane Doe is struggling at in the ICT classes with SETSS services. At home, Jane Doe becomes distracted when attempting to do homework more so then previous years. Mom would like Jane Doe to continue with ICT class and SETSS services and add medication. SOCIAL DEVELOPMENT THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT’S RELATIONSHIPS WITH PEERS AND ADULTS; FEELINGS ABOUT SELF; AND SOCIAL ADJUSTMENT TO SCHOOL AND COMMUNITY ENVIRONMENTS: Jane Doe gets along well her peers and the staff in the school. STUDENT STRENGTHS: Jane Doe is a very social young lady. Jane Doe participates in school events like the school talent show, she performed a cheerleading routine with other girls in the school. She also participates in school concerts. SOCIAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT: Jane Doe is very socially. It is easy for her to make friends. Mom is concerned that Jane Doe play fights with other students and can get carried away but mom speaks to her about this frequently. PHYSICAL DEVELOPMENT THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT’S MOTOR AND SENSORY DEVELOPMENT, HEALTH, VITALITY AND PHYSICAL SKILLS OR LIMITATIONS WHICH PERTAIN TO THE LEARNING PROCESS: Jane Doe has been diagnosed with Attention Deficit/ Hyperactivity Disorder (ADHD). She does not currently take medication. Jane Doe is otherwise reported to be in good health. STUDENT STRENGTHS: Jane Doe participates willingly in class and sports activities. She likes to dance and participates in extracurricular activities. PHYSICAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT: No concerns at this time. MANAGEMENT NEEDS THE NATURE (TYPE) AND DEGREE (EXTENT) TO WHICH ENVIRONMENTAL AND
PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS DOCUMENTATION OF STUDENT'S CURRENT PERFORMANCE AND ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS HUMAN OR MATERIAL RESOURCES ARE NEEDED TO ADDRESS NEEDS IDENTIFIED ABOVE: During classroom lessons, Jane Doe requires: -small group instructions -repeated directions -on-task focusing prompts -repeated directions -breaks -visual aids -scaffolding to write extended response questions -extended time to complete questions EFFECT OF STUDENT NEEDS ON INVOLVEMENT AND PROGRESS IN THE GENERAL EDUCATION CURRICULUM OR, FOR A PRESCHOOL STUDENT, EFFECT OF STUDENT NEEDS ON PARTICIPATION IN APPROPRIATE ACTIVITES Jane Doe continue to in a general education setting with the structure and provided in an ICT setting with where she can access more small group interaction and individual throughout the day. STUDENT NAME: Jane Doe
NYC ID:555555
STUDENT NEEDS RELATING TO SPECIAL FACTORS BASED ON THE IDENTIFICATION OF THE STUDENT'S NEEDS, THE COMMITTEE MUST CONSIDER WHETHER THE STUDENT NEEDS A PARTICULAR DEVICE OR SERVICE TO ADDRESS THE SPECIAL FACTORS AS INDICATED BELOW, AND IF SO, THE APPROPRIATE SECTION OF THE IEP MUST IDENTIFY THE PARTICULAR DEVICE OR SERVICE(S) NEEDED: Does the student need strategies, including positive behavioral interventions, s and other strategies to address behaviors that impede the student's learning or that of others?
Yes
No
Does the student need a behavioral intervention plan? No Yes For a student with limited English proficiency, does she need a special education service to address her language needs as they relate to the IEP?
Yes
No Not Applicable For a student who is blind or visually impaired, does she need instruction in Braille and the use of Braille? Yes No Not Applicable Does the student need a particular device or service to address her communication needs? Yes No In the case of a student who is deaf or hard of hearing, does the student need a particular device or service in consideration of the student's language and
STUDENT NEEDS RELATING TO SPECIAL FACTORS BASED ON THE IDENTIFICATION OF THE STUDENT'S NEEDS, THE COMMITTEE MUST CONSIDER WHETHER THE STUDENT NEEDS A PARTICULAR DEVICE OR SERVICE TO ADDRESS THE SPECIAL FACTORS AS INDICATED BELOW, AND IF SO, THE APPROPRIATE SECTION OF THE IEP MUST IDENTIFY THE PARTICULAR DEVICE OR SERVICE(S) NEEDED: communication needs, opportunities for direct communications with peers and professional personnel in the student's language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the student's language and communication mode? Yes
No
Not Applicable
Does the student need an assistive technology device and/or service? Yes No If yes, does the Committee recommend that the device(s) be used in the student's home?
Yes
No
STUDENT NAME: Jane Doe
NYC ID:555555
BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE STUDENT IS AGE 15 (AND AT A YOUNGER AGE IF DETERMINED APPROPRIATE) MEASURABLE POSTSECONDARY GOALS LONG-TERM GOALS FOR LIVING, WORKING AND LEARNING AS AN ADULT EDUCATION/TRAINING: EMPLOYMENT: INDEPENDENT LIVING SKILLS (WHEN APPROPRIATE): TRANSITION NEEDS In consideration of present levels of performance, transition service needs of the student that focus on the student's courses of study, taking into the student’s strengths, preferences and interests as they relate to transition from school to postschool activities: STUDENT NAME: Jane Doe
NYC ID:555555
MEASURABLE ANNUAL GOALS THE FOLLOWING GOALS ARE RECOMMENDED TO ENABLE THE STUDENT TO BE INVOLVED IN AND PROGRESS IN THE GENERAL EDUCATION CURRICULUM, ADDRESS OTHER EDUCATIONAL NEEDS THAT RESULT FROM THE STUDENT'S DISABILITY, AND PREPARE THE STUDENT TO MEET HIS/HER POSTSECONDARY GOALS. ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE
CRITERIA MEASURE TO DETERMINE
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
END OF THE YEAR IN WHICH THE IEP IS IN EFFECT SCIENCE Determine the central ideas or conclusions of a text; provide an accurate summary of the text distinct from prior knowledge or opinions.
IF GOAL HAS BEEN ACHIEVED Teacher Made Materials Verbal Explanation 60% Accuracy Teacher/Provider Observations
ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT SCIENCE Determine the meaning of symbols, key , and other domain-specific words and phrases as they are used in a specific scientific or technical context relevant to grades 6-8 texts and topics.
ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT Common Core ELA
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
60 % Accuracy
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
METHOD HOW PROGRESS WILL BE MEASURED
1 time per quarter
SCHEDULE WHEN PROGRESS WILL BE MEASURED
Teacher Made 1 time per quarter Materials Teacher/Provider Observations Verbal Explanation
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
Teacher Made 1 time per quarter Materials Class Activities In one year Jane Doe will be Teacher/Provider able to determine the meaning of Observations words and phrases as they are Performance 75% Accuracy used in a text, including Assessment figurative, connotative, and Task technical meanings. She will demonstrate this skill by reading a grade level text and identifying a new or unfamiliar word, she
will then use context clues or similar strategies to determine the meaning.
ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
Common Core ELA In one year with as needed, Jane Doe will be able 7 out of 10 to ask and answer questions to trials for 32 demonstrate understanding of a weeks grade level text. She will demonstrate this skill by referring explicitly to the text as the basis for the answers.
ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
Teacher Made 1 time per quarter Materials Class Activities Teacher/Provider Observations Performance Assessment Task
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
ELA Common Core- Writing
Teacher Made 1 time per quarter Materials In one year with with guidance Class Activities and , Jane Doe will be Teacher/Provider able to develop and strengthen Observations her writing by planning, revising, 3 out of 5 trials Performance editing, rewriting, or trying a new for 32 weeks Assessment approach. She will demonstrate Task this skill by constructing an essay on a grade level topic and completing all 5 stages of the writing process. ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR
CRITERIA MEASURE TO DETERMINE
METHOD HOW PROGRESS WILL BE
SCHEDULE WHEN PROGRESS WILL BE
IN WHICH THE IEP IS IN EFFECT
IF GOAL HAS BEEN ACHIEVED
MATHEMATICS Within one academic school year, Jane Doe will be able to develop an understanding of fractions as numbers. Jane Doe will be able to represent 60% Accuracy fractions on a number line, identify equivalent fractions and compare fractions. Jane Doe will also be able to demonstrate the rules for multiplying and dividing fractions.
ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
MATHEMATICS Within one academic school year, Jane Doe will be able to increase her ability to select and 60% Accuracy apply mathematical operations in a variety of contexts to compute whole numbers, fractions, decimals and integers.
ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
MATHEMATICS Within one academic school year, Jane Doe will increase her multiplication and division skills. 60% Accuracy Jane Doe will be able to apply her multiplication and division skills to perform grade level
MEASURED
MEASURED
Teacher Made 1 time per quarter Materials Teacher/Provider Observations Class Activities Performance Assessment Task
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
Teacher Made 1 time per quarter Materials Class Activities Teacher/Provider Observations Performance Assessment Task
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
Teacher Made 1 time per quarter Materials Class Activities Teacher/Provider Observations Performance Assessment
tasks including finding the GCF and LCM, order of operations and operations with fractions. ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
Task
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
Counseling: Within one year, Jane Doe will improve her communication skills as demonstrated by 3 out of 4 trials expressing her thoughts and feelings without the use of foul and/or abusive language.
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
Check Lists Verbal Explanation Performance Assessment Task Teacher/Provider Observations
STUDENT NAME: Jane Doe
1 time per quarter
NYC ID: 555555
REPORTING PROGRESS TO PARENTS Identify when periodic reports on the student's progress toward meeting the annual goals will be provided to the student’s parents: at the same time school report cards are issued STUDENT NAME: Jane Doe
NYC ID:555555
RECOMMENDED SPECIAL EDUCATION PROGRAMS AND SERVICES PROJE CTED FREQU DURA BEGIN ENCY TION LOCATION NING / SERVICE HOW LENG WHERE SERVIC DELIVERY OFTEN TH OF SERVICE E SPECIAL EDUCATION RECOMMEND PROVID SESSI WILL BE DATE(S PROGRAM/SERVICES ATIONS* ED ON PROVIDED ) SPECIAL EDUCATION PROGRAM: Integrated Co-Teaching
Language of
5 time(s) Period General
05/13/2
RECOMMENDED SPECIAL EDUCATION PROGRAMS AND SERVICES Services ELA Integrated Co-Teaching Services Math Integrated Co-Teaching Services Sciences Special Education Teacher Services [SETSS] Math Special Education Teacher Services [SETSS] ELA
Service: Engli per week sh Language of 5 time(s) Period Service: Engli per week sh Language of 3 time(s) Period Service: Engli per week sh Direct Service 3 time(s) Period Group service per week
Education Classroom
015
General Education Classroom
05/13/2 015
General Education Classroom
05/13/2 015
Special Education Classroom
05/13/2 015
Direct Service 2 time(s) Period Special Education Group service per week Classroom Language of Service: Engli sh
05/21/2 015
Language of Service: Engli sh
RELATED SERVICES: Counseling Services
30 min Group service 1 time(s) utes Language of Service: Engli per week sh
Separate 05/13/2 Location Co 015 unselor's ofiice
SUPPLEMENTARY AIDS AND SERVICES/PROGRAM MODIFICATIONS/ACCO MMODATIONS: ASSISTIVE TECHNOLOGY DEVICES AND/OR SERVICES: S FOR SCHOOL PERSONNEL ON BEHALF OF THE STUDENT: * Identify, if applicable, class size (maximum student-to-staff ratio), language if other than English, group or individual services, direct and/or indirect consultant teacher services or other service delivery recommendations.
STUDENT NAME: Jane Doe
NYC ID:555555
12-MONTH SERVICE AND/OR PROGRAM - Student is eligible to receive special education services and/or program during July/August: If yes:
No
Yes
* Student will receive the same special education program/services as recommended above. OR Student will receive the following special education program/services: PROJECT ED SPECIAL SERVICE BEGINNIN EDUCATION DELIVERY G/ PROGRAM/SERVI RECOMMENDATI FREQUEN DURATI LOCATI SERVICE CES ONS CY ON ON DATE(S) Name of school/agency provider of services during July and August: For a preschool student, reason(s) the child requires services during July and August:
STUDENT NAME: Jane Doe
NYC ID:555555
TESTING ACCOMMODATIONS (TO BE COMPLETED FOR PRESCHOOL CHILDREN ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL CHILDREN): INDIVIDUAL TESTING ACCOMMODATIONS, SPECIFIC TO THE STUDENT’S DISABILITY AND NEEDS, TO BE USED CONSISTENTLY BY THE STUDENT IN THE RECOMMENDED EDUCATIONAL PROGRAM AND IN THE ISTRATION OF DISTRICT-WIDE ASSESSMENTS OF STUDENT ACHIEVEMENT AND, IN ACCORDANCE WITH DEPARTMENT POLICY, STATE ASSESSMENTS OF STUDENT ACHIEVEMENT. TESTING ACCOMMODATIONS
CONDITIONS*
IMPLEMENTATION RECOMMENDATIONS**
NONE Extended Time Breaks Revised Test Format
In all Exams including New Time extended by 50% York State exams In all Exams including New Breaks given as needed. York State In all Exams including New Questions read and reread
TESTING ACCOMMODATIONS (TO BE COMPLETED FOR PRESCHOOL CHILDREN ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL CHILDREN): INDIVIDUAL TESTING ACCOMMODATIONS, SPECIFIC TO THE STUDENT’S DISABILITY AND NEEDS, TO BE USED CONSISTENTLY BY THE STUDENT IN THE RECOMMENDED EDUCATIONAL PROGRAM AND IN THE ISTRATION OF DISTRICT-WIDE ASSESSMENTS OF STUDENT ACHIEVEMENT AND, IN ACCORDANCE WITH DEPARTMENT POLICY, STATE ASSESSMENTS OF STUDENT ACHIEVEMENT.
Revised Test Directions
York State with the exception of the ELA exam where intended to assess reading skills In all Exams including New York State In all Exams including New York State
aloud to student
Questions read aloud to student Separate Location/Room Jane Doe needs an area with less distractions in order to focus and access her testing accommodations On-Task Focusing Prompts In all Exams including New On-Tasks focusing prompts York State as needed. *Conditions — Test Characteristics: Describe the type, length, purpose of the test upon which the use of testing accommodations is conditioned, if applicable. **Implementation Recommendations: Identify the amount of extended time, type of setting, etc., specific to the testing accommodations, if applicable. STUDENT NAME: Jane Doe
NYC ID:555555
BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE STUDENT IS AGE 15 (AND AT A YOUNGER AGE, IF DETERMINED APPROPRIATE). COORDINATED SET OF TRANSITION ACTIVITIES NEEDED ACTIVITIES TO FACILITATE THE STUDENT’S MOVEMENT FROM SCHOOL TO POST-SCHOOL ACTIVITIES Instruction Related Services Community Experiences Development of Employment and Other Post-school Adult Living Objectives
SERVICE/ACTIVITY
SCHOOL DISTRICT/AGENCY RESPONSIBLE
BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE STUDENT IS AGE 15 (AND AT A YOUNGER AGE, IF DETERMINED APPROPRIATE). COORDINATED SET OF TRANSITION ACTIVITIES NEEDED ACTIVITIES TO FACILITATE THE STUDENT’S MOVEMENT FROM SCHOOL TO POST-SCHOOL ACTIVITIES
SERVICE/ACTIVITY
SCHOOL DISTRICT/AGENCY RESPONSIBLE
Acquisition of Daily Living Skills (if applicable) Functional Vocational Assessment (if applicable) STUDENT NAME: Jane Doe
NYC ID:555555
PARTICIPATE IN STATE AND DISTRICT-WIDE ASSESSMENTS (TO BE COMPLETED FOR PRESCHOOL STUDENTS ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL STUDENTS) The student will participate in the same State and district-wide assessments of student achievement that are istered to general education students. The student will participate in an alternate assessment on a particular State or district-wide assessment of student achievement. STUDENT NAME: Jane Doe
NYC ID:555555
PARTICIPATION WITH STUDENTS WITHOUT DISABILITIES REMOVAL FROM THE GENERAL EDUCATION ENVIRONMENT OCCURS ONLY WHEN THE NATURE OR SEVERITY OF THE DISABILITY IS SUCH THAT, EVEN WITH THE USE OF SUPPLEMENTARY AIDS AND SERVICES, EDUCATION CANNOT BE SATISFACTORILY ACHIEVED. FOR THE PRESCHOOL STUDENT: Explain the extent, if any, to which the student will not participate in appropriate activities with age-appropriate nondisabled peers (e.g., percent of the school day and/or specify particular activities): FOR THE SCHOOL-AGE STUDENT: Explain the extent, if any, to which the student will not participate in regular class, extracurricular and other nonacademic activities (e.g., percent of the school day and/or specify particular activities): If the student is not participating in a regular physical education program, identify
PARTICIPATION WITH STUDENTS WITHOUT DISABILITIES the extent to which the student will participate in specially-designed instruction in physical education, including adapted physical education: EXEMPTION FROM LANGUAGE OTHER THAN ENGLISH DIPLOMA REQUIREMENT: No Yes - The Committee has determined that the student's disability adversely affects his/her ability to learn a language and recommends the student be exempt from the language other than English requirement.
STUDENT NAME: Jane Doe
NYC ID:555555
SPECIAL TRANSPORTATION TRANSPORTATION RECOMMENDATION TO ADDRESS NEEDS OF THE STUDENT RELATING TO HIS/HER DISABILITY None. Student needs special transportation accommodations/services as follows: Student needs transportation to and from special classes or programs at another site: PLACEMENT RECOMMENDATION NYC DOE Community School
SUMMARY STUDENT INFORMATION
Student Name: Jane Doe NYC ID: 555555 DOB: 7/7/2000 Gender: Female Parents Language(s) Spoken/Mode Communication: English IEP INFORMATION Date of IEP Meeting: 05/21/2015
IEP Amendment:
Reconvene of IEP Meeting: Yes No INSTRUCTIONAL/FUNCTIONAL LEVELS Reading:4th Grade Math:3rd Grade SUMMARY OF RECOMMENDATIONS Classification of Disability: Other Health Impairment
Yes
No
Recommended Services: Special Education Programs
Special Education Teacher Services [SETSS] Integrated Co-Teaching Services Integrated Co-Teaching Services Integrated Co-Teaching Services Special Education Teacher Services [SETSS] Related Services Counseling Services 12-Month Services: The student will participate in the same State and district-wide assessments of student achievement that are istered to general education students. Does Jane Doe have a Behavioral Intervention Plan? No Recommended for Specialized Transportation: specialized transportation School Type: NYC DOE Community School Medical Alert: The student has limitations which affect her school activities.
None
medical conditions and/or
learning,
The student requires medical and/or procedure(s) during the school day.
behavior and/or
Student needs
physical participation in
health care treatment(s) or
PROMOTION CRITERIA CURRENT YEAR Standard
Multiple Criteria and Modification of Achievement of Performance Standards
Modified
English Language Arts ("ELA") The student Jane Doe must meet 50 % of the 6 grade Standards must be mastered as evidenced by student work, teacher observation, assessments/grades, and attendance.
Math The student Jane Doe must meet 50 % of the 6 grade Standards must be mastered as evidenced by student work, teacher observation, assessments/grades, and attendance.
NEXT YEAR Standard
Modified
English Language Arts ("ELA") The student Jane Doe must meet 50 % of the 7 grade Standards must be mastered as evidenced by
Multiple Criteria and Modification of Achievement of Performance Standards Math The student Jane Doe must meet 50 % of the 7 grade Standards must be mastered as evidenced by student work, teacher observation,
student work, teacher observation, assessments/grades, and attendance.
assessments/grades, and attendance.
Parent Concerns:
OTHER OPTIONS CONSIDERED Special Education Teacher Services Integrated Co-teaching Counseling Services Reason(s) for Rejection: Jane Doe McCall's needs can be met with special education teacher services in the general education classroom.
ATTENDANCE PAGE PLEASE NOTE THAT YOUR SIGNATURE REFLECTS YOUR PARTICIPATION AT THE CONFERENCE AND DOES NOT NECESSARILY INDICATE AGREEMENT WITH THE INDIVIDUALIZED EDUCATION PROGRAM. ROLE (INDICATE IF NAME SIGNATURE BILINGUAL)
DISABILITY CLASSIFICATION: Learning Disability
PROJECTED DATE OF ANNUAL REVIEW:05/19/2016 NYC ID:5555555
PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS DOCUMENTATION OF STUDENT'S CURRENT PERFORMANCE AND ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS EVALUATION RESULTS (INCLUDING FOR SCHOOL-AGE STUDENTS, PERFORMANCE ON STATE AND DISTRICT-WIDE ASSESSMENTS) ELA State Exam 2014 Present Level 2 Proficiency Rating- 2.90 Growth Rate- 77% Scale Score 300 MATHEMATICS State Exam 2014 Present Level- 2 Proficiency Rating- 2.57 Growth Rate- 24% Scale Score- 324 ACADEMIC ACHIEVEMENT, FUNCTIONAL PERFORMANCE AND LEARNING CHARACTERISTICS LEVELS OF KNOWLEDGE AND DEVELOPMENT IN SUBJECT AND SKILL AREAS INCLUDING ACTIVITIES OF DAILY LIVING, LEVEL OF INTELLECTUAL FUNCTIONING, ADAPTIVE BEHAVIOR, EXPECTED RATE OF PROGRESS IN ACQUIRING SKILLS AND INFORMATION, AND LEARNING STYLE: In ELA, based on the Independent Reading Level Assessment Framework Jane Doe is reading on a 3rd grade level. This demonstrates that Jane Doe has mastered common core reading standards up to grade 3. She is currently struggling with skills that incorporate acquiring and using grade level academic language and word usage. When asked to use textual evidence to explain her ideas with a grade level text, Jane Doe demonstrates challenges to achieve this task on her own and requires s in the form of scaffolded questions and graphic organizers. In reading, Jane Doe demonstrates challenges with making inferences and drawing conclusions. In the ICT ELA classroom, often Jane Doe demonstrates a lack of focus. She is very easily distracted and requires frequent monitoring to complete classroom tasks. Jane Doe is able to work in small groups, but often requires re-direction to stay on task. When Jane Doe is focused she is able to form accurate conclusions after reading texts on her independent reading level and can respond to questions verbally and in written form. In writing Jane Doe struggles with structuring essays and short responses. Currently Jane Doe has shown progress using the R.A.C.E formula to respond to short assessment questions. Essay writing is still a challenge. Jane Doe benefits from using
PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS DOCUMENTATION OF STUDENT'S CURRENT PERFORMANCE AND ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS graphic organizers that outline where to place transition words, details and explanations within a paragraph. Jane Doe has trouble completing and turning in H.W. assignments and benefits from the reinforcement and monitoring of her school planner to stay organized and to build responsibility appropriate for middle school. MATHEMATICS Jane Doe is a 6th grade student who does not particularly enjoy Mathematics. Jane Doe has had difficulty grasping the grade level curriculum. Jane Doe has basic addition and subtraction skills. However, when subtracting numbers with regrouping, Jane Doe is more likely to make errors. Jane Doe still requires practice with her multiplication and division skills. Jane Doe was given flash cards to practice her multiplication and division skills. Therefore, Jane Doe was not able to master topics such as finding the GCF and LCM. Jane Doe is constantly distracted in class. Jane Doe had difficulty with fraction and decimal operations as well. Jane Doe was able to multiply simple fractions, however, when she was instructed to convert mixed numbers and improper fractions before multiplying, there were many errors. Jane Doe was able to follow the steps for dividing fractions and again, with simple fractions, she was able to display some success. Jane Doe is often distracted in class. Due to the constant lack of focus, Jane Doe struggles with task completion. Jane Doe is quite talkative in class and could show more progress if she would prioritize and stay focused. SCIENCE Jane Doe shows willingness to learn new concepts. She comes to science class prepared and ready to work. She greatly benefits from working one on one with a teacher or in small groups with a teacher. It is helpful for Jane Doe when instructions are broken down into clear and simple steps. Graphic organizers that chunk or section pieces of information help Jane Doe to understand complex material. Embedded questions in chunked reading material help Jane Doe to stay focused when reading. Jane Doe follows teacher instructions and explanation. Jane Doe is mostly well mannered and respectful; she remains on task with frequent teacher check-ins to ensure focus and understanding. Jane Doe benefits from additional time to complete her assignments. Jane Doe is able to comprehend scientific texts while using vocabulary reference sources like a textbook. She also benefits from diagrams and images that portray scientific ideas and concepts, as well as real world- science curriculum examples. STUDENT STRENGTHS, PREFERENCES, INTERESTS: Jane Doe enjoys school, she expresses a desire to learn and likes learning. Her favorite classes include, science, math, ELA and PE class. She feels like she enjoys the social aspect of school, she has many friends in her class. Jane Doe's extra curricular activities include dance and cheerleading. Jane Doe also enjoys spending time with her family and is looking forwards to this summer vacation as her family has planned trips. Jane Doe plays in the school orchestra and enjoys learning the viola. ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT:
PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS DOCUMENTATION OF STUDENT'S CURRENT PERFORMANCE AND ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS Mom is trying to make an appointment with a psychologist but is having difficulty finding someone. Mom needs a referral for an independent psychologist. 2013, Jane Doe saw a psychologist who recommender her to not be on medication ADHD, mom feels like Jane Doe would benefit from being on medication now. Did she receive a promotion in doubt for this year? Jane Doe would greatly benefit from a tutor outside of school. She requires some oneto-one instruction. Mom feels that Jane Doe is struggling at in the ICT classes with SETSS services. At home, Jane Doe becomes distracted when attempting to do homework more so then previous years. Mom would like Jane Doe to continue with ICT class and SETSS services and add medication. SOCIAL DEVELOPMENT THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT’S RELATIONSHIPS WITH PEERS AND ADULTS; FEELINGS ABOUT SELF; AND SOCIAL ADJUSTMENT TO SCHOOL AND COMMUNITY ENVIRONMENTS: Jane Doe gets along well her peers and the staff in the school. STUDENT STRENGTHS: Jane Doe is a very social young lady. Jane Doe participates in school events like the school talent show, she performed a cheerleading routine with other girls in the school. She also participates in school concerts. SOCIAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT: Jane Doe is very socially. It is easy for her to make friends. Mom is concerned that Jane Doe play fights with other students and can get carried away but mom speaks to her about this frequently. PHYSICAL DEVELOPMENT THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT’S MOTOR AND SENSORY DEVELOPMENT, HEALTH, VITALITY AND PHYSICAL SKILLS OR LIMITATIONS WHICH PERTAIN TO THE LEARNING PROCESS: Jane Doe has been diagnosed with Attention Deficit/ Hyperactivity Disorder (ADHD). She does not currently take medication. Jane Doe is otherwise reported to be in good health. STUDENT STRENGTHS: Jane Doe participates willingly in class and sports activities. She likes to dance and participates in extracurricular activities. PHYSICAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT: No concerns at this time. MANAGEMENT NEEDS THE NATURE (TYPE) AND DEGREE (EXTENT) TO WHICH ENVIRONMENTAL AND
PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS DOCUMENTATION OF STUDENT'S CURRENT PERFORMANCE AND ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS HUMAN OR MATERIAL RESOURCES ARE NEEDED TO ADDRESS NEEDS IDENTIFIED ABOVE: During classroom lessons, Jane Doe requires: -small group instructions -repeated directions -on-task focusing prompts -repeated directions -breaks -visual aids -scaffolding to write extended response questions -extended time to complete questions EFFECT OF STUDENT NEEDS ON INVOLVEMENT AND PROGRESS IN THE GENERAL EDUCATION CURRICULUM OR, FOR A PRESCHOOL STUDENT, EFFECT OF STUDENT NEEDS ON PARTICIPATION IN APPROPRIATE ACTIVITES Jane Doe continue to in a general education setting with the structure and provided in an ICT setting with where she can access more small group interaction and individual throughout the day. STUDENT NAME: Jane Doe
NYC ID:555555
STUDENT NEEDS RELATING TO SPECIAL FACTORS BASED ON THE IDENTIFICATION OF THE STUDENT'S NEEDS, THE COMMITTEE MUST CONSIDER WHETHER THE STUDENT NEEDS A PARTICULAR DEVICE OR SERVICE TO ADDRESS THE SPECIAL FACTORS AS INDICATED BELOW, AND IF SO, THE APPROPRIATE SECTION OF THE IEP MUST IDENTIFY THE PARTICULAR DEVICE OR SERVICE(S) NEEDED: Does the student need strategies, including positive behavioral interventions, s and other strategies to address behaviors that impede the student's learning or that of others?
Yes
No
Does the student need a behavioral intervention plan? No Yes For a student with limited English proficiency, does she need a special education service to address her language needs as they relate to the IEP?
Yes
No Not Applicable For a student who is blind or visually impaired, does she need instruction in Braille and the use of Braille? Yes No Not Applicable Does the student need a particular device or service to address her communication needs? Yes No In the case of a student who is deaf or hard of hearing, does the student need a particular device or service in consideration of the student's language and
STUDENT NEEDS RELATING TO SPECIAL FACTORS BASED ON THE IDENTIFICATION OF THE STUDENT'S NEEDS, THE COMMITTEE MUST CONSIDER WHETHER THE STUDENT NEEDS A PARTICULAR DEVICE OR SERVICE TO ADDRESS THE SPECIAL FACTORS AS INDICATED BELOW, AND IF SO, THE APPROPRIATE SECTION OF THE IEP MUST IDENTIFY THE PARTICULAR DEVICE OR SERVICE(S) NEEDED: communication needs, opportunities for direct communications with peers and professional personnel in the student's language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the student's language and communication mode? Yes
No
Not Applicable
Does the student need an assistive technology device and/or service? Yes No If yes, does the Committee recommend that the device(s) be used in the student's home?
Yes
No
STUDENT NAME: Jane Doe
NYC ID:555555
BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE STUDENT IS AGE 15 (AND AT A YOUNGER AGE IF DETERMINED APPROPRIATE) MEASURABLE POSTSECONDARY GOALS LONG-TERM GOALS FOR LIVING, WORKING AND LEARNING AS AN ADULT EDUCATION/TRAINING: EMPLOYMENT: INDEPENDENT LIVING SKILLS (WHEN APPROPRIATE): TRANSITION NEEDS In consideration of present levels of performance, transition service needs of the student that focus on the student's courses of study, taking into the student’s strengths, preferences and interests as they relate to transition from school to postschool activities: STUDENT NAME: Jane Doe
NYC ID:555555
MEASURABLE ANNUAL GOALS THE FOLLOWING GOALS ARE RECOMMENDED TO ENABLE THE STUDENT TO BE INVOLVED IN AND PROGRESS IN THE GENERAL EDUCATION CURRICULUM, ADDRESS OTHER EDUCATIONAL NEEDS THAT RESULT FROM THE STUDENT'S DISABILITY, AND PREPARE THE STUDENT TO MEET HIS/HER POSTSECONDARY GOALS. ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE
CRITERIA MEASURE TO DETERMINE
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
END OF THE YEAR IN WHICH THE IEP IS IN EFFECT SCIENCE Determine the central ideas or conclusions of a text; provide an accurate summary of the text distinct from prior knowledge or opinions.
IF GOAL HAS BEEN ACHIEVED Teacher Made Materials Verbal Explanation 60% Accuracy Teacher/Provider Observations
ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT SCIENCE Determine the meaning of symbols, key , and other domain-specific words and phrases as they are used in a specific scientific or technical context relevant to grades 6-8 texts and topics.
ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT Common Core ELA
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
60 % Accuracy
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
METHOD HOW PROGRESS WILL BE MEASURED
1 time per quarter
SCHEDULE WHEN PROGRESS WILL BE MEASURED
Teacher Made 1 time per quarter Materials Teacher/Provider Observations Verbal Explanation
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
Teacher Made 1 time per quarter Materials Class Activities In one year Jane Doe will be Teacher/Provider able to determine the meaning of Observations words and phrases as they are Performance 75% Accuracy used in a text, including Assessment figurative, connotative, and Task technical meanings. She will demonstrate this skill by reading a grade level text and identifying a new or unfamiliar word, she
will then use context clues or similar strategies to determine the meaning.
ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
Common Core ELA In one year with as needed, Jane Doe will be able 7 out of 10 to ask and answer questions to trials for 32 demonstrate understanding of a weeks grade level text. She will demonstrate this skill by referring explicitly to the text as the basis for the answers.
ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
Teacher Made 1 time per quarter Materials Class Activities Teacher/Provider Observations Performance Assessment Task
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
ELA Common Core- Writing
Teacher Made 1 time per quarter Materials In one year with with guidance Class Activities and , Jane Doe will be Teacher/Provider able to develop and strengthen Observations her writing by planning, revising, 3 out of 5 trials Performance editing, rewriting, or trying a new for 32 weeks Assessment approach. She will demonstrate Task this skill by constructing an essay on a grade level topic and completing all 5 stages of the writing process. ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR
CRITERIA MEASURE TO DETERMINE
METHOD HOW PROGRESS WILL BE
SCHEDULE WHEN PROGRESS WILL BE
IN WHICH THE IEP IS IN EFFECT
IF GOAL HAS BEEN ACHIEVED
MATHEMATICS Within one academic school year, Jane Doe will be able to develop an understanding of fractions as numbers. Jane Doe will be able to represent 60% Accuracy fractions on a number line, identify equivalent fractions and compare fractions. Jane Doe will also be able to demonstrate the rules for multiplying and dividing fractions.
ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
MATHEMATICS Within one academic school year, Jane Doe will be able to increase her ability to select and 60% Accuracy apply mathematical operations in a variety of contexts to compute whole numbers, fractions, decimals and integers.
ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
MATHEMATICS Within one academic school year, Jane Doe will increase her multiplication and division skills. 60% Accuracy Jane Doe will be able to apply her multiplication and division skills to perform grade level
MEASURED
MEASURED
Teacher Made 1 time per quarter Materials Teacher/Provider Observations Class Activities Performance Assessment Task
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
Teacher Made 1 time per quarter Materials Class Activities Teacher/Provider Observations Performance Assessment Task
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
Teacher Made 1 time per quarter Materials Class Activities Teacher/Provider Observations Performance Assessment
tasks including finding the GCF and LCM, order of operations and operations with fractions. ANNUAL GOALS WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
Task
CRITERIA MEASURE TO DETERMINE IF GOAL HAS BEEN ACHIEVED
Counseling: Within one year, Jane Doe will improve her communication skills as demonstrated by 3 out of 4 trials expressing her thoughts and feelings without the use of foul and/or abusive language.
METHOD HOW PROGRESS WILL BE MEASURED
SCHEDULE WHEN PROGRESS WILL BE MEASURED
Check Lists Verbal Explanation Performance Assessment Task Teacher/Provider Observations
STUDENT NAME: Jane Doe
1 time per quarter
NYC ID: 555555
REPORTING PROGRESS TO PARENTS Identify when periodic reports on the student's progress toward meeting the annual goals will be provided to the student’s parents: at the same time school report cards are issued STUDENT NAME: Jane Doe
NYC ID:555555
RECOMMENDED SPECIAL EDUCATION PROGRAMS AND SERVICES PROJE CTED FREQU DURA BEGIN ENCY TION LOCATION NING / SERVICE HOW LENG WHERE SERVIC DELIVERY OFTEN TH OF SERVICE E SPECIAL EDUCATION RECOMMEND PROVID SESSI WILL BE DATE(S PROGRAM/SERVICES ATIONS* ED ON PROVIDED ) SPECIAL EDUCATION PROGRAM: Integrated Co-Teaching
Language of
5 time(s) Period General
05/13/2
RECOMMENDED SPECIAL EDUCATION PROGRAMS AND SERVICES Services ELA Integrated Co-Teaching Services Math Integrated Co-Teaching Services Sciences Special Education Teacher Services [SETSS] Math Special Education Teacher Services [SETSS] ELA
Service: Engli per week sh Language of 5 time(s) Period Service: Engli per week sh Language of 3 time(s) Period Service: Engli per week sh Direct Service 3 time(s) Period Group service per week
Education Classroom
015
General Education Classroom
05/13/2 015
General Education Classroom
05/13/2 015
Special Education Classroom
05/13/2 015
Direct Service 2 time(s) Period Special Education Group service per week Classroom Language of Service: Engli sh
05/21/2 015
Language of Service: Engli sh
RELATED SERVICES: Counseling Services
30 min Group service 1 time(s) utes Language of Service: Engli per week sh
Separate 05/13/2 Location Co 015 unselor's ofiice
SUPPLEMENTARY AIDS AND SERVICES/PROGRAM MODIFICATIONS/ACCO MMODATIONS: ASSISTIVE TECHNOLOGY DEVICES AND/OR SERVICES: S FOR SCHOOL PERSONNEL ON BEHALF OF THE STUDENT: * Identify, if applicable, class size (maximum student-to-staff ratio), language if other than English, group or individual services, direct and/or indirect consultant teacher services or other service delivery recommendations.
STUDENT NAME: Jane Doe
NYC ID:555555
12-MONTH SERVICE AND/OR PROGRAM - Student is eligible to receive special education services and/or program during July/August: If yes:
No
Yes
* Student will receive the same special education program/services as recommended above. OR Student will receive the following special education program/services: PROJECT ED SPECIAL SERVICE BEGINNIN EDUCATION DELIVERY G/ PROGRAM/SERVI RECOMMENDATI FREQUEN DURATI LOCATI SERVICE CES ONS CY ON ON DATE(S) Name of school/agency provider of services during July and August: For a preschool student, reason(s) the child requires services during July and August:
STUDENT NAME: Jane Doe
NYC ID:555555
TESTING ACCOMMODATIONS (TO BE COMPLETED FOR PRESCHOOL CHILDREN ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL CHILDREN): INDIVIDUAL TESTING ACCOMMODATIONS, SPECIFIC TO THE STUDENT’S DISABILITY AND NEEDS, TO BE USED CONSISTENTLY BY THE STUDENT IN THE RECOMMENDED EDUCATIONAL PROGRAM AND IN THE ISTRATION OF DISTRICT-WIDE ASSESSMENTS OF STUDENT ACHIEVEMENT AND, IN ACCORDANCE WITH DEPARTMENT POLICY, STATE ASSESSMENTS OF STUDENT ACHIEVEMENT. TESTING ACCOMMODATIONS
CONDITIONS*
IMPLEMENTATION RECOMMENDATIONS**
NONE Extended Time Breaks Revised Test Format
In all Exams including New Time extended by 50% York State exams In all Exams including New Breaks given as needed. York State In all Exams including New Questions read and reread
TESTING ACCOMMODATIONS (TO BE COMPLETED FOR PRESCHOOL CHILDREN ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL CHILDREN): INDIVIDUAL TESTING ACCOMMODATIONS, SPECIFIC TO THE STUDENT’S DISABILITY AND NEEDS, TO BE USED CONSISTENTLY BY THE STUDENT IN THE RECOMMENDED EDUCATIONAL PROGRAM AND IN THE ISTRATION OF DISTRICT-WIDE ASSESSMENTS OF STUDENT ACHIEVEMENT AND, IN ACCORDANCE WITH DEPARTMENT POLICY, STATE ASSESSMENTS OF STUDENT ACHIEVEMENT.
Revised Test Directions
York State with the exception of the ELA exam where intended to assess reading skills In all Exams including New York State In all Exams including New York State
aloud to student
Questions read aloud to student Separate Location/Room Jane Doe needs an area with less distractions in order to focus and access her testing accommodations On-Task Focusing Prompts In all Exams including New On-Tasks focusing prompts York State as needed. *Conditions — Test Characteristics: Describe the type, length, purpose of the test upon which the use of testing accommodations is conditioned, if applicable. **Implementation Recommendations: Identify the amount of extended time, type of setting, etc., specific to the testing accommodations, if applicable. STUDENT NAME: Jane Doe
NYC ID:555555
BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE STUDENT IS AGE 15 (AND AT A YOUNGER AGE, IF DETERMINED APPROPRIATE). COORDINATED SET OF TRANSITION ACTIVITIES NEEDED ACTIVITIES TO FACILITATE THE STUDENT’S MOVEMENT FROM SCHOOL TO POST-SCHOOL ACTIVITIES Instruction Related Services Community Experiences Development of Employment and Other Post-school Adult Living Objectives
SERVICE/ACTIVITY
SCHOOL DISTRICT/AGENCY RESPONSIBLE
BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE STUDENT IS AGE 15 (AND AT A YOUNGER AGE, IF DETERMINED APPROPRIATE). COORDINATED SET OF TRANSITION ACTIVITIES NEEDED ACTIVITIES TO FACILITATE THE STUDENT’S MOVEMENT FROM SCHOOL TO POST-SCHOOL ACTIVITIES
SERVICE/ACTIVITY
SCHOOL DISTRICT/AGENCY RESPONSIBLE
Acquisition of Daily Living Skills (if applicable) Functional Vocational Assessment (if applicable) STUDENT NAME: Jane Doe
NYC ID:555555
PARTICIPATE IN STATE AND DISTRICT-WIDE ASSESSMENTS (TO BE COMPLETED FOR PRESCHOOL STUDENTS ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL STUDENTS) The student will participate in the same State and district-wide assessments of student achievement that are istered to general education students. The student will participate in an alternate assessment on a particular State or district-wide assessment of student achievement. STUDENT NAME: Jane Doe
NYC ID:555555
PARTICIPATION WITH STUDENTS WITHOUT DISABILITIES REMOVAL FROM THE GENERAL EDUCATION ENVIRONMENT OCCURS ONLY WHEN THE NATURE OR SEVERITY OF THE DISABILITY IS SUCH THAT, EVEN WITH THE USE OF SUPPLEMENTARY AIDS AND SERVICES, EDUCATION CANNOT BE SATISFACTORILY ACHIEVED. FOR THE PRESCHOOL STUDENT: Explain the extent, if any, to which the student will not participate in appropriate activities with age-appropriate nondisabled peers (e.g., percent of the school day and/or specify particular activities): FOR THE SCHOOL-AGE STUDENT: Explain the extent, if any, to which the student will not participate in regular class, extracurricular and other nonacademic activities (e.g., percent of the school day and/or specify particular activities): If the student is not participating in a regular physical education program, identify
PARTICIPATION WITH STUDENTS WITHOUT DISABILITIES the extent to which the student will participate in specially-designed instruction in physical education, including adapted physical education: EXEMPTION FROM LANGUAGE OTHER THAN ENGLISH DIPLOMA REQUIREMENT: No Yes - The Committee has determined that the student's disability adversely affects his/her ability to learn a language and recommends the student be exempt from the language other than English requirement.
STUDENT NAME: Jane Doe
NYC ID:555555
SPECIAL TRANSPORTATION TRANSPORTATION RECOMMENDATION TO ADDRESS NEEDS OF THE STUDENT RELATING TO HIS/HER DISABILITY None. Student needs special transportation accommodations/services as follows: Student needs transportation to and from special classes or programs at another site: PLACEMENT RECOMMENDATION NYC DOE Community School
SUMMARY STUDENT INFORMATION
Student Name: Jane Doe NYC ID: 555555 DOB: 7/7/2000 Gender: Female Parents Language(s) Spoken/Mode Communication: English IEP INFORMATION Date of IEP Meeting: 05/21/2015
IEP Amendment:
Reconvene of IEP Meeting: Yes No INSTRUCTIONAL/FUNCTIONAL LEVELS Reading:4th Grade Math:3rd Grade SUMMARY OF RECOMMENDATIONS Classification of Disability: Other Health Impairment
Yes
No
Recommended Services: Special Education Programs
Special Education Teacher Services [SETSS] Integrated Co-Teaching Services Integrated Co-Teaching Services Integrated Co-Teaching Services Special Education Teacher Services [SETSS] Related Services Counseling Services 12-Month Services: The student will participate in the same State and district-wide assessments of student achievement that are istered to general education students. Does Jane Doe have a Behavioral Intervention Plan? No Recommended for Specialized Transportation: specialized transportation School Type: NYC DOE Community School Medical Alert: The student has limitations which affect her school activities.
None
medical conditions and/or
learning,
The student requires medical and/or procedure(s) during the school day.
behavior and/or
Student needs
physical participation in
health care treatment(s) or
PROMOTION CRITERIA CURRENT YEAR Standard
Multiple Criteria and Modification of Achievement of Performance Standards
Modified
English Language Arts ("ELA") The student Jane Doe must meet 50 % of the 6 grade Standards must be mastered as evidenced by student work, teacher observation, assessments/grades, and attendance.
Math The student Jane Doe must meet 50 % of the 6 grade Standards must be mastered as evidenced by student work, teacher observation, assessments/grades, and attendance.
NEXT YEAR Standard
Modified
English Language Arts ("ELA") The student Jane Doe must meet 50 % of the 7 grade Standards must be mastered as evidenced by
Multiple Criteria and Modification of Achievement of Performance Standards Math The student Jane Doe must meet 50 % of the 7 grade Standards must be mastered as evidenced by student work, teacher observation,
student work, teacher observation, assessments/grades, and attendance.
assessments/grades, and attendance.
Parent Concerns:
OTHER OPTIONS CONSIDERED Special Education Teacher Services Integrated Co-teaching Counseling Services Reason(s) for Rejection: Jane Doe McCall's needs can be met with special education teacher services in the general education classroom.
ATTENDANCE PAGE PLEASE NOTE THAT YOUR SIGNATURE REFLECTS YOUR PARTICIPATION AT THE CONFERENCE AND DOES NOT NECESSARILY INDICATE AGREEMENT WITH THE INDIVIDUALIZED EDUCATION PROGRAM. ROLE (INDICATE IF NAME SIGNATURE BILINGUAL)
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