County School District Individual Educational Plan (IEP ...

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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