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__Initial Plan: Complete "ATTACHMENT A" Eligible__ Not Eligible__ No Parent Signature__ __Annual/Triennial Review (circle one) __No Change __Change Add Services__________________________ Drop Services_________________________ __Pre-K Transition to Kindergarten __Kindergarten Transition to 1st grade __Other____________________________________ __Review of Interim (Date entered SFUSD___/___/___) __Addendum to IEP dated ___/___/___ __DEMIT from Special Ed |
COMPLETE THIS SECTION AT THE END OF IEP MEETING BUT PRIOR TO PARENT SIGNATURE
- Initial Plan
Date of first IEP developed for student;
Attachment A is required (interventions or SST information is reviewed in attachment).
- Annual / Triennial Review
___No change
Student is currently enrolled in SFUSD SpED program, and service / placement to remain the same.
___Change
Student is currently enrolled in SFUSD SpED program, but services are being added or dropped, or placement is being changed.
___Triennial Review is circled when all appropriate reassessments are completed or after assessment review (form 3.l) is signed and complete.
- Other _____________________________
If no other box describes the type of IEP, team can indicate reason here i.e., parent request, final/exit/graduation IEP, etc.
- Pre-K Transition to Kindergarten or Kindergarten Transition to First Grade
A reassessment was conducted to determine if student continues to need SpED services; other boxes such as review/change may need to be checked.
- Review of Interim
Student has transferred into SFUSD with IEP from another District/ State; student is offered interim placement for 30 days. SFUSD IEP needs to be done in 30 days.
- Addendum to IEP dated _/_/__
Current, earlier IEP is being amended; also check box - annual/ change and indicate change(s), or check other boxes, if appropriate.
- Demit from Special Education
Student is not to receive SpED services; also check box – annual review/ change or other boxes as appropriate.
This IEP___/___/___
Implementation Date ___/___/___
Duration_______ Next IEP___/___/___
Last IEP___/___/___ Initial IEP___/___/___
Last Assessment Determining Eligibility ___/___/___
Next Triennial Assessment ___/___/___
- This IEP
Enter date(s) of team meeting(s). It is possible to have several meeting dates.
- Implementation Date
Usually date of following school day.
- Duration
IEPs typically last for one year. The duration may not exceed one year, but it is possible if the IEP team has compelling reasons, to write an IEP for a period of less than a year. The reason(s) should be documented in IEP.
- Next IEP
Typically, this date would be one year from date of IEP. If duration is less than one year, date of next IEP should indicate appropriate duration. Addendum meetings do not extend review dates. (Refer back to the IEP that is being changed).
- Last IEP
Enter date of last signed IEP. If an unsigned IEP has been submitted, please note with an * and give the date.
- Initial IEP
Enter date of first SFUSD IEP.
- Last Assessment Determining Eligibility
Enter date of latest evaluation (initial, reevaluation or assessment review).
- Next Triennial Assessment
This date will be 3 years after date of "Last Assessment Determining Eligibility".
MEDICAL ALERT: CHECK BOX AND FILL IN HEALTH CONCERN on PAGE 3
STUDENT INFORMATION
Last Name_______________________________ First Name____________________ HO#_________________
DOB___/___/___ Age___ Sex ___ Ethnicity__ English Language Learner ___(if ELL, address in goal section)
Home Language___________ Student’s Language____________ Interpreter Required __ in_______________
Student Address_______________________________________ Zip__________ Student Phone____________
Parent/Guardian___________________ Address__________________ Home Phone ________Work_________
School______________________ Grade____ Specify : District___ Private ___ NPS ___ Out of District ____
Resides in: Home____ Foster Home____ Licensed Children’s Institution________________________
- Parent will need to verify and/or correct student information.
- For changes to become part of database at central office level, the school site data clerk must be notified and provided with relevant information. ONLY THE SCHOOL SITE CAN MAKE PERMANENT CHANGES IN DATA INFORMATION, i.e. home address or phone number.
- A language interpreter is required when home language is not English.
Interpreter’s name should appear on signature page.
- ELL (English Language Learner) designation is determined by looking at school enrollment database.
Only the Bilingual Education and Language Academy (BELA) can make this determination, not IEP team. Communication section of IEP on page 3 will need to be completed with assistance from appropriate staff and linguistic goal(s) written for students designated ELL.
Important to note: Complete page 2 and page 3 of the IEP BEFORE completing eligibility section on page 1.
ELIGIBILITY (Disability/Category - check only one Severe ___ Non-Severe___
(To be completed after Section II, DESCRIPTION OF STUDENT EDUCATIONAL PERFORMANCE)
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____ Speech or Language Impairment |
____ Specific Learning Disability ** |
___ Emotionally Disturbed |
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____ Deaf * (LI) |
____ Orthopedically Impaired* (LI) |
____ Cognitively Impaired |
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____ Hard of Hearing * (LI) |
____ Other Health Impaired* |
____ Autistic |
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____ Deaf/Blind * (LI) |
____ Established Medical Disability* (0-5 years) |
____ Multiple Disabilities |
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____ Visually Impaired * (LI) |
____ Traumatic Brain Injury* |
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* Requires Physician Report / appropriate documentation
** Attachment C may be necessary
____ Low Incidence Eligible (LI)
____ Medi-Cal Eligible
- Check Severe or Non Severe after IEP meeting has concluded placement recommendation.
ONLY CHECK SEVERE, IF SI/SDC IS THE APPROPRIATE PLACEMENT OFFER. ALL OTHER PLACEMENT OFFERS ARE NON SEVERE.
- Check only one eligibility.
IEP team makes determination of primary disability, taking into consideration all of the information presented in Description of Student Educational Performance (Page 2 and 3 of the IEP).
- Use Continuing Notes page to discuss any other issues concerning eligibility that IEP team feels are relevant.
- Eligibility marked with * needs a medical statement attached to the initial and all triennial IEPs.
A copy of medical reports should also be in the brown Pupil Services file in section five (social/medical/developmental history).
- Specific Learning Disability**REQUIRES ATTACHMENT C ONLY WHEN IEP TEAM DOES NOT AGREE WITH PSYCHOEDUCATIONAL ASSESSMENT RESULTS.
- Check Low Incidence Eligible if student has hearing, vision, or orthopedic impairment.
- Check MediCal Eligible only if parent indicates this is the case. No documentation is necessary.
II. DESCRIPTION OF STUDENT EDUCATIONAL PERFORMANCE
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DATE |
TYPE of REPORT |
Submitted by Title/NAME |
ASSESSMENT RESULTS |
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Psychoeducational |
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Educational (Standardized Tests) |
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DIS (specify) |
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State / District Mandated Assessments (SAT 9, IWA, Proficiency, Brigance, etc.) |
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Teacher / Classroom Assessments, Observations, Report Card |
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Other |
- Latest psychoeducational report or assessment review information is summarized here and parent should be given copy of new reports.
Include name of SFUSD psychologist who wrote the report and results. ANY REPORTS FROM OUTSIDE SOURCES MUST BE SUBMITTED FOR REVIEW. Teachers: Please note that it takes at least 2 weeks for psychologist to review and return reports.
- All DIS (Designated Instruction and Services) reports are summarized here.
A copy of the full report should be given to the parent and filed in the brown Pupil Services file (section 4). Full reports are not part of the IEP.
- Teacher and classroom observations and assessments for achievement levels or for functional skill levels should be summarized here.
- Results of all standardized tests (i.e. PIAT) should be recorded.
- Results of all state and district mandated assessments are to be recorded.
Test results can be found in the cumulative record (cum) folder.
- Copy of the most recent report card or transcript may be attached to IEP.
Vision Screening Date: ___/___/___ Passed ___ Not Passed ___ Screened at: _______
Hearing Screening Date: ___/___/___ Passed ___ Not Passed ___ Screened at: _______
- Fill in results of latest vision and hearing screenings.
Information is in cum folder.
PRESENT LEVELS OF ACADEMIC / FUNCTIONAL PERFORMANCE
Student Areas of Strength: (Include parent/guardian observations and concerns; describe classroom performance, academic skill levels, including data from chart above as needed.)
_____________________________________________________________
_____________________________________________________________
Areas of Student Need:
_____________________________________________________________
- Area of Strength and Area of Need:
Comments in these areas should focus on student’s academic skills, study skills, academic interests and general scholastic performance. Include information regarding functional skill levels for students with severe impairments. Parental observations and concerns relating to their student’s academic or functional skills should be included in this section.
Does student behavior impede his or her own learning? yes ___ no___ learning of others? yes ___ no___
If yes, address INTERVENTIONS in goal section and COMPLETE BEHAVIOR SUPPORT PLAN ATTACHMENT B
Describe Student Behavior:____________________________________________________
Describe Social Interaction Strengths and Needs:___________________
_____________________________________________________________
- It is important to clearly describe student’s behavior.
A narrative describing antecedents and behavior response(s) would be appropriate.
• A BEHAVIOR SUPPORT PLAN MUST BE PART OF THE IEP when yes is checked. Use ATTACHMENT B. The Behavior Support Plan is written by the IEP team, but the SpED teacher should be prepared to lead this activity and should draft the attachment before the meeting.
• A GOAL with objectives/benchmarks RELATED TO BEHAVIOR MUST BE INCLUDED IN THE IEP when yes is checked.
Describe Student Communication Skills and/or Language Needs: ______________________________________
__ELL (If Student is ELL, as determined by Bilingual Education and Language Academy (BELA)address need for Linguistic Goal(s) in Goal Section of IEP
__ Deaf __Hard of Hearing __ Augmentative and Alternative Communication Devices Currently in Use:
(Describe Opportunities for Direct Instruction and Communication with Peers and Adults in
Student Language, and/or Mode of Communication_____________________
- ELL language need(s) will need to be determined by BELA teacher or by teacher with CLAD certificate.
A goal with objectives/benchmarks must be included in the IEP related to English language acquisition. Appropriate language teacher will need to sign IEP.
- Describe student’s communication and speech abilities.
This is where the IEP team provides concrete information about student’s communication and speech abilities. Reports from Speech and Language staff and other assessments are considered at this point and also described in Summary of Assessments on page 2 of the IEP. All DIS reports are given to parent and put in brown Pupil Services file. DIS reports are not attached to the IEP.
- Deaf __ Hard of Hearing___
In this section describe the environment where language and speech issues are being addressed, i.e. type of classroom, group or individual language lessons, etc. Include mode of communication being used, i.e. total communication, oral, sign language.
- Augmentative and Alternative Devices____(not limited to Deaf or Hard of Hearing)
Some students may use specialized electronic or computer equipment to facilitate communication. Other students may use picture communication books. Describe what items (high or low tech) are used by students and staff to facilitate language understanding and communication.
__________________________________________________________
- Discuss pertinent health concerns in this section.
If condition warrants, check Medical Alert box on page 1.
After Concluding Description of Student Performance, Return to PAGE 1 to indicate Eligibility
- AT THIS TIME CONSIDER ELIGIBILITY and complete eligibility section on page 1 of the IEP.
Before formulating NEW/REVISED MEASURABLE ANNUAL GOALS and SHORT TERM OBJECTIVES, review GOALS and SHORT TERM OBJECTIVES from previous IEP/Progress Report, and document progress on IEP found in Brown Pupil Services File.
BEHAVIOR PLAN ATTACHED? Yes___ No ___ TRANSITION PLAN ATTACHED? Yes___ No___
For Ages 14 &
15, describe Transition Service needs related to courses of study:_____________________________
__________________________________________________________
For Age 16 and
up, complete Attachments E.1 and E.2
- IT IS IMPORTANT TO REVIEW ALL PREVIOUS GOAL SHEETS.
Document progress on the IEP in the brown Pupil Services file. THIS IS NOT OPTIONAL.
- Transition Services must be addressed for all students age 14 and over.
For students ages 14 and 15, it is sufficient to use this section to describe course of study. Attachment E.1 and E.2 are not required, but can be used.
FOR STUDENTS AGE 16 or older, ATTACHMENT E.1 AND E.2 ARE REQUIRED.
- DIS and Speech Only students will also need these attachments.
- It would be appropriate for the Annual Goals and Short Term Objectives (Benchmarks) to relate to activities described in the transition services section or activities detailed in attachments E1 and E2.
- The School to Career office has an instruction packet that can be requested from your school representative that explains transition service language and activities.
SEE SAMPLE GOAL SHEET ON FOLLOWING PAGE
MEASURABLE ANNUAL GOALS & SHORT TERM OBJECTIVES (BENCHMARKS)
(Report Card to be completed by appropriate teachers and sent home at regular intervals as with all general education students)
ANNUAL GOAL #__1___ NEW___ CONTINUING___ REVISED____
Area of Need: Select ONE category per goal sheet where student needs improvement, i.e. Phonics, or Math, or Independent Living
SELECT A GOAL THAT HAS MANY SKILLS REQUIRED FOR MASTERY SO YOU CAN GROUP YOUR OBJECTIVES ON ONE PAGE. IT WOULD BE APPROPRIATE TO HAVE A GOAL PAGE FOR ANY ACADEMIC OR FUNCTIONAL SKILL AREA, i.e. LANG.ARTS, MATH, SCIENCE, WRITTEN EXPRESSION, BEHAVIOR, SOCIAL SKILLS.
Annual Goal: Determine what skills are to be developed and worked on during the year, i.e. Student will improve decoding skills, or whole number computation, or ability to use Muni independently
Baseline: Describe what skills student already possesses in this category, i.e. Student reads at 2nd grade level, but has difficulty with word attack and blending, or student can add three digit numbers but cannot subtract without using manipulatives, or student cannot safety cross busy intersections
Criteria: Determine what degree of skill must be demonstrated to show mastery, i.e. Teacher made test passed at 75%+, or teacher observation and portfolio samples, or record of attempts passed 100% of time.
Does this goal: (1) enable the student to be involved /progress in general curriculum _x_yes __no
(2) address other educational needs resulting from the disability _x_yes __no
(3) address parental concerns _x_yes __no___
1. Short-Term Objective (Benchmark): State a specific observable behavior that is desired and obtainable, i.e. Student will be able to identify short vowel sounds, or student will subtract two digit numbers, or student will cross intersections using lights, crosswalk and island appropriately.
Baseline for Short-Term Objective: Describe student’s current level of performance in relation to benchmark, i.e. Student knows long vowel sounds, or student has memorized subtraction facts to 20, or student can cross in residential street area.
Criteria: Explain how objective is going to be monitored and achievement measured, i.e. teacher developed test at 80% accuracy, teacher data sheet collection, student homework and test samples in portfolio, demonstration of skill in community setting
Person(s) Responsible: Teacher, student, para staff, parent, etc. Date: ___/___/___
2. Short-Term Objective (Benchmark): Select another observable behavior under same long range category, i.e. Student will blend beginning double consonants, or student will work word math problems that require subtraction, or student will cross at corner where there is no stoplight.
Baseline for Short-Term Objective: see above (describe what student currently is doing or level of performance)
Criteria: see above (describe how achievement will be determined and measured)
Person(s) Responsible: see above (more than one person can be indicated) Date ___/___/___
Excludes non-student days per school calendar and provider/student absences
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RSP |
DIS |
Service Delivery Model |
Start/End Date |
Frequency / Time Per Wk/Mo/Yr |
Service Location |
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- In these boxes, DIS and RSP staff indicate what, where, when and how service(s) will be provided to student. Student has been previously assessed for these services.
IEP team can request assessment for additional services, but remember a referral always involves submitting a referral form.
Use a Continuing Notes page to discuss need and /or reasons for referral(s) and indicate who will be completing these additional forms.
Asking for an assessment does not guarantee the assessment results will find the student needs service.
After the assessment is completed, the IEP team will meet again and determine the needs based upon the assessment. (Addendum to IEP will be necessary)
- If the IEP team is considering changing the service specifications, the DIS provider must be at the IEP meeting to discuss the appropriate services for the student.
SPECIAL EDUCATION TRANSPORTATION
__Transportation Services NOT NEEDED
__Continuing Need
__New Request: Approximate Start Date for Transportation Service: ___/___/___
Check as appropriate:
Type of Transportation:
__ General Education Feeder Pattern
__ Muni (Youth)/ __ Muni (Disabled)/ ___ Muni (Adult)
__ Special Requirements:
__ Door to Door
__Wheelchair __Harness __Aide/Para __Nurse
__Parent will transport student until bus service begins
__Student will be travel trained and transportation discontinued by ___/___/___
__Special Considerations (Specify: seizures, G-tube, shunt, restricted travel time, behavior, etc.):
- New requests require Transportation Information Form to be completed by IEP team.
- If transportation is needed, IEP should consider appropriateness of adding a travel training goal.
- Start date for new service (or for changes in address) is two weeks after Transportation Dept. is notified.
- If transportation is necessary for CMH services or other DIS services, the IEP team needs to indicate transportation on the IEP by checking SPECIAL REQUIREMENTS and indicating which service(s).
CMH will submit their information directly to the placement office.
ADDITIONAL SUPPLEMENTARY AIDS & SERVICES ___Not Appropriate at this time Start Date:
___Assistive Technology Devices/Services_________________ Braille Instruction___ Braille Materials___
___If the visually impaired student is not receiving instruction in Braille and the use of Braille, state rationale based on evaluation of student’s reading and writing skills and specify the appropriate reading and writing instruction (if appropriate, describe the student’s future Braille needs
- This section is NOT for referrals. To make a referral see instructions above.
SPECIFY SUPPORTS FOR SCHOOL PERSONNEL: Not Appropriate at this time ____
___ Specify and describe additional support for school personnel (to assist students in attaining goals and progressing in general curriculum). Provide appropriate documentation and specify frequency/ duration).
• In this section, outline how student will be supported while at school: i.e. how will the general education staff be consulted, assisted and notified of required modifications or accommodations.
- Discuss how existing paraprofessional assistance, if any, will be provided.
THIS AREA IS NOT TO BE USED TO MAKE A REQUEST FOR ADDITIONAL CLASSROOM SUPPORT PERSONNEL. Ask your Program Consultant for assistance and for referral packet to initiate such a request.
- Discuss how behavior issues and concerns should be handled.
Provide general education teacher with a copy of Attachment B (Behavior Plan) and goal sheet.
EXTENDED SCHOOL YEAR NEEDED (ESY) Yes___ No___ Not appropriate at this time __
(If NO, student may enroll in regular district summer program). Detail specific ESY needs on Continuing Notes page if more space is necessary.
- Special Education students may attend either the regular SFUSD summer program or ESY in accordance with an IEP.
Generally RS students attend regular district summer school. In this instance, check "No".
SUPPORTS AND MODIFICATIONS: (To assist student in attaining goals, and progressing in general curriculum)
1. Access to / Use of Supplementary Aids and Services in 1 = General Education O = Special Education Duration: ________________________
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and/or workbook |
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2. Instructional Modifications in 1 = General Education O = Special Education Duration: ________________________________
concepts and vocabulary |
check for understanding O |
into manageable parts |
3. Assignments in 1 = General Education O = Special Education Duration: _________________________________
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4. Grading Modifications in 1 = General Education O = Special Education Duration: ________________________________
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- THIS PAGE WAS DESIGNED TO BE COPIED AND GIVEN TO ALL TEACHERS WORKING WITH A SPECIFIC STUDENT.
General education teachers need to know about modifications agreed to at the IEP meeting and how this might effect their courses, grading, homework etc.
- Modifications in general education classes and special education classes can be marked separately by filling in either "circle" or "square" bullets.
Make specific comments regarding the courses/classes/times when modifications would be appropriate unless you are intending to have modification apply to everything student does.
- A general education teacher attending the IEP meeting should be asked to participate in the development of this support page.
They are representing all the general education staff and should look this over with care.
PARTICIPATION IN STATEWIDE TESTING
- Currently California is using the Stanford 9 for its STAR Program; there are always specific instructions for modifying tests, and the Stanford 9 is no exception to that rule.
Only modifications listed in this section can be used.
- No student is automatically exempt from testing.
Most students should be encouraged to participate with or without modifications. Students may be exempted from statewide testing only with written request from parent.
• If at the time of the IEP meeting, the parent or guardian has previously submitted a written request to exempt student from the STAR, check both Exempt and Parent Request.
• If no parent request has been previously filed, and the IEP team recommends exemption, check Exempt. If "exempt", the reason is IEP team recommendation. If "exempt", alternative assessment will include a review of IEP goals and objectives.
- Ignore Alternative Standards - not yet established by California Dept of Ed (CDE).
V. GENERAL EDUCATION/SPECIAL EDUCATION PARTICIPATION
1.Student participates in general education with the exception of (list subject areas / classes, activities, and/or pullout services away from general education): ______________________________________________________________________________________
2.Description of how student disability affects involvement and progress in general curriculum and/or appropriate activities:________________________________________________________________________________
3.Preschool age child participates in developmentally appropriate activities that include:________________________________________________________________________________
4.Modifications required for student to participate in school-related extracurricular and nonacademic activities for which student is otherwise eligible (assemblies, field trips, etc.___________________________________________________________________________________
5.When transitioning a student from Special Day Class (SDC) or Non-Public School (NPS) to a full time general education placement, describe activities, supports, and schedule to be used to integrate the student: _______________________________________________________________________________________
- It is important to remember that IDEA regulations require an explanation for ALL school time spent out of the general education environment.
Students in SDC are not exempt from this regulation, so specify what classes and/or services will be provided in a more restricted setting (#1).
It is necessary to describe how a student's disability affects involvement and progress in the general curriculum (# 2). THIS IMPORTANT AREA MUST BE ADDRESSED.
Consider at this point how student is doing in the general education curriculum and why it may be necessary for modifications to be implemented. Or
Describe how Pre-K student is participating in developmentally appropriate activities (i.e. how young children are provided opportunities to participate in play and exploration activities)(#3).
- Detail accommodations and modifications needed to make student able to participate in school activities, events, trips, etc (#4).
- When student is being moved to a less restrictive environment (i.e. NPS to public school, SDC to RS or Inclusion, RS to general education with consultation, etc.), describe plans and supports to insure success in this less restrictive setting (#5)
TOTAL TIME IN GENERAL EDUCATION:
______100% ______80-99% ______ 40-79% ______ 1-39% ______ 0%Explain
- Percentage of time in general education classes must be specified by checking box on page 7 of the IEP.
DISCUSSION OF PLACEMENT/SERVICE OPTIONS DISCUSSED?
1. General Education with Supplemental Aids and Services, Modifications, Supports Yes __ No___
2. General Education with Special Education Consultation_____________________ Yes __ No___
3. General Education with Special Education Resource________________________ Yes __ No___
4. Special Education Day Class __________________________________________ Yes __ No___
5. Hospital/Homebound Instruction_______________________________________ Yes __ No___
6. Other (i.e. NPS, State Special Schools) _________________________________ Yes __ No___
- It is important to discuss placement options - least restrictive to most restrictive at the IEP meeting.
YES should be checked in the "Discussed" column for 1 through 6.
- The administrative designee on the IEP should be knowledgeable about placement options, district policies and procedures.
If in doubt, postpone IEP or call for assistance.
VI. SUMMARY OF PLACEMENT OFFER (To be completed after IEP is developed):
___General Education Classroom/DIS ONLY ___General Education Classroom/ INCLUSION ___General Education Classroom/RSP
___SDC (Special Day Class) ___ NPS (Non-Public School)
___ Speech ___Vision ___Orientation/Mobility ___ Physical Therapy ___Occupational Therapy
___Community Mental Health ___Adaptive PE ___Transportation ___ Other DIS Related
___ Supports ___Modifications ___ESY (Extended School Year)
- This section is completed AFTER all other parts of the IEP are completed and is a summary of everything offered in the IEP.
- This is NOT where referrals for services are made. Do not check any service/ placement/ modification not otherwise covered in detail elsewhere in the IEP.
VII. PARTICIPANTS OF IEP COMMITTEE IN ADDITION TO PARENT/GUARDIAN
(Please print name ABOVE title)
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Name |
Signature |
Date |
Name |
Signature |
Date |
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SFUSD Administrator ** |
Special Ed Teacher ** |
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Student (optional) |
General Ed Teacher ** |
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Speech/Language |
Other |
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Other |
Other |
**Required for valid IEP
(Signature indicates attendance only)
____Upon reaching age 17, student and parent/guardian have been informed of the rights which transfer to the student upon reaching the age of majority (18), unless student is conserved.
- Everyone, other than the parent, attending IEP meeting is asked to sign; signature indicates attendance only.
Participants do not indicate agreement or dissent.
- If DIS providers are unable to attend the IEP, a signed copy of their report must be provided to the parents and the IEP team.
This report will provide information for Summary of Assessments (page 2) and Service Specifications (page 5).
- General education teacher, DIS staff, etc. do not need to be present for the entire meeting.
Plan to stagger times so staff and parent can discuss student issues with each other sequentially.
- On rare occasions, i.e. NPS students or students over age 18 attending Community-Access Transition programs, a general education teacher may not be required.
If you have questions on this issue, call your Program Consultant for clarification.
- Please be sure that parent and student are clear regarding Transfer of Rights.
This conversation must happen when the student is age 17. Rights transfer to the student at age 18.
1.__I have received a notice of my Parental Rights and Procedural Safeguards for Special Education and understand them
2.__I agree with the recommendations and give consent to implement
3.__I agree with the recommendations and give consent to implement, with the exception of__________
4.__I disagree with the entire IEP (Dissenting Statement IS / IS NOT attached)
5.__I have received all copies of reports determining eligibility
6.__I have participated in the development of the IEP
** Parent / Guardian Signature: ________________________________________ Date: _______________
If NO parent signature, complete Attachment F and submit with IEP to EPC/Special Education School Assignments.
- Procedural Safeguards are sent out to parent/guardian with Notice of Meeting, assessment referrals, discipline contacts, and any other formal contact.
You will need to cover Procedural Safeguards, line by line, if necessary, to help the parent feel comfortable checking line 1.
- A "typical" IEP would have the parent checking lines l, 2, 5, and 6. BUT, it is possible to submit and implement IEPs that have other combinations of checkmarks.
- A parent could check line 3 (i.e. requesting more speech therapy) and the rest of the IEP could be implemented the next day.
- If the parent checks line 4, you submit the IEP, but that IEP cannot be implemented until the dissent is resolved.
The last signed IEP can continue to be used to determine services and placement, if the parent will sign a statement giving consent to continue current services and program.
- DIS reports, psycho educational evaluations, behavioral assessments are all provided to the parent.
Requests for copies of reports, testing information, etc. should be honored in a timely fashion. Parent should be willing to check line 5.
- When a parent has not responded to requests to sign the IEP, complete ATTACHMENT F and submit it along with the unsigned IEP to placement office.
This attachment documents dates of phone contacts, written contacts and mail contacts that substantiate attempts to secure parent signature on completed IEP
- Parent/Guardian must be notified in writing when an IEP meeting is going to be held to discuss and plan for their student. Notice should be given 10 days prior to meeting. Send copy of Procedural Safeguards with each notice.
- Parent needs to be given at least three opportunities to respond to Notice of Meeting. A copy of each of these notices needs to be filed in the brown Pupil Services Folder. It is very important to document all attempts to contact parent and arrange IEP meeting.
- If parent does not respond to three attempts to convene meeting, the school team should proceed with IEP.
- When IEP meeting is held just for the purpose of amending services or to change a program or placement, the following needs to happen:
- The IEP being amended must be CURRENT; it is not possible to amend a document over a year old. In that case, a new full review must be held.
- An Addendum IEP will need: page 1, the Addendum/Continuing Notes page, a goal page when applicable (i.e. adding DIS service), and a signature page.
- On the Addendum/Continuing Notes page, it is important to summarize any assessments, give service specifications of time, frequency and duration. Also discuss any other pertinent information, i.e. transportation.
- This attachment is necessary for initial IEPs only. Discuss interventions tried prior to consideration for SpEd services.
- Use this attachment whenever student’s behavior impedes learning of self or others. See page 3 of the IEP.
"C" CERTIFICATION OF SPECIFIC LEARNING DISABILITY
- See Eligibility section on Page 1 of the IEP.
- Attachment C is only necessary when IEP team does not agree with assessment results. (Team is overriding psychoeducational recommendations.)
- Documentation
will need to accompany this certification.
"E" TRANSITION SERVICE LANGUAGE; HIGH SCHOOL GRADUATION AND PROFICIENCY STANDARD TESTS
- For students ages 14 and 15, describe course of study related to Transition Services. See Page 3 of IEP (III. Goals and Plans). It is optional to complete Attachments E.1 and E.2.
- FOR STUDENTS 16 OR OLDER, IT IS NECESSARY TO COMPLETE ATTACHMENTS E.1 AND E.2.
"F" DOCUMENTATION of ATTEMPT to SECURE SIGNATURE
- See directions on attachment
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