Extended School Year Online Assignment

Student’s Name:

Amy Smith

IEP Team Meeting Date (mm/dd/yy):

09/10/15

IEP Implementation Date (Projected Date when Services and Programs Will Begin):

09/14/15

Anticipated Duration of Services and Programs:

09/09/16

Date of Birth:

7/2/06

Age:

Grade:

Anticipated Year of Graduation:

2024

Local Education Agency (LEA):

Shippensburg

County of Residence:

Shippensburg

Name and Address of Parent/Guardian/Surrogate:

Phone (Home):

Christopher Smith

Phone (Work):

Other Information:

Date of Revision(s)

Participants/Roles

IEP Section(s) Amended

Role

Printed Name

Signature

Parent/Guardian/Surrogate

Parent/Guardian/Surrogate

Student*

Regular Education Teacher**

Special Education Teacher

Local Ed Agency Rep

Career/Tech Ed Rep***

Community Agency Rep

Teacher of the Gifted****

PROCEDURAL SAFEGUARDS NOTICE

Signature of Parent/Guardian/Surrogate:

Yes

The IEP must include a description of the instruction in Braille and the use of Braille unless the IEP team determines, after an evaluation of the student’s reading and writing skills, needs, and appropriate reading and writing media (including an evaluation of the student’s future needs for instruction in Braille or the use of Braille), that instruction in Braille or the use of Braille is not appropriate for the student.

No

Yes

The IEP must include a communication plan to address the following: language and communication needs; opportunities for direct communications with peers and professional personnel in the student’s language and communication mode; academic level; full range of needs, including opportunities for direct instruction in the student’s language and communication mode; and assistive technology devices and services. Indicate in which section of the IEP these considerations are addressed. The Communication Plan must be completed and is available at www.pattan.net

No

Yes

Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction (SDI), annual goals, etc.)

No

Yes

Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction, annual goals, etc.)

No

Yes

The IEP team must address the student’s language needs and how those needs relate to the IEP.

No

Yes

The IEP team must develop a Positive Behavior Support Plan that is based on a functional assessment of behavior and that utilizes positive behavior techniques. Results of the functional assessment of behavior may be listed in the Present Levels section of the IEP with a clear measurable plan to address the behavior in the Goals and Specially Designed Instruction sections of the IEP or in the Positive Behavior Support Plan if this is a separate document that is attached to the IEP. A Positive Behavior Support Plan and a Functional Behavioral Assessment form are available at www.pattan.net

No

The student is performing below expected levels in reading and math. Amy is approaching proficiency in reading writing and math benchmarks.

Notes from Second Grade Teacher:

Amy is a very intelligent girl but is easily distracted and demonstrates off-task behaviors, such as getting up from her desk while she is supposed to be working, physically and verbally refusing to do what the other students are doing, using materials inappropriately such as writing with marker on the floor, using her scissors to cut hair instead of her word cards, pushing papers and other items off desks and tables, as well as running away from whoever is trying to discipline her. She imitates the teacher while holding up other storybooks in front of the class and pretending to explain them while I am reading to other students. She has moved the name cards on the job chart so she can do the job she wants without regard for the other students having a turn. She is distracted from her work and is distracting the other students from doing their work because she does whatever she chooses to do. During handwriting lesson she was in the back of the room, doing dance steps and cartwheels. She plays with the materials that have been set out for the days’ instruction, when she chooses not to do what the other second graders are doing. She comes in late in the morning because she doesn’t want to leave Miss. Bower’s classroom and I have to call over to get her lunch choice so we can send the lunch and attendance to the office. The environment in the classroom needs to be conducive to the education of all students, but the behavior of this student severely limits her learning and socialization as well as that of the students around her.

Notes from LSS teacher:

Amy is a very caring student who worries about friends and teachers. She has trouble transitioning from a preferred task to an unpreferred task. Amy’s behavior at the start of the 2014-2015 school year have been significantly higher than the past three years. This could be due to changes in staffing. Some of the behaviors that we are currently seeing that we didn’t see last year include, running, hiding in areas she’s not supposed to be (boys bathroom and custodial office), and throwing herswlf on the floor and refusing to get up. Last year, Amy responded well to Mrs. V and Mrs. H. However, this year she isn’t consistently responding to either person. When Amy is able to focus on her academics, she does a really good job. She is also very social and tries to befriend the new people all the time.

Other functional skills (i.e. related service reports and Employment Skills)

Occupational Therapy:

Amy is currently seen directly for Occupational Therapy. She has been working towards one goal regarding self-regulation skills with the following progress:

Goal: When given a verbal, visual, or gestural prompt, Amy will improve her regulation skills as demonstrated by utilizing a tool to aide self in regulating to an expected state in 4 out of 5 consecutive charted opportunities.

Progress: Amy has been working toward recognizing emotions in order then be able to recognize what she is feeling to select appropriate tools in order to self-regulate. She can identify emotions (pictures of real people) through and iPad application with 90-100% accuracy. Gwynn worked for several months to reach this accuracy, as her beginning accuracy measures were well below 50%. She made great, consistent progress on this and will continue to use the application as she becomes consistent in receiving accuracies of 100% when labeling and recognizing emotions.

During role-play scenarios, Amy has more difficulty identifying what emotion the therapist is acting out and requires moderate (50%) assistance from the therapist to identify the emotion. When the therapist gives Amy an emotion to act out, she completes the task more independently (not requiring as much assistance) but resists acting out unfamiliar emotions and instead prefers to act out the following: sad, sill, frustrated, tired, and happy.

Other information: Amy reportedly has difficulty performing ADL’s independently, particularly related to toileting (wiping) which has effected parts of her school day. The therapist spoke to W and Ms. Z and Amy’s mom to gain more information. Ms. W and Ms. Z noted the difficulty with toileting independence does not affect Amy’s school day. Through a conversation with Amy’s mom, the therapist learned that Amy struggles with toileting independence at home, as well as at school. Amy’s mom shared that Amy often waits until the last minute to go, but does not wipe on her own, she asks for assistance from mom, She also shared that Amy wipes from back to front direction, which is concerning due to the possibility of infections. The time spent in the bathroom effects Amy’s daily routine and support from OT to target toileting, will be added to her OT goals. A goal relating to self-care and ADL, in particular toileting, will be added to Amy’s OT goals. Additionally, noted concern relating to Amy’s nearing puberty. As Amy approaches that developmental stage, the OT will provide resources and information in order to support Amy’s self-care and independence in the school setting so that she may be successful in her ADL’s at school.

Recommendations and Plan: It is recommended that Amy continue to receive direct Occupational Therapy services at a frequency of 18 sessions per year in addition to 15 minutes a month of SSP provided to teachers and staff. Her goals should be modified to be more achievable and include recognizing what emotion she is feeling prior to selecting strategies to regulate herself and to include a goal targeting self-care and ADL.

Speech/Language Therapy

Amy receives 2, 30 minute speech/language sessions per every 5 school days in a small group setting. Amy is aware of her speech schedule, and usually reminds the clinician throughout the day what time she is coming to speech. She is always willing to come to speech no matter what activity she has been working on when it is time to leave. Amy has a positive attitude and gets along well with her peers during speech sessions. Amy likes to be the boss at times, and occasionally has difficulty following directions because it’s not exactly how she would like to do the task. Amy occasionally has difficulty transitioning back to the classroom after speech sessions; however, she has gotten much better at leaving the speech room. Amy does put forth efforts during speech sessions to improve her language, articulation and fluency skills.

Language:

Amy has been working on improving her grammatical structures during speech sessions. Targets that she has been working on include verb tenses, auxiliaries/copulas, and articles. Amy has made great progress in regards to using grammar in her writing and speech. Amy has met the goal of relating to use of regular plurals, auxiliaries/ copulas, and articles. Amy does a wonderful job at using regular past tense and regular plurals, but can sometimes still struggle with the irregular forms. The goal area for the coming IEP year will focus on irregular plurals, and irregular past tense verbs.

Articulation:

Amy has been working on producing target speech sounds at the word level at 80% accuracy. Amy has made remarkable progress with her speech sounds and has met this goal! By the end of the 2014-2015 school year, Amy was producing her targets of /f/,/v/,/l/, and /s blends/ with 82% accuracy over four data points. The goal area for Amy is now to be producing her target sounds correctly at the sentence level, to continue to improve her speech intelligibility. Amy has made great progress and really strives to imitate the clinician’s placement of the articulators during speech sessions.

Fluency:

Amy is currently working on producing “easy talking” at the sentence level without the presence of fluency disrupters. Amy has made some progress with this goal; however, this is an area where she still struggles. Amy speaks with a rapid rate, and it is apparent that sometimes her motor planning for speech, cannot keep up with her processing what she wants to say. She does a great job at identifying “bumpy”. For this year, it would be beneficial to have a goal of when she is asked to repeat something in her smooth speech, that when she does the repetition it will be smooth. At this time, whenever she is asked to repeat something in her smooth speech, repetitions still have some fluency disrupters in them. It is important that Amy becomes aware of when she is using “bumpy” speech, and also when she is given the chance to repeat herself and make her speech more intelligible that she is doing that correctly.

Speech/ Language Summary

It is believed that Amy will continue to improve her language, articulation, and fluency skills. She continues to meet the federal definition of a student who has a speech/language impairment, as defined by IDEA. Amy is still in need of direct services. It is recommended that she continue to receive services at the same frequency and duration.

1. Behaviors that impede learning. (Describe the behavior, the triggers of the behavior, the triggers of the behavior and the function of the behavior.)

N/A

1. Daily living/skills: (hygiene, dressing, basic consumer skills.)

Amy is independent in daily living skills. She is uses the restroom independently. She washes and dries her hands by herself. She eats independently with minimal assistance at times to open milk cartons or ketchup packages. She retrieves her lunch and disposes of her trash and tray without assistance. Amy struggles to tie her shoes independently. Amy can button and zipper independently and often helps other students in the room with their zippers and buttons.

1. Parental concerns for enhancing the education of the student.

Parent did not share any concerns not already addressed in1-3.

1. Other relevant information.

N/A

1. How the student’s disability affects involvement and progress in the general education curriculum.

Due to Amy’s functional skills in academic areas, behavior, and communication, she would need significant modifications and adaptions to be successful in general education curriculum. Therefore, she participates in the Life Skills Support Curriculum which focuses on those reading, writing, math, behavior and communication skills needed for everyday life. Amy’s language, articulation, and fluency impairments may cause her difficulties wither her reading, writing, spelling, and communication skills within the general education classroom without support. In addition, her communication partner may find her speech difficult to understand.

1. Student’s Strengths (include interests and preferences for students who will be 16 or over during the duration of the IEP)

• Amy comes to speech sessions willingly

• Amy is able to correct errors from complete sentences when provided with the verbal or visual cues

• Amy retains skills and strategies taught for speech/language

• Amy is aware of disfluent speech

• Caring

• Friendly

• Making academic progress

• Reading fluently on a first grade level

• Adding and subtracting simple, single digit computation problems

• Identifying money and values

• Telling the time to the ¼ hour

• Copying upper and lowercase letters of the alphabet

• Persistent when working on self-directed tasks

• Amy follows the session schedule

• Eager to learn and complete tasks

• Kind

• Amy always puts forth best efforts in speech

• Amy gets along well with her peers

• Amy has a great memory for schedules

1. Academic, Developmental, Functional Needs Related to the Student’s Disability (include transition related needs for students who will be 16 or over during the duration of this IEP)

• Amy needs to increase MLU and improve sentence structure

• Amy needs to improve articulation errors.

• Amy needs to decrease disfluent speech and increase use of easy talking.

• Telling time to the 5 minute

• Reading comprehension

• Second grade computation

• Adding coins

• Reading fluently at a second grade level

• Improve self-regulation skills in classroom and school environment

• Improve self-regulation skills

• Improve independence related to ADL and self-care

• Amy needs to improve her articulation skills

• Amy needs to improve her language skills

• Amy needs to improve her fluency skills

Postsecondary Education and Training Goal:

Measurable Annual Goal

Yes/No

(Document in Section V)

Courses of Study:

Service/Activity

Location

Frequency

Projected Beginning Date

Anticipated Duration

Person(s)/Agency Responsible

Employment Goal:

Measurable Annual Goal

Yes/No

(Document in Section V)

Courses of Study:

Service/Activity

Location

Frequency

Projected Beginning Date

Anticipated Duration

Person(s)/Agency Responsible

Independent Living Goal, if appropriate:

Measurable Annual Goal

Yes/No

(Document in Section V)

Courses of Study:

Service/Activity

Location

Frequency

Projected Beginning Date

Anticipated Duration

Person(s)/Agency Responsible

IV. PARTICIPATION IN STATE AND LOCAL ASSESSMENTS

Instructions for IEP Teams:

Please select the appropriate assessment option. Information on available testing accommodations may be found in the Accommodations Guidelines available on www.education.state.pa.us.

State Assessments

Not Assessed

PSSA (Math administered in grades 3-8; Science administered in grades 4 and 8; Reading administered in grades 3-8; Writing administered in grades 5

and 8; and ELA*)

*ELA will replace the Reading and Writing PSSAs in 2014-15 for grades 3-8.

Keystone Exam (Replaces the 11th grade PSSA in high school; Student must participate by 11th grade)

Keystone Project Based Assessment (Available when student is unable to demonstrate proficiency on a Keystone Exam or Keystone Exam module.)

Validated Local Assessment (Available when selected as option by LEA)

PASA (Administered in grades 3-8, 11 for Reading and Math; Grades 4, 8, 11 for Science)

ACCESS for ELLs (Administered in grades K-12)

Alternate ACCESS for ELLs (Administered in grades 1-12)

MEASURABLE ANNUAL GOAL

Include: Condition, Name, Behavior, and Criteria

(Refer to Annotated IEP for description of these components)

Describe HOW the student’s progress toward meeting this goal will be measured

Describe WHEN periodic reports on progress will be provided to parents

Report of Progress

Given a second grade reading passage, Amy will read 103 words per minute on four out of six consecutive data collection points.

HOW: progress monitoring, graph, data collection

When: Quarterly report cards

Short term objectives / Benchmarks

Given a second grade reading passage, Amy will read 88 words per minute on four out of 6 consecutive data collection points.

MEASURABLE ANNUAL GOAL

Include: Condition, Name, Behavior, and Criteria

(Refer to Annotated IEP for description of these components)

Describe HOW the student’s progress toward meeting this goal will be measured

Describe WHEN periodic reports on progress will be provided to parents

Report of Progress

When read a first grade paragraph, Amy will respond to 10 oral comprehension questions with 90% accuracy in 4 out of 6 consecutive trials.

HOW: progress monitoring, graph, data collection

When: Quarterly report cards

Short term objectives / Benchmarks

Given a second grade reading passage, Amy will read 88 words per minute on four out of 6 consecutive data collection points.

When read a first grade reading passage, Amy will respond to 10 oral comprehension questions with 80% accuracy.

V. GOALS AND OBJECTIVES – Include, as appropriate, academic and functional goals. Use as many copies of this page as needed to plan appropriately. Specially designed instruction may be listed with each goal/objective or listed in Section VI.

Short term learning outcomes are required for students who are gifted. The short term learning outcomes related to the student’s gifted program may be listed under Goals or Short Term Objectives.

SHORT TERM OBJECTIVES – Required for students with disabilities who take alternate assessments aligned to alternate achievement standards (PASA).

MEASURABLE ANNUAL GOAL

Include: Condition, Name, Behavior, and Criteria

(Refer to Annotated IEP for description of these components)

Describe HOW the student’s progress toward meeting this goal will be measured

Describe WHEN periodic reports on progress will be provided to parents

Report of Progress

Given a second grade math concepts and applications probe and eight minutes, Amy will be able to score 21 points on four out of six consecutive data collection points.

HOW: progress monitoring, graph, data collection

When: Quarterly report cards

Short term objectives / Benchmarks

Given a second grade math concepts and applications probe and eight minutes, Amy will be able to score 19 points on four out of six consecutive data collection points.

MEASURABLE ANNUAL GOAL

Include: Condition, Name, Behavior, and Criteria

(Refer to Annotated IEP for description of these components)

Describe HOW the student’s progress toward meeting this goal will be measured

Describe WHEN periodic reports on progress will be provided to parents

Report of Progress

When shown an object or picture, Amy will write two sentences about the picture or object using the following rubric:

• 2 complete sentences

• Capitalization

• Punctuation

• Line awareness

• Correct letter size

• Spacing

• Sentences relate to pictures

• Neatness

• Sight words spelled correctly

With 80% accuracy in 4 out of 6 consecutive trials.

HOW: progress monitoring, graph, data collection

When: Quarterly report cards

Short term objectives / Benchmarks

When shown an object or picture, Amy will write two sentences about the picture or object using the above rubric with 60% accuracy in 4 out of 6 consecutive trials.

MEASURABLE ANNUAL GOAL

Include: Condition, Name, Behavior, and Criteria

(Refer to Annotated IEP for description of these components)

Describe HOW the student’s progress toward meeting this goal will be measured

Describe WHEN periodic reports on progress will be provided to parents

Report of Progress

Given verbal and/ or visual cues, Amy will identify what emotion she is feeling and why and choose appropriate strategies to calm herself and regulate herself in 4 out of 5 consecutive trials or reports from staff.

HOW: Classroom observations, therapist data collection, progress monitoring, teacher report

When: Quarterly report cards

Short term objectives / Benchmarks

Given verbal and/ or visual cues, Amy will identify what emotion she is feeling and why and choose appropriate strategies to calm herself and regulate herself in 3 out of 5 consecutive trials or reports from staff.

MEASURABLE ANNUAL GOAL

Include: Condition, Name, Behavior, and Criteria

(Refer to Annotated IEP for description of these components)

Describe HOW the student’s progress toward meeting this goal will be measured

Describe WHEN periodic reports on progress will be provided to parents

Report of Progress

Given verbal and/ or visual cues, Amy will recognize when she needs to use the restroom and, when she has a BM, wipe with proper technique, use an adequate amount of toilet paper and wipe thoroughly in 4 out of 5 consecutive trials.

HOW: Therapist data collection, Progress Monitoring, Teacher report

When: Quarterly report cards

Short term objectives / Benchmarks

MEASURABLE ANNUAL GOAL

Include: Condition, Name, Behavior, and Criteria

(Refer to Annotated IEP for description of these components)

Describe HOW the student’s progress toward meeting this goal will be measured

Describe WHEN periodic reports on progress will be provided to parents

Report of Progress

During structured activities, Amy will utilize irregular plurals, and irregular past tense verbs independently with 90% accuracy over 3 consecutive data collection points.

HOW: Session Performance Tracking with data taken monthly

When: Quarterly report cards

Short term objectives / Benchmarks

During structured activities, Amy will utilize irregular plurals, and irregular past tense verbs independently with 70% accuracy over 3 consecutive data collection points.

MEASURABLE ANNUAL GOAL

Include: Condition, Name, Behavior, and Criteria

(Refer to Annotated IEP for description of these components)

Describe HOW the student’s progress toward meeting this goal will be measured

Describe WHEN periodic reports on progress will be provided to parents

Report of Progress

During structured activities, Amy will utilize target phonemes in all positions of words at the sentence level with 80% accuracy over 3 consecutive data collection points.

Targets include but aren’t limited to: /f/, /v/, /s blends/, /l/

HOW: Session Performance Tracking with data taken monthly

When: Quarterly report cards

Short term objectives / Benchmarks

Amy will produce /f/ in all positions of words at the sentence level with 80% accuracy over 3 consecutive data collection points.

Amy will produce /f/ in all positions of words at the sentence level with 80% accuracy over 3 consecutive data collection points.

Amy will produce /s blends/ in all positions of words at the sentence level with 80% accuracy over 3 consecutive data collection points.

Amy will produce /l/ in all positions of words at the sentence level with 80% accuracy over 3 consecutive data collection points.

MEASURABLE ANNUAL GOAL

Include: Condition, Name, Behavior, and Criteria

(Refer to Annotated IEP for description of these components)

Describe HOW the student’s progress toward meeting this goal will be measured

Describe WHEN periodic reports on progress will be provided to parents

Report of Progress

During structured activities, When Amy exhibits fluency disruptors and is asked to repeat her statement, Amy will use smooth speech during the repetition with 80% accuracy over 3 consecutive data collection points.

HOW: Session Performance Tracking with data taken monthly.

When: Quarterly report cards

Short term objectives / Benchmarks

During structured activities, When Amy exhibits fluency disruptors and is asked to repeat her statement, Amy will use smooth speech during the repetition with 70% accuracy over 3 consecutive data collection points.

Modifications and SDI

Location

Frequency

Projected Beginning Date

Anticipated Duration

Provide Amy a quiet, “safe” space or activity where she can calm and regulate herself such as out of sight other students or in a comfortable spot (bean bag, carpet, walk in hallway, talk to teacher/ staff, etc.

When she needs to calm down

9/14/15

9/9/16

Provide Amy with a visual bathroom chart/ guide (steps to toileting successfully) which she will have available to her to reference before performing bathroom ADL and self- care

Daily

9/14/15

9/9/16

Repetition and redirection

Daily

9/14/15

9/9/16

Improve on-task behavior with positive reinforcements and consequences

Daily

9/14/15

9/9/16

Provide Amy with a structured, consistent environment with clearly defined limits

Daily

9/14/15

9/9/16

Modeling, cueing, and gesturing

Daily

9/14/15

9/9/16

Encourage communication to expand vocabulary

Daily

9/14/15

9/9/16

Provide ample wait time after giving directions (10 seconds)

Daily

9/14/15

9/9/16

Amy will provided with assistance to ensure understanding of the assessment directions and clarification of test questions

When tests are given

9/14/15

9/9/16

Amy will be permitted to take regular education tests in the special education room.

When tests are given

9/14/15

9/9/16

CBI (community Based Instruction) trips will be provided to reinforce etiquette and social skills in a community.

School to community

At least 4x per year

9/14/15

9/9/16

Use of manipulatives for academic tasks

Daily

9/14/15

9/9/16

Teacher communication to parent about Amy’s day

School to home

At least twice a week.

9/14/15

9/9/16

Speech therapy will take place in the form of small group and/ or individualized therapy with the Speech/ Language Clinician

Speech room and/or various settings around the building

Average of 2, 30- minute sessions per every 5 school days.

9/14/15

9/9/16

Take-home activities/ assignments should be provided by the speech clinician to elicit carry- over of skills

Speech room and/or various settings around the building

Minimum 9x/IEP year

9/14/15

9/9/16

Speech Clinician will provide a model of correct target objectives through use of visual and/ or verbal cues

Speech room and/or various settings around the building

During speech sessions

9/14/15

9/9/16

Clinician will provide multiple opportunities for Amy to practice her language, articulation, and fluency objectives.

Speech room and/or various settings around the building

During speech sessions

9/14/15

9/9/16

Service

Location

Frequency

Projected Beginning Date

Anticipated Duration

OT

18, 30- minute sessions per IEP year

9/14/15

9/9/16

Speech Language

Avg. of 2x per every 5 school days (session lasting 30 minutes) totaling at least 54 sessions by the end of the IEP year.

9/14/15

9/9/16

School Personnel to Receive Support

Support

Location

Frequency

Projected Beginning Date

Anticipated Duration

All staff who work with the student

Specially designed instruction will be distributed to staff members who work with the student

Regular School

1st week of each course

9/14/15

9/9/16

All staff who work with the student

Specially designed instruction will be distributed to staff members who work with the student regarding self- regulation and school related ADL

School

1st week of each course

9/14/15

9/9/16

Support Service

N/A

Support Service

N/A

Support Service

N/A

Student IS eligible for ESY based on the following information or data reviewed by the IEP team:

Amy is eligible for Extended School Year because she participated this past summer and it helped behaviorally with the transition back to school this fall.

OR

As of the date of this IEP, student is NOT eligible for ESY based on the following information or data reviewed by the IEP team:

• When presented with 10 specific grammar activities, Amy will independently produce target grammatical structures in sentences in 80% of the attempts, across 3 data collection points.

• Throughout a 100-word speech sample, provided decreasing cues, Amy will produce her target speech sounds, in all positions of words, with 80% accuracy, across 3 data collection points. Targets to include but not limited to: f, v, s- blends

• During therapy sessions, Amy will produce “easy talking” at the sentence level without the presence of fluency disrupters in 9/10 trials over 3 collection data points.

ESY Service to be Provided

Location

Frequency

Projected Beginning Date

Anticipated Duration

It is the responsibility of each public agency to ensure that, to the maximum extent appropriate, students with disabilities, including those in public or private institutions or other care facilities, are educated with students who are not disabled. Special classes, separate schooling or other removal of students with disabilities from the general educational environment occurs only when the nature or severity of the disability is such that education in general education classes, EVEN WITH the use of supplementary aids and services, cannot be achieved satisfactorily.

• What supplementary aids and services were considered? What supplementary aids and services were rejected? Explain why the supplementary aids and services will or will not enable the student to make progress on the goals and objectives (if applicable) in this IEP in the general education class.

• What benefits are provided in the general education class with supplementary aids and services versus the benefits provided in the special education class?

• What potentially beneficial effects and/or harmful effects might be expected on the student with disabilities or the other students in the class, even with supplementary aids and services?

• To what extent, if any, will the student participate with nondisabled peers in extracurricular activities or other nonacademic activities?

Amy participates in the Life Skills Support Curriculum which focuses on those reading, writing, math, behavior and communication skills needed for everyday life. The age range in this classroom exceeds the maximum range allowed for in state law. The IEP team feels that in spite of this, this classroom is the most appropriate placement.

Due to Amy’s functional skills in academic areas, behavior, and communications, she would need significant modifications and adaptations to be successful in a general education curriculum.

Itinerant: Special education supports and services provided by special education personnel for 20% or less of the school day

Supplemental: Special education supports and services provided by special education personnel for more than 20% of the day but less than 80% of the school day

Full-Time: Special education supports and services provided by special education personnel for 80% or more of the school day

Autistic Support

Blind-Visually Impaired Support

Deaf and Hard of Hearing Support

Emotional Support

Learning Support

X

Life Skills Support

Multiple Disabilities Support

Physical Support

X

Speech and Language Support

Name of School District where the IEP will be implemented:

Name of School Building where the IEP will be implemented:

Yes

No. If the answer is “no,” select the reason why not.

Special education supports and services required in the student’s IEP cannot be provided in the neighborhood school

Other. Please explain:

SECTION A: For Students Educated in Regular School Buildings with Non Disabled Peers – Indicate the Percentage of time INSIDE the regular classroom for this student:

Column 1

Column 2

Calculation

Indicate Percentage

Percentage Category

Total hours the student spends in the regular classroom per day

Total hours in a typical school day

(including lunch, recess & study periods)

(Hours inside regular classroom ÷ hours in school day) x 100 = %

(Column 1 ÷ Column 2) x 100 = %

Section A: The percentage of time student spends inside the regular classroom:

Using the calculation result – select the appropriate percentage category

3.83

6.50

58.92%

58.92% of the day

INSIDE the Regular Classroom 80% or More of the Day

X INSIDE the Regular Classroom 79-40% of the Day

INSIDE the Regular Classroom Less Than 40% of the Day

SECTION B: This section required only for Students Educated OUTSIDE Regular School Buildings for more than 50% of the day – select and indicate the Name of School or Facility on the line corresponding with the appropriate selection: (If a student spends less than 50% of the day in one of these locations, the IEP team must do the calculation in Section A)

Column 1

Column 2

Calculation

Indicate Percentage

Total hours the student spends in the regular classroom per day

Total hours in a typical school day (including lunch, recess & study periods)

(Hours inside regular classroom ÷ hours in school day) x 100 = %

(Column 1 ÷ Column 2) x 100 = %

Section A: The percentage of time student spends inside the regular classroom:

Example 1

5.5

6.5

(5.5  6.5) x 100 = 85%

85% of the day

(Inside 80% or More of Day)

Example 2

(3 5) x 100 = 60%

60% of the day

(Inside 79-40% of Day)

Example 3

(1 5) x 100 = 20%

20% of the day

(Inside less than 40% of Day)