Individual Education Program (IEP)

A Technical Assistance Guide

State of South DakotaDepartment of Education

Special Education Programs700 Governors Drive

Pierre, SD 57501

Developed with the assistance of:Ann Larsen, Director of Special Education Programs

Chris Sargent, Education SpecialistSpecial Education Programs Staff

August 2007

The Individuals with Disabilities Education Act (IDEA) was reauthorized in 2004 followed by the publication of the Federal Registers implementing regulations on August 14, 2006. The Office of Special Education Programs included in the Federal Register the Analysis of Comments and Changes section in the preamble which provided the rationale for each of the regulatory changes. Federal Register Analysis information included within this document is taken directly from the Federal Register to assist in providing clarification and support to the applicable section of the IEP.

Purpose of the IEP

There are two main parts of the Individual Education Program (IEP requirement: first, the IEP meeting, at which parents, the student, evaluators, school personnel, and others jointly make decisions about the students eligibility and the educational program for a student with disabilities who requires special education or special education and related services; second, the IEP document, which acts as a written record of the decisions reached at the meeting. The overall IEP requirements have a number of purposes and functions:

1. The IEP meeting serves as a communication vehicle between parents and school personnel. It enables them, as equal participants, to jointly decide what the student’s needs are, what services will be provided to meet those needs, and what the anticipated outcomes will be.

2. The IEP process serves as an opportunity to resolve any differences between parents and school personnel, either through the meeting itself, or if necessary, through procedural safeguards available to parents.

3. The IEP sets forth in writing a commitment of resources necessary to enable a student with disabilities to receive needed special education or special education and related services.

4. The IEP is a management tool that is used to ensure that each student is provided special education or special education and related services appropriate to individual learning needs.

5. The IEP is a compliance and monitoring document that can be used to ensure that students are receiving a “free appropriate public education” (FAPE).

6. The IEP serves as an evaluation device for use in determining the extent of student’s progress in the general curriculum.

2

TABLE OF CONTENTS

Page 3 Completing the IEPPage 5 Page 1Page 11 Page 2Page 14 Page 3Page 18 Page 4Page 26 Page 5Page 30 Page 6Page 35 Page 7Page 37 Page 8Page 42 Page 9Page 45 AddendumPage 49 The IEP Process- Federal Comments SectionPage 50 Dismissal Procedures

Appendix A

Page 52 Justification StatementsPage 53 Standard AccommodationsPage 54 Technical Assistance for Writing GoalsPage 57 Medicaid Sample FormPage 59 Consent to Invite AgenciesPage 60 Determination of Eligibility/Continued EligibilityPage 68 Exit Survey

3

Completing the IEP

4

5

_______________________________School District Individual Education Program Page 1

Student Name Meeting Date Purpose of Meeting Initial Eligibility, IEP, Placement Annual Review of IEP Three Year Reevaluation Dismissal from Services Date: _______________________ Parent Request Other: __________________________________________

Student Information Management System (SIMS) Number

Age Grade

Date of Birth

Male Female Date Services Begin Discussed evaluation results/progress/assessment method Yes ____ (Parent/Guardian initial)

Copy of evaluation results received Yes ____ (Parent initial)

Ethnicity: (W,B,I,H,A)

School of Residence Annual Review Date*Transition Planning Needed No

Yes (If yes, attach applicable transition pages.)

Attendance Center Parent/Guardian Name, Address, Phone

Hm: Wk:

Student is eligible for special education or special education and related services as determined by the IEP team

Yes No

An annual copy of Parent/Guardian Rights was received and reviewed

_______________(Date) ________ (Parent/Guardian Initial)

Date of Eligibility Determination:

Three Year Reevaluation Due By: Parent/Guardian Name, Address, Phone

Hm: Wk:

A copy of the IEP was provided to parent/guardian Yes _______ (Parent/Guardian Initial)

IEP Team MembershipParent/Guardian

Signature Date

Parent/Guardian

Student

Superintendent/Designee

General Classroom Teacher

Special Education Teacher

Speech/Language Pathologist

Evaluator

Title

Title

Title

Child Count Information (Required Information)Disabling Condition

0500-D/B 0505 -ED 0510-CD 0515-HL 0525-SLD 0530-MD 0535-OI 0540 –VL 0545 –D 0550-S/L 0555-OHI 0560-A 0565-TBI 0570-DD

A. Minutes per week in Special Education _________ Minutes ServicesB. Minutes per week in Related Services __________ __________ __________ __________ __________ __________

C. A + B = (Total minutes of Special Education/Related Services) __________

Placement

0100 General Class with Modifications 80-100% 0110 Resource Room 40-79% 0120 Self-Contained Classroom 0-39% 0130 Separate Day School 0140 Residential Facility 0150 Home/Hospital 0315 Early Childhood Setting 80-100% 0325 Early Childhood Setting 40-79% 0330 Early Childhood Setting 0-39% 0335 Separate Class 0345 Separate School 0355 Residential Facility 0365 Home 0375 Service Provider Location

Parent/Guardian declines all special education services

Parent/Guardian Signature: _____________________________________________________________________

6

Directions for Completing Page 1

Student NameState the full name of the student, including middle name or initial. Identify the gender of the student by checking the correct box.

Meeting Date Identify the date the meeting is actually held (month, day, and year).

Purpose of meetingThe purpose(s) must correspond with the purpose(s) stated on the prior notice form sent to the parent/guardian.

(SIMS) Student Information Management System number

Write the child’s SIMS number in the blank. To obtain the SIMS # log into SIMS or DDN campus. If you do not have access, contact your data entry person or look in student’s cumulative folder.

Age Grade

Fill in the age of the child on the day that the meeting is held. Identify the regular classroom grade of the child. If the child is in a non-graded placement, identify the grade the student is enrolled as in the SIMS.

Date of Birth State the child’s full date of birth (month, day, and year).

Date Services Begin

Identify the date (month, day, and year) the IEP services will be initiated. This date would typically be the day of or the day after the IEP meeting date. A situation in which the date may not be the day of or the day after the meeting is as follows:

A child is moving from the Part C program to the Part B program and the IEP is developed within 90 day prior to the child’s 3rd birthday. The date services begin would be reflected as the child’s third birthday.

Discuss evaluation results

Evaluation results copy received by parents

The parent/guardian must initial here to document that evaluation results and/or progress on goals and objectives was discussed at the meetings.Parent/guardian must also initial here to document that a copy of evaluation results were received by the parent. If an evaluation was not conducted put N/A.

School of Residence Identify the child’s school district of residence.

Annual review date

This is the date (month, day, and year) the IEP will be reviewed by the IEP team. The date may be less than one year but cannot exceed 365 days. This timeline cannot be extended or waived. If parents cannot attend the meeting within the time line, hold the meeting and reschedule a meeting with the parent to review/revise the IEP developed.

Transition planning needed

Transition planning needs to begin no later than the first IEP to be in effect when the student is 16, or younger if determined appropriate by the IEP team. If transition is needed please attach the transition pages 4a & 4b. If not needed you do not need to include pages 4a & 4b.

Attendance Center Identify the school building or center that the child actually attends.

Parent/Guardian Information

§300.30 Parent(a) Parent means-- (1) A biological or adoptive parent of a child; (2) A foster parent, unless State law, regulations, or contractual obligations with a State or local entity prohibit a foster parent from acting as a parent; (3) A guardian generally authorized to act as the child’s parent, or authorized to make educational decisions for the child (but not the State if the child is a ward of the State); (4) An individual acting in the place of a biological or adoptive parent (including a grandparent, stepparent, or other relative) with whom the child lives, or an individual who is legally responsible for the child’s welfare; or

7

(5) A surrogate parent who has been appointed in accordance with §300.519 or section 639(a)(5) of the Act.(b) (1) Except as provided in paragraph (b)(2) of this section, the biological or adoptive parent, when attempting to act as the parent under this part and when more than one party is qualified under paragraph (a) of this section to act as a parent, must be presumed to be the parent for purposes of this section unless the biological or adoptive parent does not have legal authority to make educational decisions for the child. (2) If a judicial decree or order identifies a specific person or persons under paragraphs (a)(1) through (4) of this section to act as the “parent” of a child or to make educational decisions on behalf of a child, then such person or persons shall be determined to be the “parent” for purposes of this section.

The parent or parent’s name(s) of the child should be entered here. In order to assure correspondence is sent to the proper mail address, acquire the address from the parents and document it in this section. In the event the district needs to contact parents by telephone, numbers should be documented in this space and re-checked annually.

Eligibility

IDEA establishes three criteria for special education program eligibility. These include: The student must have a diagnosed disability, the disability must have an adverse effect on educational performance, and the student must require specially designed instruction to meet unique needs. * The student must also meet SD eligibility requirements for the stated disability as listed in the Administrative Rules of South Dakota.

Parental Rights also known as Procedural Safeguards

After the initial referral, a copy of parental right (procedural safeguards) must be given to parents one time per year. Parents need to initial and date this section to verify this has been done. Parental rights could be sent with the written notice for the meeting, the day of the annual IEP meeting or the beginning of each school year. This date should reflect the date it actually occurs.

A copy of parent rights must also be given to the parents: (1) Upon initial referral or parental request for evaluation; (2) Upon request by a parent; (3) Upon receipt of the first State complaint and first due process complaint; and

(4) In accordance with the discipline procedures.

Date of Eligibility Determination

This is the date of eligibility determination and must be documented. 300.306

Three Year Reevaluation Due By:

This is the month, day, and, year of the next three year evaluation. This date must not exceed three years from the date of the eligibility determination. Reevaluation may occur not more than once a year, unless the parent and the district agree otherwise.

Parent/Guardian Information

Two spaces are provided for parent information in cases of joint custody.

Copy of the IEP A copy of the IEP must be provided to the parents at the close of the IEP team meeting. The parents must initial this section of the form that they have received a copy of the document. This copy can be the hand written draft developed at the meeting. It does not need to be “pretty” but it does need to contain the decisions made by the team during the meeting. The district can re-type the document to improve its appearance and send another copy to the parents after the meeting. Parent must be provided a copy of the IEP at the conclusion of the meeting.

§300.321 IEP Team.(a) General. The public agency must ensure that the IEP Team for each child with a disability includes-- (1) The parents of the child; (2) Not less than one regular education teacher of the child (if the child is, or may be, participating in the regular education environment); 3) Not less than one special education teacher of the child, or where appropriate, not less then one special education provider of the child;

8

(4) A representative of the public agency who-- (i) Is qualified to provide, or supervise the provision of, specially designed instruction to meet the unique needs of children with disabilities; (ii) Is knowledgeable about the general education curriculum; and (iii) Is knowledgeable about the availability of resources of the public agency. (5) An individual who can interpret the instructional implications of evaluation results, who may be a member of the team described in paragraphs (a)(2) through (a)(6) of this section; (6) At the discretion of the parent or the agency, other individuals who have knowledge or special expertise regarding the child, including related services personnel as appropriate; and (7) Whenever appropriate, the child with a disability.(b) Transition services participants. (1) In accordance with paragraph (a)(7) of this section, the public agency must invite a child with a disability to attend the child’s IEP Team meeting if a purpose of the meeting will be the consideration of the postsecondary goals for the child and the transition services needed to assist the child in reaching those goals under §300.320(b). (2) If the child does not attend the IEP Team meeting, the public agency must take other steps to ensure that the child’s preferences and interests are considered. (3) To the extent appropriate, with the consent of the parents or a child who has reached the age of majority, in implementing the requirements of paragraph (b)(1) of this section, the public agency must invite a representative of any participating agency that is likely to be responsible for providing or paying for transition services.(c) Determination of knowledge and special expertise. The determination of the knowledge or special expertise of any individual described in paragraph (a)(6) of this section must be made by the party (parents or public agency) who invited the individual to be a member of the IEP Team.(d) Designating a public agency representative. A public agency may designate a public agency member of the IEP Team to also serve as the agency representative, if the criteria in paragraph (a)(4) of this section are satisfied.

Note: Alternative means of meeting participation, such as video conferences and conference calls may be used. If a team member participates through alternative means, the district should document their name and how they participated under the signature section on the IEP. For example: Mary Smith, parent, participated through conference call.

Note: Signing as an IEP team member does not mean consent or agreement to the information developed in the IEP document. It only means that you were present or participated in the IEP team meeting.

Parent(s)/Guardians(s)

The persons taking part in the meetings usually are the parents, foster parents, legal guardians or surrogate parents of the child. The district is responsible to make every reasonable effort to ensure that one or both parents participate in the meetings for their child.

ARSD 24:05:25:17. Conduct of IEP team without parents. An IEP team meeting may be conducted without a parent in attendance if the district is unable to convince the parents that they should attend. The district must have written documentation of its attempts to arrange a mutually agreed upon time and place, such as the following:

(1)  Detailed records and dates of telephone calls made or attempted to parents and the results of those calls;

(2)  Detailed copies of dated correspondence sent to the parents and any responses received; and

(3)  Detailed records and dates of visits made to the parent's home or place of employment and the results of those visits.

Student

Students should be encouraged to participate in their IEP meeting whenever appropriate. Parents and the students IEP team will make this decision. The student must be invited to the IEP meeting if the purpose is the consideration of postsecondary goals and transition services. If the student does not attend the district must ensure the students preferences and interests are considered at the meeting.

Superintendent/designee The district representative filling this role at the IEP meeting must be: qualified to provide, or supervise the provision of, specially designed instruction to

meet the unique needs of students with disabilities; knowledgeable about the general education curriculum; and

9

knowledgeable about the availability of resources of the school district.

Note: The individual selected to act as the districts administrative designee “MUST” have the authority to spend district funds and to make those decisions at the time of the IEP meeting. For example: The school counselor was selected to be the administrative designee at Alice’s IEP meeting. The team decided that Alice needed a Kurzweil reading program to assist with her reading disability. The counselor stated they would have to check with the Superintendent before agreeing to that buy the program. The IEP team would need to reconvene at a later date with the decision. In this scenario, the counselor is not familiar with the availability of district recourses and cannot delegate funds. Therefore they do not meet the requirements of the administrative representative.

Regular Classroom Teacher

Not less than one regular education teacher of the student must attend the IEP meeting if the student is, or may be, participating in the regular education environment.

Special Education TeacherNot less than one special education teacher of the student must attend the meeting or, if appropriate, at least one special education provider of the student.

Speech/language Pathologist

If speech and language is the primary area of disability, the speech/language pathologist must be at the meeting. They may also be a member of the students IEP team when speech/language is considered a related service needed by the student.

Evaluator

This member of the IEP team is an individual who can interpret the instructional implications of evaluation results. This individual may be one of the IEP team members described above.

Other

At the discretion of the parent or the district, other individual who have knowledge or special expertise regarding the student may be invited to participate at the IEP meeting. Other members may include but not limited to a psychologist, physical therapist, occupational therapist, counselor, behavior specialists etc. Be sure to include the person’s position title following their name.

Transition Requirements: To the extent appropriate, and with the consent of the parent or student who has reached the age of majority, the district must invite a representative of any participating agency that is likely to be responsible for providing or paying for transition services. Refer to Appendix A for a sample release/consent form.

Child Count InformationDue to the State’s general supervision mandates, this section of the IEP is “REQUIRED” to be completed by the district at the end of each annual IEP team meeting and addendum meeting.

Disabling Condition: Below are the codes for the thirteen disabling conditions, plus preschool developmentally delayed.

0500 - Deaf-Blind0505 - Emotionally Disturbed0510 - Cognitive Disability0515 - Hearing Loss0525 - Specific Learning Disabled0530 - Multiple Disabilities0535 - Orthopedic Impairments0540 - Vision Loss0545 - Deafness0550 - Speech/Language Impairments0555 - Other Health Impaired0560 - Autism0565 - Traumatic Brain Injury

For explicit definitions and criteria for each of the disability categories, refer to the following technical assistance guides:1. “Determining Eligibility for Special Education in South Dakota” http://doe.sd.gov/oess/specialed/forms/index.asp 2. “Response to Intervention (RtI)” See special education web site3. “Special Education Progress – Reported Data Elements SIMS/DDN Campus http://doe.sd.gov/ofm/sims/docs/SIMSManual12-06.pdf

10

0570 - Developmentally DelayedEthnicity Indicate in the space provided the students primary race. White, Black, Indian,

Hispanic or Asian.

Minutes per week in Special Education

This data should correlate with the total amount of time documented under special education services to be provided on page 8 of the IEP.

Minutes per week in Related Services

This data should correlate with the total amount of time documented under related services to be provided on page 6 of the IEP.

A + B = (Total minutes of Special Education/Related Services

This data will equal the total amount of time the student is receiving special education services outside the general education setting.

Placement This determination is made on page 8 of the IEP. Check the box that applies to the team decision regarding the student’s least restrictive environment.

Declining Special Education Services§ 300.300 Parental consent(3) If the parents of a child fails to respond or refuses to consent to services under paragraph (b)(1) of this section, the public agency may not use the procedures in subpart E of this part (including mediation procedures under 330.507 through 300.516) in order to obtain agreement or a ruling that the services may be provided to the child.(4) If the parent of the child refuses to consent to the initial provision of special education and related services or the parent fails to respond to a request to provide consent for the initial provision of services, the public agency- (i) Will not be considered to be in violation of the requirement to make available FAPE to the child for the failure to provide the child with the special education and related services for which the public agency request consent…

Parents Decline Special Education Services

A parent may refuse to provide consent for a student to be placed into special education or may withdraw consent for services in writing at any time. Parent must be fully informed of the results of their decision and must provide their signature indicating they are declining services.

Note: On Page 9 of the IEP, parent must sign consent for initial placement into special education. The district cannot provide services without written parent consent for the initial provision of special education and related services.

11

Present Levels of Academic Achievement and Functional Performance Page 2

Based on evaluation, include academic achievement and functional performance (strengths and weaknesses) in the areas affected by the student’s disability, including transition in the IEP to be in effect when the student turns 16; parent concerns; and how the student’s disability affects the student’s involvement and progress in the general education curriculum. (For a preschool child, how the disability affects his/her participation in appropriate activities.)

Student Name: IEP Date:

* Remember to address: Skill or Transition Area (Academic achievement AND functional performance) Strengths & Needs How the student’s disability affects his/her involvement/progress in the general education curriculum for the skill area Parent input

12

Directions for Completing Page 2

Present Levels of Academic Achievement and Functional Performance (PLAAFPs)

§300.304 (b) (1) Evaluation ProceduresIn conducting the evaluation, the public agency must use a variety of assessment tools and strategies to gather relevant functional, developmental, and academic information about the child including information provided by the parent.§300.320 (a)(1)(i)(ii) Individual Education Program…IEP…must include a statement of the child’s present levels of academic achievement and functional performance, including the child’s involvement and progress in the general education curriculum (i.e., the same curriculum as for nondisabled children); or for preschool children, as appropriate, how the disability affects the child’s participation in appropriate activities…

Federal Register Analysis: It is not necessary to include a definition of “functional” in these regulations because we believe it is a term that is generally understood to refer to skills or activities that are not considered academic or related to a child’s academic achievement. Instead, “functional” is often used in the context of routine activities of everyday living. We do not believe it is necessary to include examples of functional skills in the regulations because the range of functional skills is as varied as the individual needs of children with disabilities. We also decline to include examples of how functional skills are measured because this is a decision that is best left to public agencies, based on the needs of their children. However, it should be noted that the evaluation procedures used to measure a child’s functional skills must meet the same standards as all other evaluation procedures, consistent with §300.304(c)(1).

§300.324 Development, review, and revision of IEP.(a) Development of IEP. (1) General. In developing each child’s IEP, the IEP Team must consider-- (i) The strengths of the child; (ii) The concerns of the parents for enhancing the education of their child; (iii) The results of the initial or most recent evaluation of the child; and (iv) The academic, developmental, and functional needs of the child.

The Present Levels of Academic Achievement and Functional Performance (PLAAFP) is a summary describing the student's current achievement/performance in the skill areas affected by the disability as determined by an evaluation.For students of transition age, the team should identify where the student is functioning in relationship to what he/she plans to do after finishing high school. For details refer to the “Technical Assistance Guide for Transition in The IEP”.http://www.tslp.org/IEP.htm

The PLAAFP must include:Strengths: Identify the specific skills (linked to academic and functional assessment) the student has accomplished in the skill areas affected by the disability (including transition). Needs: For the skill areas affected by the disability (including transition), identify the specific skills (linked to academic and functional assessment) required by the student to achieve the present goals and make progress toward content standards in the general curriculum. How the student's disability affects his or her involvement and progress in the general curriculum: Answer the questions; is the student receiving instruction in the general curriculum? How is the disability affecting progress in the general curriculum? What core content areas is the disability affecting? What is the observable effect of the disability in the general education setting? For preschool children, the PLAAFP describes how the disability affects the child's participation in age appropriate activities.Parent Concern: Documents the parents concerns or comments regarding their child educational program.

DO NOT:1. Make or write placement decision in the PLAAFPs.2. Put test score in the PLAAFPs.

Refer to Appendix A for example PLAAFPs.

13

Students Name State the full name of the student, including middle name or initial.

IEP Date Identify the date the meeting is actually held (month, day, and year).

Strengths For each identified disability area (math reasoning, math calculation, reading, behavior, transition, written language, articulation etc). There needs to be a list of specific skills pinpointing what the student is able to perform in the general curriculum. These skills will represent the specific skill the student can perform based upon their current ability or performance level rather than what they should be accomplishing at their current grade or age level. This list of skills comes from a variety of functional/developmental evaluation information gathered during the initial or reevaluation process. These skills can be listed in the PLAAFP as bullets or in paragraph form.

Needs For each identified disability area (math, reading, behavior, transition, written language, articulation etc). There needs to be a list of specific skills pinpointing what the student is unable to perform in the general curriculum. These skills will represent the specific skill the student needs to learn based upon their current ability or performance level rather than what they should be accomplishing at their current grade or age level. This list of skills comes from a variety of functional/developmental evaluation information gathered during the initial or reevaluation process. These skills can be listed in the PLAAFP as bullets or in paragraph form.

Effect of the disability on progress/involvement in the general curriculum

When developing or revising student’s IEP, the team needs to discuss and document what impact the disability is having on the student’s ability to perform in generally curriculum. Are they involved and progress in the general curriculum? Document the team’s discussion.

Parent Input Document the parent concerns or comments they may have regarding the evaluation results, PLAAFPS etc. If the parent does not have concerns, note that as well.

14

Consideration of Special Factors Page 3

Is the student limited English proficient? Yes NoIf the answer to this question is “yes”, please explain the language needs of the student as these needs relate to the student’s IEP.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Are there any special communication needs? Yes NoIf the answer to this question is “yes”, what direct instruction will be provided in the student’s mode of communication?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Does the student require Braille? Yes NoIf the answer to this question is “yes”, what Braille services will be provided?____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Does the student’s behavior impede his or her learning or that of others? Yes NoIf yes, what strategies are required to appropriately address this behavior, including positive behavioral interventions and supports?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Assistive Technology Devices and Services? Yes No If yes, what device or service will be provided? _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Physical Education: Regular Not Required Adaptive: Refer to Goals/Goals & Objectives

Hearing Aid Maintenance: Not Applicable Yes: Personnel Responsible for Monitoring ____________________________Describe the monitoring process/frequency necessary for maintenance: __________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________

Assessment 1. Student will be taking state and district wide assessments with or without accommodations. (Accommodations will be determined on page 7.) (Annual goals required) 2. Student will be taking an alternate assessment (The alternate assessment is for students working in the alternate achievement standards) (Annual goal and short term objectives required) a. Does the student meet the significant cognitive disability criteria? (If no, student is not eligible to take the alternate

assessment) Yes No b. Explain the reason why the student cannot participate in the regular assessment. __________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________

c. Explain the reason why the alternate assessment selected is appropriate for this student_____________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________

3. State and/or district-wide assessments are not required at this student’s grade level during the course of this annual IEP.

15

Directions for completion of page 3

Development of IEP§300.324 Development, review, and revision of IEP.(a) Development of IEP. (1) General. In developing each child’s IEP, the IEP Team must consider-- (i) The strengths of the child; (ii) The concerns of the parents for enhancing the education of their child; (iii) The results of the initial or most recent evaluation of the child; and (iv) The academic, developmental, and functional needs of the child. (2) Consideration of special factors.

Is the student limited English proficient?

§300.324 (s)(2)(ii) In developing each child’s IEP the IEP team must consider in the case of a child with limited English proficiency, consider the language needs of the child as those needs relate to the child’s IEP.§300.306 A child must not be determined to be a child with a disability under this part if the determinant factor for that determination is limited English proficiency…Federal Register Analysis: Students who have Limited English Proficiency (LEP) are students whose primary language is something other than English. In order to evaluate a student with limited English proficiency who may have a disability, it is important to first determine the student's primary language and proficiency in English (Ortiz, 1977). The purpose for establishing the student's primary or dominant language is twofold: (1) To determine if the disability is evident in the primary language rather than learning of a second language, English; and (2) If the disability is evident in the student's primary language, then instruction for implementation of the IEP needs to be provided in the student's primary language.

For example: The child may visit a language tutor, or receive extra assistance in the area of their second language.

Are there any special communication needs?

§300.324 (a)(2)(iv) The IEP team must consider the communication needs of the child and in the case of a child who is deaf or hard of hearing, consider the child's language and communication needs, opportunities for direct communications with peers and professional personnel in the child's language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the child's language and communication mode.

These considerations for a child that is deaf or hard of hearing are to ensure that local educational agencies better understand the unique needs of children who are deaf or hard of hearing.

Does the student require Braille?

§300.324 (a)(2)(iii) The IEP team must in the case of a child who is blind or visually impaired, provide for instruction in Braille and the use of Braille unless the IEP Team determines, after an evaluation of the child's reading and writing skills, needs, and appropriate reading and writing media (including an evaluation of the child's 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 child.

For example: It may be the appropriate time for the decision to be made between large print and Braille.

Does the student’s behavior impede his or her learning or that of others?

§300.324 (a)(2)(i) The IEP team must in the case of a child whose behavior impedes the child’s learning or that of other, consider the use of positive behavioral interventions and supports, and other strategies, to address that behavior.

This section is intended to give the IEP team an opportunity to be proactive in addressing behavior issues for students with disabilities. IDEA focuses on intervention and strategies, not assessment to address the needs of a child whose behavior impedes learning or that of others. Therefore, functional behavioral assessment or formal behavior evaluations are not required in order to address a students behavior issues in this section. Briefly describe the specific behaviors the student displays and the “positive” intervention strategies that all staff will need to know and implement.

16

However, if the evaluation team has determined that behavior is an area of concern and that specific evaluations are necessary for the purpose of determining eligibility or to provide appropriate instruction, then it would be logical to conclude that “yes” would be checked in this section. In these circumstances information contained in this section may reference a specific individual behavior program and/or IEP goals.

For example: Positive behavioral supports for a student that is non-attentive and/or disruptive in the classroom could include the physical placement of the teacher as compared to the child, the physical placement of peers and/or other visual distractions as compared to the child, other types of interventions, behavioral contracts, etc. Another example of positive behavioral supports could be the tracking of antecedents, behavior, and consequences to gauge the effectiveness of the intervention being used.

Assistive Technology Services/ Devices

§300.5 Assistive technology devices.Describe in this section the assistive technology devices that will be provided to increase maintain or improve the functional capabilities of the student. This does not include surgically implanted medical devices. §300.6 Assistive technology services.Assistive technology services are services that directly assist the student in the selection, acquisition or use of an assistive technology device. This may include an evaluation of student need, purchasing, selecting, coordinating and training the student or staff. §300.105 Assistive technology.(a) Each public agency must ensure that assistive technology devices or assistive technology services, or both, as those terms are defined in §§300.5 and 300.6, respectively, are made available to a child with a disability if required as a part of the child’s-- (1) Special education under §300.36; (2) Related services under §300.34; or (3) Supplementary aids and services under §§300.38 and 300.114(a)(2)(ii).(b) On a case-by-case basis, the use of school-purchased assistive technology devices in a child’s home or in other settings is required if the child’s IEP Team determines that the child needs access to those devices in order to receive FAPE.

Physical Education: 34 CFR 300.108 (a) Physical educationGeneral. Physical education services, specially designed if necessary must be made available to every child with a disability receiving FAPE, unless the public agency enrolls children without disabilities and does not provide physical education to children without disabilities in the same grades.

Physical education is required for all students. If a student with disabilities will participate in the regular physical education program simply check “Regular” in this section. (Some students at the secondary level may be required to take a ½ unit of health or PE.) Students in pre-school programs are not required to take physical education, for those students, mark the box labeled “Not Required”.

Based upon the needs identified in the present levels of academic achievement and functional performance, if the student requires adaptive physical education, check “Adaptive” and include the necessary goals (and objectives if required) when developing the students program.

Hearing Aid Maintenance:

34 CFR 300.113 Routine checking of hearing aides and external components of surgically implanted medical devices.(a) Hearing aids. Each public agency must ensure that hearing aids worn in school by children with hearing impairments, including deafness, are functioning properly.(b) External components of surgically implanted medical devices. …each public agency must ensure that the external components for surgically implanted medical devices are functioning properly.

If the student does not have hearing aids/medical device, mark the box labeled “Not Applicable” 17

in this section.

If the student has a hearing aid(s)/medical device, the IEP must include a plan to ensure they are routinely monitored. In this box, identify the title of the district staff person responsible for the monitoring the hearing aid(s)/medical device, specify how often monitoring will take place, and what process will be used to monitor the working condition and repair of the instrument(s)/device.

Assessment: 34 CFR 300.320 Individual Education Programs(6)(i) A statement of any individual appropriate accommodations that are necessary to measure the academic performance of the child on State and district wide assessments…(ii) If the IEP Team determines that the child must take an alternate assessment instead of a particular regular State or district wide assessment of the student achievement, a statement of why- (A) The child cannot participate in the regular assessment; and

(B) The particular alternate assessment selected is appropriate for the child

IEP team must select one of the three options:

1. Student will be taking state and district wide assessments with or without accommodations.

If the student will be taking state and district wide assessment with or without accommodations,the team only needs to develop annual goals in the IEP and not short term objectives or bench-marks. These students typically are those working in the general content standards.

Standard accommodations needed during the administration of the assessments are based upon what is needed by the student in their individualized program. Therefore, the specific accommodations needed for each assessment to be taken during the course of this IEP will be determined on IEP page 7. If the accommodation is not “required” by the student in their IEP, it cannot be provided during the assessment administration.

2. Student will be taking an alternate assessment.

The students taking the alternate assessment must meet the criteria for significant cognitivedisability. To be identified as having a significant cognitive disability, the student must meet allof the following criteria:

1. The student has an active IEP with annual goals and short term objectives/benchmarks which focus on Alternate Content Standards; and

2. The student’s cognitive abilities are 2.0 standard deviations or more below the mean (inclusive of the standard error of measurement); and

3. The student primarily requires direct and extensive instruction to acquire, maintain, generalize and transfer skills done in naturally occurring settings of the student’s life. (e.g. school, community, home, vocational/career, and recreation and leisure)

For students taking the alternate assessment, the IEP must include annual goals and short term objective or benchmarks.

For student taking the alternate assessment the IEP team must explain the following: a. The reason why the student cannot participate in the regular assessment, and;

b. The reason why the alternate assessment selected is appropriate for this student.

Accommodations or modifications needed by the student during the administration of theassessments are based upon what is needed in their individualized program. If the accommodation or modification is not “required” by the student in their IEP, it cannot be provided during the assessment administration.

3. State and/or district-wide assessments are not required at this student’s grade level during the course of this annual IEP.

Be aware of the beginning and ending date of the IEP you are developing. If state or district wide assessments will be conducted during the time frame of the IEP, be sure to select the appropriate option.For example: The annual IEP meeting is held in May for student in the 10th grade. Testing will occur during the next school year but prior to developing a new IEP.

18

Measurable Postsecondary Goals (MPSGs) – Based on Age-Appropriate Assessment Page 4A

(Required on or before the student’s 16th birthday) note: The term “Measurable Postsecondary Goals” replaces “Life Planning Outcomes” (What does the student plan to do after high school?) – Current OSEP guidance requires at least one linked annual goal AND at least one service/activity for each MPSG identified. Assessment results should determine which MPSGs are addressed.

Employment: ______________________________________________________________________________________________

_____________________________________________________________________________(See linked annual goal(s) #_______)

Education: __________________________________________________________________________________________________

OR__________________________________________________________________________(See linked annual goal(s) #_______)

Training: __________________________________________________________________________________________________

_____________________________________________________________________________(See linked annual goal(s) #_______)

Independent Living: (where appropriate) _________________________________________________________________________

_____________________________________________________________________________(See linked annual goal(s) #_______)

Transition Courses of Study (Required on or before the student’s 16th birthday) (Complete for the current school year through the planned exit year)(Should relate to and help the student to progress towards achievement of the Measurable Postsecondary Goals listed above)

Grade Grade Grade Grade Grade

Comments: _________________________________________________________________________________________________

Transfer of Parent/Guardian Rights (Must be addressed on or before the 17th birthday).

Student will turn 17 on ___________. Student was informed of this transfer of rights on _______/______/______.

Graduation or Completion of an Approved Program (Must be addressed at least one year prior to graduation date.)

Student is to graduate/complete program: (Date) ______/_______/_______ Individualized district specific requirements and remaining courses needed to complete an approved secondary education program:

___________________________________________________________________________________________________________

_________________________________________________________________________________________________________

Summary of Performance – (For students who are graduating with a regular diploma or aging out of special education) A summary of the child’s academic achievement & functional performance, which shall include recommendations on how to assist the child in meeting the child’s postsecondary goals, is required. A suggested form and instructions are available on the SEP web site.

One Year Follow-Up – (For students who are graduating, aging out, or dropped out) Students will be contacted one year after

19

exiting, by a contract agency, to determine their status in regards to employment, postsecondary school, and other outcomes.

20

Directions for completing page 4A

§300.320 Definition of individualized education program.(b) Transition services. Beginning not later than the first IEP to be in effect when the child turns 16, or younger if determined appropriate by the IEP Team, and updated annually, thereafter, the IEP must include-- (1) Appropriate measurable postsecondary goals based upon age appropriate transition assessments related to training, education, employment, and, where appropriate, independent living skills; and (2) The transition services (including courses of study) needed to assist the child in reaching those goals. (c) Transfer of rights at age of majority. Beginning not later than one year before the child reaches the age of majority under State law, the IEP must include a statement that the child has been informed of the child’s rights under Part B of the Act, if any, that will transfer to the child on reaching the age of majority §300.520.

Measurable Post-Secondary Goals (After High School)In the early stages of transition, these goals may be broad, but hopefully will become more specific and measurable as the student refines his/her ideas and reports these to the IEP team. The measurable postsecondary goals should answer the question “What will the student do after high school?” in the areas of employment, education OR training and independent living (where appropriate). Some students may know exactly what it is they want to do or are planning to do. However, others may have no idea of their future plans. By completing age-appropriate transition assessments, including informal checklists, career interest inventories, informal interviews, job shadows, etc., many students will be able to develop dreams and goals for the future following high school. These measurable postsecondary goals should be reviewed by the team annually and revised as needed, based on the student’s strengths, preferences and interests.

Appropriate measurable postsecondary goals must be based upon age-appropriate transition assessments related to: Employment (required) Education OR Training (required) Independent Living Skills (where appropriate)

Assessment results should clarify which measurable post-secondary goals are addressed. If a student is able to complete daily living activities independently, and needs no assistance, a goal for independent living skills would not need to be written. Also, if a student is not planning to attend post-secondary education, the area of education would not need to be addressed, but instead, a goal for postsecondary training would be written. For each measurable post-secondary goal identified, BOTH a linked annual goal AND at least one transition service/activity need to be developed!

The more specific one is in writing these goals, the easier it will be for them to be measurable. To help make the goals measurable, use verbs like “will work”, “will enroll”, “will live”, and wording that clarifies when and how much.These goals should be the student’s desired “destination”, and the IEP should be the roadmap to get them there prepared. For more information, see the “Technical Assistance Guide for Transition in the IEP” at http://www.tslp.org/IEP.htm

Employment(Required)

Based upon the student’s interests, strengths, and needs, which have been identified through age-appropriate transition assessment, and documented on the present levels page, specify the student’s employment goal. This could address paid employment (competitive, supported, sheltered), unpaid, non-employment, part-time employment, etc.

For example:I will be employed as a math or science college professor.I will either enlist in the military or work full-time for my dad’s concrete business.I will work part part-time producing Native American artwork.After graduation, I will work in a school as a janitor, part-time to start with.I will enlist in the Navy when I am 18 and enroll in computer programming.I will be a registered nurse and work in a hospital.

Education(A Measurable post-secondary goal for EITHER Training OR Education is required)

Based upon the student’s interests, strengths, and needs, which have been identified through age-appropriate transition assessment, specify the student’s education goal. This could address a 4 year college, technical school, 2 year college, military, etc.

For example:

21

I will attend a university in SD which has a 4-year nursing program.In January, I will enroll in Lake Area Tech’s Auto Mechanics Program.

Training(A Measurable post-secondary goal for EITHER Training OR Education is required)

Based upon the student’s interests, strengths, and needs, which have been identified through age-appropriate transition assessment, specify the student’s training goal. This could address specific vocational or career field, independent living skill training, vocational training program, apprenticeship, on-the-job training, military, Job Corps, etc.

For example:I will enroll in a Commercial Driver’s License training through Career Learning Center and obtain a CDL.I will take a drawing class. I will also take a ‘budgeting class’ through the Independent Living Center in the community I am living.I will receive on-the-job training through Vocational Rehabilitation to learn how to be a janitor.I will complete the basic training and enroll in an advanced computer training program.

Independent Living Skills (Where appropriate)

Based upon the student’s interests, strengths, and needs, which have been identified through age-appropriate transition assessment, specify the student’s independent living goal. This could address adult living, daily living, independent living, financial, transportation, etc.

For example:I will continue living with my dad for several years.I will live with family until I can afford to live on my own.I will live independently with supports for budgeting & time management.I will live in a dorm by myself or with one roommate.

§300.320 Definition of individualized education program.(b) Transition services. Beginning not later than the first IEP to be in effect when the child turns 16, or younger if determined appropriate by the IEP Team, and updated annually, thereafter, the IEP must include-- (2) The transition services (including courses of study) needed to assist the child in reaching those goals.

Course of StudyThe courses of study should show a direct relationship between what the student’s educational experiences in high school and the student’s desired measurable post-secondary goals. While the level of specificity in the identification of courses is not dictated in the law, common sense would suggest that the more specific one can be in identifying the courses, and showing how they relate to the measurable post-secondary goals, the greater the likelihood that the students will see the relevance and importance of the courses they will be taking. Choosing and documenting elective courses empowers students. Hopefully, the student will then have a vested interest in remaining in school.

Using the student’s measurable post-secondary goals as its guide, the IEP team will need to decide what coursework is needed for the student to successfully reach the stated goals. For instance, students planning to enroll at a college or a technical institute must understand the minimum and recommended course requirements for admission. Does the math sequence contain enough upper-level courses? For students planning to pursue postsecondary education, actively involving regular education teachers and high school guidance counselors in the planning process should be a given.

Perhaps the best way to think about the Courses of Study is as the series of courses and experiences that a student needs to achieve his/her desired measurable post-secondary goals. The course of study should include regular education courses, advanced placement courses, specially designed instruction, community and employment experiences, etc. The listing of educational courses and experiences in the course of study for a student with a mild disability would most likely follow the course offerings of the general education population. The course of study for students with moderate or severe disabilities may be different. Instead of listing specific course titles, for students with moderate to severe disabilities, one should list course content areas (e.g., mobility, self-advocacy/ determination, independent living, money management, personal relationships, etc.)

The course of study should consist of classes and experiences that the student will be taking at the time the IEP is being written through the remainder of the years until graduation from high school or aging out of the school system. The classes listed in the course of study are not ‘mandatory’ or definite, but rather a map of what classes and experiences would benefit the student in reaching the stated measurable post-secondary goals in the IEP. In other words, the IEP team can agree to change one or more of the classes due to interests changing, course failures, etc. The course of study is dependent on the student’s interests, abilities and those courses and electives offered at the student’s school.

22

1. Student planning to attend college to become a high school math teacher:Grade 10 Grade 11 Grade 12English English English

US History World History US GovernmentAlgebra II Geometry Calculus/TrigonometryBiology Chemistry Personal Finance

Fine Arts Spanish II AccountingSpanish I General Business Psychology

Graphic Design Become Your Own Expert! (self-advocacy)

High School Math Tutoring

2. Student planning to enter workforce:Grade 9 Grade 10 Grade 11 Grade 12English I English II English III English IV

Geography US Government World History US HistoryConsumer Math Pre-Algebra Algebra I Personal FinancePhysical Science Biology Pottery Culinary Arts IICarpentry Trades Welding Drawing World of Work

Health/PE Career Studies Culinary Arts I Self AdvocacyComputer I Computer Tech Aide Project Skills Project Skills

3. Student who will age out of school system:Year 2

(age 16/17)Year 3

(age 17/18)Year 4

(age 18/19)Year 5

(age 19/20)Year 6

(age 20/21)Practical Math Basic Math Basic Math - money

managementBasic Math - checkbook Basic Math - Personal

Finances Practical Language Arts Practical Lang. Arts II Practical Lang. Arts III Practical Lang. Arts IV Practical Lang. Arts VI

Social Living Social Living Social Living Health & Sexuality Health & SexualityIn School Work

ExperienceExperience Based Career Education

Project Skills Project Skills Employer-Paid Work

Basic Foods Basic Foods II Daily Living Skills Daily Living Skills Daily Living Skills World of Work World of Work Chorus Chorus Chorus

PE PE PE PE PESelf Advocacy Self Advocacy Self Advocacy Self Advocacy Self Advocacy

4. Student planning to attend a technical institute for computer studies:Grade 9 Grade 10 Grade 11 Grade 12English I English II English III English IV

Geography US History World History US GovtGeneral Math Pre-Algebra Algebra I Personal Finance

Physical Science in the Community

Biology in the Community Biology in the Community II Community Based Computer Interning

Computer I Advanced Computer Graphic Design Web Page DesignPE PE Health World of Web Art

Self Advocacy Unit Self Advocacy Unit Self Advocacy Unit Self Advocacy Unit

23

Transfer of Rights§300.320 Definition of individualized education program.(b) Transition services. Beginning not later than the first IEP to be in effect when the child turns 16, or younger if determined appropriate by the IEP Team, and updated annually, thereafter, the IEP must include—(c) Transfer of rights at age of majority. Beginning not later than one year before the child reaches the age of majority under State law, the IEP must include a statement that the child has been informed of the child’s rights under Part B of the Act, if any, that will transfer to the child on reaching the age of majority under §300.520.

By age 17 or earlier, the student’s IEP must include a statement that the student has been informed of the rights that will transfer to him or her upon reaching age 18. In this section, document the day, month and year the student will turn 17 years old and the day, month year that the parents and the student were informed of the transfer of rights.

Unless parents assume guardianship, all rights previously afforded to parents will transfer when the student turns 18 years of age. The student will receive the prior notice for the IEP and will approve the Individual Education Program. Consent to evaluate or change in educational placement, review of records, and mediation/due process will become rights of the student.

For additional information regarding guardianship, refer to the following website: http://dhs.sd.gov/gdn/ http://www.legis.state.sd.us/statutes/DisplayStatute.aspx?Type=Statute&Statute=29A-5

Graduation or Completion of an Approved Program

§300.102 Limitation--exception to FAPE for certain ages.(iii) Graduation from high school with a regular high school diploma constitutes a change in placement, requiring written prior notice in accordance with §300.503.

§300.305 Additional requirements for evaluations and reevaluations.e) Evaluations before change in eligibility.(1) Except as provided in paragraph (e)(2) of this section, a public agency must evaluate a child with a disability in accordance with §§300.304 through 300.311 before determining that the child is no longer a child with a disability.(2) The evaluation described in paragraph (e)(1) of this section is not required before the termination of a child’s eligibility under this part due to graduation from secondary school with a regular diploma, or due to exceeding the age eligibility for FAPE under State law.

Parents must be informed through the IEP process at least one year in advance (typically at the 11 th Grade IEP meeting) of the intent to graduate their child upon completion of the individual educational program and to terminate services by graduation. The IEP shall state specifically how the student in need of special education will satisfy the district’s graduation requirements. In the space provided, document the number of credits needed and the specific classes/courses that the students must complete to meet graduation requirements. Please do not attach lists of the district courses required for graduation, transcripts, or make statements such as “refer to”.

Before a student exits special education and receives a diploma, the IEP team must verify that:a. the school district’s graduation requirements will be or have been met, orb. the student’s measurable annual goals will be substantially completed, andc. new measurable annual goals are not needed for the coming school year.

CFR 300.102 (a)(3)(iii) Written notice requiredGraduation from high school with a regular high school diploma constitutes a change in placement, requiring written prior notice in accordance with 300.503.

Summary of Performance

Summary of PerformanceCFR 300.304 Evaluation procedures.(B) (e) Evaluations before change in placement.

(1) Except as provided in paragraph (e)(2) of this section, a public agency must evaluate a child with a disability in accordance with §§300.304 through 300.311 before determining

24

that the child is no longer a child with a disability.(2) The evaluation described in paragraph (e) (1) of this section is not required before the

termination of a child’s eligibility under this part due to graduation from secondary school with a regular diploma, or due to exceeding the age eligibility for FAPE under State law.

(3) For a child whose eligibility terminates under circumstances described in paragraph (e)(2) of this section, a public agency must provide the child with a summary of the child’s academic achievement and functional performance, which shall include recommendations on how to assist the child in meeting the child’s postsecondary goals.

This Summary will typically be discussed and given to the student at the exit IEP meeting.Refer to the “Technical Assistance Guide for Transition in the IEP” at http://tslp.org/IEP.htmfor a recommended form and examples to use when developing a summary of performance.

State Performance Plan Indicator 14

Indicator 14, mandated by IDEA 2004, involves tracking post school outcomes for special education students. District outcome data could be used to improve transition programming. Exit Surveys: Districts are contacted in the spring and asked to complete and submit exit surveys (Appendix A) for all special education students who have dropped out, will be aging out of special education, or graduating with a regular diploma during the current school year. Up-to-date contact information should be gathered at senior and exit IEPs. One Year Follow-Up: For students who graduated, aged out, or dropped out. Students will be contacted one year after exiting, by a contract agency, to determine their status in regards to employment, postsecondary school, and other outcomes (Appendix B).

25

Transition Services / Coordinated Set of Activities Page 4B These 7 categories are from section 300.42 of IDEA 2004*Transition Services must be a coordinated set of Activities/Strategies designed within a results oriented process. This means that the activities are those steps or things that need to happen that will lead to post-school results and help the student achieve their desired post secondary goals. All of the activities that will need to happen to help students achieve their post secondary goals cannot be done by the school alone. Thus, the activities should include those things that others (students, families and the appropriate adult services, agencies or programs) will need to do. When viewed as a whole, the activities should demonstrate involvement and coordination between schools, students, families and the appropriate adult services, agencies or programs.

Instruction: Activity Recommendations Personnel/Agency/Person Responsible Date Initiated Date Completed

Related Services: Activity Recommendations Personnel/Agency/Person Responsible Date Initiated Date Completed

Community Experiences:Activity Recommendations Personnel/Agency/Person Responsible Date Initiated Date Completed

Employment: Activity Recommendations Personnel/Agency/Person Responsible Date Initiated Date Completed

Other Post-School Adult Living Objectives: Activity Recommendations Personnel/Agency/Person Responsible Date Initiated Date Completed

Acquisition of Daily Living Skills (When appropriate): Activity Recommendations Personnel/Agency/Person Responsible Date Initiated Date Completed

Functional Vocational Evaluation (When appropriate): Activity Recommendations Personnel/Agency/Person Responsible Date Initiated Date Completed

26

Directions for Completing Page 4B

Transition Services / Coordinated Set of Activities

Transition services must be a coordinated set of activities or strategies, designed within a results- oriented process. The activities/strategies are those things that need to happen that will lead to post-school results and help the student to achieve the desired measurable post-secondary goals. The IEP team will review/revise the activities annually. Members of the team may list activities/services for the upcoming year OR they may choose to list ALL activities/services needed from the present time until the student graduates or ages out. If based on the student’s PLAAFPs for transition, there are no needs in one or more of the seven transition service areas, then simply indicate Not Applicable (N/A) on the form. At a bare minimum, at least one activity/service must be listed which ties back to each of the student’s Measurable Postsecondary Goals.

Activity Recommendations

Instruction: Activities listed under this heading have to do with ‘instruction’, whether it is formal or informal. This could include, but is not limited to such things as:**Broad curricular areas of needed coursework, educational experiences, skill training, etc. or**Activities/strategies which are necessary to prepare for and take part in college, continuing education, further skill training, adult living, etc.Related Service: This area of the statement of needed transition services is not for identifying the needed related services for the current IEP year. That is to be addressed in another section of the IEP. Rather, this area pertains to the projected needs for related services beyond high school. Will the related services that the student is currently receiving be necessary beyond high school? (Ex. - If a student is receiving mental health counseling and it is probable that counseling will need to continue following graduation from high school, the team would then address activities that can be done this year to help insure continued mental health counseling following high school. This may also pertain to speech/ language, OT, PT, etc.) This particular service area will not apply to the majority of students.Community Experience: Activities listed here should emphasize strategies that are generally provided outside the school building and that prepare the student for participation in community life.Employment: These activities will focus on development of work-related behavior, job seeking and keeping skills, career exploration, actual employment, etc.Other Post-School Adult Living Objectives: Activities listed in this area should focus on adult living skills. These are generally those activities that are done occasionally - such as, registering to vote, getting driver’s license, renting or buying a home, filing taxes, buying insurance, etc.Acquisition of Daily Living Skills (when appropriate): These activities will also focus on adult living skills but are generally on a daily basis - such as, preparing meals, cleaning, paying bills, personal hygiene, etc.Functional Vocational Evaluation (when appropriate): This is an assessment process that provides information about job or career interests, aptitudes, and skills. This process can include observations, formal or informal measures, and should be practical.

Personnel/Agency/Person Responsible

All of the activities that will need to happen to help students achieve their post-secondary goals cannot be done by the school alone. Students, families, and appropriate adult services agencies or programs, along with the school, may be responsible for completing the activities listed. This is an excellent way for families to develop more ownership of the IEP.

Date Initiated This can be the starting date of the IEP, or better yet, the date that the activity will be started.

Date Completed Activities should be checked off as they are completed. If an activity/service identified for the current year was not completed as recommended, the team should decide at the next IEP whether or not to carry it over to the next year’s activities.For several pages of possible activities and services, please refer to the

“Technical Assistance Guide for Transition in the IEP” at http://tslp.org/IEP.htm.

27

Student Name Title of Personnel Responsible

Measurable Annual Goal #_____ Proc. Code/s

Date Prog.Code

Comments:

Short Term Instructional Objectives or Benchmarks (Required for students who take alternate assessments aligned to alternate achievement standards.

Proc. Code/s

Date Prog.Code

Comments:

Accommodations/Modifications/Supplementary Aides and Services1.____________________________________________________________________2.____________________________________________________________________3.____________________________________________________________________4.____________________________________________________________________5. ____________________________________________________________________

Frequency__________________________________________

Location________________________________________

Begin Date________________________________________

Duration________________________________________

Statement of the program modifications or supports for school personnel (as appropriate):

Frequency Location Begin Date Duration

Procedure Codes (Complete at IEP meeting)1. Teacher-made tests 6. Work Samples2. Observations 7. Portfolios3. Weekly tests 8. Oral Tests4. Unit tests 9. Data Response5. Student Conferences 10. Other:

Progress Codes P= Progress being madeI= Insufficient Progress to meet goalX= Not addressed this Reporting PeriodM=Met goal

Reporting Frequency to Parents Quarterly Reports Trimester Reports Other: _______

Reporting Method to Parents Conferences Report Card Goal Page Copy Other:

Educational Goals and Objectives/Benchmarks Page 5 ___

28

Directions for Completing Page 5

§300.320 Definition of individualized education program.(a) General. As used in this part, the term individualized education program or IEP means a written statement for each child with a disability that is developed, reviewed, and revised in a meeting in accordance with §§300.320 through 300.324, and that must include-- (2)(i) A statement of measurable annual goals, including academic and functional goals designed to-- (A) Meet the child’s needs that result from the child’s disability to enable the child to be involved in and make progress in the general education curriculum; and (B) Meet each of the child’s other educational needs that result from the child’s disability;

Student Name State the full name of the student, including middle name or initial.

Title of Person Responsible

The position title of each person responsible for implementing the annual goal should be listed in this section. Do not use individual names. The parent and student may be included.

Measurable Annual Goals

Annual goals must include the condition performance and criteria specific to the student PLAAFPs.Condition: The condition segment of an annual goal represents the circumstances under which you will be presenting information or material to the student so the skill they are to perform can be measured or observed. It is sometimes referred to as the “when given” statements.The performance segment of the annual goal represents the very specific skill or observable behavior the student will be expected to perform when the condition presents itself.Performance: These skills are identified on an individual basis through developmental or functional assessment. The skills identified should link to the districts general curriculum and content standards beginning at the student current level of performance working towards grade level content.Criteria: The criteria segment of the annual goal represents how the skill or behavior will be measured. The criteria must include how well (accuracy) and how often (consistency) the student must perform the skill or behavior in order to consider it mastered.Note: The procedure codes you document in this section of the IEP represent what will be used to gather or measure the criteria.Please use as many goal pages as necessary, numbering them “5A”, “5B” and so on.

Refer to Appendix A for sample goals.

Short Term Instructional Objectives ORBenchmarks

Required for all students working in alternate content standards and taking the alternate assessment.

Short-term objectives are measurable, intermediate steps between a student's present level of educational performance and the annual goals established for the student. Their development is based on a logical breakdown of the major components of the annual goals and they measure progress toward meeting the goals. They set the general direction to be taken by those who will implement the IEP and are the basis for developing a detailed instructional plan for the student.ORBenchmarks represent the actual content or performance the student is to accomplish at a specific interval or grade level. The IEP Team should evaluate skills and performance levels to meet goals and select those for possible benchmarks in the IEP.

A district may choose to use either a short-term objective or benchmark format; however there must be more than one short-term objective or benchmark for each annual goal.

§300.320 Definition of individualized education program.(a) General. As used in this part, the term individualized education program or IEP means a written statement for each child with a disability that is developed, reviewed, and revised in a meeting in accordance with §§300.320 through

29

300.324, and that must include-- (4) A statement of the special education and related services and supplementary aids and services, based on peer-reviewed research to the extent practicable, to be provided to the child, or on behalf of the child, and a statement of the program modifications or supports for school personnel that will be provided to enable the child-- (i) To advance appropriately toward attaining the annual goals; (ii) To be involved in and make progress in the general education curriculum in accordance with paragraph (a)(1) of this section, and to participate in extracurricular and other nonacademic activities; and (iii) To be educated and participate with other children with disabilities and nondisabled children in the activities described in this section; (7) The projected date for the beginning of the services and modifications described in paragraph (a)(4) of this section, and the anticipated frequency, location, and duration of those services and modifications.§300.42 Supplementary aids and services.Supplementary aids and services means aids, services, and other supports that are provided in regular education classes, other education-related settings, and in extracurricular and nonacademic settings, to enable children with disabilities to be educated with nondisabled children to the maximum extent appropriate in accordance with §§300.114 through 300.116.

Federal Register Analysis: There is nothing in the Act that requires an IEP to include specific instructional methodologies. Therefore, consistent with section 614(d)(1)(A)(ii)(I) of the Act, we cannot interpret section 614 of the Act to require that all elements of a program provided to a child be included in an IEP. The Office of Special Education Programs (OSEP) longstanding position on including instructional methodologies in a child’s IEP is that it is an IEP Team’s decision. Therefore, if an IEP Team determines that specific instructional methods are necessary for the child to receive FAPE, the instructional methods may be addressed in the IEP.

Accommodations -Modifications – Supplementary Aides and Services

The IEP team needs to consider the skill area affected by the disability in the annual goal and determine if accommodations/modifications need to be made for the student to be successful in his or her program. Ask the question, are they accommodations/modifications the student “MUST” have in order to benefit from the program. They MUST be provided at the frequency, duration and location specified in the IEP. These are not optional or delivered at the discretion of the teacher.Do not include instructional practices that a teacher provides for the entire class or accommodations/modifications needed because of a one time lesson plan activity or things the student “might” need. These types of accommodations/modifications are provided to any student when appropriate just because you are a good teacher.

Program Modifications or Supports for School Personnel.

Write a description of any program modifications or supports for school personnel necessary for the child to advance appropriately toward the annual goals, to progress in the general curriculum, and to be educated and participate with other children both with and without disabilities.Examples:

FM system will be installed in the regular education classroom. General education teacher will receive training in sign language to facilitate

communication with student during class time.

Frequency Specify the frequency the accommodations/modifications will need to be provided. (i.e. daily, weekly, monthly etc.)

Example, oral tests to be provided for “all testing occurrences” or a calculator to be provided whenever the student is required to do “division problems”. Do not write “as needed” or at the discretion of the teacher. Use the box and put in an example using the boxes.

Location For each modification/accommodation listed, the team must specify the location in which it will 30

need to be provided. (i.e. art, geography, math, consumer science etc.) All teachers must be informed of the accommodations/modifications they are required to implement in their class. The student’s teachers must have access to copies of the IEP.

Example, oral tests to be provided for “all testing occurrences” in “Science and Geography” class or a calculator to be provided whenever the student is required to do “division problems” in “Math” class.

Beginning Date Specify the date (month, day, year) that the modification/accommodation will be implemented if different than the duration of the IEP.

Duration Federal Register Analysis: The meaning of the term “duration” will vary, depending on such things as the needs of the child, the service being provided, the particular format used in an IEP, and how the child’s day and IEP are structured. What is required is that the IEP include information about the amount of services that will be provided to the child, so that the level of the agency’s commitment of resources will be clear to parents and other IEP team members. The amount of time to be committed to each of the various services to be provided must be appropriate to the specific service, and clearly stated in the IEP in a manner that can be understood by all involved in the development and implementation of the IEP.

Many times this timeline will be the duration of the IEP (one year from the meeting date). However, this timeline must be considered for each accommodation/modification individually by the IEP team.

Procedure Codes The procedure code indicates the assessment method(s) that will be used to measure progress. From the list below, select the assessment method that matched the criteria written the annual or the objective/benchmark. More than one procedure code may be selected to measure progress (i.e. weekly test and work samples).

Date This date will be the date (month, day, and year) that the progress report is written.

Progress Codes The progress code listed in sections will represent the level of progress made by the student on each annual or the short term objective/benchmark during the reporting period.

Comments Additional space if provide to make personal comments to parent regarding the students progress toward the annual goal.Note: If progress reports are written on a copy of the goal pages and not on the original, be sure to place the document containing the yearly progress information in the students file when the new IEP is written.

Reporting Frequency to Parents

Check the box that represents the frequency the parent will receive progress reports. This should, at a minimum, coincide with the frequency that general education students receive report cards.

Reporting Method to Parents

Check the box(s) that indicated how progress toward the annual goal will be reported to the parents. More than one box may be checked.

31

Related Services to Be Provided Page 6

Related Service to be Provided Title of Person Responsible

Amount of Service

Location of Service

Duration of Service (If less than duration of IEP)

A. Occupational Therapy

B. Physical Therapy

C. Psychological Services

D. Counseling Services (including rehabilitation counseling)

E. Social Work Services (in schools)

F. Audiological Services

G. Recreation Therapy

H. School Nurse/Health Services

I. Speech/Language Therapy

J. Transportation (Specify when, how often, where, distance, costs, etc.)

K. Orientation and Mobility

L. Medical Services (Diagnostic Services only)

M. Interpreting Services

N. Parent Counseling/Training

O. Other

32

Directions for Completing Page 6

ARSD 24:05:27:03.     IEP team to determine related services . In developing a child's individual educational program, the members of the IEP team shall determine whether any developmental, corrective, or other supportive services, including transportation, are required to assist a child to benefit from special education. These services must be written into the individual educational program as related services.ARSD 24:05:27:04.     Determination of related services. In deciding whether a particular developmental, corrective, or other supportive service is a related service, the members of the IEP team shall review the results of the individual evaluations used to determine the child's need for special education. Based on the specific special education services to be provided, the team shall determine whether or not related services are required in order to implement the special education program being recommended.ARSD 24:05:24.01:01.     Students with disabilities defined . Students with disabilities are students evaluated in accordance with chapter 24:05:25 as having autism, deaf-blindness, deafness, hearing loss, cognitive disability, multiple disabilities, orthopedic impairment, other health impairments, emotional disturbance, specific learning disabilities, speech or language impairments, traumatic brain injury, or vision loss including blindness, which adversely affects educational performance, and who, because of those disabilities, need special education or special education and related services. If it is determined through an appropriate evaluation, under chapter 24:05:25, that a student has one of the disabilities identified in this chapter, but only needs a related service and not special education, the student is not a student with a disability under this article. If, consistent with this chapter, the related service required by the student is considered special education, the student is a student with a disability under this article.

Related services are those services required by the individual student in order to benefit from his/her special education program. The IEP team will determine what related services are needed, the person responsible, the amount, location, and duration of the service. The need for a related service is based upon the program already developed by the IEP team. If the IEP decides that a related service is needed, turn back to the goal page that the therapy will impact and add the position title to the list of persons responsible for carrying out the goal/objective.

For example, due to a student’s behavior, the team assessed, developed PLAAFPs and wrote a behavior goal as part of the students program. In determining “what related service was needed for the student to benefit from the program”, the team indicated the student would benefit from the related service of counseling. “Counselor” was added to the list of persons responsible for implementing the behavior goal. The team does not go back and write a goal specific to counseling. The same principle applies to a child with developmental delay.

For example, a child was determined eligible as developmentally delayed under the areas

of fine motor and gross motor. The IEP team developed PLAAFPs and wrote a fine and gross motor goal as part of the child’s program of specialized instruction. The preschool special teacher is assigned as the person responsible for carrying out the program. In determining “what related service was needed for the student to benefit from the program”, the team indicated the child would benefit from the related service of Occupational Therapy. “Occupational Therapist” was added to the list of persons responsible for implementing the fine motor goal. The team does not go back and write a goal specific to Occupational Therapy.

If a district will be using a parent’s private or public benefits (Medicaid) you need to very carefully document the amount of services and duration of services. Parental consent is required each time a public agency accesses a parent’s private or public benefits. Parents need to know how many times you will be accessing their insurance. There is a sample parent consent form in Appendix B.

For each related service needed, the IEP teams documents the following:Title of Person ResponsibleThe title of the personnel responsible to carry out the related service should be identified in this section. If

Amount of ServiceThe amount of service must include the number of minutes/hour that will be provided to the student on

Location of ServiceThe location of service needs to describe specifically the location where the student will be

Duration of ServiceThe duration reflects the length of time to be committed to each of the various services and be

33

the service will be provided by more than one person, note the person responsible, amount, location and duration for each person that will be delivering the service.Example: Physical Therapist

Example if a district is accessing private or public insurance:Physical Therapist

a daily, weekly, monthly basis.Example: 30 minutes/wk.

30 minutes a week

receiving the service.Example: Gymnasium

PT office in gym.

clearly stated in the IEP. Many times the duration will be the duration of the IEP (one year from the meeting date). However, this timeline must be considered individually by the IEP team for each related service.Example: End of the 1st semester. X 32 school weeks = 960 minutes of serviceSee sample form in Appendix.

Occupational Therapy

§300.34 Related services.(6) Occupational therapy— (i) Means services provided by a qualified occupational therapist; and (ii) Includes-- (A) Improving, developing, or restoring functions impaired or lost through illness, injury, or deprivation; (B) Improving ability to perform tasks for independent functioning if functions are impaired or lost; and (C) Preventing, through early intervention, initial or further impairment or loss of function.

Refer to “Determining Eligibility for Special Education in South Dakota” for eligibility criteria for OT services. http://doe.sd.gov/oess/specialed/forms/index.asp

Physical Therapy §300.34 Related services. (9) Physical therapy means services provided by a qualified physical therapist.

Refer to “Determining Eligibility for Special Education in South Dakota” for eligibility criteria for PT services. http://doe.sd.gov/oess/specialed/forms/index.asp

Psychological Services

§300.34 Related services.(10) Psychological services includes-- (i) Administering psychological and educational tests, and other assessment procedures; (ii) Interpreting assessment results; (iii) Obtaining, integrating, and interpreting information about child behavior and conditions relating to learning; (iv) Consulting with other staff members in planning school programs to meet the special educational needs of children as indicated by psychological tests, interviews, direct observation, and behavioral evaluations; (v) Planning and managing a program of psychological services, including psychological counseling for children and parents; and (vi) Assisting in developing positive behavioral intervention strategies.

Counseling Services (including rehabilitation counseling)

§300.34 Related services.(2) Counseling services means services provided by qualified social workers, psychologists, guidance counselors, or other qualified personnel.(12) Rehabilitation counseling services means services provided by qualified personnel in individual or group sessions that focus specifically on career development, employment preparation, achieving independence, and integration in the workplace and community of a student with a disability. The term also includes vocational rehabilitation services provided to a student with a disability by vocational rehabilitation programs funded under the Rehabilitation Act of 1973, as amended, 29 U.S.C. 701 et seq.

Social Work §300.34 Related services.

34

Services (in schools) (14) Social work services in schools includes-- (i) Preparing a social or developmental history on a child with a disability; (ii) Group and individual counseling with the child and family; (iii) Working in partnership with parents and others on those problems in a child’s living situation (home, school, and community) that affect the child’s adjustment in school; (iv) Mobilizing school and community resources to enable the child to learn as effectively as possible in his or her educational program; and (v) Assisting in developing positive behavioral intervention strategies.

Audiological Services

§300.34 Related services.(1) Audiology includes-- (i) Identification of children with hearing loss; (ii) Determination of the range, nature, and degree of hearing loss, including referral for medical or other professional attention for the habilitation of hearing; (iii) Provision of habilitative activities, such as language habilitation, auditory training, speech reading (lip-reading), hearing evaluation, and speech conservation; (iv) Creation and administration of programs for prevention of hearing loss; (v) Counseling and guidance of children, parents, and teachers regarding hearing loss; and (vi) Determination of children's needs for group and individual amplification, selecting and fitting an appropriate aid, and evaluating the effectiveness of amplification.

Recreation Therapy

§300.34 Related services.(11) Recreation includes-- (i) Assessment of leisure function; (ii) Therapeutic recreation services; (iii) Recreation programs in schools and community agencies; and (iv) Leisure education.

School Nurse/Health Services

§300.34 Related services.(13) School health services and school nurse services means health services that are designed to enable a child with a disability to receive FAPE as described in the child’s IEP. School nurse services are services provided by a qualified school nurse. School health services are services that may be provided by either a qualified school nurse or other qualified person.

Speech Therapy Services

§300.34 Related services (15) Speech-language pathology services includes-- (i) Identification of children with speech or language impairments; (ii) Diagnosis and appraisal of specific speech or language impairments; (iii) Referral for medical or other professional attention necessary for the habilitation of speech or language impairments; (iv) Provision of speech and language services for the habilitation or prevention of communicative impairments; and (v) Counseling and guidance of parents, children, and teachers regarding speech and language impairments.

Transportation §300.34 Related services (16) Transportation includes-- (i) Travel to and from school and between schools; (ii) Travel in and around school buildings; and (iii) Specialized equipment (such as special or adapted buses, lifts, and ramps), if required to provide special transportation for a child with a disability.

Transportation services should be clearly spelled out in this section. Identify who will provide the transportation, special equipment and personnel (if any) to assure safety of the child, cost, responsible party to pay for transportation, and schedule of transportation service (days of the week, times of the day).

Orientation and §300.34 Related services (7) Orientation and mobility services-- (i) Means services provided to blind or visually impaired

35

Mobility children by qualified personnel to enable those students to attain systematic orientation to and safe movement within their environments in school, home, and community; and (ii) Includes teaching children the following, as appropriate: (A) Spatial and environmental concepts and use of information received by the senses (such as sound, temperature and vibrations) to establish, maintain, or regain orientation and line of travel (e.g., using sound at a traffic light to cross the street); (B) To use the long cane or a service animal to supplement visual travel skills or as a tool for safely negotiating the environment for children with no available travel vision; (C) To understand and use remaining vision and distance low vision aids; and (D) Other concepts, techniques, and tools.

Medical Services(Diagnostic Services only)

§300.34 Related services (5) Medical services means services provided by a licensed physician to determine a child’s medically related disability that results in the child’s need for special education and related services.

Medical services are provided as a related service only in the cases where a medical diagnosis is needed to assure the proper identification of the child's educational needs. For example, the school district may provide a physician review to assure that attention deficits are not related to hearing or other physical problems of the child.

Interpreting Services

§300.34 Related services (4) Interpreting services includes-- (i) The following, when used with respect to children who are deaf or hard of hearing: Oral transliteration services, cued language transliteration services, sign language transliteration and interpreting services, and transcription services, such as communication access real- time translation (CART), C-Print, and Type Well; and (ii) Special interpreting services for children who are deaf-blind.

Parent Counseling/Training

§300.34 Related services (8)(i) Parent counseling and training means assisting parents in understanding the special needs of their child; (ii) Providing parents with information about child development; and (iii) Helping parents to acquire the necessary skills that will allow them to support the implementation of their child’s IEP or IFSP.

Other This section of the form is provided to include related services not included in any of the other general categories listed.For Example:Personal Assistant - Paraprofessional – 7:45 am to 3:30 pm M-W-F – Transport to and from School/Student Class Schedule – 2007-08 School Year

If a paraprofessional is assigned to a classroom and not the student, it does not need to be documented.

36

State/District Assessment Accommodations Page 7 1. Student will be taking the assessment without accommodations.

2. Student will be taking the assessment with the accommodations.

***Teams must consider if the accommodations are approved for the applicable test administration.

***List the accommodations the student will be taking for each test/test area. (Only those accommodations identified for instruction on the goal pages can be considered for state and district wide testing. The accommodations selected for use must relate to the students disability.)

Grades 3-4-5-6-7-8-11 Grades 5 & 9 District Specific Tests Dakota STEP Stanford Name: Reading Writing Area(s) ____________________________ ______________________________ ____________________________ ____________________________ ______________________________ ____________________________ ____________________________ ______________________________ ____________________________ ____________________________ ______________________________ ____________________________ Math ____________________________ ______________________________ ____________________________ ____________________________ ______________________________ ____________________________ ____________________________ ______________________________ ____________________________ ____________________________ ______________________________ ____________________________ Grades 5-8-11 Science ____________________________ ______________________________ ____________________________ ____________________________ ______________________________ ____________________________ ____________________________ ______________________________ ____________________________

* Alternate AssessmentAll accommodations documented in the IEP are allowed to be used for students taking the alternate assessment.

37

Directions for Completing Page 7

§300.320 Definition of individualized education program.(a) General. As used in this part, the term individualized education program or IEP means a written statement for each child with a disability that is developed, reviewed, and revised in a meeting in accordance with §§300.320 through 300.324, and that must include-- (6)(i) A statement of any individual appropriate accommodations that are necessary to measure the academic achievement and functional performance of the child on State and district wide assessments consistent with section 612(a)(16) of the Act; and

State/District Assessment Accommodations: The Individuals with Disabilities Education Act presupposes that all special education students will fully participate in all district-wide assessments in the same manner as their non-disabled peers unless the IEP team determines that: (1) such participation is not appropriate without reasonable accommodations or (2) such assessment is not appropriate and identifies an alternate form of assessment. Special Education Programs has an assessment flowchart available at the following website: http://doe.sd.gov/oess/specialed/news/docs/AssessmentFlowchart.pdf. http://doe.sd.gov/oess/specialed/Assessment_Standards/index.asp

Taking assessments without accommodations

Student will be taking the assessment without accommodations. If this option is selected nothing else needs to be completed on this page.

Taking assessments with accommodations Teams must consider if the accommodations are approved for the applicable test administration.

In order for an accommodation to be considered for statewide assessment, it must first be an accommodation identified as an instructional accommodation in the IEP that is used regularly by the student. Accommodations that are not approved for test administration cannot be provided as they invalidate the test results. Additional information is located in the Test Coordinators Handbook or you can visit the following website: http://doe.sd.gov/oess/specialed/forms/pdf/SDAccommodationsManual.pdf.

Refer to Appendix A for a list of approved standard accommodations.

Alternate Assessment Unlike the D-STEP which has allowable accommodations that may not include all accommodations identified on the IEP, the alternate (D-STEP-A) allows any accommodations that a student may need that are identified as accommodations on the student’s IEP. Another difference is that on the D-STEP all accommodations identified on the IEP for statewide testing must be provided, on the D-STEP-A the teacher can determine what accommodations need to be used during the testing window.  Just as providing accommodations on the D-STEP "levels the playing field" allowing students to access the assessment, accommodations provided on the D-STEP-A may actually hinder a student’s equal access to the assessment.  Judgments based on the students independence level, setting, and frequency are made based on the student’s performance during the testing window.  It is possible that a teacher may want to see how a student performs with fewer or less restrictive accommodations during the testing window in order to provide an accurate picture of the student’s performance level. Therefore, specific accommodations do not need to be identified strictly for testing purposes, rather any accommodations that have been identified on the student’s IEP are allowed and it is up to the discretion of the teacher as to how those accommodations will be provided during the testing window. 

38

Least Restrictive Environment Page 8

Continuum of Alternative Placements 0100 General Classroom with Modifications 80-100% 0110 Resource Room 40-79% 0120 Self-Contained Classroom 0-39% 0130 Separate Day School 0140 Residential Facility 0150 Home/Hospital

Continuum of Alternative Placements (Ages 3-5) 0315 Early Childhood Setting 80-100% 0325 Early Childhood Setting 40-79% 0330 Early Childhood Setting 0-39% 0335 Separate Class 0345 Separate School 0355 Residential Facility 0365 Home 0375 Service Provider Location

Special Education to be provided: Description of services Amount of service Location of service

Participation with Non-Disabled Peers (Complete for all students Ages 6-21)Program Options

Art Industrial Technology Music

Vocational Education Family & Consumer Science Other____________________

Comments

Non-Academic Counseling Meals Employment Referrals

Recess Health Services Other____________________

Comments

Extracurricular Athletics Clubs Groups

Recreation Other____________________

Comments

Justification for Placement--An explanation of the extent, if any, to which the child will not participate with non-disabled children in regular classes, and non-academic activities. (Please use accept/reject format for each alternative placement considered.)

The team addressed the potential harmful effects of the special education placement.

39

Directions for Completing Page 8

§300.115 Continuum of alternative placements.(a) Each public agency must ensure that a continuum of alternative placements is available to meet the needs of children with disabilities for special education and related services.(b) The continuum required in paragraph (a) of this section must-- (1) Include the alternative placements listed in the definition of special education under §300.38 (instruction in regular classes, special classes, special schools, home instruction, and instruction in hospitals and institutions); (2) Make provision for supplementary services (such as resource room or itinerant instruction) to be provided in conjunction with regular class placement.§300.116 Placements.In determining the educational placement of a child with a disability, including a preschool child with a disability, each public agency must ensure that--(a) The placement decision-- (1) Is made by a group of persons, including the parents, and other persons knowledgeable about the child, the meaning of the evaluation data, and the placement options; and (2) Is made in conformity with the LRE provisions of this subpart, including §§300.114 through 300.118;(b) The child’s placement-- (1) Is determined at least annually; (2) Is based on the child’s IEP; and (3) Is as close as possible to the child’s home;(c) Unless the IEP of a child with a disability requires some other arrangement, the child is educated in the school that he or she would attend if nondisabled;(d) In selecting the LRE, consideration is given to any potential harmful effect on the child or on the quality of services that he or she needs; and(e) A child with a disability is not removed from education in age-appropriate regular classrooms solely because of needed modifications in the general education curriculum.Placement Codes Students Ages 6-21

Description

0100

Regular Classroom with Modification

A student is in this category if he/she receives special education or special education and related services inside the regular class 80 percent or more of the day of the school day. This may include children and youth with disabilities placed in:

Regular class with special education/related services provided within regular class; Regular class with instruction within the regular class and with special education/related

services provided outside regular class, or Regular class with special education services provided in a resource room.

0110

Resource Room

A student is in this category if he/she receives special education or special education and related services inside regular class no more than 79% of day and no less than 40% percent of the day of the school day:

Resource room with special education/related services provided with the resource room, Resource room with part-time instruction in a regular class.

0120Self-Contained Classroom

A student is in this category if he/she receives special education and related services inside regular class less than 40 percent of the day of the school day. This includes only children and youth with disabilities educated on the regular campus. Do not include students who received education programs in public or private separate day or residential facilities. This may include children and youth placed in:

Self-contained special classrooms with part-time instruction in a regular class, or Self-contained special classrooms full-time on a regular school campus

0130Separate Day School

A student in this category received education services in public or private separate day school facilities. This includes children with disabilities receiving special education and related services, at public expense, for greater than 50 percent of the school day in public or private separate schools. This may include children placed in:

public and private day schools for students with disabilities; public and private day schools for students with disabilities for a portion of the school

day (greater than 50 percent) and in regular school buildings for the remainder of the school day; or

public and private residential facilities if the student does not live at the facility.

0140 A student is in this category receives education services and lives in public or private residential 40

Residential Facility facilities during the school week. This includes children with disabilities receiving special education and related services, at public expense, for greater than 50 percent of the school day in public or private residential facilities. This may include children placed in:

public and private residential schools for students with disabilities; or public and private residential schools for students with disabilities for a portion of the

school day (greater than 50 percent) and in separate day schools or regular school buildings for the remainder of the school day.

Do not include students who received education programs at the facility, but do not live there.

0150Home/Hospital

A student is in this category receives education services in homebound/hospital environments and includes children with disabilities placed in and receiving special education and related services in:

hospital programs, or homebound programs.

Do not include children with disabilities whose parents have opted to home-school them and who receive special education at the public expense.

Placement Codes Students ages 3-5

Description

0315

Early Childhood Setting 80-100%

A student is in this category if he/she attends an Early Childhood Program that includes at least 50% non-disabled children; receives special education and related services outside the regular classroom for less than 21% of the school day.

0325

Early Childhood Setting 40-79%

A student is in this category if he/she attends an Early Childhood Program that includes at least 50% non-disabled children; receives special education and related services outside the regular classroom for more then 21% but less than 60% of the school day

0330

Early Childhood Setting 0-39%

A student is in this category if he/she attends an Early Childhood Program that includes at least 50% non-disabled children; receives special education and related services outside the regular classroom for more than 60% of the school day.

Examples of an Early Childhood Program:

--Head Start --Group child care--Kindergarten --Reverse mainstream classroom --Private preschools--Preschool classes offered to an eligible pre-kindergarten population by the public school system

Calculating Percentage of time spent in a regular early childhood program:Numerator = # hours per week spent in a regular early childhood program

Denominator = # hours spent in a regular early childhood program PLUS # hours spent receiving special education and related services outside the regular early childhood programSee example of calculation: http://doe.sd.gov/oess/specialed/docs/LRE.PDF.

0335

Separate Class

A student is in this category if he/she attends special education program. A program that includes less than 50% non-disabled children.

0345

Separate School

A student is in this category if he/she attends a special education program in public or private day schools designed specifically for children with disabilities.

41

0355

Residential Facility

A student is in this category if he/she attends education programs in publicly or privately operated residential schools or residential medical facilities on an inpatient basis.

0365

Home

A student is in this category if he/she receives special education and related services in the principal residence of the child’s family or caregivers, and who did not attend an early childhood program or a special education program provided in a separate class, separate school or residential facility.

0375

Service Provider Location

A student is in this category if he/she receives special education and related services from a service provider, and who did not attend an early childhood program or a special education program provided in a separate class, separate school, or residential facility. Examples: Specialized instruction provided in the service provider’s office, in school buildings, on an outpatient basis in hospital facilities, libraries and other public locations.

§300.320 Definition of individualized education program.(4) A statement of the special education and related services and supplementary aids and services, based on peer-reviewed research to the extent practicable, to be provided to the child, or on behalf of the child, and a statement of the program modifications or supports for school personnel that will be provided to enable the child-§300.320 (a)(7) Comment Initiation, Frequency, Location and Duration of Services What is required is that the IEP include information about the amount of services that will be provided to the child, so that the level of the agency's commitment of resources will be clear to parents and other IEP Team members.   The amount of time to be committed to each the various services to be provided must be appropriate to the specific service and clearly state in the IEP in a manner that can be understood by all involved into the development and implementation the IEP.

Special Education to be Provided

The service area, amount of service and location of service to be provided must be documented for the total amount of time a student is removed from their typical peer group. Only the amount of time the student is removed from their peers group is calculated to determine the placement category.For Example:Articulation – 30 minutes weekly – Speech therapy room.Written Language – 10 minutes daily – Resource roomFine Motor – 20 minutes weekly – Head Start therapy room

Services provided to the student in the regular classroom setting should also be documented. This may include a teacher or paraprofessional spending time in a general education class with the student. For Example: Math/paraprofessional assistance – 15 minutes daily – General math classroomIf all services are provided in the general education setting, write a statement indicating this.

§300.117 Nonacademic settings.In providing or arranging for the provision of nonacademic and extracurricular services and activities, including meals, recess periods, and the services and activities set forth in §300.107, each public agency must ensure that each child with a disability participates with nondisabled children in the extracurricular services and activities to the maximum extent appropriate to the needs of that child. The public agency must ensure that each child with a disability has the supplementary aids and services determined by the child’s IEP Team to be appropriate and necessary for the child to participate in nonacademic settings.

Participation with Non-disabled Peers When the IEP team decides to remove a student from their non-disabled peers, the team must

discuss all of the other opportunities available for the student to participate. Check all of the boxes that apply to time the student will participate with their peers. In the comment section, the team should list other situations in which the student would be able to participate with their non-disabled peers.

42

§300.320 Definition of individualized education program(5) An explanation of the extent, if any, to which the child will not participate with nondisabled children in the regular class and in the activities described in paragraph (a)(4) of this section;

Justification for Placement

The IEP team must provide a written justification regarding their decision to place a student in any setting outside the regular classroom. Removal from the regular educational classroom shall occur only when the nature or severity of the child's needs is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily.

Accept/Reject Format:The IEP team must provide a written description of the options considered and the reasons why those options were rejected for EACH option on the continuum from least restrictive to most restrictive down to the option chosen. Then describe why the chosen options were accepted. Written descriptions are NOT required for options on the continuum which are more restrictive than the one accepted by the IEP team. For Example:General classroom with modifications: Rejected – Describe whyResource room: Rejected – Describe whySelf contained classroom: Accepted – Describe why

Specify Instructional Needs:The written descriptions should describe the student’s instructional needs that resulted in the team’s decision. Do not restate the students PLAAFPs or the supplementary aids and services. For the options rejected, discuss the instructional strategies that were attempted and failed in that setting. For the option selected, specify the student’s instructional needs that will be met in this placement category that cannot be met in the regular education setting.

Potential Harmful Effects: In addition, the team must discuss the potential harmful effects of the accepted special education placement. If the team’s discussion addressed the potential harmful effects of the special education placement, check the box.

Acceptable justifications may include a combination of the following: clearly outlines the groups discussion and serious consideration goes beyond description of a preferred option such as "student needs better ratio than

this option can provide" and tells why this is essential to student's unique learning needs and describes those needs

Unacceptable Justifications: reflects nonacademic reason reflects non-individualized reason reflects administrative convenience reflects decision based on disability category is identical to all other students in that placement is based on availability of related services is based on availability of services is based on availability of space

43

Extended School Year Page 9

Extended School Year Services: needed not needed to be determined by (Date) ______/______/______

Goal(s) # *Type of Service

Beginning Date

mm/dd/yyEnding Datemm/dd/yy

MinutesPer Week **Based on

* Instruction, related services (specify), other (list)

** Regression/Recoupment, Emerging Skills, or Maintenance of Critical Life Skills

Parent/Guardian Consent Required For Initial Placement Only

“Consent” means that the parent(s)/guardian(s) have been fully informed of all information relevant to the activity for which consent is sought, in the native language, or other mode of communication; the parent(s)/guardian(s) understand and agree in writing to the carrying out of the activity for which consent is sought, and the consent describes that activity and lists any records which will be released and to whom; and the granting of consent by the parent(s)/guardian(s) is voluntary and may be revoked in writing at any time.

__________________________________ ________________________Parent/Guardian Signature Date

Clarifying Comments:

44

Directions for Completing Page 9

§300.106 Extended school year services.(a) General. (1) Each public agency must ensure that extended school year services are available as necessary to provide FAPE, consistent with paragraph (a)(2) of this section.(2) Extended school year services must be provided only if a child’s IEP Team determines, on an individual basis, in accordance with §§300.320 through 300.324, that the services are necessary for the provision of FAPE to the child.

ESY services are not intended to advance skills but are provided to students that 1) experience significant regression/recoupment of previously learned skills without the provision of such services 2) need to maintain critical life skills or 3) to support the establishment of an emerging skills. The IEP team must consider the following elements when determining the need for ESY services.

the likelihood of significant regression, and the rate of probable recoupment of skills, if the lack of services over breaks in service will halt a student’s progress toward developing critical life skills; if the break in service will interrupt a student with a disability at a critical breakthrough period of learning a skill; if the break in service will intensify “interfering behavior” such as aggression and self-injury.

Note: The need for extended school year services must be addressed each year for all students. For additional information, refer to “Primer on the Provision of Extended School Year Service” at: http://doe.sd.gov/oess/specialed/forms/pdf/SDESYServicesDocument05JCcb%20final.pdf

ESY Services Needed

Check this box if the IEP team determines that ESY service is needed. The program must be developed.

Document the following information when planning the ESY services for a student: The number of each goal that will be reinforced during ESY services; The type of service—direct instruction, specific related services that will be provided, or other; The beginning date of services (Estimate the start of services by month, date, and year); The ending date of services (Estimate the end of services by month, date, and year); The minutes per week of each service listed; and;

The reason that the service is needed (regression/recoupment, emerging skills, or maintenance of critical life skills)

ESY Services Not Needed

If data collected indicates a student does not regress over periods when school is not in session, extended school year services are not indicated. If no extended school year services are needed, mark "no" on this section of the form. Note: A review of data may be necessary before school is out to be sure circumstances have not changed resulting in the need for ESY services. For example, after 4 months of service, the student initiates the “r” sound. The team may want to consider ESY service to maintain the productions of this sound.

ESY Services to be Determined by (Date)

If it is not known at the time the IEP is developed whether extended school year services will be needed, the IEP team will specify a date by which the team will reconvene to discuss and determine if There will need to be documentation in the file that the team met on or before the date indicated to make the determination if services need to be provided. Documentation should include:--prior notice of meeting to be held--addendum regarding the teams decision --if it is determined ESY services are needed, complete the ESY page in the IEP.

45

Parent/Guardian Consent Required For Initial Placement Only

§300.300 Parental consent.(b) Parental consent for services. (1) A public agency that is responsible for making FAPE available to a child with a disability must obtain informed consent from the parent of the child before the initial provision of special education and related services to the child.§300.9 Consent.Consent means that--(a) The parent has been fully informed of all information relevant to the activity for which consent is sought, in his or her native language, or other mode of communication;(b) The parent understands and agrees in writing to the carrying out of the activity for which his or her consent is sought, and the consent describes that activity and lists the records (if any) that will be released and to whom; and(c)(1) The parent understands that the granting of consent is voluntary on the part of the parent and may be revoked at anytime.(2) If a parent revokes consent, that revocation is not retroactive (i.e., it does not negate an action that has occurred after the consent was given and before the consent was revoked).

Parental Consent for Initial Placement

Parental consent must be obtained before initial placement of a child in a program providing special education or special education and related services. The district cannot provide services without written parent consent for the initial provision of special education and related services.

This section must be signed by the parent of the child. (Refer to directions for completing page 1 for the definition of “parent”).If the student is 18 years of age or older and does not have a guardian assigned, the student must sign to provide initial consent.

If the student is initially being provided services in South Dakota upon transferring from another state and determined eligible, initial consent for services for South Dakota must be obtained.

Note: It is important to remember that a student’s social worker, probation officer etc. does not have the authority to provide consent for special education evaluation or services.

Clarifying Comments

The Comment section is provided to allow the IEP team to add information or clarification to plans that do not fit in any other section of the form.

Note: Comments documented in this section are a binding part of the IEP.

46

47

Individual Education Plan AddendumAddendum to IEP dated _______/_______/_______

Student Name Meeting Date Date of Birth

Purpose of Meeting (Agenda Items)A copy of this IEP addendum was provided to parent/guardian

Yes (Parent/Guardian Initial) Copy Mailed to Parent_______________

(Date)IEP Team Membership Signatures Date

Parent/GuardianParent/GuardianStudentSuperintendent/DesigneeGeneral Classroom TeacherSpecial Education TeacherSpeech/Language PathologistEvaluatorTitleTitleTitleChild Count Information (Required Information)Disabling Condition

0500-D/B 0505 -ED 0510-CD 0515-HI 0525-SLD 0530-MD 0535-OI 0540 –VI 0545 –D 0550-S/L 0555-OHI 0560-A 0565-TBI 0570-DD

A. Minutes per week in Special Education _________ B. Minutes per week in Related Services Minutes Services _________ __________ _________ __________ _________ __________C. A + B = (Total minutes of Special Education/Related Services) _________

Placement

0100 Regular Classroom with Modification 0110 Resource Room 0120 Self-Contained Classroom 0130 Separate Day School: _________________ 0140 Residential Facility: _______________ 0150 Home/Hospital 0315 Early Childhood Setting 80-100% 0325 Early Childhood Setting 40-79% 0330 Early Childhood Setting 0-39% 0335 Separate Class 0345 Separate School 0355 Residential Facility 0365 Home 0375 Service Provider Location

Meeting Notes

48

IEP Addendum (Continued)

Student Name: Meeting Date:

49

Directions for Completing an Addendum

IEP Addendum An addendum to the IEP can be made at any time for any reason. Some of the most common reasons to draw the IEP team together for IEP amendment include:

1. There is change in the health status of a student;

2. The student has met goals and objectives at a faster (slower) rate than anticipated, requiring new/different goals and objectives to be written;

3. An IEP team meeting may be necessary if the student is making insufficient progress toward his/her annual goals.

4. A member of the team feels a change of placement should be considered by the team;

5. A member of the team feels additional (fewer) related services are needed and should be considered by the team;

6. Extended school year services are potentially needed, requiring the team to reconvene for determination of need and the development of an Extended School Year IEP;

7. New evaluation findings are brought to the attention of a member of the team that require the committee to reevaluate placement, goals and objectives, related services, or other portions of the IEP.

8. The team needs to discuss if the student has met their graduation requirements.

Please specify the purpose of the Addendum on the Addendum cover sheet.

This section of the addendum form allows the IEP team to write any addendum information they wish to add or change the current IEP document.

The Addendum form may not be used, however, to extend an IEP beyond the 365-day timeline. This timeline cannot be extended.

If the IEP team is modifying or adding to the goals and objectives of the IEP, simply make a statement to that effect on the addendum form and attach the completed goals and objective sheets to the IEP addendum.

The signature lines on the cover sheet of the addendum form provide space for all IEP team members to sign the addendum. Their signature implies “participation” and not agreement or consent in the case of a parent.

§300.324 Development, review, and revision of IEP.(4) Agreement. (i) In making changes to a child’s IEP after the annual IEP Team meeting for a school year, the parent of a child with a disability and the public agency may agree not to convene an IEP Team meeting for the purposes of making those changes, and instead may develop a written document to amend or modify the child’s current IEP. (ii) If changes are made to the child’s IEP in accordance with paragraph (a)(4)(i) of this section, the public agency must ensure the child’s IEP team is informed of those changes.(6) Amendments. Changes to the IEP may be made either by the entire IEP Team at an IEP Team meeting, or as provided in paragraph (a)(4) of this section, by amending the IEP rather than by redrafting the entire IEP. Upon request, a parent must be provided with a revised copy of the IEP with the amendments incorporated.

50

Note: In making changes to the IEP, a district needs to determine the person with the authority to conduct such a change.

Note: Districts must provide written notice following an amendment agreement.

Example: A parent calls the district and would like to discuss a change to their child’s IEP. The district and the parent agree to make a change to the IEP. The district completes a prior notice that states when the parent called, what was discussed and the change that was agreed upon. The amendment is completed and attached to the prior notice and sent to the parent. The prior notice states that the amendment will go into effect on XXXX date, which is after the 5 days prior notice.

Example: A parent is visiting the school and the district and the parent are discussing a change to the child’s IEP. The parent and the district agree to a change. While the parent is at the school, the district completes the amendment and has the parent sign. The district also completes the prior notice which states what they just agreed to. The district explains that the change will go into effect after the 5 days prior notice unless the parent wishes to waive the 5 days prior notice waiting period. The parent signs the waiver right away and the change can go into effect immediately.

51

The IEP Process – What you need to know?The following information is taken from the August 14, 2006 Federal Register IDEA Comment Section of the regulations. The comment sections are guidance given by the Office of Special Education Programs.

Federal Register Analysis: Referral Since not all child find and referral processes in States and LEAs would necessarily meet the requirement in section 615(k)(5)(B)(iii) of the Act that the teacher of the child, or other personnel of the LEA, must express specific concerns about a pattern of behavior demonstrated by the child “directly to the director of special education of such agency or to other supervisory personnel of the agency,” we are removing from §300.534(b)(3) the requirement that concerns be expressed in accordance with the agency’s established child find or special education referral system.We continue to believe the child find and special education referral system is an important function of schools, LEAs, and States. School personnel should refer children for evaluation through the agency’s child or special education referral system when the child’s behavior or performance indicates that they may have a disability covered under the Act. Having the teacher of a child (or other personnel) express his or her concerns regarding a child in accordance with the agency’s established child find or referral system helps ensure that the concerns expressed are specific, rather than casual comments, regarding the behaviors demonstrated by the child and indicate that the child may be a child with a disability under the Act. For these reasons, we would encourage those States and LEAs whose child find or referral processes do not permit teachers to express specific concerns directly to the director of special education of such agency or to other supervisory personnel of the agency, to change these processes to meet this requirement.Changes: In light of some State child find procedures, we have removed from §300.534(b)(3) the requirement that the teacher or other LEA personnel must express concerns regarding a child’s pattern of behavior in accordance with the agency’s established child find or special education referral system.

Federal Register Analysis: Draft IEP As noted in §300.306(a)(2), the public agency must provide a copy of an evaluation report and the documentation of determination of eligibility at no cost to the parent. Whether parents receive all evaluation reports before an IEP Team meeting, however, is a decision that is best left to State and local officials to determine. With respect to a draft IEP, we encourage public agency staff to come to an IEP Team meeting prepared to discuss evaluation findings and preliminary recommendations. Likewise, parents have the right to bring questions, concerns, and preliminary recommendations to the IEP Team meeting as part of a full discussion of the child’s needs and the services to be provided to meet those needs. We do not encourage public agencies to prepare a draft IEP prior to the IEP Team meeting, particularly if doing so would inhibit a full discussion of the child’s needs. However, if a public agency develops a draft IEP prior to the IEP Team meeting, the agency should make it clear to the parents at the outset of the meeting that the services proposed by the agency are preliminary recommendations for review and discussion with the parents. The public agency also should provide the parents with a copy of its draft proposals, if the agency has developed them, prior to the IEP Team meeting so as to give the parents an opportunity to review the recommendations of the public agency prior to the IEP Team meeting, and be better able to engage in a full discussion of the proposals for the IEP. It is not permissible for an agency to have the final IEP completed before an IEP Team meeting begins

52

Dismissal Procedures

Question: What is the process for dismissing a student from special education and/or a related service?

Answer: CFR 300.405 (c)(i)(e) Evaluations before change in eligibility. (1) Except as provided in paragraph (e)(2) of this section, (graduation with a regular diploma or exceeding the age of eligibility for FAPE) a public agency must evaluate a child with a disability in accordance with 300.304 through 300.311 before determining that the child is no longer a child’s with a disability.

300.304 Evaluation procedures.The district must implement the same evaluation procedures used to determine continued eligibility. The evaluation team must determine what evaluations are needed, including parent input, to determine if the student continues to need special education and related services. Written notice in accordance with 300.503 (Prior notice by the public agency; content of notice) must be provided to the parents that describes any evaluation procedures the district intends to conduct. A variety of assessment tools and strategies to gather relevant functional, developmental, and academic information about the student is to be used. No single measure or assessment can be used as sole criterion for determining eligibility. The district must ensure all other evaluation procedures are followed.300.305 Additional requirements for evaluations and reevaluation. If the IEP Team and other qualified professionals, as appropriate, determine that no additional data are needed to determine whether the child continues to be a child with a disability, and to determine the child’s educational needs, the public agency must notify the child’s parents of:

That determination and the reasons for the determination; and The right of the parents to request an assessment to determine whether the child continues to be a child with a

disability, and to determine the child’s educational needs.300.306 Determination of eligibility.Based upon the relevant functional, developmental and academic information gathered, a group of qualified professionals and the parents of the child determine whether the child is a child with a disability. A copy of the evaluation report and the documentation of determination of eligibility are to be provided to the parents.

Additional procedures for identifying children with specific learning disabilities apply when determining if a child continues to be child with a disability.300.307 Specific learning disabilities.300.308 Additional group member.300309 Determining the existence of a specific learning disability300.310 Observation300.311 Specific documentation for the eligibility determination

The same process and requirements used for initial evaluation and/or reevaluation apply before determining that the child is no longer a child’s with a disability. To dismiss a student from special education or special education and related services the district would precede as follows:1. The district evaluation team would review the student’s information and decide what evaluation information is necessary before determining the child is no longer a child with disability.2. Once the district has decided what evaluations are necessary, contact the parent, review the districts evaluation plan with the parent and ask them if they agree or if they recommend any changes to the district evaluation plan.3. The district must complete the written prior notice/consent document and list the test/evaluations, records, and reports that will be used to determine if the child continues to be eligible for services. 4. When documenting previous evaluation information to be used on the prior notice, indicate the area or name of the evaluation and the date it was administered. This also holds true with any information to be used that was not administered during the 25 school day evaluation timeline. This will let the parent know that previous information will be used and that a new evaluation will not be administered. Parent consent is required if any new evaluation information will be gathered or administered. 5. Parents must be informed of their right to request an assessment to determine whether the child continues to be a child with a disability, and to determine the child’s educational needs in the prior notice.6. All the evaluation procedures stated in 300.304 Evaluation procedures apply.

53

7. Copies of all evaluation reports/documentation used by the team to determine if the child continues to be a child with a disability must be provided to parents.8. Prior notice is sent to parent setting up a meeting at a mutually agreeable time at which time the IEP team will review the evaluation data and determine if the child continues to be eligible for services.9. The team will complete the evaluation report and the documentation of determination of eligibility (content required for students identified with specific learning disabilities) reporting the team’s decision regarding the child’s eligibility for services. A copy of this document with the team’s decision must be given to parents.

54

APPENDIX A1. Justification Statements

1. Student needs a combination of large and small group instruction.

2. Student needs multiple instructional methods and repetitive teaching strategies to acquire and maintain skills.

3. Student needs direct strategy instruction with the opportunity to apply these skills in the general classroom/curriculum.

4. Student will benefit from skill practice, repetition and guided instruction in the assigned goal area(s).

5. Without small group assistance, student will not develop skills needed to be successful in the general education

classroom.

6. Student lacks the skills necessary for participating independently and successfully in the large group setting.

7. Student needs an individualized program tailored to learning style and needs additional practice to master skills.

8. Student needs direct instruction to attain the identified goal(s).

9. Student needs extended support in managing his/her behavior.

10. Student requires small group instruction with repetition and immediate feedback to responses in the goal area(s).

11. Student has need for consistency and behavioral monitoring throughout the day.

12. Student needs a more intense behavioral intervention program.

13. Student needs a setting that provides a therapeutic intervention, immediate feedback for all behaviors, and consistency in

programming across the entire day.

14. Student needs immediate intervention to process inappropriate behavior.

15. Student needs an alternate curriculum in a highly structured setting.

16. Student needs an alternate setting to address transition goal(s).

17. Student needs direct instruction with an opportunity to apply these skills in the general curriculum/classroom.

18. Student’s developmental needs require direct instruction.

19. Student needs more structure and small group instruction.

20. Student needs specialized instruction with skill practice, repetition, and guided instruction in assigned goal area(s).

21. This placement provides guided activities to stimulate growth in developmental areas.

22. This placement provides learning opportunities in developmental areas as identified in the goal(s).

23. This placement provides peers to model language skills and usage.

24. Student needs extended support in developing study and organizational skills.

25. Student needs an educational program tailored to the student’s instructional level and learning rate.

55

2. Standard Accommodations for Statewide Assessment

Rea

ding

Mat

hem

atic

s

Scie

nce

Acc

omm

odat

ion

Cod

es Accommodations for Special Populations

IEP/ 504 LEP

IEP/ 504 LEP

IEP/ 504 LEP Presentation Accommodations

      1 Large-print test booklets and/or answer documents       2 Visual aids (magnifiers, templates)

      3 Sign language (ASL, cued speech)           4 Abacus for visually impaired VI students       5 Braille test booklets

6 Test Items read aloud (does NOT include Reading Comprehension passages)

7 Repeating and/or simplifying directions

      8Amplification equipment (hearing aid, auditory trainer)

      9 Audio amplification equipment

   

 

  10 Talking calculators provided the student is tested individually or with the use of headphones.

              Response Accommodations

      11

Responses marked directly in test booklet or on large print answer document, also includes oral, sign language, Braille, and recorded responses to test items (answers must be transcribed to scorable answer document by scribe)

      12 Large-diameter pencil, pencil grip, special pencil or pen

      13 Use of dictionaries, word lists, glossaries

14 Visual organizers (i.e. templates, masks, markers, graph paper, rulers)

             Setting, Timing, and Scheduling Accommodations

15Environmental modifications (i.e. special lighting, adaptive or special furniture, location with minimal distractions, noise buffers, carrels, special seating)

16 Small group administration 17 Individual administration       18 Home/Hospital Setting

19Flexible schedules (i.e. time of day, multiple breaks, etc.)

            20 Other (with prior approval from SD DOE)

56

3. TA Goal WritingOverview: Annual goals must include a condition, the performance and the criteria specific to the child’s present levels of performance.

Avoid using vague, indefinable terms in goals when targeting “behavior” or “social skills”, without identifying the particular behavior (tantrums or inattention) or social skills (turn taking or eye contact). Other words that might be red flags are:

Appropriate: Who knows what is appropriate? Improve: To what level? Make progress: How much progress? How will that be measured? Increase/decrease: How much? Acceptable grade-level: What does that mean? Participate in: To what extent?

ConditionThe condition segment of an annual goal represents the circumstances under which you will be presenting information or material to the student so the skill they are to perform can be measured or observed. It is sometime referred to as the “when given” statements.

PerformanceThe performance segment of the annual goal represents the very specific skill or observable behavior the student will be expected to perform when the condition presents itself.

These skills are identified on an individual basis through developmental or functional assessment. The skills identified should link to the districts general curriculum and content standards beginning at the student current level of performance working towards grade level content.

CriteriaThe criteria segment of the annual goal represents how the skill or behavior will be measured. The criteria must include how well (accuracy) and how often (consistency) the student must perform the skill or behavior in order to consider it mastered.

The procedure codes you document on the goal page of the IEP represent what will be used to gather or measure the criteria.

When given ____ number of words,

When given a narrative or expository reading passage at (student’s) independent reading level…

When given a passage at (students) instructional level…

When in a grocery store…

Following one verbal request…

(Student) will say the initial, middle and ending sounds…(Student) will paraphrase figurative language by highlighting words with multiple meanings…(Student) will read aloud, with fluency, at a rate of ___correct works per minute…(Student) will raise his hand and wait to be called upon…(Student) will produce the / s / v l sounds in isolation…(Student) will add ___/25 sums to 10…(Student) will debit (subtract) money spent and credit (add) money deposited to balance the check book…

With ___% accuracy in ___consecutive trial.

With ___% accuracy in ___ consecutive trials graphed weekly…

With ___% accuracy in ___of ___trials.

For ___consecutive steps in ___of ___attempts over a six week period.

For ___seconds in ___consecutive trials.

57

When given a picture of an object…

When given a direction…

Before having an outburst…

During class instruction…

Given the choice of four proper nouns…

When given a ____ grade math calculation problem involving addition and subtraction… When given an assignment…

Given a choice to two sentences…

When asked to write a story…

When given sentences with no punctuation…

When given a ___ grade reading passage…

When completing a written assignment…

When given a list of words and meanings…

When shown four words…

Given a play clock…

When asked to add a number to zero…

When given a word having duel meanings…

When in the community grocery store…

(Student) will subtract two digit numbers with no regrouping…(Student) uses the correct punctuation at the end of sentences.(Student) will comply with a request with no more than two verbal prompts…(Student) will choose the sentence with correct capitalization…(Student) will write the upper and lower case letters in sequence with no reversals…(Student) will arrive to work on time…(Student) will solve pencil and paper two-digit addition and subtraction calculations with regrouping….(Student) will make eye contact and respond “hello”…(Student) will calculate at least ___ correct digits per four minute timing…(Student) will solve three-digits divided by two digits with a remainder…(Student) will state the initial sound of each word…(Student) will state the __letter names and __ letter sounds(Student) will write a resume with correct punctuation, grammar, and spelling…(Student) will write the numbers 1 through 25 with no omissions or number reversals…(Student) will sit at his desk and work for 10 minutes…(Student) will go to his “cool down” space for no longer than 10 minutes to gain control of his frustrations…(Student) will answer five factual questions…(Student) will state the main idea and two details…(Student) will predict what will happen next in the story…(Student) will read ___correct words per minute…(Student) will be able to state ___ correct responses per three minute

With ___% accuracy in ___minutes.

In one minute with __% accuracy in __out of __ trials.

With no more than ___ errors for an accuracy rate of ___% on ___ consecutive trials.

58

When given a curriculum-based letter naming probe at the kindergarten level…

When given a MAZE comprehension passage at the ___ grade level... 

When given a big mac switch

When spoon is placed in student’s hand

Given a list of …..

After previewing a book…

Given a story problem involving money…

Given a name and a phone book…

Given a series of (_____) numbers…

When given a set of objects…

Given a set of fractions…

Given a word bank…

When provided with a reading passage, (level determined by present level of performance information)…

After reading a passage…

When provided a reading selection…

timing…(Student) will press on the switch to activate TV, fan, or CD player with less than three cues (prompt from the elbow)(Student) will scoop food and bring food to mouth with 1 cue at the elbow(Student) will answer five factual questions…

(Student) will state the main idea and two details…

(Student) will predict what will happen next in the story…

(Student) will alphabetize the words…

(Student) will point to the name…

(Student) will state the math operation to use…

(Student) will retell the story in sequence…

(Student) will stop and ask for help…

(Student) will predict possible story scenarios…

(Student) will ask questions…

(Student) will state ___ pieces of important information in a reading selection…

(Student) will read for ___minutes without redirection…

(Student) will increase time spent on task from ___minutes to ____minutes…

(Student) will select coins and bills to match amount needed…

(Student) will use calculator to determine correct change…

59

4. Medicaid Sample FormPLEASE COMPLETE THIS FORM AND RETURN IT TO YOUR LOCAL SCHOOL DISTRICT. ALL INFORMATION PROVIDED IS STRICTLY CONFIDENTIAL.

MEDICAID INFORMATION/AUTHORIZATION FORM _______________________ (School District)

_________________________(Address)_________________________(Address)

STUDENT’S MEDICAID NUMBER:_________________________________________STUDENT’S SIMS NUMBER:______________________________________________

STUDENT INFORMATION

STUDENT NAME:_____________________________________ BIRTHDATE_____________

PARENT’S NAME:_____________________________________________________________

ADDRESS:____________________________________________________________________

CITY, STATE, ZIP:_____________________________________________________________

PHYSICIAN’S NAME:__________________________________________________________

ADDRESS:____________________________________________PHONE:_________________

CITY, STATE, ZIP:_____________________________________________________________

AUTHORIZATION FOR MEDICAID CLAIM

(Please initial one)_____My child is Medicaid eligible. I give my consent for__________________(Provider) to submit claims to Medicaid for covered services. I authorize Medicaid to make these payments to the school district. I authorize the release of any information from the school district to ____________(Provider),and by the ________________(Provider) to Medicaid as necessary to request payment of Medicaid benefits. I understand that I may revoke this permission at any time by notifying the _____________________(Provider).

_____My child is not Medicaid eligible.

_____I do not wish to provide this information.

I understand that all services will be provided to my child, without delay, without regard to Medicaid coverage status during time frame of IEP. If amount of services changes during the duration of the IEP, a new consent authorization form must be signed. Consent must be obtained each time access to public benefits is sought. Services to be provided are documented in student’s IEP.

_________________________________________________ __________________________Signature of Parent or Guardian DateOr 18 year old as own Guardian

60

AVAILABLE FOR CHILDREN UNDER AGE 19

The State Children’s Health Insurance Program (CHIP), expands the State Medicaid program to specifically serve low-income uninsured children. CHIP provides FREE medical coverage for children under age 19. Examples of medical payments include: physician, hospital, dental, nursing care, home health care, family planning, clinic, rehabilitation hospital, prescription drugs, and certain diagnostic services, as well as certain Special Education Services provided by school districts.

WHAT IS CHIP?

The purpose of CHIP/Medicaid is to assure the availability of quality medical care, including certain special education costs, to families who meet income eligibility. If financially eligible, children are eligible with or without private health insurance. The program is financed jointly by state and federal government and is run by the South Dakota Department of Social Services.

BENEFITS TO FAMILIES AND SCHOOLS

School districts are required to provide special education services to all eligible children. However, in an effort to maintain the highest quality of special education services to all eligible children and their families, the districts are now seeking assistance in accessing funds for certain special education costs. The benefits for eligible children and their families are two-fold. First, the costs of most medical services for your child will be paid for by CHIP/Medicaid. Second, the school districts now have available a funding source to help defray the cost of special education services provided at the local level.

WHAT SCHOOL SERVICES ARE COVERED?

The South Dakota Medicaid/CHIP program provides coverage of services in school districts for the following special education related services when they are provided by properly licensed or certified professionals: psychological services, physical therapy services, occupational therapy services, speech therapy services, audiological services, and nursing services. These services are provided as part of an evaluation or an individual education program (IEP/IFSP).

WHAT WILL IT COST ME?

Special education services are provided to the parent at no cost. With your voluntary approval by signing the form on the reverse side, the school district will be allowed to file for CHIP/Medicaid reimbursement at no cost to you, and you will not lose any CHIP/Medicaid benefits. The funds received from Medicaid will be used by your School District to enhance Special Education services.

HOW DO I BECOME ELIGIBLE?An application is available through your local Department of Social Services office. If you are unable to determine the location of your county office, you can call 1-800-305-3064 to determine the office nearest you. Check with your local Department of Social Services for current income guidelines.

CHIP provides health insurance coverage to uninsured children whose family income is up to 200 percent of the federal poverty level (monthly income of $3,225 for a family of four).

61

62

5. CONSENT FOR EXCHANGE AND RELEASE OF INFORMATION

I hereby give permission for the mutual exchange of confidential student information

between________________________________________ School District and:

_____ SD Division of Rehabilitation Services (Vocational Rehabilitation) and/or

_____ Other Agency (ies)______________________________________________(Initial those that apply)

Regarding: _____ _________________________ __________________ (student’s name) (birth date)

Purpose of disclosure:

____ For invitation to the student’s Individual Education Program (IEP) meetings

____ Releasing records for eligibility determination:Which may include information regarding history, psychological and multi-faceted evaluations, scholastic achievement, health records, functional performance, attendance, educational placement, and Individual Education Programs.

_____ Other: _________________________________________________________

THIS FORM WILL BECOME PART OF THE STUDENT’S EDUCATIONAL RECORD AND SHALL BE VALID FOR ONE YEAR.

Consent:ARSD 24:05:30:17. Consent. “Consent” means that the parents have been fully informed of all information relevant to the activity for which consent is sought, in the native language, or other mode of communication; the parents understand and agree in writing to the carrying out of the activity for which consent is sought, and the consent describes that activity and lists any records which will be released and to whom; and the granting of consent by the parent is voluntary and may be revoked in writing at any time.

Parent Signature Date

Student Signature Date

63

64

6. DETERMINATION OF ELIGIBILITY/CONTINUED ELIGIBILITY

DETERMINATION OF ELIGIBILITY/CONTINUED ELIGIBILITY

Students Name: ____________________________________Date:_____________________________

Summary of Evaluation Reports(Basis for making the determination is drawn from a variety of sources, including aptitude and achievement tests, parent input and teacher recommendations, as well as information about the child’s physical condition, social or cultural background, and adaptive behavior)Name of Test Date Administered Test Scores/Results______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

__________________________________________________________

List the academic, developmental, and functional needs of the student resulting in an adverse effect on the child’s educational performance. ______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________

________________________________________________________________

65

REQUIRED DOCUMENTATION FOR SPECIFIC LEARNING DISABILITIESCheck the appropriate box:_____RtI criteria will be used to determine eligibility. OR_____Discrepancy criteria will be used to determine eligibility.

If the child has participated in a process that assesses the child’s response to scientific, research-based intervention document the following:The instructional strategies used in the RtI process that assesses the child’s response to scientific, research-based intervention:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Student-centered RtI data collected: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(Required for RtI and Discrepancy)The child does not achieve adequately for the child’s age or to meet state-approved grade-level standards in one of more of the following areas, when provided with learning experiences and instruction appropriate for the child’s age or state- approved grade-level standards: _____ Oral Expression _____ Listening Comprehension _____ Written Expression _____ Basic Reading Skills _____ Reading Fluency Skills _____ Reading Comprehension _____ Mathematic Calculation _____ Mathematics Problem Solving

66

_____ Based upon the data gathered the evaluation team determines the child has not made sufficient progress to meet age or state-approved grade-level standards in one or more of the areas identified above when using a process based on the child’s response to scientific, research-based interventions. OR_____The child exhibits a pattern of strengths and weaknesses in performance, achievement, or both, relative to age, State-approved grade level standards, or intellectual development, that is determined by the team to be relevant to the identification of a specific learning disability in one or more of the areas identified above when using appropriate assessments.

(Required for RtI and Discrepancy)Document data that demonstrate that prior to, or as part of, the referral process, the child was provided appropriate instruction in regular education settings by qualified personnel:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ANDData-based documentation of repeated assessments of achievement at reasonable intervals, reflecting formal assessment of student progress during instruction, which was provided to the child’s parents:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Based upon the above data, the evaluation team must determine that the underachievement in the child suspected of having a specific learning disability:_____is due to the lack of appropriate instruction in reading or math; OR_____is not due to the lack of appropriate instruction in reading or math.

(Required for RtI and Discrepancy)Observation: Relevant behaviors, if any, noted during the observation of the child and relationship of those behaviors to academic functioning. The observation must occur in the child’s learning environment (including regular classroom setting) to document the child’s academic performance and behavior in the areas of difficulty.In the case of a child of less than school age or out of school, a group member must observe the child in an environment appropriate for a child of that age.Observer_________________________________________ Dates of Observation _________________________

_____Information from an observation in routine classroom instruction and monitoring of the child’s performance was done before the child was referred for an evaluation: OR _____Observation of the child’s performance in the regular classroom was done after the child has been referred for an evaluation: ______________________________________________________________________________________________________________________________________________________________________________________

67

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(Required for RtI and Discrepancy)

Educationally relevant medical findings, if any (attach medical report if needed):___________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________(Required for RtI and Discrepancy) The evaluation team determines that the child’s achievement level problem is/is not primarily the result of:

_____Is_____Is Not - Visual, hearing or motor disabilities;_____Is_____Is Not – Cognitive disability;_____Is_____Is Not - Emotional disturbance;_____Is_____Is Not - Cultural factors;_____Is_____Is Not - Environmental or economic disadvantage;_____Is_____Is Not - Limited English proficiency.

If the child has participated in a process that assesses the child’s response to scientific, research-based intervention: Document how and when parents were notified about the State’s policies regarding the amount and nature of student performance data that would be collected and the general education services that would be provided, strategies for increasing the child’s rate of learning and the parents right to request an evaluation.___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________1. SPECIFIC LEARNING DISABILITY - Based upon the above information the team agrees the child:_____has a specific learning disability_____does not have a specific learning disability

This report reflects my conclusions. If not, person(s) in disagreement will indicate such and may submit a separate statement.

Name Position______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree

68

2. COGNITIVE DISABILITY - The following characteristics are indicative of students in need of special education due to a cognitive disability.___General intellectual functioning 2 standard deviations or more below the mean as determined by the full scale score on an individual cognitive evaluation, plus or minus standard error of measurement.___Exhibits deficits in adaptive behavior and academic or pre-academic skills as determined by an individual evaluation.

3. DEVELOPMENTAL DELAY - The following characteristics are indicative of children 3, 4, or 5 years old who are in need of special education due to a developmental delay. Check those that apply:___Functions at a developmental level 1.5 standard deviations below the mean in any two developmental areas; or___Functions at a developmental level 2 standard deviation below the mean in any one area of development. Check the areas of development: ___Adaptive Functioning Skills ___Social and Emotional Development ___Cognitive Development ___Physical Development ___Communication Development

4. HEARING LOSS___A student may be identified as having a hearing loss when an unaided hearing loss of 35 to 69 decibels is present that makes the acquisition of receptive and expressive language skills difficult with or without the help of amplification.

5. DEAFNESS___The unaided hearing loss is in excess of 70 decibels and precludes understanding of speech through the auditory mechanism, even with amplification, and demonstrates an inability in processing linguistic information through hearing, even with amplification.

6. DEAF-BLINDNESS___Students may be identified as deaf-blind when both a vision and hearing impairment exists which causes such severe communication and other developmental and educational needs that they cannot be accommodated in special education programs solely for children with deafness or children with blindness.

7. EMOTIONAL DISTURBANCE - The following characteristics are indicative of students in need of special education due to an emotional disturbance. Check those that apply:___An inability to learn which cannot be explained by intellectual, sensory or health factors. ___An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. ___Inappropriate types of behavior or feelings under normal circumstances.___A general pervasive mood of unhappiness or depression.___A tendency to develop physical symptoms or fears associated with personal or school problems. The following criteria must also be met:___The serious behavior problems occur over a long period of time (not less than 6 months).___Documentation from 2 or more sources (one must be the school) of the frequency & severity of the targeted behaviors.___Student's performance falls 2 standard deviations below the mean in emotional functions as measured in school, home, and community on nationally formed technically adequate measures.___An adverse effect on educational performance is verified through the evaluation process.

8. SPEECH OR LANGUAGE DISORDER - Check those that apply:ARTICULATION DISORDER:___Performance on a standardized articulation test falls 2 standard deviations below the mean & intelligibility is affected in conversation; or

69

___Test performance is less than 2 standard deviations below the mean but the student is judged unintelligible by the speech language clinician and one other adult; or___Performance on a phonological assessment which falls in the profound or severe range & intelligibility is affected in conversation; or___An error persists 6 months to 1 year beyond the chronological age when 90% of students have typically acquired the sound based on developmental articulation norms.

FLUENCY DISORDER:___The student consistently exhibits one or more of the following symptomatic behaviors of dysfluency: (a) Sound, syllable, or word repetition; (b) Prolongations of sounds, syllables, or words; (c) Blockages; or (d) Hesitations.___There is a significant discrepancy from the norm (5 dysfluencies per minute) as measured by speech sampling in a variety of contexts; or ___The disruption occurs to the degree that the individual or persons who listen to the individual evidence reactions to the manner of speech and the disruptions so that communication is impeded.

VOICE DISORDER:___Consistent deviations in one or more of the parameters of voice: pitch, quality, or volume exist; and___The voice is discrepant from the norm as related to age, gender, and cultural and is distracting to the listener; and___The disorder is not the result of a temporary problem such as: normal voice changes, allergies, colds, or other such conditions.

LANGUAGE DISORDER:___Through age 8, performance falls 1.5 standard deviations below the mean on standardized evaluations;___Beginning at age 9, a difference of 1.5 standard deviations between performance on a individually administered language instrument and expected potential as measured by an individually administered intelligence test.___The student's pragmatic skill, as measured by checklists, language samples and/or observation, adversely affects the student's academic and social interactions.

9. MULTIPLE DISABILITIES___Concomitant impairments (such as a cognitive disability-blindness or a cognitive disability-orthopedic impairment), the combination of which causes such severe educational needs that they cannot be accommodated in special education programs solely for one of the impairments. The term does not include deaf-blindness.

10. VISION LOSS -A deficiency in visual acuity shall be one of the following: ___Visual acuity of no better than 20/70 in the better eye after correction; or ___Restricted visual field; or ___Limited ability to move about safely in the environment due to a visual disability; or ___Blindness - Visual acuity of 20/200 or less in the better eye with correcting lenses or a limited field of vision such that the widest diameter subtends an angular distance of no greater that 20 degrees or has a medically indicated expectation of visual deterioration.

11. ORTHOPEDIC IMPAIRMENT - There must be evidence of the following:___Impaired motor functioning significantly interferes with educational performance; and___Deficits in muscular or neuromuscular functioning that significantly limits the student's ability to move about, sit, or manipulate materials required for learning; and___Student's bone, joint, or muscle problems affect ambulation, posture, or gross and fine motor skills; and

70

___Medical data by a qualified medical evaluator describes and confirms and orthopedic impairment.

12. AUTISM - An autistic disorder is present in a student if at least 6 of the following 12 characteristics are expressed by a student with at least two of the characteristics from subdivision (1), one from subdivision (2), and one from subdivision (3):(1)Qualitative impairment in social interaction, as manifested by at least two of the following: ___Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction;___Failure to develop peer relationships appropriate to developmental; ___A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people such as lack of showing, bringing, or pointing out objects of interest; ___Lack of social or emotional reciprocity;

(2)Qualitative impairment in communication as manifested by at least one of the following: ___Delay in or total lack of, the development of spoken language not accommodated by an attempt to compensate

through alternative modes of communication such as gesture or mime;___In individual with adequate speech, marked impairment in the ability to initiate or sustain conversation with others;___Stereotyped and repetitive use of language or idiosyncratic language;___Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level;

(3)Restricted repetitive and stereotyped patterns of behavior, interests, and activities as manifested by at least one of the following:___Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus;___Apparently inflexible adherence to specific, nonfunctional routines or rituals;___Stereotyped and repetitive motor mannerisms such as hand or finger flapping or twisting, or complex whole- body movements;___Persistent preoccupation with parts of objects.A student with autism also exhibits delays or abnormal functioning in at least one of the following areas, with onset generally prior to age three:___Social interaction;___Symbolic or imaginative play;___Language as used in social communication.

13. OTHER HEALTH IMPAIRED___Having limited strength, vitality or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that : Is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, Tourette syndrome, nephritis, rheumatic fever, and sickle cell anemia; and That adversely affects a student's educational performance.

14. TRAUMATIC BRAIN INJURY___An acquired injury to the brain caused by an external physical force, resulting in a total or partial functional disability or psychosocial impairment, or both, that adversely affects a student's educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem solving; sensory; perceptual; and motor abilities; psychosocial behavior; physical functions; information processing; and speech.

The term does not apply to brain injuries that are congenital or degenerative, or brain injuries inducted by birth trauma.

71

ELIGIBILITY DETERMINATION:

____YES - The team agrees this student:

a. has a diagnosed disability;b. the disability adversely effects the students educational performance; andc. the student requires specifically designed instruction to benefit from a free appropriate public education.____NO – The student is not eligible for special education or special education and related services.

The team determined this student meets eligibility criteria under the following category: (check the category that will be reported on child count)__500 - Deaf-Blindness __540 – Vision Loss __505 - Emotional Disturbance __545 – Deafness __510 – Cognitive Disability __550 – Speech/Language__515 - Hearing Loss __555 - Other Health Impairment__525 – Specific Learning Disability __560 – Autism__530 - Multiple Disabilities (list category(s) of eligibility) __565 - Traumatic Brain Injury____________________________________________ __570 - Developmental Delay__535 - Orthopedic Impairment (cognitive, physical, communication, adaptive, social/emotional) RELATED SERVICES – Student need to be determined during IEP program development1. Criteria for Occupational Therapy ServicesThe student has a disability and requires special education; the student needs occupational therapy to benefit from special education; and the student must demonstrate performance on a standardized assessment instrument that falls at least 1.5 standard deviations below the mean in one or more of the following areas: fine motor skills, sensory integration, or visual motor skills.2. Criteria for Physical Therapy ServicesThe student has a disability and requires special education; the student needs physical therapy to benefit from special education; and the student must demonstrate performance on a standardized assessment instrument that falls at least 1.5 standard deviations below the mean on a standardized motor assessment instrument.3. Speech – Language Pathology To be provided as a related service, the IEP team must determine that the related service is necessary in order for the student to benefit from the special education program.

72

How to Fill out the Specific Learning Disability when using the:DETERMINATION OF ELIGIBILITY/CONTINUED ELIGIBILITY

Students Name: ____________________________________Date:_____________________________

Summary of Evaluation Reports(Basis for making the determination is drawn from a variety of sources, including aptitude and achievement tests, parent input and teacher recommendations, as well as information about the child’s physical condition, social or cultural background, and adaptive behavior)Name of Test Date Administered Test Scores/Results___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

List the academic, developmental, and functional needs of the student resulting in an adverse effect on the child’s educational performance. ___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

REQUIRED DOCUMENTATION FOR SPECIFIC LEARNING DISABILITIESCheck the appropriate box:_____RtI criteria will be used to determine eligibility. OR

List the name (acronym), date the test was given to the child, and the standard scores/ability scores (when applicable) for each test administered or to be used by the team to determine if the child is an eligible child.Determining if a student has a specific learning disability, like any other disability determination under IDEA, cannot be based on any single criterion – meaning a single test, assessment, observation or report. An evaluation of a student suspected of having SLD must include a variety of assessment tools and strategies. The evaluation must include input from the student’s parents as well as observation of the student’s academic performance and behavior in the general education classroom. Once all agreed upon assessments and evaluation measures have been completed and the student’s parents have received copies of the evaluation along with full explanations of the finding, the IEP team can meet to make its determinations.

For each area affected, describe the specific functional and/or developmental skills displayed by the child. A comparison may be documented between the student’s current skills and those they should be displaying at their age or grade level.

73

_____Discrepancy criteria will be used to determine eligibility.

If the child has participated in a process that assesses the child’s response to scientific, research-based intervention document the following:The instructional strategies used in the RtI process that assesses the child’s response to scientific, research-based intervention:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Student-centered RtI data collected: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(Required for RtI and Discrepancy)The child does not achieve adequately for the child’s age or to meet state-approved grade-level standards in one of more of the following areas, when provided with learning experiences and instruction appropriate for the child’s age or state- approved grade-level standards: _____ Oral Expression _____ Listening Comprehension _____ Written Expression _____ Basic Reading Skills _____ Reading Fluency Skills _____ Reading Comprehension _____ Mathematic Calculation _____ Mathematics Problem Solving

List each of the specific strategies implemented during the RtI process. Interventions generally take place prior to referring a student for a complete evaluation. Tier 1:Tier 2:Tier 3:

List the resulting data collected for each of the strategy implemented during the RtI process. This documentation of progress is generally done using curriculum-based measurements (CBM).

Based upon the above data, check each area of potential disability. This information must be provided whether determining eligibility using RtI or the discrepancy model.

This determination will be based on the student’s mastery of grade level content appropriate for the student’s age, including performance against the state’s academic content standards in reading and math. For a student who has been retained in a grade or is otherwise not in the grade typical for his age, achievement against the state’s grade-level academic standards for the students enrolled grade might be used to determine underachievement.

74

_____ Based upon the data gathered the evaluation team determines the child has not made sufficient progress to meet age or state-approved grade-level standards in one or more of the areas identified above when using a process based on the child’s response to scientific, research-based interventions. OR_____The child exhibits a pattern of strengths and weaknesses in performance, achievement, or both, relative to age, State-approved grade level standards, or intellectual development, that is determined by the team to be relevant to the identification of a specific learning disability in one or more of the areas identified above when using appropriate assessments.

(Required for RtI and Discrepancy)Document data that demonstrate that prior to, or as part of, the referral process, the child was provided appropriate instruction in regular education settings by qualified personnel:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

This information must be provided whether determining eligibility using RtI or the discrepancy model.

Students whose lack of achievement can be attributed to a lack of appropriate instruction in reading or math should not be determined to have an SLD. Such students should be provided with appropriate instruction in general education as well as scientific, research-based interventions. Appropriate instruction in reading must include explicit and systematic instruction in:

Phonemic awareness; Phonics; Vocabulary development; Reading fluency, including oral reading skills; Reading comprehension strategies; Mathematic Calculation; and Mathematics Problem Solving.

75

ANDData-based documentation of repeated assessments of achievement at reasonable intervals, reflecting formal assessment of student progress during instruction, which was provided to the child’s parents:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Based upon the above data, the evaluation team must determine that the underachievement in the child suspected of having a specific learning disability:_____is due to the lack of appropriate instruction in reading or math; OR_____is not due to the lack of appropriate instruction in reading or math.

(Required for RtI and Discrepancy)Observation: Relevant behaviors, if any, noted during the observation of the child and relationship of those behaviors to academic functioning. The observation must occur in the child’s learning environment (including regular classroom setting) to document the child’s academic performance and behavior in the areas of difficulty.

This information must be provided whether determining eligibility using RtI or the discrepancy model.

A student’s progress should be documented by using an objective and systemic process administered at reasonable intervals. In other words, information such as teacher reports and teacher made tests, while helpful, are not adequate for this determination. Data should be used to determine the effectiveness of a particular instructional strategy or program and should be provided to parents in order to keep them informed of their child’s progress, so that they can support instruction and learning at home.

If the group charged with determining whether a student has a SLD decides that this documentation is not adequate, a decision may be made to delay making a final determination and continue to collect additional information about the student. In order to extend the time by which the evaluation will be completed, parents must consent to the time extension. The evaluation process must be completed within 25 school days from the districts receipt of parent consent.

Each member participating in the determination must provide written certification that the documentation reflects the member’s conclusion. If any member(s) disagree with the conclusion, a statement of that member(s) conclusion must also be included in the documentation.

Parents must be given a copy of the evaluation report and the documentation of determination at no cost. If parents disagree with the determination, they may seek resolution through the dispute resolution provisions of IDEA. These provisions are part of the Notice of Procedural Safeguards that must be provided to parents prior to the evaluation of a student suspected of having a disability.

Possible sources for review: Attendance records; Enrollment gaps; Instruction by highly qualified teacher; Other _________________________.

76

In the case of a child of less than school age or out of school, a group member must observe the child in an environment appropriate for a child of that age.Observer_________________________________________ Dates of Observation _________________________

_____Information from an observation in routine classroom instruction and monitoring of the child’s performance was done before the child was referred for an evaluation: OR _____Observation of the child’s performance in the regular classroom was done after the child has been referred for an evaluation:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

(Required for RtI and Discrepancy)

Educationally relevant medical findings, if any (attach medical report if needed):___________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________

This information must be provided whether determining eligibility using RtI or the discrepancy model

The school district shall ensure the child is observed in the child’s learning environment (including the regular classroom setting) to document the child’s academic performance and behavior in the areas of difficulty.

In the case of a child of less than school age or out of school, a group member must observe the child in an environment appropriate for a child of that age.

The information should include: The name of the observer; The dates of observation; The location of the observation; The summary of relevant behaviors, if any, noted during the observation of the child and relationship of the

behaviors to academic functioning.

The observation may be conducted during the RtI process or as part of the comprehensive evaluation.

The team must document any medical information including any medical diagnoses, health conditions or medications that may impact the child’s education.

77

(Required for RtI and Discrepancy) The evaluation team determines that the child’s achievement level problem is/is not primarily the result of:

_____Is_____ Is Not - Visual, hearing or motor disabilities;_____Is_____ Is Not – Cognitive disability;_____Is_____ Is Not - Emotional disturbance;_____Is_____ Is Not - Cultural factors;_____Is_____ Is Not - Environmental or economic disadvantage;_____Is_____ Is Not - Limited English proficiency.

If the child has participated in a process that assesses the child’s response to scientific, research-based intervention: Document how and when parents were notified about the State’s policies regarding the amount and nature of student performance data that would be collected and the general education services that would be provided, strategies for increasing the child’s rate of learning and the parents right to request an evaluation.___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

1. SPECIFIC LEARNING DISABILITY - Based upon the above information the team agrees the child:_____has a specific learning disability_____does not have a specific learning disability

This report reflects my conclusions. If not, person(s) in disagreement will indicate such and may submit a separate statement.

Name Position______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree______________________________ ________________________________ ( )Agree ( )Disagree

If the evaluation team determines the child’s lack of achievement can be attributed primarily to any of these factors, the child should not be identified as having a specific learning disability. Such students may be served under other appropriate disability categories.

Documentation must show that the student’s parents were fully informed about the policies, strategies, and services provided as part of the RtI process, including the parent’s right to request a formal evaluation under IDEA at any point during the RtI process.

As with any eligibility determination, the determination of whether a student has a SLD and requires special education is made by a group that included the student’s parents and a team of qualified professionals. Those professionals must include the student’s regular education teacher (or teacher qualified to teach a child of the student’s age) and other qualified individuals to conduct diagnostic examinations. These individuals could be a school s psychologist, a speech-language pathologist or a special educator. The individuals that make up the group may vary depending on the nature of the student’s suspected disability.

78

7. Exit Survey and One-Year Follow-up(This survey is completed online and is here for your reference only.)

Post School Status of Special Education Graduates, SD Department of Education Indicator #14 School Year ______

Exit SurveyNote: Teacher will complete this online prior to student’s exit from High School by dropping out, aging out or receiving a diploma.

1. Graduate’s First Name: ________________________________________________

2. Middle Name (optional): ________________________________________________

3. Last Name: ______________________________

4. SIMS # ____________________________

Note: Include the student’s name whether they graduated from high school with a diploma, certificate of completion, aged out, dropped out or exited in an optional manner.

5. Address: ___________________________________

___________________________________

6. Birth Date: (Month/Day/Year) _____/_____/_____

7. Telephone #: ____________ 8. Cell # _____________________ 9. e-mail ______________

10. School District: _______________________ 11. High School: __________________________

12. Exit Status: (1) Regular Diploma (2) Aged out (3) Certificate of Completion (Not offered in SD)

(4) Graduated with other Diploma [GED] (5) Dropped out

(6) Other ____________________

(NOTE: Students meeting graduation requirements should be marked “diploma.” Students exiting without a diploma at age 21

should be marked “aged out.”)

13. Gender: (1) Male (2) Female

14. Race/Ethnicity: (Select one)

(1) Asian (5) Native Hawaiian/Pacific Islander (2) Black/African American (6) White (3) Hispanic/Latino American (7) Two or more races (4) American Indian/Native Alaskan (8) Not disclosed

79

15. Disability: (Refer to list below & write in the disability status/code.) ________

01 – Emotional/behavioral disability 07 – Multiple disabilities 12 – Communication disorders 03 – Orthopedic impairments 08 – Deafness 13 – Autism04 – Health impairments 09 – Hearing impairments 14 – Traumatic brain injury05 – Specific learning disabilities 10 – Visual impairments06 – Mental retardation 11 – Deaf-Blindness

 From the Transition Plan in the final IEP, please obtain answers to #16 and #17.

16. Anticipated post school outcome(s): (Check all that apply.)

(1) University/4-year college (5) Supported employment (9) Left blank (2) Community/2-year college (6) Military (10) Not applicable (3) Vocational/technical college (7) Supported living (11) Other: _______________ (4) Employment (8) Independent living

17. Which of the following linkages with adult services were recommended for the student at graduation? (Check all that apply.)

(1) Division of Vocational Rehabilitation (5) Mental health (2) Division of Developmental Disabilities (6) Adjustment Training Center (3) Disabled Student Services (college) (7) Not applicable (4) Social Security (SSI/SSDI) (8) Other:_________________________________

18. Did this student take the most recent statewide assessment (during junior year—or if student dropped out before junior year, during eighth grade)? Read each line 13a to 13e and enter one of the following codes:

(1) Yes (2) No (3) Don’t know

(13a) Regular assessment with no accommodations

(13b) Regular assessment with accommodation

(13c) Alternate assessment against grade level achievement standards (Not available in SD for 06/07)

(13d) Alternate assessment against alternate achievement standards

(13e) Alternate assessment against modified achievement standards (Not available in SD for 06/07)

19. Was this student identified as an English Language Learner (ELL) during the student’s last year of school?

(1) Yes (2) No (3) Don’t know

20. During high school, did this student participate in any of the following: Project Skills, Youth Leadership Forum, Catch the Wave, Self-advocacy training

80

21. In the last year of high school, does/did the student work in any of the following? (check each option that applies)

(15a) Volunteer

(15b) Work experience/work study

(15c) Competitive employment

(15d) Don’t know

22. How many year(s) of math classes did this student complete during high school?

(1) One (2) Two (3) Three (4) Four

23. Did this student complete at least one semester of Algebra?

(1) Yes (2) No

23b. Which Algebra was taken: (a) Algebra with non-disabled peers (b) Modified algebra separate from non-disabled peers.

23c. What grade did the student receive in Algebra?

(1) A (2) B (3) C (4) D (4) F

CONTACT INFORMATION AFTER LEAVING HIGH SCHOOLFamily member name:

_____________________________________________________Address:_______________________________________________________________Home Phone: ___________________________________________________________Cell Phone: _____________________________________________________________E-mail:_________________________________________________________________

Family member name: _____________________________________________________

Address:_______________________________________________________________Home Phone: ___________________________________________________________Cell Phone: _____________________________________________________________E-mail:_________________________________________________________________

Best Friend name: _____________________________________________________

Address:________________________________________________________________Home Phone: ___________________________________________________________Cell Phone: _____________________________________________________________

81

E-mail:__________________________________________________

One Year Follow-up Survey

Note: This survey will be completed AFTER the student’s exit from High School via a phone survey. Phone survey will be completed between April and June the year following exit of High School

Telephone InterviewGraduate’s Name: ________________________________________________

High School last attended: ________________________________________

17. Status of telephone interview: (1) Completed (2) Not completed

(Conduct interview with graduate or a family member. Indicate person interviewed below.)

17a. Person interviewed: (1) Graduate (2) Family member (3) Other

(SURVEY INTRODUCTION SCRIPT)

“Hello, I’d like to speak with _____. My name is _____. I am calling for the _____ School District. We are conducting

a study on last year’s graduates. I’d like to ask you how _____ is doing. All information is strictly confidential. This

will only take a few minutes.”

NOTE : Only ask the following questions [17a & 17b] of those student exiters who “Dropped out” or who “Dropped out

other” from data collected from Appendix A. Otherwise go on to question 18.

17a. It was noted on information collected from your school during last year that you had dropped out of school. Did

you return to high school? yes no [If student responds “no” ask 17b. If student responds “yes” go to 18]

17b. Which of the following are reasons you chose not to return to school

Academic difficulty Economic e.g., needed to work Social/Interpersonal difficulties Health reasons Independent Living

82

Other ________________________________________________________

POSTSECONDARY SCHOOL SECTION

18. Has _____ ever been enrolled in any type of post-secondary school or training program?

(1) Yes (2) No (3) Don’t know

(IF YES, record school name,status, and type.)

18a. School Name: ____________________________________________

18b. Status: (1) Full time (2) Part time (3) Don’t know

18c. Type: (Check box below.)

(1) University/4-year college (6) Certification program (GED) (2) Community/2-year college (7) Union apprenticeship (3) Vocational/technical college (8) Employment training (Job Corps) (4) Military (9) Don’t know (5) Vocational training program (10) Other: ________________

19. Is _____ currently enrolled in any type of post-secondary school or training program?

(1) Yes (2) No (3) Don’t know

If yes, Full time (12+ credit hours) If yes, Part time (fewer than 12 credit hours)

(IF YES, record school name and type.)

19a. School Name: ____________________________________________

19b. Type: (Check box below.)

(1) University/4-year college (6) Certification program (GED) (2) Community/2-year college (7) Union apprenticeship (3) Vocational/technical college (8) Employment training (Job Corps) (4) Military (9) Don’t know (5) Vocational training program (10) Other: ________________

If “yes” to 18 and/or 19 skip to 21, If “no” to 18 and/or 19 ask question 20

20. “What do you believe to be the reason that you have not enrolled in post-secondary education since high

school?” (check up to three reasons. If more than three are mentioned, ask/help the student to pick the most

important ones.)

(20a) Lack of postsecondary opportunities in the immediate locale

(20b) Student lacks necessary skill/qualifications to enter postsecondary education

83

(20c) Student lacks transportation

(20d) Student has not received necessary services from community agencies (e.g., VR)

(20e) Student is working

(20f) Student has personal/family obligations that preclude going to postsecondary education

(20g) Student does not want to go to postsecondary education

(20h) Student has health problems that preclude going to postsecondary education

(20i) Student believes they cannot afford to go to school.

21. Did _____ make any contact with an adult service agency, such as Division of Vocational Rehabilitation, Division of Developmental Disabilities, etc.?

(1) Yes (2) No (3) Don’t know

(IF YES, mark agencies contacted. NOTE: this does not necessarily mean the graduate is receiving services, but has contacted the agency.)

21a. Agency Type: (Check all that apply.)

(1) Division of Vocational Rehabilitation (2) Division of Developmental Disabilities (3) Disabled Student Services (college) (4) Mental health (5) Yes, but don’t know agency name (6) Other:_________________________________________

EMPLOYMENT SECTION

22. Does _____ currently work for pay? (1) Yes (2) No (3) Don’t know

(22a) Competitive Employment for pay ---Full Time (35+ hours)

(22ai) Competitive Employment for pay---Part Time (less than 35 hours)

(22aii) Are you working only one job??? Yes _______ No ___________

(22aiii) If no, how many other jobs and number of hours each?? # of jobs_____ Hrs/job ______

(22b) Competitive Employment as a volunteer or in a training capacity

(22c) In the Military___________________(branch)

(22d) Family member’s home or business

(22e) Sheltered Employment for workers with Developmental Disabilities

(22f) Supported Employment program in community for workers with Developmental Disabilities

(22g) Working while incarcerated

(22gi) Work Study--college

(22h) Other ___________________________________84

(IF YES to 21., complete following.)

22i. Employer (business) name: _____________________________

22j. Number of hours per week: ________________

22k. How long have you been employed with this employer? ________________

22.l Is this the only employer you have had since graduations? (1) Yes (2) No

22m. Wage amount: $______________________

22n. Wage period (Check the box that applies to the wage amount in 21k.)

(1) Hourly (3) Monthly (5) Other:_______________ (2) Weekly (4) Annually (6) Don’t know

(IF NO to 22., state the following and complete as directed)

23. “You said that you have not worked since high school. Why not? (check up to three reasons. If more than three are indicated, ask/help student to pick the three most important ones)

(23a) Lack of employment opportunities in the immediate area

(23b) Lacks necessary employment skills

(23c) Lacks transportation

(23d) Has not received necessary services from community agencies (e.g., VR)

(23e) Student is enrolled in school

(23f) Student has family obligations

(23g) Student does not want to work

(23h) Student believes he/she would lose benefits (e.g., SSI/disability/unemployment)

(23j) Student has health issues that preclude working

(23k) Other _____________________________________

24. Does _____ currently live with family? (1) Yes (2) No

25. Is _____ covered by family’s health insurance? (1) Yes (2) No (3) Don’t know

(IF NO or DON’T KNOW to 24, complete the following.)

24a. Is _____ covered by any other insurance (e.g., employment benefits, Medicaid,

SSI, etc.)? (1) Yes (2) No (3) Don’t know

85

(IF YES) 24b. Type of Insurance: ______________________________

Final Question

25. “I am going to read a list of areas where young people sometimes have problems. Usually, there are programs and services in every community that help people with these problems. Let me know if you want more information about how to contact them”. (check only one option for each service)

25a. Employment (1) No (2) Yes, more information (3) Yes, Crisis

25b. Living in the Community (1) No (2) Yes, more information (3) Yes, Crisis

25c. Education (1) No (2) Yes, more information (3) Yes, Crisis

25d. Finances (1) No (2) Yes, more information (3) Yes, Crisis

25e. Medical Care (1) No (2) Yes, more information (3) Yes, Crisis

25f. Transportation (1) No (2) Yes, more information (3) Yes, Crisis

25g. Legal (1) No (2) Yes, more information (3) Yes, Crisis

25h. Social/Leisure (1) No (2) Yes, more information (3) Yes, Crisis

25i. Other (1) No (2) Yes, more information (3) Yes, Crisis

Specify __________________________________________

Additional Comments:

All surveys for Indicator #14 tobe completed from:

April-September year following graduation

86