County School District Individual Educational Plan …

Student:

General Information

Date of IEP Meeting: Student Name: Address:

Parent/Guardian: DOB: Grade: Purpose of Meeting:

County School District Individual Educational Plan (IEP)-

School: Student Number: Age: Previously Amended: Reevaluation Due Date: Initiation Date of IEP: Review Due Date: Duration Date:

Primary Exceptionality:

Other Program and Service Areas: A copy of the IEP was provided to the parent:

at the meeting other (describe):

Special Considerations

In considering the following factors, if the IEP team determines that a student needs a particular device or service, including an intervention, accommodation, or program modification, the IEP must include a statement to that effect in the development of the IEP

Yes

No Does the student's behavior impede his/her learning or the learning of others?

Yes

No If yes, does the student have a functional behavior assessment (FBA) and/or behavior intervention plan (BIP)?

If there is not a FBA/BIP, describe positive behavioral interventions, strategies and supports considered in the development of this IEP.

Yes

No Does the student have limited English proficiency?

If yes, describe how the student's language needs are being addressed.

Yes

No Is the student blind or visually impaired?

Yes

No If yes, is instruction in Braille or the use of Braille appropriate?

Yes

No Does the student have communication needs? If yes, those needs must be addressed in this IEP.

Yes

No Is the student deaf or hard-of-hearing?

If yes, what opportunities for direct communication with peers and professionals in the student's language are needed?

If yes, what opportunities for direct instruction in the student's language are needed?

Yes

No Does the student need assistive technology devices or services?

Yes

No Does the student require instruction or the provision of information in the area of self-determination to be able to actively

N/A participate in IEP meetings and self-advocate?

PEER Downloadable Form (Rev. 07/13)

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Student:

Diploma Option

The student is pursuing a course of study leading to:

Standard Diploma

Special Diploma, Option 1

Special Diploma, Option 2

N/A

General Factors and Assessment Data

Health concerns:

Results of statewide or districtwide assessments (e.g. Florida Comprehensive Achievement Test; Florida Alternate Assessment):

Results of the initial or most recent evaluation (district and/or independent):

Domains

The student's needs that result from his or her disability are addressed through the following domains or transition service activities areas:

Domains:

Transition Service Activity Areas:

Curriculum and Learning Environment

Instruction

Independant Functioning

Related Services

Communication

Community Experience

Social/Emotional Behavior

Employment

Health Care

Post-School Adult Living

Daily Living, if appropriate

Interagency responsibilities or linkages, if needed:

Functional Vocational Evaluation, if appropriate

The parents' concerns for enhancing the education of the student:

Parent input was obtained through: PEER Downloadable Form (Rev. 07/13)

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Student:

Transition Components

How was student input obtained?

What is/are the student's measurable postsecondary goal(s) related to postsecondary education and/or training?

What is/are the student's measurable postsecondary goal(s) related to employment?

What is/are the student's measurable postsecondary goal(s) related to independent living (where appropriate)?

Describe the student's course of study (such as participation in advanced placement courses or a career and technical education program):

Transfer of Rights

Yes

NA At least one year prior to the student's eighteenth birthday, the student was informed of his or her rights under Part B of

the Individuals with Disabilities Education Act (IDEA 2004) that will transfer from the parent to the student on reaching

the age of majority, which is eighteen years of age.

Yes

NA A separate and distinct notice of the transfer of rights was provided closer to the time of the student's eighteenth

birthday.

Additional information as appropriate (e.g. date of receipt; initials documenting receipt)

PEER Downloadable Form (Rev. 07/13)

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Student:

Present Level of Academic Achievement and Functional Performance

Information on transition needs and/or self-determination is included here as appropriate.

Domain / Transition Service: Describe the strengths of the student.

Describe the levels of achievement and functioning based on classroom data, including observations, work samples, and age appropriate transition assessments (if appropriate).

Describe how the student's disability affects the student's involvement and progress in the general curriculum.

Annual Goals and Short-Term Objectives or Benchmarks Goal:

Mastery Criteria:

% Accuracy; For

Assessment Procedures:

Teacher Developed Checklist or Chart

Test(s): Teacher and/or Standardized

Student Work Product

Interview with:

Progress Reports will be sent every: Short-term Objective or Benchmark:

minutes(s);

of

opportunities; Other:

Graded Work Sample Curriculum Based Assessments Documented Observation Other:

Short-term Objective or Benchmark:

Short-term Objective or Benchmark:

Short-term Objective or Benchmark:

Number of Additional Goal Pages: PEER Downloadable Form (Rev. 07/13)

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Student:

Assessment

Each student must participate in the general statewide assessment (GSA) and/or course-specific end of course (EOC) assessment(s), without accommodations, unless determined otherwise by the IEP team in accordance with Rule 6A-1.0943, F.A.C. Based on the nature and impact of this student's disability and educational program, the following has been determined:

N/A for student's current grade

The student will participate in the General Statewide Assessment and/or End of Course assessment(s) without accommodations.

The student will participate in the General Statewide Assessment and/or End of Course assessment(s) with accommodations.

If known, the GSA and/or EOC assessment the student will take:

Yes

N/A A parent has provided consent for classroom/instructional accommodations not allowed on statewide assessment.

The student will participate in the Florida Alternate Assessment

For Students Participating in Alternate Assessments

The IEP team is responsible for determining whether a student with a disability will be assessed with the general statewide assessment or with the Florida Alternate Assessment. The decision is based on the criteria found in Rule 6A-1.0943(4), F.A.C.. The team may only determine that an alternate assessment is appropriate if the statements below accurately characterize the student's current educational situation. If the decision of the IEP team is to assess the student through alternate assessment, the parent must be notified of the implications of that decision, including that the student cannot earn a standard diploma. In accordance with rule 6A-1.0943(4), F.A.C., an IEP team may only select the Florida Alternate Assessment for a student if the answers to the following statements are "yes" (Y).

Yes

No Does the student have a significant cognitive disability?

Yes

No Is the student unable to master the grade-level general state content standards, pursuant to Rule 6A-1.09401,

F.A.C., even with appropriate and allowable instructional accommodations, assistive technology, or accessible

instructional materials?

Yes

No Is the student participating in a curriculum based on the state standards access points, pursuant to Rule 6A-1.09401,

F.A.C., for all academic areas?

Yes

No Does the student require direct instruction academics based on access points, pursuant to Rule 6A-1.09401, F.A.C., in

order to acquire, generalize, and transfer skills across settings?

Describe why the Florida Alternate Assessment and/or the alternate district assessment(s) is/are appropriate.

Yes

No

The IEP Team has made the decision to assess this student using the state standards access points. By receipt of the IEP, the parent has been notified that the implication of this decision is that the student will not be eligible

for a standard high school diploma.

All students must be afforded the opportunity to participate in districtwide assessment. Identify below the alternate district assessment(s) to be administered to this student. If none will be administered, indicate with "N/A."

For Students Participating in Assessments with Accommodations

Assessment accommodations may be used only if they do not alter the underlying content that is being measured by the assessment or negatively affect the assessment's reliability or validity. Only accommodations allowed by individual test administration manuals may be implemented on standardized tests. In accordance with Rule 6A-1.0943, Florida Administrative Code, the need for any unique accommodations for use on state assessments must be approved by the Commissioner of Education.

Assessment Accommodations

Please identify which accommodation(s), if any, will also used as an assessment accommodation. Please refer to the most current test administration manual. Be sure to check the accommodations the student is currently using. (Check all that apply.)

Presentation Signed presentation of directions Signed presentation of items and answer choices Oral presentation of directions Oral presentation of items and answer choices Directions repeated, clarified Student to demonstrate understanding of directions Verbal encouragement

Leveled books Note-taking assistance Recorded books and text recordings Simplified or graphic directions Self instruction or self-questions Sample problems and tasks Verbal description of images or reading descriptive text provided

PEER Downloadable Form (Rev. 07/13)

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Student: Word recognition and comprehension supports

Description

Paper-based Presentation Options Regular print Large print Braille document Reading passage booklet Straightedge to maintain or enhance visual attention to test items Portions of the assignment masked to direct attention to uncovered item Positioning tools such as a book stand or page holder Colored transparencies or overlays Workbooks secured to the work area Highlighter to mark key phrases or words in directions and passages

Computer-based Presentation Options Large print font Color contrast Zoom

Responding Options Mouse, keyboard or assistive technology using either device to indicate answers

The student is eligible to receive paper-based accommodations if one or more of the following is/are true:

Paper-based testing requirement The student cannot access assessment on the computer The student requires an accommodation that cannot be implemented in conjunction with a computer-based administration The student has a flexible scheduling/extended time accommodation that required testing one session over more than one day The student is hospitalized/homebound Screen reader Colored plastic transparency filters placed over the computer screen; eyeglasses with colored lenses

Mathematics grids/guides to organize mathematical computation

Written, signed or verbal responses by student entered on the computer by administrator or proctor

Periodic check by administrator to be sure student is entering answer choices correctly

Indicate type of response

Computer switch, pointing device or other communication device to indicate answers Indicate type of device Assistive devices to access the keyboard Indicate type of device

Answers entered directly in the work booklet if a separate sheet is used

Braille responses on a separate answer sheet Pencils, pencil grips, crayons, spacers or other handwriting supports

Slant board Physical support or positioning Alphabet strips Dictionaries and thesauruses Organizers, outlines, checklists and other writing supports Spelling and grammar checks

Scheduling Options Assignments administered over several brief sessions, allowing frequent breaks Specific sessions administered at specific time of day

Description

Setting Options

Extended time Description

Time management tools like checklists, planners or visual schedules Established timelines and/or predictable routines

Assignments or tests administered in a familiar place Assignments or tests administered by a familiar person who has been appropriately trained Assignments or tests administered individually Assignments or tests administered in a small group setting of a size comparable to the normal instruction group size

Describe group size: Special lighting

Description

Preferential seating Compartmentalized containers and binders Other Assistive Device Options Visual magnification device Description Auditory amplification device Description Real coins Abacus or product such as Graphic Aid for Mathematics, Math Window or geoboard (students with visual impairments only)

Description

Light box Other

Adaptive or special furniture Description

Special acoustics, such as FM system or special room Description

Increased opportunity for movement Decreased opportunity for movement Reduced stimuli White noise (sound machines) or approved music to reduce auditory distractions Description Physical access

English/sign language or sign language/English language dictionary; sign picture, word, synonyms, and index only; no definitions (students who use sign language as their primary means of communication only)

Other assistive technology typically used by the student in classroom instruction, provided the purpose of the assignment is not violated Description

Adapted calculator, raised number line, or Braille ruler (students with visual impairments only) Other

Other

Other

PEER Downloadable Form (Rev. 07/13)

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Student: Unique Accommodations In accordance with Rule 6A-1.0943, FAC, school districts may request unique accommodations for individual students with disabilities. Each unique accommodation must be approved by the Commissioner of Education prior to its use. Written requests for unique accommodations must be submitted by using the Unique Accommodations Request Form. Accommodation requests must be reviewed by district level staff before being sent to the FDOE. In addition, the signatures of both the district ESE coordinator and the district assessment coordinator are required.

The IEP teams is not requesting unique accommodations

The IEP team will submit a request for the following unique accommodation(s) to district level staff for consideration

Special Education Services

Specially Designed Instruction

Initiation

Duration

Frequency

Location

Related Services

The team considered the need to related services and determined none are needed at this time.

Supplementary Aids and Services

The team considered the need to related services and determined none are needed at this time.

Extended School Year Services

The team considered the need to related services and determined none are needed at this time.

PEER Downloadable Form (Rev. 07/13)

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Student:

Classroom/Instructional Accommodations

The IEP team has considered the following guiding questions prior to the selection of the accommodations

1. What instructional and assessment tasks are difficult for the student to do independently? Are these difficulties documented in the present level statement? 2. Why are these tasks difficult for the student? 3. What accommodations will allow the student to access the information and demonstrate performance of the tasks? 4. How will the IEP team know if the accommodations is effective?

Presentation Signed presentation of directions Signed presentation of items and answer choices Oral presentation of directions Oral presentation of items and answer choices Directions repeated, clarified Student to demonstrate understanding of directions Verbal encouragement Leveled books Note-taking assistance Recorded books and text recordings Simplified or graphic directions Self instruction or self-questions Sample problems and tasks Verbal description of images or reading descriptive text provided Word recognition and comprehension supports

Description

Initiation Duration Frequency

Location

Paper-based Presentation Options Regular print Large print Braille document Reading passage booklet Straightedge to maintain or enhance visual attention to test items Portions of the assignment masked to direct attention to uncovered item Positioning tools such as a book stand or page holder Colored transparencies or overlays Workbooks secured to the work area Highlighter to mark key phrases or words in directions, items and passages

Computer-based Presentation Options Large print font Color contrast Zoom Screen reader Colored plastic transparency filters placed over the computer screen; eyeglasses with colored lenses

Initiation Initiation

Duration Duration

Frequency Frequency

Location Location

Responding Options Mouse, keyboard or assistive technology using either device to indicate answers Written, signed or verbal responses by student entered on the computer by administrator or proctor

Indicate type of response

Computer switch, pointing device or other communication device to indicate answers

Indicate type of device Assistive devices to access the keyboard

Indicate type of device Mathematics grids/guides to organize mathematical computation Periodic check by administrator to be sure student is entering answer choices correctly Answers entered directly in the work booklet if a separate sheet is used Braille responses on a separate answer sheet Pencils, pencil grips, crayons, spacers or other handwriting supports Slant board Physical support or positioning Alphabet strips Dictionaries and thesauruses Organizers, outlines, checklists and other writing supports Spelling and grammar checks

Initiation

Duration

Frequency

Location

PEER Downloadable Form (Rev. 07/13)

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