Individualized Education Plan

Transcription

1 KIDSS Southeast Kansas Interlocal # N. Pine Pittsburg, KS Individualized Education Plan Printed:10/20/2011 Legal Name: First Parent: Phones: Address : Second Parent: home: mom: dad: KIDS ID: Birthdate: Age at IEP: Grade: Comp Evaluation : IEP Meeting: home: Phones: mom: Initiation: dad: Other: home: Phones: mom: dad: Neighborhood School: Attendance Building: Present Levels of Academic and Functional Performance Health/Physical Strengths and/or Concerns:(vision,hearing, motor abilities, general health)

2 1. Does the student require a health care plan? Yes[ ] No[ ] If yes, address needs with the nurse. 2. Are adaptations or other interventions needed for physical education? Yes [ ] No [ ] 3. Is the student blind or visually impaired? Yes [ ] No [ ] If yes, consider Braille instructions. (for guidance see OSEP memorandum 96-4 Policy Gudiance on Educating the Blind and Visually Impaired.) Strengths and/or Concerns: Social/Emotional 1. Has the team determined that the child's behavior impedes their learning or that of others? Yes [ ] No [ ] 2. If yes, what strategies will be utilized to address this behavior? 3. Did the team discuss the need for mental health consultation? Yes [ ]No[ ] Strengths and/or Concerns: General Intelligence

3 Academic Performance 1.Describe the child's present levels of educational performance, including strengths and concerns. 2. How does the child's disability or giftedness affect their involvement and progress in the general curriculum and the state assessments (or for preschool children, as appropriate, how does the disability affect the child's participation in appropriate activities)? 3. Have strategies been considered that will promote the development of student responsibility for academic achievement and decrease student dependency on adult assistance? Yes [ ] No [ ] If yes, these strategies include: Strengths and/or Concerns: Communication 1. Does the child have any needs related to limited English proficiency? Yes [ ]No [ ] 2. Is the student deaf or hard of hearing? Yes [ ] No [ ] 3. Primary language of the student [ ], of the home [ ]. 4. Does the student have specific communication needs? Yes [ ] No [ ] Address any other special communication needs here. Other

4 Do the parents have any additional concerns regarding the present levels of academic achievement or functional performance? If yes, please include. Transition Services Student Interests and Preferences 1.What are the students primary interests based on the results of the Interlocal provided age-appropriate transition assessment? 2.If a different assessment method was used, please describe. 3. Date assessment was completed (month,year). Post Secondary Goals Please write the student's measurable post-secondary goal that addresses each of the following areas. 1. Education and Training: After high school, the student will: 2. Employment: After high school the student will: 3. Independent Living (if appropriate): After high school the student will:

5 Graduation Plan/Course of Study It is anticipated this student will complete the coursework to: [ ] Graduate with a regular high school diploma [ ] Graduate under an alternative graduation requirement plan [ ] Complete their educational program or exit at the end of the school year during which the student becomes 21 years of age Total number of credits required by this district for graduation: [ ] Anticipated month and year of graduation/completion of program: [ ] In addition to the core courses required to meet the above plan, list other courses or courses of study that align with the student's post-secondary goals Other graduation planning (optional): 9th: 10th: 11th: 12th: Instruction Instruction is the use of formal techniques to impart knowledge. It is typically

6 provided in schools through academic instruction, general education classes, tutoring, etc. Other instructional activities that could be provided by other entities or in other locations are: adult basic education, technical preparation programming, community colleges, universities, and vocational training centers. [ ] This is not an area of concern. Instruction needs for meeting the post-secondary goals ae being met through the planned course of study. [ ] This is an area of concern in meeting the post-secondary goals; activities are listed below. Transition Related Services Considerations should include assistive technology; orientation and mobility training; speech and language pathology; audiology; psychological services; physical and occupational therapy; recreation; counseling services, including rehabilitation counseling; and medical services for diagnostic or evaluation purposes. [ ] These needs are being met. This is not an area of concern in meeting the post-secondary goals. [ ] This is an area of need in meeting the post-secondary goals; activities are listed below. Community Experiences Community Experiences are those activities provided outside of the school building, in community settings, by families, schools, school-to-work internships and apprenticeships and other agencies that may provide these experiences including JTPA, independent living centers, vocational rehabilitation, community developmental disabilities organizations, and mental health centers. These experiences may include activities such as school sponsored field trips, participation in community

7 organizations and clubs (e.g., Girl Scouts or 4-H activities), community work experiences, and counseling services. [ ] These needs are being met. This is not an area of concern in meeting the post-secondary goals. [ ] This is an area of concern in meeting the post-secondary goals; activities are listed below. Employment&Other Post-School/Adult Living Outcomes ============================================================================= ===== This should include employment or other post-school adult living objectives the student needs to achieve desired post-school goals. These could be services leading to a job or career or those that support activities done occasionally, such as registering to vote, filing taxes, renting a home, accessing medical services, filing for insurance or accessing adult services such as Social Security Income (SSI). [ ] These needs are being met. This is not an area of concern in meeting the post-secondary goals. [ ] This is an area of concern in meeting the post-secondary goals; activities are listed below. Daily Living Skills Daily living skills are those activities that adults do every day (e.g., preparing meals, budgeting, maintaining a home, paying bills, caring for clothes, grooming, etc.).

8 [ ] These needs are being met. This is not an area of concern in meeting the post-secondary goals. [ ] This is an area of concern in meeting the post-secondary goals; activities are listed below. Functional Vocational Evaluation ============================================================================= ===== Results of an assessment process that provided information about job or career interest,aptitudes, and skills as well as work habits and work attitudes. [ ] A functional vocational evaluation was determined not to be needed to assist in meeting the post-secondary goal. [ ] Provision of a functional vocational evaluation was needed to assist in meeting the post seconday goal. Results of the evaluation are as follows: Vocational Rehabilitation and Other Agencies 1. Did the IEP Team determine that the student, if age 16 or older, may benefit from Kansas Rehabilitation Services (KRS) assistance? [ ] Yes [ ] No 2. If Yes, was consent to release confidential information obtained prior to KRS notification? 3.If No, and KRS notification is not necessary, please explain:

9 4. Is it likely that the child will be eligible for another outside agency to be responsible for providing or paying for transition services? [ ] Yes [ } No [ ] Too early to determine 5. If yes, please list representatives of any appropriate agencies that were invited to the IEP meeting: Name: Name: Name: Agency: Agency: Agency: If other agency collaboration is needed, list name of agency, contact person, needed services, and any other pertinent information: Goal No. Goal Text: Goals/Benchmarks State Standard: Baseline: Evaluation Procedure: Benchmark # 1 Text: Provider Responsible:

10 Benchmark # 2 Text: Provider Responsible: Benchmark # 3 Text: Provider Responsible: Benchmark # 4 Text: Provider Responsible: Benchmark # 5 Text: Provider Responsible: Benchmark # 6 Text: Provider Responsible: Benchmark # 7 Text: Provider Responsible: Anticipated Services to be Provided Special Education Services 1. What special education, consisting of specially designed instruction, will be provided for the child? (See K.A.R (jjj) for guidance.)

11 2 What is the anticipated frequency, duration, and location of the special education to be provided? Frequency: (times per week or month) Duration: (how long will the service be continued,ie.,iep year or number of weeks) Location: (where service will be provided, ie., gen.ed classroom, resource room, other) Length of service: (expressed in minutes, class periods, or other units but should be specific, not a range. Should match information on Anticipated Services page) Related Services 1. What related services will be provided for the child in order for them to benefit from special education? (See K.A.R (ccc) for guidance.) 2 What is the anticipated frequency, duration, and location of the related services to be provided? Frequency: (times per week or month) Duration: (how long will the service be continued,ie.,1 IEP year or number of weeks) Location: (where service will be provided, ie., gen.ed classroom, resource room, other) Length of service: (expressed in minutes, class periods, or other units, but should be specific, not a range. Should match information on Anticipated Services page)

12 Supplementary Aids and Services 1. What supplementary aids and services will be provided in the general education classroom and other education-related settings to enable the child to be educated with nondisabled children to the maximum extent appropriate? (See K.A.R (sss) for guidance.) 2 What is the anticipated frequency, duration, and location of the supplementary aids and services to be provided? Frequency: (times per week or month) Duration: (how long will the service be continued,ie.,1 IEP year or number of weeks) Location: (where service will be provided, ie., gen.ed classroom, resource room, other) Length of service: (expressed in minutes, class periods, or other units, but should be specific, not a range. Should match information on Anticipated Services page) Program Modifications 1. Describe program modifications and accommodations that will occur in general education classrooms and other education-related settings (if any). 2 What is the anticipated frequency, duration, and location of the modifications and accommodations to be provided? Frequency: (times per week or month) Duration: (how long will the service be continued,ie.,1 IEP year or number of weeks) Location:

13 (where service will be provided, ie., gen.ed classroom, resource room, other) Length of service: (expressed in minutes, class periods, or other units but should be specific, not a range. Should match information on Anticipated Services page) 3. Are additional supports or training for personnel needed? [ ] Yes [ ] No 4. If yes, please list additional support or training and give anticipated frequency, duration, and location. Frequency: Duration: Location: Length: Participation with Non-Disabled Students in the Regular Education Environment 1. To what extent, if any, will the child not participate with non-identified children in general education classes, the general education curriculum, extracurricular activities, and other non academic activities? 2. If the child will not be fully participating in the general education curriculum and classroom, explain why not. 3. Are there any potential harmful effects of the recommended placement on the student and/or the quality of services for the student? [ ] Yes [ ]No

14 4. Do the positive effects of the placement outweigh the potential harmful effects? [ ] Yes [ ]No 5. The IEP team has determined that for the student to have opportunities to participate with non-identified peers in extracurricular and nonacademic activities, regularly-scheduled special education and related services may not occur when their delivery would prevent the child from participating in field trips, assemblies, special events for the general education classroom or school, state or district-wide assessments, and other such activities. [ ] Yes [ ] No Participation in District-wide Assessments [ ] Student will participate in all District-Wide assessments without accommodations. [ ] Student will participate in District-Wide assessments with these accommodations in the following area(s) PLEASE LIST: [ ] Student will participate in District-Wide assessments with these modifications in the following area(s) PLEASE LIST: [ ] Student will participate in an alternate District-Wide assessment as described below: PLEASE LIST INDICATORS TO BE ASSESSED. [ ] Grade in which student is enrolled is not being assessed.

15 Participation in State Assessments [ ] Student will participate in all State assessments without accommodations. [ ] Student will participate in the State assessments with these accommodations in the following area(s) PLEASE LIST: [ ] Student will participate in the Modified State assessment only in the following area(s)please LIST: [ ] Student will participate in the Alternate State assessment only in the following area(s)please LIST INDICATORS TO BE ASSESSED: [ ] Grade in which student is enrolled is not being assessed. If the student is not participating in the regular assessment, explain why. Explain why the chosen assessment is appropriate for the student. Extended School Term Are Extended School Term services necessary for this student with a disability? [ ] Yes [ ] No If the above answer is Yes: [ ] The IEP Team currently has enough information to determine necessary ESY services and they are contained in this IEP. A worksheet MUST be submitted to the Interlocal and attached to the IEP. [ ] The IEP Team will need to gather additional data to determine specific program plans and services and will reconvene to determine services and complete the worksheet to be added to the IEP. ============================================================================= =======

16 Behavior Intervention Plan A Behavior Intervention Plan means a plan consisting of positive strategies and services to address the behavior of the child with a disability and to help the student learn socially appropriate and responsible behavior in the school and other community-based educational settings. Be sure to include information on any Functional Behavior Assessments that have been done. Assistive Technology Plan Does this student require assistive technology devices and/or services in order to be involved and to progress in the general curriculum or to be educated in a less restrictive environment? Yes[ ] No[ ] Document the Assistive Technology services and/or devices necessary to increase, maintain, or improve educational capabilities of the student. Assistive Technology

17 The IEP team has determined that Legal First Name does not require assistive technology at this time. Special Considerations ============================================================================= =====- Yes or No [ ] 1. Have the strengths of the student been addressed on the IEP? [ ] 2. Have the student's needs identified in the most recent evaluation been considered in the development of the IEP (including observed needs and the student's performance on the general state and district wide assessments)? [ ] 3. Have the parents' concerns for enhancing the education of their child been addressed on the IEP? [ ] 4. Is special transportation needed? [ ] 5. Does the student need adaptations to participate in extra-curricular activities? The provision of the regularly-scheduled special education and related sevices is not possible due to events that are beyond the control of the school such as school closure due to weather or other emergencies, emergency drills, or when the child is absent from school (this does not include suspension or expulsion of the student). To the Student: Notification of Transfer of Rights Beginning on the date you turn eighteen years of age, we will provide both you and

18 your parents with all notices required by special education laws and regulations. All other rights accorded to parents under special education laws and regulations will be transferred to you, or, if you have a legal guardian, to the legal guardian. Transfer of Rights The student has been informed that at age 18 all rights afforded parents under special education law will transfer to the student unless he/she has been legally adjudicated to be an incapacitated person or a child in care. This means that in the absence of court directive, the student will become the educational decision maker. Notice provided to: Parents (Date ) Student (Date ) Notice of Destruction of Special Education Records Special education records for each child with an exceptionality are maintained by the school district until no longer needed to provide educational services to the child. This notice is to inform you that the special education records for this student will be destroyed after five (5) years following program completion or graduation from high school, unless the student (or the student's legal guardian) has taken possession of the records prior to that time. Progress Report How often will the Parent(s)/Legal Decision Maker be informed of the student's progress?

19 At least one time every [ ] quarter [ ] 8 weeks [ ] 6 weeks [ ] 4 weeks, which is at least as often as parents are informed of their nonexceptional children's progress. By what means will the Parent(s)/Legal Educational Decision Maker be informed of the student's progress? Check all that apply: [ ] written report [ ] parent-teacher conference [ ] Participants in the IEP Team Meeting to develop this IEP. Name Position Date

20 Text After Signatures If the IEP was late, please provide information below: Date of 1st attempt and reason for 1st meeting not held: Date of 2nd attempt and reason for 2nd meeting not held: Date of 3rd attempt and reason for 3rd meeting not held: Other pertinent information not included in the IEP: If any mandatory IEP members were legally excused from the IEP team meeting, please document the justification for their absence on the "Excusal From Attending of IEP Meeting" form. It can be found on the Interlocal website. The parents were each given a copy of the Parent Rights. [ ] The parents were each given a copy of the IEP. [ ]