Derek Doe Legal Name of Student 12345678910 Local Student ID (LASID) Exceptional Student Unit Administrative Unit Name

N/A State Student ID (SASID) 123 Herring Circle, Aurora, CO 80000 AU Address

01/07/2001 Date of Birth 720-555-555 AU Phone Number

3/16/2011 Date

SECTION 1: TYPE OF MEETING Eligibility

Initial Eligibility Meeting 3-Year Reevaluation Special Evaluation

SECTION 2: DATES OF MEETINGS Individualized Education Program

Initial IEP X Annual Review Amendment to IEP Dated:__________ Other: _______________________ N/A (Student Did not qualify) Date of next eligibility meeting (on or before) Date of next IEP review meeting (on or before) Date of initial consent for evaluation Date initial evaluation completed Date of initial eligibility determination Post secondary goals due during the year when the student is 15 but no later than the end of 9th grade
Date 2/24/2014 Date 3/16/2012 Date x Date x Date x Date

Date Initial Consent for Services:_____________

Is there an Educational Surrogate Parent (ESP)? Yes Students Parent/ Guardian(s)/ESP Address City/State/Zip Telephone Number Email

No X N/A Apt. #123 303-4444444 Work 720-222-2222 Cell Home Cell Work

John & Jane Doe 1234 Village Ct. Aurora, CO 80012 303-555-5555 Home

INDIVIDUALIZED EDUCATION PROGRAM

3/16/11

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

ECTION 6: PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE INCLUDING INPUT FROM PARENT & STUDENT SECTION S 4: PROCEDURAL SAFEGUARDS Student Strengths, Preferences, Interests I have been provided the special education procedural safeguards in my native language or other mode of communication. X Yes No 300.324(a)(i) strengths of the child 300.321(b)(2) preferences and interests 300.43(a)(2) John Doe 3-16-11
Parent/Guardian/ESP Signature 300.504(a) Date

SECTION 6: PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE INCLUDING INPUT FROM PARENT & STUDENT

Dereks greatest strengths involve physical activities like sports and gym class. Derek also is successful in mathematics and is at or near grade level. Derek by admission expresses interests in both science and social S ECTION 5: IEP PARTICIPANTS studies and does not mind reading if he is interested in the subject. THE FOLLOWING PARTICIPANTS ATTENDED THE IEP MEETING: DerekLevels Doe John Doe Jane Doe Present of Educational Performance Summary Include results of initial or most recent evaluation Student 300.321(a)(7); 300.321(b)(1) Students Parent/Guardian/ESP 300.321(a)(1) Students Parent/Guardian/ESP 300.321(a)(1)
300.324(a)(iii) Results of initial or most recent evaluation

Jan Harder Nicole Harder-Gonzales Derek Special struggles Education with Director his attention or Designee stamina; 300.321(a)(4)(i)-(iii) he has trouble keeping General on task Education without Teacher redirection 300.321(a)(2); during 300.324(a)(3)(i)-(ii) independent tasks.

Kari Sparks Multi-factored Special Education evaluations Teacher/Provider were used 300.321(a)(3) to assess Dereks

performance in attention, reading, written language, and spelling. Presently he was rated on The Conners Teaching Rating Scale significant elevations for the hyperactivity index and hyperactivity subscales, and the Conners Parent Rating Scale indicated clinically significant scores for the impulse-hyperactive, learning problems, anxiety, and THE FOLLOWING PERSONS WERE ALSO IN ATTENDANCE AT THE MEETING hyperactivity index subscales. The WISC-IV Individual Subtest Scores Derek scored below average on 7/10 subjects (reading and writing). On the Wood Cock Johnson th NAME for word comprehension/identification Derek scored TITLE REA/A GENCY REPRESENTED Assessment in the 11th percentile where his peers on average scored atAthe 50 percentile making him far below grade level. nd Wheeling Elementary Derek is in 3rd grade but is reading at 2 grade level and struggles with comprehension. Derek also struggles in spelling and is only successful with 1st grade level spelling words. Kari Sparks Special Education Teacher In correlation with struggles with reading and spelling, Derek struggles to satisfactorily complete writing prompts and other written assignments at grade level. These difficulties in Wheeling Elementary

Nicole Harder General Classroom Teacher Amy Thompson Speech Language Pathologist LEA Alex Banks Occupational Therapist LEA Describe the age appropriate transition assessment process used to develop the post-school goals 300.320(b)(1) Wheeling Elementary LisatoHarter School Therapist This section be completed for the first IEP to be in effect when the student is transition age, or earlier if deemed appropriate by the IEP team Wheeling Elementary Vice Principal N/A Alan Meder Student Needs and Impact of Disability How does the students disability affect his/her involvement and progress in the general curriculum and participation in appropriate activities? 300.324(a)(ii) concerns of parent 300.324(a)(iv) academic, developmental, and functional needs (access skills) 300.320(a)(1) How the childs disability affects the childs involvement and progressin the general curriculum and participation in appropriate activities Derek s retention of 3rd grade did not produce the results desired by both the student and his parents and is a signifier that Dereks specific exceptionalities need to be more directly addressed. Dereks struggles with attention and reading comprehension are hindering his progress in spelling, writing, science and social studies and causing him to fall significantly behind his peers at grade level and his chronological age.
attention, reading, spelling and writing inhibit Dereks progress in the general curriculum.

3/16/11

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

Measurable Post-School Goals

This section to be completed for the first IEP to be in effect when the student is transition age, or earlier if deemed appropriate by the IEP team What are the students preferences, interests and desired outcomes in future post-secondary education, employment and independent living? Be sure to include feedback from the student N/A Post-School Education/Training Goal:

N/A
Employment Goal:

N/A
Independent Living Skills Goal (when appropriate):

N/A

3/16/11

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

SECTION 7: CONSIDERATION OF SPECIAL FACTORS

A. Does this student exhibit behavior that requires a Behavior Intervention Plan? Yes X No
If yes, generate Behavior Intervention Plan.

B. Is the student blind or visually impaired? Yes X No

If yes, generate Learning Media Plan.

300.324(1)(2)(i)

300.324(1)(2)(iii)

C. Is the student deaf or hard of hearing? Yes X No

If yes, generate Communication Plan.

D. Is the student deaf-blind? Yes X No

If yes, generate Learning Media & Communication Plan.

300.324(a)(2)(iv)

300.324(1)(2)(iii) & 300.324(a)(2)(iv)

E. Does the student require a Health Care Plan? Yes X No

If yes, indicate location of Plan.

F. Does the student have Limited English Proficiency? Yes X No If yes, specify how this will be addressed: 300.324(a)(2)(ii)

G. Does the student need Assistive Technology devices or services? X Yes No Assistive technology would be beneficial for Derek
If yes, specify:

H. Does the student require Special Transportation? Yes X No

If yes, specify:

300.324(a)(2)(v) Digitized lessons or textbooks on audio recorded, digital visual cueing system for writing assignments, Digital Audio/visual study aids, digital/media based assignments when applicable.

300.34 Related Services (a) 300.34 (c)(16) 300.107(b)

3/16/11

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

SECTION 8: POST-SCHOOL CONSIDERATIONS

This section to be completed for the IEP to be in effect when the child is 15, but not later than the end of 9th grade 300.320(b)

Projected date of graduation/program completion: STUDENT IS NOT OF TRANSITION AGE 300.102(a)(3)(i)-(iii) limitation to FAPE Projected type of completion document ________________________________________N/A_______________________
Post-School Education/Training Goal (from Section 6: Measurable Post-School Goals): 300.320(b)(1) N/A Planned Course of Study: 300.320(b)(2) N/A Transition Services and Activities: 300.320(b)(2) N/A Agency/community supports that may provide transition services in the coming school year: 300.321(b)(3) participants in meeting N/A Career Employment Goal (from Section 6: Measurable Post-School Goals)300.320(b)(1) N/A Planned Course of Study: 300.320(b)(2) N/A Transition Services and Activities: 300.320(b)(2) N/A Agency that may provide transition services in the coming school year: 300.321(b)(3) participants in meeting N/A Independent Living Skills Goal (when appropriate) (from Section 6: Measurable Post-School Goals): 300.320(b)(1) Planned Course of Study: 300.320(b)(2) Transition Services and Activities: 300.320(b)(2) Agency that may provide transition services in the coming school year: 300.321(b)(3) participants in meeting If the student will turn 20 during the course of this IEP period, student and parent(s) have been informed of the transfer of rights at the age of majority (21).
Yes No X N/A 300.320(c) Transfer of rights at age of majority.

NOTE: Graduation will permanently end entitlement to a free and appropriate public education (FAPE) under the federal Individuals with Disabilities Education Act 2004 and the Colorado Rules for the Administration of the Exceptional Childrens Educational Act. Therefore, after graduation this student will no longer be entitled to receive special education and related services from a school district or other local education agency.

3/16/11

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

SECTION 9: ANNUAL GOALS AND/OR OBJECTIVES 300.320(a)(2)(i) For Students who are transition age, indicate what post-school area this will support: X Education/Training Area of Need: Attention Stamina/ Independence

Employment

Independent Living Unit of Measurement: 300.320(a)(3)(i Weekly observations in diverse situation /setting and quarterly progress reports over a specific duration of 8 weeks.

Measurable Goal: 300.320(a)(2)(i) Derek will return to independent activity and stay on task without redirection for 10 minutes by the next annual IEP meeting. Objective (if needed): Derek will be observed expressing capacity to return to task and stay on task for 3 minutes with verbal redirection by 6/16/2011. Derek will be observed expressing capacity to return to task and stay on task for 5 minutes with visual redirection by 9/16/2011. Derek will be observed expressing capacity to return to task and stay on task for 8 minutes without redirection by 12/16/2011.

Related Standard/Expanded Benchmark/Access Skill:

Communication and Basic Language Skills

Baseline Data Point: Approximate 2 minute attention span during independent activity; observation over 4 weeks bi-weekly

Evaluation Method: X Monitor and Chart Progress Focused Assessments Portfolio Collection Other: 300.320(a)(3)(i) Progress Report (Describe how parents will be informed of the students progress toward goals and how frequently this will occur) 300.320(a)(3)(iii) PROGRESS REPORTS WILL BE PROVIDED QUARTERLY Reporting Date: 03/16/2011 Progress: ____ Supporting Data Point: Reporting Date: 06/16/2011 Progress: ____ Supporting Data Point: Reporting Date: 0916/2011 Progress: ____ Supporting Data Point: Employment Reporting Date: 12/16/2011 Progress: ____ Supporting Data Point: Independent Living Unit of Measurement: 300.320(a)(3)(i)
6

For Students who are transition age, indicate what post-school area this will support: Education/Training Area of Need: N/A Measurable Goal: 300.320(a)(2)(i) Objective (if needed):
3/16/11

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

Related Standard/Expanded Benchmark/Access Skill: Evaluation Method: Monitor and Chart Progress Focused Assessments Reporting Date: _3__/__16_/____ Progress: ____ Supporting Data Point: Reporting Date: ___/___/____ Progress: ____ Supporting Data Point: Portfolio Collection Other:________

Baseline Data Point: 300.320(a)(3)(i) Reporting Date: ___/___/____ Progress: ____ Supporting Data Point:

Reporting Date: ___/___/____ Progress: ____ Supporting Data Point:

Progress Reporting Key: 4) Goal met 3) Progress made, goal to be met on time 2) Insufficient progress made, goal not to be met on time 1) Student did not work on this goal.
Attach additional supporting charts/ graphs if available

SECTION 9: ANNUAL GOALS AND/OR OBJECTIVES 300.320(a)(2)(i) For Students who are transition age, indicate what post-school area this will support: Education/Training Area of Need: Reading

Employment

Independent Living Unit of Measurement: 300.320(a)(3)(i) Accuracy on assessments and quarterly progress reports

Measurable Goal: 300.320(a)(2)(i) When reading Derek will increase his word recognition from 57 to 65 (73 is his grade level average) and increase his correct decoding of nonsense words to 20. Objective (if needed): When given a list of words at 2nd grade level Derek will accurately pronounce them 3/3 times at 70% accuracy consecutively for 2 weeks by 6/16/2011. Also, Derek will increase his word recognition to 60 and decode 10 words correctly by 6/16/2011. When given a list of words at 2nd grade level Derek will accurately pronounce them 3/3 times at 80% accuracy consecutively for 2 weeks by 9/16/2011. Also, Derek will increase his word recognition to 62 and decode 14 words correctly by 9/16/2011. When given a list of words at 2nd grade level Derek will accurately pronounce them 3/3 times at 90% accuracy consecutively for 2 weeks by 12/16/2011. Also, Derek will increase his word recognition to 64 and decode 18 words correctly by 12/16/2011.

Related Standard/Expanded Benchmark/Access Skill:

Communication and Basic Language Skills

Baseline Data Point: Results and re-test WISC-IV & Woodcock Reading Mastery assessments
7

3/16/11

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

Evaluation Method: X Monitor and Chart Progress Focused Assessments

Portfolio Collection

Other:_____________________________

300.320(a)(3)(i)

Progress Report (Describe how parents will be informed of the students progress toward goals and how frequently this will occur) 300.320(a)(3)(iii) PROGRESS REPORTS WILL BE PROVIDED QUARTERLY Reporting Date: 03/16/2011 Progress: ____ Supporting Data Point: Reporting Date: _6__/16___/2011____ Progress: ____ Supporting Data Point: Reporting Date: _9__/16___/2011____ Progress: ____ Supporting Data Point: Employment Reporting Date: _12__/16___/2011____ Progress: ____ Supporting Data Point: Independent Living Unit of Measurement: 300.320(a)(3)(i) Baseline Data Point: Portfolio Collection Other:________ 300.320(a)(3)(i) Reporting Date: ___/___/____ Progress: ____ Supporting Data Point:

For Students who are transition age, indicate what post-school area this will support: Education/Training Area of Need: N/A Measurable Goal: 300.320(a)(2)(i) Objective (if needed): Related Standard/Expanded Benchmark/Access Skill: Evaluation Method: Monitor and Chart Progress Focused Assessments Reporting Date: ___/___/____ Progress: ____ Supporting Data Point: Reporting Date: ___/___/____ Progress: ____ Supporting Data Point:

Reporting Date: ___/___/____ Progress: ____ Supporting Data Point:

SECTION 9: ANNUAL GOALS AND/OR OBJECTIVES 300.320(a)(2)(i) For Students who are transition age, indicate what post-school area this will support: Education/Training Area of Need: Writing

Employment

Independent Living Unit of Measurement: 300.320(a)(3)(i) Type-Taken Ratio Assessment

Measurable Goal: 300.320(a)(2)(i) When given a writing prompt/ assignment Derek will increase his total type-taken ratio to 80% in 75% of sampled work. Benchmarks: Derek will increase his type-take ratio to 73% of 75% of his sampled work by 6/16/2011. Derek will increase his type-take ratio to 75% of 75% of his sampled work by 9/16/2011.
3/16/11

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

Derek will increase his type-take ratio to 78% of 75% of his sampled work by 12/16/2011.

Related Standard/Expanded Benchmark/Access Skill:

Organization
Portfolio Collection

Evaluation Method: Monitor and Chart Progress Focused Assessments

Baseline Data Point: Test of Written Language Assessment/ X Other:Writing Samples/Progress Reports 300.320(a)(3)(i)

Progress Report (Describe how parents will be informed of the students progress toward goals and how frequently this will occur) 300.320(a)(3)(iii) PROGRESS REPORTS WILL BE PROVIDED QUARTERLY Reporting Date: 03/16/2011 Progress: ____ Supporting Data Point: Reporting Date: _6__/16/2011____ Progress: ____ Supporting Data Point: Reporting Date: _9__/16___/2011____ Progress: ____ Supporting Data Point: Employment Reporting Date: _12__/_16__/ 2011____ Progress: ____ Supporting Data Point: Independent Living Unit of Measurement: 300.320(a)(3)(i) Baseline Data Point: Portfolio Collection Other:________ 300.320(a)(3)(i) Reporting Date: ___/___/____ Progress: ____ Supporting Data Point:

For Students who are transition age, indicate what post-school area this will support: Education/Training Area of Need: N/A Measurable Goal: 300.320(a)(2)(i) Objective (if needed): Related Standard/Expanded Benchmark/Access Skill: Evaluation Method: Monitor and Chart Progress Focused Assessments Reporting Date: ___/___/____ Progress: ____ Supporting Data Point: Reporting Date: ___/___/____ Progress: ____ Supporting Data Point:

Reporting Date: ___/___/____ Progress: ____ Supporting Data Point:

Progress Reporting Key: 4) Goal met 3) Progress made, goal to be met on time 2) Insufficient progress made, goal not to be met on time 1) Student did not work on this goal.
Attach additional supporting charts/ graphs if available

SECTION 9: ANNUAL GOALS AND/OR OBJECTIVES 300.320(a)(2)(i) For Students who are transition age, indicate what post-school area this will support: Education/Training Area of Need: Spelling

Employment

Independent Living

3/16/11

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

Measurable Goal: 300.320(a)(2)(i) When given a list of 1st grade level words Derek will correctly spell 75% of words on 3/3 trials for 3 consecutive weeks. Benchmark: Derek will correctly spell 100% on Kindergarten spelling words for 3 consecutive weeks by 6/16/2011. Derek will correctly spell 30% on 1st Grade spelling words for 3 consecutive weeks by 9/16/2011. Derek will correctly spell 50% on 1st Grade spelling words for 3 consecutive weeks by 12/16/2011.

Unit of Measurement: 300.320(a)(3)(i) Accuracy Weekly spelling Tests/ Progress Reports

Related Standard/Expanded Benchmark/Access Skill:

Communication and Basic Language Skills

Evaluation Method: Monitor and Chart Progress Focused Assessments Portfolio Collection Progress Report (Describe how parents will be informed of the students progress toward goals and how frequently this will occur) 300.320(a)(3)(iii) PROGRESS REPORTS WILL BE PROVIDED QUARTERLY Reporting Date: 03/16/2011 Progress: ____ Supporting Data Point: Reporting Date: _6/16_/2011____ Progress: ____ Supporting Data Point: Reporting Date:_9_/16___/2011__ Progress: ____ Supporting Data Point: Employment

Baseline Data Point: Assessments Other:_____________________________ 300.320(a)(3)(i)

Reporting Date: _12__/_16__/_2011___ Progress: ____ Supporting Data Point: Independent Living Unit of Measurement: 300.320(a)(3)(i) Baseline Data Point:

For Students who are transition age, indicate what post-school area this will support: Education/Training Area of Need: N/A Measurable Goal: 300.320(a)(2)(i) Objective (if needed): Related Standard/Expanded Benchmark/Access Skill: Evaluation Method: Monitor and Chart Progress Focused Assessments Reporting Date: ___/___/____ Progress: ____ Supporting Data Point: Reporting Date: ___/___/____ Progress: ____ Supporting Data Point: Portfolio Collection

Other:________

300.320(a)(3)(i) Reporting Date: ___/___/____ Progress: ____ Supporting Data Point:

Reporting Date: ___/___/____ Progress: ____ Supporting Data Point:

Progress Reporting Key: 4) Goal met 3) Progress made, goal to be met on time 2) Insufficient progress made, goal not to be met on time 1) Student did not work on this goal.
Attach additional supporting charts/ graphs if available
3/16/11 10

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

Progress Reporting Key: 4) Goal met 3) Progress made, goal to be met on time 2) Insufficient progress made, goal not to be met on time 1) Student did not work on this goal.
Attach additional supporting charts/ graphs if available

SECTION 10: ACCOMMODATIONS & MODIFICATIONS Accommodations

What type(s) of accommodation(s) if any is (are) necessary for the student to access the general curriculum and/or appropriate activities to make effective progress? 300.320(a)(4)(i)-(iii) 300.320(a)(6)(i)

Access to occupational therapy based objects (bike tire around chair, exercise ball and sensory box); Lessons or textbooks on tape, visual cueing system for writing assignments, Preferential seating, taking tests in a separate setting or digitally on a computer, frequent breaks, Audio/visual study aids, and digital/media based assignments when applicable.

Modifications
What standards, if any, need to be modified, expanded, and/or prioritized for the student to access the general curriculum and/or appropriate activities to make effective progress? Derek needs Kindergarten-1st grade level spelling words

SECTION 11: EXTENDED SCHOOL YEAR DETERMINATION 300.106 Criteria/Inquiry: Did the student experience significant regression on their IEP goals and objectives? Yes X No Did the student require an unreasonably long period of time to relearn previously learned skills? Yes No Are there other factors relevant in determining eligibility for ESY services? Yes No Decision: Is the student eligible for Extended School Year Services? Yes X No To be determined by: _____________ If yes, attach documentation for each question and record services on service summary in Section 13. Identify which goals will be worked on during the Extended School Year Below:

3/16/11

11

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

SECTION 12: STATE/DISTRICT ASSESSMENTS: District Assessments:

Check whether the student will participate in the District Assessment or the District Alternate for each content area(s) administered at the child/students grade level. Check all that apply .

Reading/Writing/Language Arts Math Science Other__________________ Other__________________

Regular x x x

Alternate

Not Assessed at This Grade Level

If the student is eligible for the district alternate assessment, provide justification: Not Eligible List district assessment accommodations: Student receives more, but shorter sessions with breaks in between, Student receives extended time

State Assessments
Check whether the student will participate in the CSAP or CSAP Alternate for each content area(s) administered at the child/students grade level. Check all that apply.

Reading/Writing/Language Arts Math Science 11th grade only:

CSAP

CSAPA or 11th Grade Alt.

ACT

Not Assessed at This Grade Level

If the student will be participating in the CSAPA provide justification: 300.320(a)(6)(ii)(A) and (B) List any CSAPA Accommodations/Adaptations:

Check all Standard Accommodations to be used in the CSAP Administration: 300.320(a)(6)(i)

Standard Presentation Accommodations No accommodations needed Braille version of the test Large-print version of the test (18 point font) X Read aloud directions only Signing of directions only Oral presentation of entire test (science, math, writing only) Signing presentation of entire test Translated oral presentation of entire test X Student receives more, but shorter sessions with breaks in between X Student receives extended time
3/16/11

Standard Response Accommodations No accommodations needed Use of scribe to write oral responses or fill in bubbles in the test book (scribe) X Use of scribe to write oral responses to constructed items only (scribe) Use of signing as an alternative response (must also then scribe into test booklet) Use of assistive technology to communicate response to test items

12

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

Student uses additional manipulative for mathematics assessment Describe Non-Standard Accommodations:

Other Allowable Accommodations:

If student is taking an alternate assessment, parents have been informed about the differences between regular and the alternate assessments (both state and district) and the effects of these, if any (including that, for students taking alternate assessments, their achievement will be measured based on alternate achievement standards).

SECTION 13: SERVICE DELIVERY STATEMENT

300.320(a)(7) THE IEP TEAM HAD DECIDED THAT THE SPECIAL EDUCATION TEACHER WILL NEED TO PROVIDE SPECIALLY DESIGNED INSTRUCTION TO DEREK. THE TEACHER WILL RESPOND TO DEREK'S STRUGGLES BY FOCUSING ON STRENGTHENING DEREK'S ATTENTION SPAN AND TEACHING COPING METHODS TO INCREASE FOCUS. ALSO, EMPHASIS WILL BE MADE ON INCREASING AND EXPANDING DEREK'S COMPREHENSION OF READING, WRITING AND SPELLING SKILLS. THIS WILL OCCUR IN THE RESOURCE ROOM FOR A MINIMUM OF 45 MINUTES A DAY. DEREK WILL ALSO RECEIVE 1 HOUR WEEKLY OF OCCUPATIONAL THERAPY TO ASSIST WITH STRENGTHENING HIS ATTENTION/FOCUS STAMINA.

SPECIAL EDUCATION AND RELATED SERVICES IN THE LEAST RESTRICTIVE ENVIRONMENT

Specialized Instruction Area and/or Related Services 300.320(a)(4) Service Provider 300.18 HQ Sp. Ed. Teacher Start Date 300.320(a)(7) End Date 300.320(a) (7) Frequency of Special Education/Related Services-Direct Use ONE column only per identified service Per Day 300.320(a)(7) Per Week 300.320(a)(7) Per Month 300.320(a)(7) Frequency of Special Education/Related Services Indirect Including Case Management Use ONE column only per identified service Per Day 300.320(a)(7) Per Week 300.320(a)(7) Per Month 300.320(a)(7)

SPECIAL EDUCATION OCCUPATIONAL THERAPY

SPECIAL ED TEACHER OCCUPATIONAL THERAPIST

3/16/11 3/16/11

3/16/12 3/16/12

45 minutes 0

3 hrs 45 mins 1 hr

15 hrs 4 hrs 0 1hr 4 hrs

Total Amount of Time:

45 HPD

HPW

_________HPM

________HPD

1 HPW

_________HPM

SECTION 14: RECOMMENDED PLACEMENT IN THE LEAST RESTRICTIVE ENVIRONMENT (SPECIAL EDUCATION SETTING)
Placement Options Considered
3/16/11

Selected: General

Discussion must address each of the following for all

To provide Derek with the Least Restrictive Environment the IEP

13

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

1. 2. 3.

General education class at least 80% of the time General education class at least 80% of the time General education class at least 80% of the time

education class at least 80% of the time 1. X Yes No 2. X Yes 3. X Yes No No

placement options:

team has decided to keep Derek in the general education class at least 80% of the time.

Possible advantages for the student Possible disadvantages for the student Modifications/supplementary aids & services considered to reduce possible disadvantage to the student

GENERAL EDUCATION SERVICES Complete this section for students ages 3-5 as of Dec. 1, only:
Description Integrated Education Program Other:___________________ Hours Per Week

EDUCATIONAL ENVIRONMENT
Selected Ages 3-5 (as of Dec. 1)NOT APPLICABLE Selected Ages 6-21 (as of Dec. 1)

General education early childhood program at least 80% of the time General education early childhood program 40% to 79% of the time General education early childhood program less than 40% of the time Separate class Separate school N/A Residential facility Home

General education class at least 80% of the time General education class 40% to 79% of the time General education class less than 40% of the time Separate school Residential facility Homebound/hospital Correctional facilities (including short-term detention)

SECTION 15: PRIOR WRITTEN NOTICE

The IEP includes services to be provided to assist your child to make progress. The Present Level of Academic Achievement and Functional Performance in Section 6 includes information about the data used as a basis for the decisions recorded in the IEP. Other options considered: Why those options were rejected: 1. General education class 40% to 79% of the time Parents and IEP committee felt other options were too restrictive for Derek and rejected 2. General education class less than 40% of the time more than 20% away from general education class or separate school options. 3. Separate school Other factors:

Case Manager:

Kari Sparks
Name 3/16/11

_Special Education Teacher _____________

Title

__303-555-555__________
Phone

____3/16/11___________
Date 14

Derek Doe Legal Name of Student

N/A State Student ID (SASID)

01/07/2001 Date of Birth

3/16/2011 Date

Parents of a child with a disability have protection under the procedural safeguards. For a copy of the procedural safeguards or assistance in understanding this information, please contact the person named above. 300.503(b)(4)
X copy of the IEP has been provided to the parent(s). 300.322(f)

3/16/11

15