ࡱ>  ymy bjbj .{{uK``DU \ ,!4;<<<?QYL*$)u>@?uu)``<<"{"{"{u`R<<az"{u"{"{M,"<3eJNvy4M0p^ xH^h^]e"{(klo,]]]))hy]]]uuuu^]]]]]]]]] &:  FORMTEXT Name of School  FORMTEXT Street Address  FORMTEXT City State and Zip Student Name:  FORMTEXT       Grade:  FORMTEXT    Gender:  FORMDROPDOWN  DOB:  FORMTEXT       Age:  FORMTEXT 0 Meeting DateIEP Implementation date Projected Date when services will beginAnticipated Duration of this IEPSchool Year FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT 2011- FORMTEXT 2012Student Address: Street:  FORMTEXT       City/State/Zip:  FORMTEXT       Parent/Guardian Name (include address in section I if different that above):  FORMTEXT        Contact numbersHomeWork(1)Work(2)Cell/OtherPhone FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT      E-Mail FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT      County of Residence: School Building:  FORMDROPDOWN   FORMTEXT      Anticipated Year of Graduation:  = (12-gradenow)+endyear \* MERGEFORMAT 2022  FORMCHECKBOX  If consortium Student: Sending District:  FORMDROPDOWN  FORMCHECKBOX  Current Vo-Tech Student  FORMCHECKBOX  Future Vo-Tech StudentCIP Code:  FORMDROPDOWN Primary Disability:  FORMDROPDOWN Secondary Disability (If applies)  FORMDROPDOWN Other Information:  FORMTEXT       *Medical Assistance #:  FORMTEXT       IEP TEAM/SIGNATURES* Signature on this IEP documents attendance, and not agreement. The Individualized Education Program (IEP) Team makes the decisions about the student s program and placement. The students parent(s), the students special education teacher, and a representative from the local education agency are required members of this team. Signature on this IEP documents attendance, not agreement. NAME (typed or printed) POSITION (typed or printed) SIGNATURE*  FORMTEXT        FORMTEXT Parent/Guardian/Surrogate FORMTEXT        FORMTEXT Parent/Guardian/Surrogate FORMTEXT        FORMTEXT Student* FORMTEXT        FORMTEXT Regular Education Teacher** FORMTEXT        FORMTEXT Special Education Teacher FORMTEXT       FORMTEXT Local Educational Agency Rep(Chair) FORMTEXT       FORMTEXT Community Agency Repesentative FORMTEXT       FORMTEXT Career (vocational) Tech Ed Rep*** FORMTEXT       FORMTEXT Teacher of the Gifted**** FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      * The IEP team must invite the student if transition services are being planned or if the parents choose to have the student participate. % ** If the student is, or may be, participating in the regular education environment % *** As determined by the LEA as needed for transition services and other community services % **** A teacher of the gifted is required when writing an IEP for a student with a disability who also is gifted. % One individual listed above must be able to interpret the instructional implications of any evaluation results.Written input received from the following members:  FORMTEXT       PROCEDURAL SAFEGUARDS NOTICE I have received a copy of the Procedural Safeguards Notice during this school year. The Local Education Agency has informed me whom I may contact if I need more information. (Note a copy of the notice may be available on the District Web Page) Signature of Parent/Guardian/Surrogate: TRANSFER OF RIGHTS AT AGE OF MAJORITY For purposes of education, the age of majority is reached in Pennsylvania when the individual reaches 21 years of age. Likewise, for purposes of the Individuals with Disabilities Education Act, the age of majority is reached for students with disabilities when they reach 21 years of age. REVISIONS The LEA and parent have agreed to make the following changes to the IEP without convening an IEP meeting, as documented by:  FORMTEXT see attached IEP Revision forms Date of Revision(s)Participants / RolesIEP Section(s) Amended  FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       I. SPECIAL CONSIDERATIONS THE IEP TEAM MUST ADDRESS BEFORE DEVELOPING THE IEP. ANY FACTORS CHECKED AS  YES MUST BE ADDRESSED IN THE IEP. Is the Student blind or visually impaired?  FORMCHECKBOX  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 students reading and writing skills, needs, and appropriate reading and writing media (including an evaluation of the students 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.  FORMCHECKBOX  No Is the Student deaf or hard of hearing?  FORMCHECKBOX  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 students language and communication mode; academic level; full range of needs, including opportunities for direct instruction in the students 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 HYPERLINK "http://www.pattan.net"www.pattan.net.  FORMCHECKBOX  No Does the student have communication needs?  FORMCHECKBOX  Yes Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction (SDI), annual goals, etc.)  FORMCHECKBOX  No Does the student need assistive technology devices and/or services?  FORMCHECKBOX  Yes Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction (SDI), annual goals, etc.)  FORMCHECKBOX  No Does the student have limited English proficiency?  FORMCHECKBOX  Yes Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction (SDI), annual goals, etc.)  FORMCHECKBOX  No Does the student exhibit behaviors that impede his/her learning or that of others?  FORMCHECKBOX  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 HYPERLINK "http://www.pattan.net"www.pattan.net  FORMCHECKBOX  No  FORMCHECKBOX  Other (Specify)  FORMTEXT       II. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT & FUNCTIONAL PERFORMANCE Include the following information related to the student: Students present levels of academic achievement (e.g., most recent evaluation of the student, results of formative assessments, curriculum based-assessments, transition assessments, progress toward current annual goals) Summative Data (i.e. PSSA)  FORMTEXT NA Benchmark (i.e. 4Sight, DIBELS)  FORMTEXT       Diagnostic (i.e. DRA, Running Record, baseline scores)  FORMTEXT       Formative (i.e. curriculum based assessments, rubrics, LFS summarizers, progress monitoring data)  FORMTEXT       Progress toward current goals  FORMTEXT       Student s present levels of functional performance (e.g results from a functional behavioral assessment, results of ecological assessments, progress towards current goals). Classroom skills (study skills, on task, homework. Etc.)  FORMTEXT       Other functional skills (i.e. related service reports and Employment Skills)  FORMTEXT       Behaviors that Impede Learning (Describe the behavior, the triggers of the behavior and the function of the behavior) Antecedents to the behavior of concern Behavior of ConcernConsequences of Maintaining the behavior of concernPerceived function of the behavior of concernTo gain:  FORMTEXT       To avoid, escape, or postpone  FORMTEXT      When  FORMTEXT (Antecedents to the behavior of concern)the student FORMTEXT (the behavior of concern)in order to FORMTEXT (Perceived function of the behavior)Identify educational (skill) deficit(s) related to the behavior of concern which are not noted in other sections of the present levels. FORMTEXT       Daily living/skills: (hygiene, dressing, basic consumer skills)  FORMTEXT NA Present levels related to current postsecondary transition goals if the student s age is 14 or younger if determined appropriate by the IEP team (e.g., results of formative assessments, curriculum-based assessments, progress toward current goals) Long term postsecondary goal (e.g. interests and preferences; employment plans; field of study; type of job student may be interested in; etc. Note: report any formal assessment data related to interests here.)  FORMTEXT       Student s plan to reach this goal (e.g. does the student plan to go directly into the work force; attend a 2 or 4 year college; trade school; military; etc.)  FORMTEXT       Progress on transition related goals  FORMTEXT       Academic and/or non-academic skills and abilities needed to achieve post secondary goal (.e.g reading and math level as it relates to employability in chosen career path; social skills, motor skills, independent living skills, etc. Note: report any formal assessment data related to skills here.)  FORMTEXT       Parental concerns for enhancing the education of the student  FORMTEXT Parent did not share any concerns not already addressed in 1-3 Other Relevant Information  FORMTEXT       How the student s disability affects involvement and progress in the general education curriculum  FORMTEXT       Student s Strengths (include interests and preferences for students who will be 16 or over during the duration of this IEP)  FORMTEXT   Academic, Developmental, Functional Needs Related to the Students Disability (include transition related needs for students who will be 16 or over during the duration of this IEP)  FORMTEXT   III. TRANSITION SERVICES This is required for students age 14 or younger if determined appropriate by the IEP team. If the student does not attend the IEP meeting, the school must take other steps to ensure that the students preferences and interests are considered. Transition services are a coordinated set of activities for a student with a disability that is designed to be within a results oriented process, that is focused on improving the academic and functional achievement of the student with a disability to facilitate the students movement from school to post school activities, including postsecondary education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation that is based on the individual students needs taking into account the students strengths, preferences, and interests.  FORMCHECKBOX  Transition does not apply to this student (skip this section) The student has been provided with a copy of PDEs Transition folder  FORMCHECKBOX  Yes  FORMCHECKBOX  No Graduation Planning  FORMCHECKBOX  Student will complete standard district requirements & credits.  FORMCHECKBOX  Course requirements will be adapted as outlined in the students goals and/or specially designed instruction.  FORMCHECKBOX  Student will graduate based on completion of IEP goals and objectives Student will participate in Regular Graduation project  FORMCHECKBOX  Yes Graduation project will be the focus of the students transition plan. Student is expected to complete all requirements.  FORMCHECKBOX  No Student will not participate in the Graduation project. Alternative transition activities will be used. (these activities must be described in the Annual Goals, Objectives and Specially Designed Instruction sections of this IEP.  FORMCHECKBOX  Student has completed the Graduation Project. Voter Registration (complete only for students who will be age 17 or older during the duration of this IEP)  FORMCHECKBOX  The student requires assistance registering to vote.  FORMCHECKBOX  The student & parents are requesting assistance from the school. (if yes, these activities must be described in the independent living section below)  FORMCHECKBOX  The student & parents are not interested in making use of school based-assistance in accomplishing voter registration.  FORMCHECKBOX  The student does not require assistance registering to vote. Agency Participation  FORMCHECKBOX  The team has discussed the participation of agencies and determined that this is not appropriate due to the students age.  FORMCHECKBOX  Agencies were invited to attend this meeting (as noted on the IEP invitation).  FORMCHECKBOX  The team has determined that agency involvement in the next IEP meeting is not necessary because the student is successfully pursuing post secondary goals independently.  FORMCHECKBOX  The team has determined that the following agencies should be invited to the next IEP and the parent has agreed to permit the District to extend an invitation. AgencyReason FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       POST SCHOOL GOALS  Based on age appropriate assessment, define and project the appropriate measurable postsecondary goals that address education and training, employment, and as needed, independent living. Under each area, list the services/activities and courses of study that support that goal. Include for each service/activity the location, frequency, projected beginning date, anticipated duration, and person/agency responsible. Postsecondary Education and Training Goal:  FORMTEXT      Program Code (if Vo-Tech):  FORMTEXT      Measurable Annual Goal Document in Section V Yes No Courses of Study (List only those provided during the duration of this IEP) FORMTEXT Math, English, Science, SSPostsecondary Education and Training Goal (continued)(Other Services/ Activities needed)LocationFrequencyProjected Beginning DateAnticipated DurationPerson(s)/Agency Responsible FORMTEXT Exploration FORMTEXT Enrollment Exams  FORMTEXT Application Employment Goal:  FORMTEXT       Measurable Annual Goal Document in Section V Yes No Courses of Study (List only those provided during the duration of this IEP) FORMTEXT       School YearService /Activity (Including Courses of Study)LocationFrequencyProjected Beginning DateAnticipated DurationAgency Responsible Independent Living Goal:  FORMTEXT       Measurable Annual Goal Document in Section V Yes No Courses of Study (List only those provided during the duration of this IEP) FORMTEXT      Service /Activity (Including Courses of Study)LocationFrequencyProjected Beginning DateAnticipated DurationAgency ResponsibleIEP Goal Yes/No IV. PARTICIPATION IN STATE AND LOCAL ASSESSMENTS Pennsylvania System of School Assessment (PSSA) or Pennsylvania Alternate System of Assessment (PASA)Please check the appropriate assessments. If the student will be assessed using the PSSA or the PSSA-Modified, the IEP Team must choose which assessment will be administered for each content area (Reading, Mathematics, and Science). For example, a student may take the PSSA-Modified for Reading and the PSSA for Mathematics and Science. If the student will be assessed using the PASA, the IEP Team need not select content areas because ALL content areas will be assessed using the PASA. PSSA (Please choose the appropriate option and content areas for the student. A student may be eligible to be assessed using the PSSA-Modified assessment for one or more content areas and be assessed using the PSSA for other content areas.) PSSA-Modified (Please choose the appropriate option and content areas for the student. A student may be eligible to be assessed using the PSSA-Modified assessment for one or more content areas and be assessed using the PSSA for other content areas.) Allowable accommodations may be found in the PSSA Accommodations Guidelines at: HYPERLINK "http://www.portal.state.pa.us/portal/server.pt/community/testing_accommodations__security/7448"www.portal.state.pa.us/portal/server.pt/community/testing_accommodations__security/7448 Criteria regarding PSSA-Modified eligibility may be found in Guidelines for IEP Teams: Assigning Students with IEPs to State Tests (ASIST) at: HYPERLINK "http://www.education.state.pa.us/portal/server.pt/community/special_education/7465/assessment/607491"www.education.state.pa.us/portal/server.pt/community/special_education/7465/assessment/607491 Criteria regarding PASA eligibility may be found in Guidelines for IEP Teams: Assigning Students with IEPs to State Tests (ASIST) at: HYPERLINK "http://www.education.state.pa.us/portal/server.pt/community/special_education/7465/assessment/607491"www.education.state.pa.us/portal/server.pt/community/special_education/7465/assessment/607491Not Assessed (Please select if the student is not being assessed by a state assessment this year) FORMCHECKBOX  Assessment is not administered at this students grade levelReadingMathScienceWritingStudent will participate without accommodations FORMCHECKBOX  PSSA (Grades 3-8,11)  FORMCHECKBOX  PSSA (Grades 3-8,11)  FORMCHECKBOX  PSSA (Grades 3-8,11)  FORMCHECKBOX  PSSA (Grades 5, 8,11)  FORMCHECKBOX  PSSA-M Grades 4-8,11) FORMCHECKBOX  PSSA-M Grades 4-8,11) FORMCHECKBOX  PSSA-M Grades 4, 8,11)Student will participate with accommodations: See below FORMCHECKBOX  PSSA (Grades 3-8,11)  FORMCHECKBOX  PSSA (Grades 3-8,11)  FORMCHECKBOX  PSSA (Grades 3-8,11)  FORMCHECKBOX  PSSA (Grades 5, 8,11)  FORMCHECKBOX  PSSA-M Grades 4-8,11) FORMCHECKBOX  PSSA-M Grades 4-8,11) FORMCHECKBOX  PSSA-M Grades 4, 8,11) Changes In Test Environment: FORMTEXT NA FORMTEXT NA FORMTEXT NA FORMTEXT NAAssistive Devices/Special Arrangements FORMTEXT NA FORMTEXT NA FORMTEXT NA FORMTEXT NAAdapted Test Forms FORMTEXT NA FORMTEXT NA FORMTEXT NA FORMTEXT NAOther Accommodations* FORMTEXT NA FORMTEXT NA FORMTEXT NA FORMTEXT NA*Note: In all cases where an adaptation results in the student not using the answer booklet (i.e. dictating, word processor, etc.), the test administrator is required to transfer the students answers verbatim to the PSSA testing booklet. PASA (Grades 3-8, 11 for Reading and Math, Grades 4, 8 , 11 for Science) FORMCHECKBOX  Student will participate in the PASAExplain why the child cannot participate in the PSSA: FORMTEXT      Explain why the PASA is appropriate: FORMTEXT       Choose how the students performance on the PASA will be documented FORMCHECKBOX  Videotape (which will be kept confidential as all other school records) FORMCHECKBOX  Written narrative (which will be kept confidential as all other school records) STUDENT PARTICIPATION LOCAL ASSESSMENTS FORMCHECKBOX  Student will not participate in Local assessments because there are none given during the duration of this IEP. FORMCHECKBOX  Student will participate in Local assessments without accommodations; or FORMCHECKBOX  Student will participate in Local assessments with the following accommodations:  FORMTEXT Please see PSSA Section Above; or FORMCHECKBOX  The student will take an alternate local assessment Explain why the child cannot participate in the regular assessment: FORMTEXT       Explain why the alternate assessment is appropriate:  FORMTEXT       Complete this heading chart only when issuing these goal pages as an IEP report Card Reporting Period: FORMTEXT       School year FORMTEXT      Date Issued To Parent FORMTEXT      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 students gifted program may be listed under Goals or Short Term Objectives. MEASURABLE ANNUAL GOAL MEASURABLE ANNUAL GOAL Include: Condition, Name, Behavior, and Criteria (Refer to Annotated IEP for description of these components)Describe HOW the students progress toward meeting this goal will be measuredDescribe WHEN periodic reports on progress will be provided to parentsReport of Progress SHORT TERM OBJECTIVES Required for students with disabilities who take alternate assessments aligned to alternate achievement standards (PASA). Short term objectives / BenchmarksVI. SPECIAL EDUCATION/ RELATED SERVICES / SUPPLEMENTARY AID AND SERVICES / PROGRAM MODIFICATIONS - Include, as appropriate, for nonacademic and extracurricular services and activities. PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION: SDI may be listed with each goal or as part of the table below. Include supplementary aids and services as appropriate. For a student who has a disability and is gifted, SDI also should include adaptations, accommodations, or modifications to the general education curriculum, as appropriate for a student with a disability. Modification Or SDILocation*FrequencyBeginning DateAnticipated Duration *Include CPAVTS in location if student is enrolled in Vo-Tech Challenging Behavior Plan (If not needed check box  FORMCHECKBOX ) Prevention (Antecedent Strategies)  FORMTEXT       Replacement Behavior (Achieving the same function)  FORMTEXT       Reinforcement for when the student performs the replacement behavior  FORMTEXT       Consequences and procedures to follow when the student performs the behavior of concern  FORMTEXT       B. RELATED SERVICES: 1. List the services that the student needs in order to benefit from or access his/her special education program: ServiceLocationFrequency*Projected Beginning DateAnticipated Duration FORMDROPDOWN   FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT       FORMDROPDOWN   FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT       FORMDROPDOWN   FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT       FORMTEXT       FORMDROPDOWN   FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN   FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMDROPDOWN   FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      *The District and parents agree that the frequency denoted in the column above excludes the summer break (i.e the period of time between the last student day of the current school year and the first student day of the next school year) and holiday breaks when school is closed (i.e. Thanksgiving, Winter break, spring break etc.) unless specifically noted. Is this Student eligible for School Based Access billing?  FORMCHECKBOX  Yes: Please indicate services  FORMTEXT        FORMCHECKBOX  No C. SUPPORTS FOR SCHOOL PERSONNEL  List the staff to receive the supports and the supports needed to implement the student s IEP. . School Personnel to Receive SupportSupportLocationFrequencyBeginning DateAnticipated DurationAll staff who work with the studentSpecially designed instruction will be distributed to staff members who work with the studentRegular school1st week of each course. D. GIFTED SUPPORT SERVICES FOR A STUDENT IDENTIFIED AS GIFTED WHO ALSO IS IDENTIFIED AS A STUDENT WITH A DISABILITY Support services are required to assist a gifted student to benefit from gifted education (e.g., psychological services, parent counseling and education, counseling services, transportation to and from gifted programs to classrooms in buildings operated by the school district). Support ServiceNASupport ServiceNASupport ServiceNA EXTENDED SCHOOL YEAR The IEP team has considered and discussed ESY services, and determined that: 1) Consideration  FORMCHECKBOX  This is the Students first IEP the team has not yet had the opportunity to collect data over breaks in programming.  FORMCHECKBOX  ESY for the current school year was already reviewed on  FORMTEXT       (Note must be before February 28th if the student is identified with MR, AUT, SED)  FORMCHECKBOX  The IEP team discussed the following considerations for ESY: YesNoYesNo FORMCHECKBOX  FORMCHECKBOX Do present education levels (Section II above) show progress on Annual goals and objectives. FORMCHECKBOX   FORMCHECKBOX Do the parents report negative changes in adaptive behaviors? FORMCHECKBOX   FORMCHECKBOX Does the student demonstrate self sufficiency & independence? FORMCHECKBOX   FORMCHECKBOX Is there data indicating that successive interruptions in educational program resulted in withdrawal from the learning process? FORMCHECKBOX  FORMCHECKBOX Are there any medical reports indicating difficulties which may be exacerbated during breaks? FORMCHECKBOX  FORMCHECKBOX Did the student receive ESY services in the Past? Determination  FORMCHECKBOX  As of  FORMTEXT       the IEP team has determined student is NOT in need of ESY services for the following reason(s):  FORMCHECKBOX  The student is Eligible for ESY for the following reason(s):  3) Reasons for determination  FORMTEXT Click Here to Enter data The Annual Goals and, when appropriate, Short Term Objectives from this IEP that are to be addressed in the students ESY Program are: Annual Goal to MaintainShort Term ObjectivesIf the IEP Team has determined ESY is appropriate complete the following: ESY Service to be providedLocationFrequencyProjected Beginning DateAnticipated Duration VII. EDUCATIONAL PLACEMENT A. QUESTIONS FOR IEP TEAM The following questions must be reviewed and discussed by the IEP team prior to providing the explanations regarding participation with students without disabilities. 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?  Explanation of the extent, if any, to which the student will not participate with students without disabilities in the regular class. (Also explain any related services that are to be discontinued as of this IEP)  FORMTEXT        FORMTEXT       Explanation of the extent, if any, to which the child will not participate with non-disabled children in the general education curriculum:  FORMTEXT       Profile of Educational services  FORMCHECKBOX  High School  FORMTEXT 7.30  FORMCHECKBOX  Middle School  FORMTEXT 7.00  FORMCHECKBOX  Elementary  FORMTEXT 6.50 FrequencyService/ServicePull out Instructional time in MinutesTime in Regular Ed. in classroom (inclusion) in minutesDailyWith Special Ed TeacherWith AideMathReadingLanguage ArtsWeekly*SpeechOT Monthly*Off SiteTrip TypeHours Per Month in Special Ed SettingHours Per Month in Community SettingVocational/Co-Op/Job CoachCBI TripsAdventure TripTotal Hours in School FORMTEXT 7.00Average total hours in special ed. setting per day =(sum(c1:c9)+((sum(c10:c14))/5)+((sum(c15:c18))/30.4))/60 \# "0.00" 0.00Average total hours inclusion with teacher per day  =((sum(d1:d9)+((sum(d10:d14))/5)+((sum(d15:d18))/30.4))/60) \# "0.00" 0.00Average total hours inclusion with an aide per day =((sum(e1:e9)+((sum(e10:e14))/5)+((sum(e15:e18))/30.4))/60) \# "0.00" 0.00Total hours the student spends in the Regular Ed Setting FORMTEXT  =b25-b26 77Percentage of Time the student spends inside the regular ed classroom FORMTEXT  =b29/b25 1100.00%Amount of special education professional supports FORMTEXT  =(b26+b27)/b25 0.00.00% Type of Support Amount of special education supports  FORMCHECKBOX  Itinerant: Special education supports and services provided by special education personnel for 20% or less of the school day  FORMCHECKBOX  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  FORMCHECKBOX  Full-Time: Special education supports and services provided by special education personnel for 80% or more of the school day Type of special education supports Check all that apply.Check which one is the primary support. FORMCHECKBOX Autistic Support FORMCHECKBOX  FORMCHECKBOX Blind-Visually Impaired Support FORMCHECKBOX  FORMCHECKBOX Deaf and Hard of Hearing Support FORMCHECKBOX  FORMCHECKBOX Emotional Support FORMCHECKBOX  FORMCHECKBOX Learning Support FORMCHECKBOX  FORMCHECKBOX Life Skills Support FORMCHECKBOX  FORMCHECKBOX Multiple Disabilities Support FORMCHECKBOX  FORMCHECKBOX Physical Support FORMCHECKBOX  FORMCHECKBOX Speech and Language Support FORMCHECKBOX  D. Location of students program Name of School District where the IEP will be implemented: (please list the HOME School District, not the District where the program is located) FORMTEXT      Name of School Building where the IEP will be implemented: FORMTEXT       Is this school the students neighborhood school (i.e., the school the student would attend if he/she did not have an IEP)?  FORMCHECKBOX  Yes  FORMCHECKBOX  No. If the answer is no, select the reason why not.  FORMCHECKBOX  Special education supports and services required in the students IEP cannot be provided in the neighborhood school  FORMCHECKBOX  Other. Please explain:  FORMTEXT       VIII. PENNDATA REPORTING: Educational Environment (Complete either Section A or B; Select only one Educational Environment) To calculate the percentage of time inside the regular classroom, divide the number of hours the student spends inside the regular classroom by the total number of hours in the school day (including lunch, recess, study periods). The result is then multiplied by 100. SECTION A: For Students Educated in Regular School Buildings with Nondisabled Peers Indicate the percentage of time INSIDE the regular classroom for this student:Time spent outside the regular classroom receiving services unrelated to the students disability (e.g., time receiving ESL services) should be considered time inside the regular classroom. Educational time spent in age-appropriate community-based settings that include individuals with and without disabilities, such as college campuses or vocational sites, should be counted as time spent inside the regular classroom. Calculation for this Student: Column 1Column 2CalculationIndicate PercentagePercentage CategoryTotal hours the student spends in the regular classroom per dayTotal 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 FORMTEXT       FORMTEXT       FORMTEXT      % FORMTEXT      % FORMCHECKBOX  INSIDE the Regular Classroom 80% or More of the Day  FORMCHECKBOX  INSIDE the Regular Classroom 79-40% of the Day  FORMCHECKBOX  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) FORMCHECKBOX  Approved Private School (Non Residential) FORMTEXT       FORMCHECKBOX  Other Public Facility (Non Residential) FORMTEXT       FORMCHECKBOX  Approved Private School (Residential) FORMTEXT       FORMCHECKBOX  Hospital/Homebound FORMTEXT       FORMCHECKBOX  Other Private Facility (Non Residential) FORMTEXT       FORMCHECKBOX  Correctional Facility FORMTEXT       FORMCHECKBOX  Other Private Facility (Residential) FORMTEXT       FORMCHECKBOX  Out of State Facility FORMTEXT       FORMCHECKBOX  Other Public Facility (Residential) FORMTEXT       FORMCHECKBOX  Instruction Conducted in the Home FORMTEXT       Column 1Column 2CalculationIndicate PercentageTotal hours the student spends in the regular classroom  per dayT68:<PRTprtv yrcyRyr!jh)>*CJUmHnHujh)>*CJU h)>*CJjh)>*CJU h)5CJh-:CJaJ#j(h-:h-:CJUaJ#jh-:h-:CJUaJh-:h)CJaJh-:h-:CJaJmHnHu#jh-:h-:CJUaJh-:h-:CJaJjh-:h-:CJUaJ:t  l $ l .%$Ifa$gdtt d.!#dgd)gd)    , . 0 4 6 8 : L N j l n p ~ 󧝋sdWh)>*CJmHnHujh)>*CJUjzh)>*CJUhWh)CJ"jhHs8h)>*CJUhHs8h)>*CJjhHs8h)>*CJUh%93h)5CJ!jh)>*CJUmHnHujbh)>*CJU h)>*CJjh)>*CJU h)5CJ h)CJ       . 0 2 < > @ B V X Z b d f h | ١ْpch-:CJ\mHnHujh-:CJU\ h-:CJ\jh-:CJU\jIh)>*CJUjh)>*CJUh)5>*CJ!jh)>*CJUmHnHuj'h)>*CJU h)>*CJjh)>*CJUh) h)5CJh*?h)CJ!  @ bJJJ2$ l .%$Ifa$gd-:$ l .%$Ifa$gdttkdx$$Ifl\&"(j 0")44 layttt| ~   & ( * 4 6 8 : <   t v ~Ѵodjh)5U\jG h)>*CJU h)CJ\j h)>*CJU!jh)>*CJUmHnHujh)>*CJUjh)>*CJU h)>*CJ h)CJh) h)5CJh-:CJ\mHnHujh-:CJU\jih-:CJU\& : `P8$ l .%$Ifa$gdtt %d$Ifgdttkd$$IflC\&"(j 0")44 layttt: < v %d$Ifgdttxkd $$IflC0&(0")44 layttt   & 0 @ P f ~~~~~$d$Ifa$gdtt %dgd)ekd $$IflC(")0")44 laytttf h t I:) ,d$Ifgdtt$d$Ifa$gdttkd> $$IflCrA (b b0")644 laytttv   *,@BDNPTVjlnxz~wjrh)5U\jh)5U\jh)5U\h)jU h)5U\j h)5U\ji h)5U\ jh)5U\mHnHujh)5U\j h)5U\ h)5\. 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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 15.56.5(5.5 6.5) x 100 = 85%85% of the day (Inside 80% or More of Day)Example 235(3 5) x 100 = 60%60% of the day (Inside 79-40% of Day)Example 315(1 5) x 100 = 20%20% of the day (Inside less than 40% of Day)For help in understanding this form, an annotated IEP is available on the PaTTAN website at HYPERLINK "http://www.pattan.net"www.pattan.net Type Annotated Forms in the Search feature on the website. If you do not have access to the Internet, you can request the annotated form by calling PaTTAN at 800-441-3215.  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Carlisle School DistrictBig Spring School DistrictMechanicsburg School DistrictNorthern York School DistrictSouth Middleton School District FORMTEXT Shippensburg School District623 West Penn St. Carlisle PA 1701345 Mount Rock Rd Newville PA 17241500 S. Broad St. Mechanicsburg, PA 17055149 S. Baltimore Street Dillsburg PA 170194 Forge Road Boiling Springs PA 17007 FORMTEXT 317 N. Morris St.  FORMTEXT Shippensburg PA 17257 NOTICE OF RECOMMENDED EDUCATIONAL PLACEMENT PRIOR WRITTEN NOTICE (NOREP/PWN) School Age Child's Name:  REF sname \* Caps \* MERGEFORMAT   Date Sent  FORMTEXT       Name and Address of Parent/Guardian/Surrogate  FORMTEXT       For LEA Use Only Date of Receipt of Signed NOREP/PWN  FORMTEXT       This notice summarizes recommendations for your child's education program. 1. Type of action taken:  FORMCHECKBOX Proposes initial provision of special education and related services (For this action, the school may not proceed without your written consent in Section 8 of this document)  FORMCHECKBOX Refusal to initiate an evaluation (Must issue Procedural Safeguards Notice) FORMCHECKBOX Proposes to change the identification, evaluation or educational placement of the child or the provision of a free appropriate public education (FAPE) FORMCHECKBOX Refusal to change the identification, evaluation or educational placement of the child or the provision of a free appropriate public education (FAPE) FORMCHECKBOX Change of placement for disciplinary reasons (Must issue Procedural Safeguards Notice) FORMCHECKBOX Due process hearing, or an expedited due process hearing, initiated by LEA FORMCHECKBOX Graduation from high school FORMCHECKBOX Exiting special education FORMCHECKBOX Exiting high school due to exceeding the age eligibility for a free appropriate public education (FAPE) FORMCHECKBOX Extended School Year (ESY) services FORMCHECKBOX Response to request for an independent educational evaluation (IEE) at public expense FORMCHECKBOX Other  FORMTEXT       2. A description of the action proposed or refused by the LEA:  REF placement    FORMTEXT        REF agewaive   3. An explanation of why the LEA proposed or refused to take the action:  FORMTEXT The IEP team has reviewed and revised the students IEP and feels that this placement continues to be the most appropriate setting. 4. A description of other options that the IEP team considered and the reasons why those options were rejected. If the action proposed or refused is in regard to educational placement, options considered must begin with the regular educational environment with supplementary aids and services (information about supplementary aids and services is available on the PaTTAN website at HYPERLINK "http://www.pattan.net"www.pattan.net): Options ConsideredReason for Rejection FORMTEXT Regular Education FORMTEXT The team feels that more services are needed than can be provided in regular ed alone. FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT       5. A description of each evaluation procedure, assessment, record or report used as a basis for the proposed action or action refused:  FORMDROPDOWN   FORMDROPDOWN   FORMTEXT       6. A description of other factors that were relevant to the LEAs proposal or refusal:  FORMTEXT No other relevant factors were discussed. 7. The educational placement recommended for your child is (State the amount and type of special education supports, e.g., Itinerant Learning Support, Supplemental Autistic Support, Full-Time Emotional Support): Amount of special education supports  FORMCHECKBOX  Itinerant: Special education supports and services provided by special education personnel for 20% or less of the school day  FORMCHECKBOX  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  FORMCHECKBOX  Full-Time: Special education supports and services provided by special education personnel for 80% or more of the school day Type of special education supports  FORMCHECKBOX Autistic Support FORMCHECKBOX Blind-Visually Impaired Support FORMCHECKBOX Deaf and Hard of Hearing Support FORMCHECKBOX Emotional Support FORMCHECKBOX Learning Support FORMCHECKBOX Life Skills Support FORMCHECKBOX Multiple Disabilities Support FORMCHECKBOX Physical Support FORMCHECKBOX Speech and Language Support Attached are state and local resources you can consult to help you understand your rights and how the special education process works. For help in understanding this form, an annotated NOREP/Prior Written Notice is available on the PaTTAN website at HYPERLINK "http://www.pattan.net"www.pattan.net Type Annotated Forms in the Search feature on the website. If you do not have access to the Internet, you can request the annotated form by calling PaTTAN at 800-441-3215.  THE ARC OF PENNSYLVANIA 101 South Second Street Suite 8 Harrisburg, PA 17101 800-692-7258 HYPERLINK "http://www.thearcpa.org"www.thearcpa.org PARENT EDUCATION NETWORK (PEN) 2107 Industrial Highway York, PA 17402-2223 717-600-0100 (Voice/TTY) 800-522-5827 (Voice/TTY) 800-441-5028 (Spanish in PA) 717-600-8101 (Fax) HYPERLINK "http://www.parentednet.org"www.parentednet.org PARENT EDUCATION AND ADVOCACY LEADERSHIP CENTER (PEAL) 1119 Penn Avenue Suite 400 Pittsburgh, PA 15222 412-281-4404 (Voice) 866-950-1040 (Voice) 412-281-4409 (TTY) 412-281-4408 (Fax) HYPERLINK "http://www.pealcenter.org"www.pealcenter.org HISPANICS UNITED FOR EXCEPTIONAL CHILDREN (HUNE, INC.) 202 West Cecil B. Moore Avenue Philadelphia, PA 19122 215-425-6203 (Voice) 215-425-6204 (Fax) HYPERLINK "http://www.huneinc.org"www.huneinc.org THE MENTOR PARENT PROGRAM, INC. P.O. Box 47 Pittsfield, PA 16340 814-563-3470 (Voice) 888-447-1431 (Voice in PA) 800-855-1155 (TTY) 814-563-3445 (Fax) HYPERLINK "http://www.mentorparent.org"www.mentorparent.org DISABILITIES RIGHTS NETWORK 1414 North Cameron Street Suite C Harrisburg, PA 17103 800-692-7443 (Toll-Free Voice) 877-375-7139 (TDD) 717-236-8110 (Voice) 717-346-0293 (TDD) 717-236-0192 HYPERLINK "http://www.drnpa.org"www.drnpa.org PENNSYLVANIA BAR ASSOCIATION 100 South Street Harrisburg, PA 17101 800-932-0311 HYPERLINK "http://www.pabar.org"www.pabar.org BUREAU OF SPECIAL EDUCATIONS CONSULTLINE, A PARENT HELPLINE 800-879-2301 ConsultLine personnel are available to parents and advocates of children with disabilities or children thought to be disabled to explain federal and state laws relating to special education; describe the options that are available to parents; inform the parents of procedural safeguards; identify other agencies and support services; and describe available remedies and how the parents can proceed. OFFICE FOR DISPUTE RESOLUTION 6340 Flank Drive Harrisburg, PA 17112-2764 717-541-4960 (Phone) 800-222-3353 (Toll free in PA only) 800-654-4984 (TTY) 717-657-5983 (Fax) HYPERLINK "http://ODR.pattan.net"http://ODR.pattan.net The Office for Dispute Resolution administers the mediation and due process systems statewide, and provides training and services regarding alternative dispute resolution methods. THE PENNSYLVANIA TRAINING AND TECHNICAL ASSISTANCE NETWORK (PaTTAN) Harrisburg 800-360-7282 King of Prussia 800-441-3215 Pittsburgh 800-446-5607 HYPERLINK "http://www.pattan.net"www.pattan.net  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Carlisle School DistrictBig Spring School DistrictMechanicsburg School DistrictNorthern York School DistrictSouth Middleton School District FORMTEXT Shippensburg School District623 West Penn St. Carlisle PA 1701345 Mount Rock Rd Newville PA 17241500 S. Broad St. Mechanicsburg, PA 17055149 S. Baltimore Street Dillsburg PA 170194 Forge Road Boiling Springs PA 17007 FORMTEXT 317 N. Morris St.  FORMTEXT Shippensburg PA 17257 PA Medical Assistance (MA) Billing Parental Consent Form Local Education Agencies (LEAs) are eligible to receive federal Medicaid reimbursement for medically necessary services provided to their special education students when the services meet the requirements of the states Medicaid program and are provided in accordance with the students IEP. The Individuals with Disabilities Education Improvement Act of 2004 (IDEA) and the Family Educational Rights and Privacy Act (FERPA) require schools to obtain written parental consent to share students education and health-related records such as IEPs and Evaluation Reports. We are requesting your permission to share this information with the PA Department of Education, the PA Department of Public Welfare, and a physician or nurse practitioner in order to bill Medical Assistance. In addition to the Medicaid-covered services your child receives as part of his/her IEP, MA will continue to pay for medically necessary, Medicaid-covered services that are provided to your child outside of school. ________________________________________________________________________ I understand that if I give permission, I may withdraw it for future services at any time. However, it does not negate an action that has occurred after consent was given and before the consent was revoked. my refusal to give consent will not change the services my child receives under his/her IEP. whether I consent or refuse, I will not have to pay for these services. upon request, I may receive copies of my childs records that are disclosed as a result of this authorization.  FORMCHECKBOX  I give my childs school permission to share my childs education and health-related information and bill Medical Assistance.  FORMCHECKBOX  I do not give my childs school permission to share my childs educational and health-related information and bill Medical Assistance.  REF SchoolName    REF SchoolOther  Name of School  REF sname \* Caps \* MERGEFORMAT   REF dob  Students Full Name : Date of Birth ref mtdate \* MERGEFORMAT   REF EIEPDate  IEP Meeting DateAnticipated Duration of ServicesParent/Guardian Name (print)Parent/Guardian SignatureDate  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Carlisle School DistrictBig Spring School DistrictMechanicsburg School DistrictNorthern York School DistrictSouth Middleton School District FORMTEXT Shippensburg School District623 West Penn St. Carlisle PA 1701345 Mount Rock Rd Newville PA 17241500 S. Broad St. Mechanicsburg, PA 17055149 S. Baltimore Street Dillsburg PA 170194 Forge Road Boiling Springs PA 17007 FORMTEXT 317 N. 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00d8]0^0 !00d8]0^0$a$  !`'gdQ$a$gd  Individualized Education Program (Aug 2010 revision) Page  PAGE 2 Individualized Education Program (Aug 2010 revision) Page  PAGE 1  ref mtdate \* MERGEFORMAT   IEP for  Ref sname \* MERGEFORMAT   Individualized Education Program (IEP) Page of date \@ " MMMM d, yyyy" October 2, 2011 Individualized Education Program (Aug 2010 revision) Page  PAGE 5 Individualized Education Program (IEP) (08/1/04) Page  PAGE 6 Individualized Education Program (Aug 2010 revision) Page  PAGE 7 Individualized Education Program (Aug 2010 revision) Page  PAGE 8 Individualized Education Program (Aug 2010 revision) Page  PAGE 12  ref mtdate \* MERGEFORMAT 07/01/09 IEP for  Ref sname \* MERGEFORMAT   Individualized Education Program (Aug 2010 revision) Page  PAGE 18 PDE/BSE Notice of Recommended Educational Placement/Prior Written Notice NOREP/PWN) (July 2009) Page  PAGE 19 PDE/BSE Notice of Recommended Educational Placement/Prior Written Notice NOREP/PWN) (July 2008) Page  PAGE 1 Parent Input (Jan 30th, 2001) Page:  PAGE 3 of  NUMPAGES 21 July 2008 Page:  PAGE 2 of  NUMPAGES 21 PDE/BSE Notice of Recommended Educational Placement/Prior Written Notice NOREP/PWN) (July 2009) IEP Snapshot Page  PAGE 1 of IEP Snapshot Page  PAGE 1 of RESOURCES RESOURCES /0@ABwx~  ɽɽՃՃxiշjh-:UmHnHu*hWmHnHu*jh-:Uh-:0JmHnHu h-:0J5jh-:0J5U*hW0JmHnHu* h-:0Jjh-:0J5U h-:5h h-:5h-:h-:6OJQJmHnHujh-:6OJQJUh-:6OJQJ) !"#$jlmnopq  !~6gdQgd?N 20d8]0gd?N  !~6gd?N !0d8]0 "#XY^_efghjklmopq  HINOUVXh)>*CJmHnHu h h) h)0J5jh)U*hWmHnHu*jh)U h)5h) h-:0Jjh-:UmHnHuh-:mHnHujh-:U h h-:h-: h-:5 h-:0J53Z[\]^_`a  %d8]gdx=$a$gdQ t",0d8]0gdQ$a$gd  !0d8]0 20d8]0gdQXYZ[aCDJKLMNdfrxy012346EJԣԮԣԣԣԣޮh)5OJQJ h)H*h)0JmHnHu h)0J5jh)0JU*hW0JmHnHu* h)0Jjh)0JU h)CJh) h)5hSh)0Jjh)U*:NOP1234567  %d8]gd8? !0d8]0  d8]  %d8] !R&  %d8]gdx=JKQRSTXYZinouvwx|}~8 8 8 8888F8Ļ̳̯̘̯~l_[V h[\h{&h{&CJ\mHnHu"jhI h{&CJU\ h{&CJ\jh{&CJU\ h)h\0hnh)OJQJhnh)5OJQJh?Nhhi5h)mHnHujhiUhi hiCJhh)5jh)U*hWmHnHu*h)jh)U!7YZ[}~8G8888919 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(Syb]$B@]$"x]$]$]$(]$]$X] ] ] @] ] p] ] ] ] x IEPcommand$(iiepdate %!'eiepdate %!'op](]@]X]p]8 Z'tservice %!' spedpercent %!' level %(  norepdate %(o]]](]@]X8assignvar = ActiveDocument.FormFields("tsupport").Result7program = ActiveDocument.FormFields("placement").Result= ActiveDocument.FormFields("assignment").Result = assignvarSelect Case assignvarHCase "Life Skills Support", "Emotional Support", "Multiple Disabilities"KYou have indicated-Life Skills, Emotional Support or Multiple disabilities. $ $ Include an age waiver statement? $'  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.'   agewaive %(dk End Selectopp]]p21 %!8Less than 21% outside of the regular education classroom'dkp2160 %!521% to 60% outside of the regular education classroom'dkxp61 %!661% or more outside of the regular education classroom'dk percent %(o]P]hAPSNR %!RApproved Private School (Non Residential) 100% of the time outside of the District'd@k8APSR %!NApproved Private School (Residential) 100% of the time outside of the District'dkPFNR %!QOther Private Facility (Non Residential) 100% of the time outside of the District'H%d(k PFR %!MOther Private Facility (Residential) 100% of the time outside of the District'dkPUFR %!KOther Public Facility (residential)100% of the time outside of the District'dkPSF %!QOther Public Facility (Non-Residential) 100% of the time outside of the District'dkHHB %!?Hospital or Home Bound 100% of the time outside of the District'dkCF %!>Correctional Facility 100% of the time outside of the District'dkOSF %!>Out of State Facility 100% of the time outside of the District'd kIH %!JInstruction conducted in the home 100% of the time outside of the District'dkOTH %!otherLevelDescript %!' ) 100% of the time outside of the District'dk percent %(o  B@   B@H% B@   B@ B@8%  B@@%o(]0]H]`dob %!'sname %!' Gage %(F|jyyyy  $' Z $  $" $$$  'k0  d 'k age %(If varage < 14 Then?ActiveDocument.FormFields("transitionNO").CheckBox.Value = TrueAActiveDocument.FormFields("transitionyes").CheckBox.Value = False>ActiveDocument.FormFields("RegGradyes").CheckBox.Value = False: ActiveDocument.FormFields("voter").CheckBox.Value = False/ActiveDocument.FormFields("STname").Result = "" ElseA ActiveDocument.FormFields("transitionNO").CheckBox.Value = FalseA ActiveDocument.FormFields("transitionyes").CheckBox.Value = True> ActiveDocument.FormFields("reggradyes").CheckBox.Value = True9 ActiveDocument.FormFields("voter").CheckBox.Value = True6 ActiveDocument.FormFields("transitionPR").Result = ""< ActiveDocument.FormFields("transitionpostgoal").Result = ""5 ActiveDocument.FormFields("STname").Result = varname End Ifop x adcontact1 %B@Ho@ ](]@ ESYBeforeDate %!'*esyrdate %!', *G ,esyddate %(cGjo X]]AddAct %(ESYNo %!TIn addition, the team has discussed ESY and has determined that it is not necessary.'0 norepfirst %!2( norepnormal %!2(2ActiveDocument.FormFields("noreptext").Result = ""dX kP ESYYes %!8In addition, the team has determined ESY is appropriate.'0 norepfirst %!2( norepnormal %!2( NOREPText %(dx kp ESYEval %!vIn addition, the team has determined that data must be collected before a determination of ESY eligiblity can be made.'0 norepfirst %!2( norepnormal %!2( NOREPText %(ESYNOREP %(d0 k( 0AddAct %(o ]8]P]h]]]]]mtdate %!'>Fyyyy >$H'@d @$H'@ @EIEPdate %(iiepdate %!' @'Fo]P ]h iiepdate %!'Leiepdate %!'@ Ld B@N R B@P @d B@N  B@ R B@To Xmtdate %! 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Brad Polovickvtname %(dFko@ vtcip %!Nonendvtcip %!empout %(vtcip %!vtcode %(kno Macro2 Macro' Macro recorded 07/15/03 by Bill Gillet tl B@r  !~| Annual Goal !v%xB@z !B@ With Selection.Find .Text = "school year" .Replacement.Text = "" .Forward = False .Wrap = wdFindAsk .Format = False .MatchCase = False .MatchWholeWord = False .MatchWildcards = False .MatchSoundsLike = False! .MatchAllWordForms = False End With Selection.Find.Execute Selection.MoveRight Count:=2oH ] ] ] ] ] ]D ]0 ]H Warning!! $ ?Once you create the snapshot all changes must be made manually. $ 7Do not create until you have a final version of the IEP $  $ Do you wish to continue $'  Snapshot creation cancelled.A@PdFkA@ %' %' sdisnap B@ !B@ !modification or sdi9d5(d9 9999999qP !B@  %'  %'  snapstrengths B@  B@N B@P  B@N sdisnap B@ B@  B@ B@ R B@ ! !~~ snapshotendC@ 99q !B@ !beginning date9d5(d9 9999999qh !B@ !B@ !B@  snapshotend B@nobehaviorplan %!'  $ Behavior Plan $ B@N  '  %'  B@N B@ R B@ !B@ ! 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Instead  Q requires extensive modifications and accommodations of curriculum and materials.pssano %(-According to the 6 criteria outlined by PDE, . is eligible to take the alternate assessment.pASAYES %(VIDEO %!2(?o? supdate B@ !B@ !supdate9d5(d9 9999999q>  B@P B@  B@T B@A@Jo>as %!as2 %!2(d@>as2 %!2(k>o>Xbvi %!bvi2 %!2(d=bvi2 %!2(k=o=dhh %!dhh2 %!2(d@=dhh2 %!2(k=o=es %!es2 %!2(A@d<es2 %!2(agewaive %(kp<oh<`ls %!ls2 %!2(d<ls2 %!2(k;o;lss %!lss2 %!2(A@d;lss2 %!2(agewaive %(kH;o@;mds %!mds2 %!2(A@d:mds2 %!2(agewaive %(k:o:hps %!ps2 %!2(dH:ps2 %!2(k :o:sl %!sl2 %!2(d9sl2 %!2(k9o9]peThe template will Fill out the calculations sections automatically. Would you like to calculate now? $4choose NO if you have not filled out the profile yet $', , GA@cGjo8]]]6x8 ComPLanCheck %!2!G6jmYou have checked that this is a student with a hearing disability. You must complete the Communication Plan.A@67o7(  !~|BehaviorAssessmentTable !v%xB@z !B@oH7]behaviorplancheck %!2!G>jYou have checked that this student exhibits challenging behaviors. Do you want to include the behavior assessment chart in the present levels? $'< <  BehaviorLevels B@A@8dFk>6o6kWill the Service be Weekly or Monthly. 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Trebuchet MSI. ??Arial Unicode MS;WingdingsA. *MS Shell Dlg71 Courier?= *Cx Courier New5. .[`)Tahoma3*Ax TimesA$BCambria Math @h a&J_T_T!4 [x 2QXZ?T:* ! xx BIG SPRING SCHOOL DISTRICTWilliam Gillet Bill Gilleth                  ^: y 8`bjbj .{{RP \q8U \ ,+H`!Esss<ssss:ssssIs3eJ:sR0s`!F`!s`!spssssssss-Fsssssss`!sssssssss :  FORMTEXT 2008 may use graph, large lined, or widely spaced paper. Student may use an adaptive calculator (i.e. large keys, voice output) for the mathematics assessment where calculator use is permitted. MEASURABLE ANNUAL GOAL: MEASURABLE ANNUAL GOAL Include: Condition, Name, Behavior, and Criteria (Refer to Annotated IEP for description of these components)Describe HOW the Students progress toward meeting this goal will be measured and WHEN period progress reports will be provided to parents.Report of ProgressDOMAIN:HOW:DESCRIPTION OF PROGRESS:WHEN:  FORMTEXT Quarterly report cardsSHORT TERM OBJECTIVES Required for Children with disabilities who take alternate assessments aligned to alternate achievement standards (PASA) MEASURABLE ANNUAL GOAL MEASURABLE ANNUAL GOAL Include: Condition, Name, Behavior, and Criteria (Refer to Annotated IEP for description of these components)Describe HOW the students progress toward meeting this goal will be measuredDescribe WHEN periodic reports on progress will be provided to parentsReport of Progress SHORT TERM OBJECTIVES Required for students with disabilities who take alternate assessments aligned to alternate achievement standards (PASA). Short term objectives / Benchmarks Student may answer the question orally if they are unable to use a pencil or have handwriting that is illegible Student may be granted an extension on assignment and project completion dates when the assignment meets the following criteria: (1) Projects/assignments with a completion date at least five consecutive school days beyond the date the assignment is given to the student. (2). The student must demonstrate to the assigning teacher that some written progress has been made on the assignment and that there was sufficient effort toward project completion to warrant extended time. Student may be granted an extension on a short term or overnight assignment, if the student or Learning Support teacher request such an extension prior to the original due date of the assignment. Major assignments (those which count more than 10% of a students grade) and long-term projects (projects for which a student may have more than 2 days to complete) will be divided by the regular education teacher into smaller, more manageable segments to assist student with organization and completion. Specific deadlines for each step in these projects will be provided by the regular education teacher. Remind students to write down assignments at the end of the class period. Student will obtain signatures from teachers in an assignment book each day. For the first month this IEP is in effect classroom teachers will prompt the student for a signature each day. After the first month, the student will be expected to obtain signatures independently and teacher prompts will be more random. Student will use a homework assignment book to record assignments to be completed out of class. These assignments should be recorded by class period, and reflect the subject and classroom teacher, and indicate the date the assignment is due. Student will be permitted to complete assignments in a Learning Support classroom or Resource Room. The services provided to students in this setting will be to assist in understanding, researching, and completing assignments that are not evaluative in nature. Assistance also can include reading and clarifying assignments, assisting the student in developing outlines, researching issues or topics, and instructing in the use of educational resources. General directions may be provided via an audiotape or CD Use of 1*2*3 Magic Teacher will make a phone call home to parents. Teacher and student will make a phone call home to parents. Student will explain the behavior they performed which initiated the call. Use the Gem Trail in the classroom as a behavior management tool. Lose a point in the Level system. Place the student in a time out setting. Antecedents to the behavior of concern Behavior of ConcernConsequences of Maintaining the behavior of concernPerceived function of the behavior of concernTo gain:  FORMTEXT       To avoid, escape, or postpone  FORMTEXT      When  FORMTEXT (Antecedents to the behavior of concern)the student FORMTEXT (the behavior of concern)in order to FORMTEXT (Perceived function of the behavior)Identify educational (skill) deficit(s) related to the behavior of concern which are not noted in other sections of the present levels. FORMTEXT       Student may use a Braille edition of the PSSA Student may use a Bailler/Notetaker. Student may use letter boards, picture communication systems, voice output systems and other augmentative communication systems Students with visual impairments may use the Cranmer abacus on the non-calculator section of the mathematics test. A lapse in services might substantially reduce the students chances of mastering a critical life skill or behavior related to the IEP A skill or behavior is crucial for the student to meet the IEP goals of self-sufficiency and independence. Test administrator may mark an answer booklet at the direction of the student. FM system or other assistive listening devices may be used. Student may use highlighters, place markers and reading windows. Provide an alphabet strip on desk. Use color coding to facilitate organization; e.g., different color paper for each topic; use highlighters for emphasis. Use instructional centers in the classroom to reinforce skills being taught. Use manipulatives to assist in making concepts more concrete and more sensory stimulating. Use peer teaching when the classroom organization permits an accomplished peer to assist in material presentation and understanding. Provide small group instruction, whenever possible. Provide consistent structure in the classroom environment, e.g., consistent structure; establishing and maintaining routines such as introductory remarks; visually and/or verbally presenting daily requirements in a similar format; and consistently maintaining discipline. Use visual, auditory and tactile methods, i.e., multiple teaching strategies, when presenting new concepts and new material, or during re-teaching.  FORMTEXT (Student Name) has a goal of participating in community and recreation/leisure activities resources with  FORMTEXT (agency, family supprt etc.) Interpreters may clarify instructions. Successive Interruptions have resulted in the student withdrawing from the learning process Student may use a large print edition of the PSSA Student may use a magnification device Student may mark answers in the test booklet, including drawings and graphics A calculator may be used for math assignments that are not specifically designed to assess the students ability to add, subtract, multiply, or divide. Calculator use may be limited to simple arithmetic when an assessment or activity is designed to assess mathematical processes. Math Test Items may be read or provided via audiotape or CD Use of the touch math system. The classroom teacher will provide the student with access to a second copy of notes. These notes can be teacher generated notes or comprehensive notes from another student willing to provide their notes. Student will be permitted to use a tape recorder to record notes from a lecture. If a notebook grade is required, student will be expected to produce some type of student generated output that will indicate that the student attended to the material presented, (i.e. an outline of important points, a summary of material presented, a transcribed copy etc.) Student may use a number line. Use a color coding system to organize notebook. Student will be provided with an extra set of text books for the current classes to which they are assigned. These books are to be taken home and used for reference and returned to the providing teacher prior to the end of the course. Complete book identification and documentation will be maintained by the teacher. Use a folder system to help student organize. Provide parent with information on student assignments/projects and the dates these assignments are required to be completed and turned in to the assigning teacher. The Special Education roster teacher will communicate at least once per week with the parents via email or phone and obtain an acknowledging response from the parent. Document parental contacts by date, method, number/address, and significant content. If unable to contact parent, document attempts. The classroom teacher will communicate at least once per week with the parents via email or phone and obtain an acknowledging response from the parent or documentation of the attempt to make contact if the parent doesnt respond. Provide preferential seating arrangements to help the student feel more comfortable Permit additional breaks or extended rest breaks for students during the test session. Directions for all assessments may be read aloud Questions can be read aloud (excluding the reading assessment) Student will have access to recordings of textbooks and other materials such as Books on Tape or some other digital audio format). The Special Education Roster teacher for this student will coordinate with classroom teachers at the beginning of each semester and determine which books need to be available as an audio copy and coordinate the acquisition of these materials through the Supervisor of Special Education. The student will take a long time to recoup (recover) the skills or behavior patterns learned during the school year. Provide the student with preferential seating; the preferred seating will be: Teacher will provide an agreed upon verbal or nonverbal cue to redirect the student back on task. The student will regress (revert to a lower level of functioning) in skills or behaviors as a result of an interruption in educational programming A pattern of difficulties with regression and recoupment make it unlikely that the student will maintain the skills and behaviors relevant to IEP goals and objectives A pattern of difficulties with regression and recoupment make it unlikely that the student will maintain the skills and behaviors relevant to IEP goals and objectives Testing in a separate room in order to reduce distraction The Test administrator may simplify the language or repeat directions as necessary. Student will be provided with Adaptive/Special Furniture (study Carrel etc.) Testing in a small group (special ed. classroom) Classroom language taught by the speech therapist. Provide visual or verbal cues Small group and/individual therapy with SLP Modeling Supplement auditory information with visual materials Repetition Rephrase [rather than repeat] verbal questions and directions Role playing A speech book will be sent home as a communication tool. Use of speech folder for home transfer activities Use of a tape recorder in the therapy room. Allow think time with prompts and reminders to stay focused on lesson Therapist may use classroom materials for speech. Present verbal information in short chunks/steps Cue student prior to giving verbal questions Present verbal questions as Yes/No or multiple choice format Use of pictures, icons, social stories Spelling will not count against the student during tests and evaluations unless a dictionary or other spelling assistive device has been available during these writing assessments. (Dictionaries or other assistive spelling devices including electronic dictionary and thesaurus programs, will not be allowed if the teaching objective of the evaluated lesson is the correct spelling of assessed words). Modify the length, type or level of words on spelling lists. A dictionary or spelling assistive device will be made available during reading and writing assessments, unless the assessment has been specifically designed to evaluate spelling skills. Matching questions should have the longest part of the question, e. g., the definition, on the left side of the page or in the left column, and the smaller portion, usually the word to be defined, on the right side as the choice for responses. Most people read left to right, and matching a longer definition to a shorter word is an easier task. Allow the student time to organize thoughts prior to beginning an essay test. The student may mentally review the material in preparation for the written response and/or the student may create notes during the test period for organizing the response. Only materials available to all students in the classroom will be allowed during this review process, and the created notes may be used for the duration of the test. Quizzes, which are of short duration, are generally characterized by one to five questions reflecting a concept just learned or practiced in homework and which are immediately followed by additional instruction will be administered by the regular education teacher. Before the quiz is graded, the student will have the option of going to the resource room for additional time to complete the quiz. The afternoon following the regularly scheduled morning final exam period may be used as extended time for exam completion if extra time is needed. The starting and completion time for tests, and any SDI offered to the student and rejected by that student should be recorded on the face sheet of the test. The student may dictate test and assessment answers to a regular education teacher, learning support personnel, or to other adults with the concurrence of the assessment administering teacher. The dictated responses will be transcribed onto the test booklet or answer sheets as provided by the assessment administering teacher. The person transcribing the responses will legibly print their name, sign, and date the transcription. The student will be provided with assistance to ensure understanding of the assessment directions and clarification of test questions. Reasonable extra time will be allowed for tests and assessments. The test must be completed within a specified time frame (for example 1 extra hour for a test designed to be completed in 80 minutes) and can be completed that same day after school, during the next class resource period, or at another suitable time arranged to the satisfaction of the student and involved staff. The exact amount of extra time per assignment must be agreed upon, either before the student begins the test or as soon as the student, or appropriate staff , determine that such time is necessary. The extra time agreement will be written on the test, regardless of whether the student uses all the time allowed or not. Instructions for tests involving mathematics will be read aloud to the student. Test problems considered to be word problems which contain sentences describing a situation for numerical resolution will be read aloud. Test questions that are not word problems that consist mainly of terms, expressions, and/or equations, and problems of similar composition, will not be read aloud but may be clarified at the students request as to the type of question. Teachers will ensure that the student understands all directions on a given test. Tests for regular education classes, may, be taken under the supervision of a Special Education teacher in an alternate location such as the Resource Room. The student will be permitted to take advantage of this modification at any time during the test as long as the evaluation time constraints are within compliance. Resource Room personnel can provide assistance to ensure understanding of the assessment directions and requirements and can clarify the meaning of questions. Tests and evaluations requiring equipment that is not available in the resource room (i.e. sports or technical/vocational shop equipment, must be taken in the regular education setting. Classroom teachers will provide a study guide for tests to help the student focus on the most important material aspects of the curriculum material included in the assessment. Word banks will be provided to the student by the regular education teacher for all fill-in the blank type assessments. The number of response options available to the student will match the number of fill-in the blank questions on that assessment. Tests and other assessments will be read aloud to the student by an electronic reading device or a staff member. Reading aloud tests and other assessments means that the entire test, including instructions, directions and all questions, statements, word banks, and other parts of the assessment, will be read aloud. Directions for all test items may be translated into the students most comfortable form of communication (i.e. sign language, native language, etc. Student will participate in a career exploration course as part of the regular curriculum. Student will participate in an 11th grade career seminar course that includes developing resume writing and interview skills. Student will attend CIT. Student will participate in the Districts Co/Op program. Student will attend Vo-Tech. Student will participate in an internship program. Student will participate in a Special Education Vocational training program that includes on-site job coaching. Student will participate in a job related social skills curriculum. Student will participate in a job shadowing activity as part of the regular education curriculum. District will assist Parents with opening a case with MH/MR. District will assist parents with opening a case with OVR. Student will participate in a Special Education Vocational training program that includes assistance with obtaining an independent Job. Student will participate in a volunteer program.  FORMTEXT (Student Name) has a goal of  FORMTEXT (Competative, Supprted, Sheltered) employment in the area of  FORMTEXT (career area).  FORMTEXT (Student Name) has a goal of  FORMTEXT (Competative, Supprted, Sheltered) employment and is attending the Vo-techs  FORMTEXT 50.0402 (Advertisting Art & Design) program in the area of  FORMTEXT (career area). Student will participate in community based instruction. Student will participate in District facilitated community based recreation activities. Student will explore community recreation and leisure facilities. Assist student with joining local clubs District will assist parents with linking up with Center for Independent living District will assist parents with linking up with CPARC District will assist parents with linking up with DPW District will assist parents with linking up with SSI District will assist parents with linking up with MH/MR Student will participate in the Districts Real Deal house project. Student will participate in Special Olympics  FORMTEXT (Student Name) has a goal of living in  FORMTEXT (a group home, with parents, etc.). The IEP team has determined that an employment outcome is not appropriate for  FORMTEXT (Student Name). The IEP team has considered an employment outcome and does not support an educational program that prepares _____ to enroll in post secondary educational/training at this time. Facilitate contact with military recruiters. The IEP team supports an educational program that will prepare  FORMTEXT (student Name) to enroll in  FORMTEXT (type of school - 2 year, 4 year etc).  FORMTEXT (student Name)will need supports in order to  FORMTEXT (enroll, explore, etc.).  REF sname \* MERGEFORMAT   is interested in studying  FORMTEXT (content area/major). Assist with ASVAB registration. Review acceptance requirements. Assist with Application completion. Assist with setting up campus tours. Help student request brochures/information. Assist with obtaining Financial Aid. Assist with locating information on special services at the post secondary institution. Assist with requesting updated psychological Testing. Assist with PSAT/SAT registration with accommodations. 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Student may use a Word processor or typewriter with spell check, grammar check, word prediction functions and other supports turned off Student may use a word processor for assignments over a pre-agreed upon length. Use graphic organizers. Use lined paper for writing tasks.     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