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INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

IEP Committee Meeting Date: / / Projected Annual Review Date: / /

IEP Implementation Date: / / / (Projected date when services and programs will begin)

Date of Birth: / / Age: _______

Projected End Date: (Projected date when services and programs will end)

Primary Eligibility:

Gender:  Female  Male Ethnicity: _________ Secondary Eligibility:

Grade: _______ School: _____________________________ Current Eligibility Date: / /

Projected Re-evaluation Date: / /

Parent/Guardian Name(s):

Address:

Phone Number:

Email:

IEP COMMITTEE PARTICIPANTS (Signatures are not required.)  Initial (Written Parental Permission for Initial Placement must be signed before implementation.)  Annual

Name Position Name Position

Names and Positions of Excused IEP Committee Members (Attach document to IEP) Name Position Name Position

The IEP meeting was conducted via alternate means of technology:  N/A  Video Conferencing  Conference Call  Other:

This IEP meeting was recorded:  Yes  No

EVALUATIONS Check any evaluations or follow-ups needed to determine special education services and/or related service needs.  Functional Behavioral Assessment (FBA)  Assistive Technology Assessment  Occupational or Physical Therapy Evaluation  List other evaluation(s)/follow-up(s)

/

_____________________________________________________________________

_______________________

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

IEP COMMITTEE PARTICIPANTS (Signatures are not required.) IEP Action:  Review  Revise  Amend  ESY Date:

Name Position Name Position Agency Representative Interpreter

General Educator Other:

Special Educator Other:

Parent/Guardian Other:

Parent/Guardian Other:

Student Other:

Names and Positions of Excused IEP Committee Members (Attach document to IEP) Name Position Name Position

The IEP meeting was conducted via alternate means of technology:  N/A  Video Conferencing  Conference Call  Other:

This IEP meeting was recorded:  Yes  No

EVALUATIONS Check any evaluations or follow-ups to determine special education services and/or related service needs.

Functional Behavioral Assessment (FBA)  Assistive Technology Assessment  Occupational or Physical Therapy Evaluation  List other evaluation(s)/follow-up(s) ______________________________________________________________

PROCEDURAL SAFEGUARD NOTICE  I have received a copy of the Procedural Safeguards Notice, and my rights and those of my child have been fully

explained. The public agency has informed me of whom I may contact if I need additional information.  I do not wish to receive a copy of the Procedural Safeguards Notice. The public agency has informed me of whom I

may contact if I need additional information.

Parent/Guardian Signature:___________________________________________ Date: ________________________ SUMMARY OF REVISION

Describe any changes in services and supports in the IEP (e.g., addition or deletion of services provided, increase or decrease in frequency of services provided).

 Check to verify that all changes were made in the IEP.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE Student’s Strengths, Preferences, and Interests Levels of performance should reflect the following and include current data sources: 1) the student’s current performance in math and reading, 2) the strengths, both academic and functional, of the student; 3) a description of the student’s social, behavioral, and/or emotional sk ills; 4) the student’s interests; 5) the student’s preferences; 6) If the student is 14 years or older, how the student’s level of academic and f unctional achievement will affect the pursuit of postsecondary goals. If preschool, include developmentally appropriate activities.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE Impact of Disability and Student Needs (Critical Skills and Behaviors or Developmentally Appropriate Activities) Levels of impact and needs should reflect the following and include current data sources: 1) the direct impact of the student’s disability in accessing or progressing in the general curriculum (reading and math curriculum, behavior, and functional activities (if the student has a reading deficit, the student’s Individual Reading Plan content should be included); 2) the gap for the student academically, functionally, and/or developmentally and how this compares to his peers; 3) any needed accommodations and/or modifications; 4) if preschool, age-appropriate developmental sk ills the student is lack ing compared to peers; 5) transition sk ills—describe how the effects of the disability will impact postsecondary transition; and 6) content of the EL student's Language Service Plan, if applicable.

Parent/Student Input Include any concerns of the parent and, as appropriate, the student for enhancing his or her education.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

ANNUAL GOAL BASELINE DATA Baseline data to determine the annual goal must include: (a) a data source, (b) a clear description of the observable “target” sk ill or behavior, (c) the condition under which the “target” sk ill or behavior can be observed, and (d) the current rate of performance based on baseline data.

AREA OF ANNUAL GOAL Social Emotional Skills and Relationships:  Social  Emotional  Behavioral  Other: Knowledge and Skills:  Communication  Pre-Academic  Cognitive  Other: Appropriate Behavior to Meet Needs:  Gross/Fine Motor Skills  Adaptive/Daily Living Skills  Other:

MEASURABLE ANNUAL GOAL Goal # Measurable Annual Goal MoM

Obj. # Short-Term Instructional Objectives/Benchmarks (STIO/Bs) 1 2 3 4 5

REPORT OF PROGRESS Methods of Measurement (MoM) Progress on Annual Goal (PAG)

OBS = Observation CRT = Criterion-Referenced Test CBM = Curriculum-Based Measure WS = Work Samples D/P = Demonstration/Performance Other:

A. The student is making sufficient progress to meet the annual goal. B. The student is making insufficient progress to meet the annual goal.

(An IEP meeting must be held to discuss revisions.) C. The annual goal has been met or exceeded. D. This annual goal has not been introduced yet.

Date of Report

Current Level of Performance (CLP) for Report of Progress Describe the student’s current performance on the annual goal based on progress on STIO/Bs using the identified method(s) of measurement (OBS, CRT, CBM, WS, D/P, etc.). Include performance on each unmastered objective in each report of progress.

PAG

Notification of Progress Provided to Parents/Guardians Type  Progress Notes  Report Cards  Goals Sheets  Other:

Frequency  Every 4½ Weeks  Every 6 Weeks  Every 9 Weeks  Other:

Ages 3-5

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

ANNUAL GOAL BASELINE DATA Baseline data to determine the annual goal must include: (a) a data source, (b) a clear description of the observable “target” sk ill or behavior, (c) the condition under which the “target” sk ill or behavior can be observed, and (d) the current rate of performance based on baseline data.

AREA OF ANNUAL GOAL Social Emotional Skills and Relationships:  Social  Emotional  Behavioral  Other: Knowledge and Skills:  Communication  Pre-Academic  Cognitive  Other: Appropriate Behavior to Meet Needs:  Gross/Fine Motor Skills  Adaptive/Daily Living Skills  Other:

MEASURABLE ANNUAL GOAL Goal # Measurable Annual Goal MoM

Obj. # Short-Term Instructional Objectives/Benchmarks (STIO/Bs) 1 2 3 4 5

REPORT OF PROGRESS Methods of Measurement (MoM) Progress on Annual Goal (PAG)

OBS = Observation CRT = Criterion-Referenced Test CBM = Curriculum-Based Measure WS = Work Samples D/P = Demonstration/Performance Other:

A. The student is making sufficient progress to meet the annual goal. B. The student is making insufficient progress to meet the annual goal.

(An IEP meeting must be held to discuss revisions.) C. The annual goal has been met or exceeded. D. This annual goal has not been introduced yet.

Date of Report

Current Level of Performance (CLP) for Report of Progress Describe the student’s current performance on the annual goal based on progress on STIO/Bs using the identified method(s) of measurement (OBS, CRT, CBM, WS, D/P, etc.). Include performance on each unmastered objective in each report of progress.

PAG

Notification of Progress Provided to Parents/Guardians Type  Progress Notes  Report Cards  Goals Sheets  Other:

Frequency  Every 4½ Weeks  Every 6 Weeks  Every 9 Weeks  Other:

Ages 3-5

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

ANNUAL GOAL BASELINE DATA Baseline data to determine the annual goal must include: (a) a data source, (b) a clear description of the observable “target” sk ill or behavior, (c) the condition under which the “target” sk ill or behavior can be observed, and (d) the current rate of performance based on baseline data.

AREA OF ANNUAL GOAL Social Emotional Skills and Relationships:  Social  Emotional  Behavioral  Other: Knowledge and Skills:  Communication  Pre-Academic  Cognitive  Other: Appropriate Behavior to Meet Needs:  Gross/Fine Motor Skills  Adaptive/Daily Living Skills  Other:

MEASURABLE ANNUAL GOAL Goal # Measurable Annual Goal MoM

Obj. # Short-Term Instructional Objectives/Benchmarks (STIO/Bs) 1 2 3 4 5

REPORT OF PROGRESS Methods of Measurement (MoM) Progress on Annual Goal (PAG)

OBS = Observation CRT = Criterion-Referenced Test CBM = Curriculum-Based Measure WS = Work Samples D/P = Demonstration/Performance Other:

A. The student is making sufficient progress to meet the annual goal. B. The student is making insufficient progress to meet the annual goal.

(An IEP meeting must be held to discuss revisions.) C. The annual goal has been met or exceeded. D. This annual goal has not been introduced yet.

Date of Report

Current Level of Performance (CLP) for Report of Progress Describe the student’s current performance on the annual goal based on progress on STIO/Bs using the identified method(s) of measurement (OBS, CRT, CBM, WS, D/P, etc.). Include performance on each unmastered objective in each report of progress.

PAG

Notification of Progress Provided to Parents/Guardians Type  Progress Notes  Report Cards  Goals Sheets  Other:

Frequency  Every 4½ Weeks  Every 6 Weeks  Every 9 Weeks  Other:

Ages 3-5

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

ANNUAL GOAL BASELINE DATA Baseline data to determine the annual goal must include: (a) a data source, (b) a clear description of the observable “target” sk ill or behavior, (c) the condition under which the “target” sk ill or behavior can be observed, and (d) the current rate of performance based on baseline data.

AREA OF ANNUAL GOAL Social Emotional Skills and Relationships:  Social  Emotional  Behavioral  Other: Knowledge and Skills:  Communication  Pre-Academic  Cognitive  Other: Appropriate Behavior to Meet Needs:  Gross/Fine Motor Skills  Adaptive/Daily Living Skills  Other:

MEASURABLE ANNUAL GOAL Goal # Measurable Annual Goal MoM

Obj. # Short-Term Instructional Objectives/Benchmarks (STIO/Bs) 1 2 3 4 5

REPORT OF PROGRESS Methods of Measurement (MoM) Progress on Annual Goal (PAG)

OBS = Observation CRT = Criterion-Referenced Test CBM = Curriculum-Based Measure WS = Work Samples D/P = Demonstration/Performance Other:

A. The student is making sufficient progress to meet the annual goal. B. The student is making insufficient progress to meet the annual goal.

(An IEP meeting must be held to discuss revisions.) C. The annual goal has been met or exceeded. D. This annual goal has not been introduced yet.

Date of Report

Current Level of Performance (CLP) for Report of Progress Describe the student’s current performance on the annual goal based on progress on STIO/Bs using the identified method(s) of measurement (OBS, CRT, CBM, WS, D/P, etc.). Include performance on each unmastered objective in each report of progress.

PAG

Notification of Progress Provided to Parents/Guardians Type  Progress Notes  Report Cards  Goals Sheets  Other:

Frequency  Every 4½ Weeks  Every 6 Weeks  Every 9 Weeks  Other:

Ages 3-5

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

ANNUAL GOAL BASELINE DATA Baseline data to determine the annual goal must include: (a) a data source, (b) a clear description of the observable “target” sk ill or behavior, (c) the condition under which the “target” sk ill or behavior can be observed, and (d) the current rate of performance based on baseline data.

AREA OF ANNUAL GOAL Academic:  Reading  Math Functional:  Communication  Social  Emotional  Behavioral  Gross/Fine Motor Skills  Adaptive Daily Living Skills  Career and Technical Educational Employment  Other:

Other: Other_______________________________________________________________________________________

MEASURABLE ANNUAL GOAL Goal # Measurable Annual Goal TA* MoM

Obj. # Short-Term Instructional Objectives/Benchmarks (STIO/Bs) 1 2 3 4 5

REPORT OF PROGRESS Methods of Measurement (MoM) Progress on Annual Goal (PAG)

OBS = Observation CRT = Criterion-Referenced Test CBM = Curriculum-Based Measure WS = Work Samples D/P = Demonstration/Performance Other: _____________________________

A. The student is making sufficient progress to meet the annual goal. B. The student is making insufficient progress to meet the annual goal.

(An IEP meeting must be held to discuss revisions.) C. The annual goal has been met or exceeded. D. This annual goal has not been introduced yet.

Date of Report

Current Level of Performance (CLP) for Report of Progress Describe the student’s current performance on the annual goal based on progress on STIO/Bs using the identified method(s) of measurement (OBS, CRT, CBM, WS, D/P, etc.). Include performance on each unmastered objective in each report of progress.

PAG

Notification of Progress Provided to Parents/Guardians Type  Progress Notes Other: Frequency Every 4½ Weeks Every 6 Weeks Every 9 Weeks Other:

*TA = Transition Activity

Goal Sheets: Report Cards:

Ages 6-20

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

ANNUAL GOAL BASELINE DATA Baseline data to determine the annual goal must include: (a) a data source, (b) a clear description of the observable “target” sk ill or behavior, (c) the condition under which the “target” sk ill or behavior can be observed, and (d) the current rate of performance based on baseline data.

AREA OF ANNUAL GOAL Academic:  Reading  Math Functional:  Communication  Social  Emotional  Behavioral  Gross/Fine Motor Skills  Adaptive Daily Living Skills  Career and Technical Educational Employment  Other:

Other: Other_______________________________________________________________________________________

MEASURABLE ANNUAL GOAL Goal # Measurable Annual Goal TA* MoM

Obj. # Short-Term Instructional Objectives/Benchmarks (STIO/Bs) 1 2 3 4 5

REPORT OF PROGRESS Methods of Measurement (MoM) Progress on Annual Goal (PAG)

OBS = Observation CRT = Criterion-Referenced Test CBM = Curriculum-Based Measure WS = Work Samples D/P = Demonstration/Performance Other: _____________________________

A. The student is making sufficient progress to meet the annual goal. B. The student is making insufficient progress to meet the annual goal.

(An IEP meeting must be held to discuss revisions.) C. The annual goal has been met or exceeded. D. This annual goal has not been introduced yet.

Date of Report

Current Level of Performance (CLP) for Report of Progress Describe the student’s current performance on the annual goal based on progress on STIO/Bs using the identified method(s) of measurement (OBS, CRT, CBM, WS, D/P, etc.). Include performance on each unmastered objective in each report of progress.

PAG

Notification of Progress Provided to Parents/Guardians Type  Progress Notes Other: Frequency Every 4½ Weeks Every 6 Weeks Every 9 Weeks Other:

*TA = Transition Activity

Goal Sheets: Report Cards:

Ages 6-20

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

ANNUAL GOAL BASELINE DATA Baseline data to determine the annual goal must include: (a) a data source, (b) a clear description of the observable “target” sk ill or behavior, (c) the condition under which the “target” sk ill or behavior can be observed, and (d) the current rate of performance based on baseline data.

AREA OF ANNUAL GOAL Academic:  Reading  Math Functional:  Communication  Social  Emotional  Behavioral  Gross/Fine Motor Skills  Adaptive Daily Living Skills  Career and Technical Educational Employment  Other:

Other: Other_______________________________________________________________________________________

MEASURABLE ANNUAL GOAL Goal # Measurable Annual Goal TA* MoM

Obj. # Short-Term Instructional Objectives/Benchmarks (STIO/Bs) 1 2 3 4 5

REPORT OF PROGRESS Methods of Measurement (MoM) Progress on Annual Goal (PAG)

OBS = Observation CRT = Criterion-Referenced Test CBM = Curriculum-Based Measure WS = Work Samples D/P = Demonstration/Performance Other: _____________________________

A. The student is making sufficient progress to meet the annual goal. B. The student is making insufficient progress to meet the annual goal.

(An IEP meeting must be held to discuss revisions.) C. The annual goal has been met or exceeded. D. This annual goal has not been introduced yet.

Date of Report

Current Level of Performance (CLP) for Report of Progress Describe the student’s current performance on the annual goal based on progress on STIO/Bs using the identified method(s) of measurement (OBS, CRT, CBM, WS, D/P, etc.). Include performance on each unmastered objective in each report of progress.

PAG

Notification of Progress Provided to Parents/Guardians Type  Progress Notes Other: Frequency Every 4½ Weeks Every 6 Weeks Every 9 Weeks Other:

*TA = Transition Activity

Goal Sheets: Report Cards:

Ages 6-20

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

ANNUAL GOAL BASELINE DATA Baseline data to determine the annual goal must include: (a) a data source, (b) a clear description of the observable “target” sk ill or behavior, (c) the condition under which the “target” sk ill or behavior can be observed, and (d) the current rate of performance based on baseline data.

AREA OF ANNUAL GOAL Academic:  Reading  Math Functional:  Communication  Social  Emotional  Behavioral  Gross/Fine Motor Skills  Adaptive Daily Living Skills  Career and Technical Educational Employment  Other:

Other: Other_______________________________________________________________________________________

MEASURABLE ANNUAL GOAL Goal # Measurable Annual Goal TA* MoM

Obj. # Short-Term Instructional Objectives/Benchmarks (STIO/Bs) 1 2 3 4 5

REPORT OF PROGRESS Methods of Measurement (MoM) Progress on Annual Goal (PAG)

OBS = Observation CRT = Criterion-Referenced Test CBM = Curriculum-Based Measure WS = Work Samples D/P = Demonstration/Performance Other: _____________________________

A. The student is making sufficient progress to meet the annual goal. B. The student is making insufficient progress to meet the annual goal.

(An IEP meeting must be held to discuss revisions.) C. The annual goal has been met or exceeded. D. This annual goal has not been introduced yet.

Date of Report

Current Level of Performance (CLP) for Report of Progress Describe the student’s current performance on the annual goal based on progress on STIO/Bs using the identified method(s) of measurement (OBS, CRT, CBM, WS, D/P, etc.). Include performance on each unmastered objective in each report of progress.

PAG

Notification of Progress Provided to Parents/Guardians Type  Progress Notes Other: Frequency Every 4½ Weeks Every 6 Weeks Every 9 Weeks Other:

*TA = Transition Activity

Goal Sheets: Report Cards:

Ages 6-20

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

SPECIAL CONSIDERATIONS* Communication (Required) Does the student have special communication needs? Yes No

Assistive Technology (Required) Does the student need assistive technology services or devices to maintain or improve functional capabilities? Yes No Does the student need assistive technology assessment? Yes No

Services for Students who are Blind or Visually Impaired  N/A In the case of a student who is blind or visually impaired, provide for instruction in and the use of Braille unless the IEP Committee determines, after an evaluation of the student’s reading and writing media, Braille instruction is not appropriate.

Evaluation Date: Yes No Instruction in Braille considered? Instruction in Braille appropriate? Yes No

Were the parents provided information regarding the Mississippi School for the Blind? Yes No

Services for Students who are Deaf or Hearing Impaired  N/A In the case of the student who is deaf or hearing impaired, consider language and communication needs, opportunities for direct communication needs, academic level, and full range of needs, including direct instruction in the student’s language and communication mode. Student’s language and communication mode:

Yes No Is direct instruction in the student’s language and communication mode needed?

Were the parents provided information regarding the Mississippi School for the Deaf? Yes No

Behavior Intervention  N/A In the case of a student whose behavior impedes the student’s learning or the learning of other students, consideration must be given to the use of positive behavior interventions, supports, and other strategies to address that behavior. 1. Has the IEP Committee developed goals and interventions to address specific behavior concerns? Yes  No 2. Has a Functional Behavioral Assessment (FBA) been conducted? Yes No Date Completed: 3. Has a Behavior Intervention Plan (BIP) based on a Functional Behavioral Assessment been developed?**

 Yes  No Date developed: Implementation Date: Review / Revised Dates:

**If a student has a BIP, he or she must have a corresponding annual goal(s) to address behavioral concerns.

Services for Students with Limited English Proficiency  N/A In the case of a student with limited English proficiency, consideration is given to the language needs of the student as such needs relate to the student’s IEP. What is the student’s native language?

Is the student receiving English Learner Services?  Yes  No If not, why?

If yes, date of the most recent Language Service Plan (updated annually):

**The contents of the student's Language Service Plan should be considered when writing the PLAAFP. * Indicate all relevant Special Considerations in the PLAAFP.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of

SPECIAL EDUCATION AND RELATED SERVICES Special Education

Service Area Location Start Date End Date

Duration/Frequency

Related Services Service Area Location Start Date End

Date Duration/Frequency

Program Modifications Service Area Start Date End Date

Instructional/Functional Accommodations Service Area Start Date End Date

Supports for Personnel Service Area Location Start Date End Date

Area A. Reading B. Spelling C. English D. Math E. Social Studies

F. Science G. Health H. Lunch I. PE J. Guidance/Counseling

K. Music L. Art M. Computer Science N. Extracurricular O. Speech Language T. EL Services

P. Title I Q. Technology R. CTE S. Library

U. Other: ______________ V. Other: ______________ W. Other : ______________ X. Other: ______________ Y. Other: ______________

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: _______________ Public Agency/School District:________________________________

Student’s Name: ___________________________________________ MSIS:____________________________

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of

PARTICIPATION IN STATEWIDE ASSESSMENT PROGRAM  This student is not required to participate in statewide assessments as he or she is older than 18 years of age.  This student meets the criteria for SCD and is younger than 8 years of age.

SIGNIFICANT COGNITIVE DISABILITY (SCD) DETERMINATION To be classified as a student having a significant cognitive disability, ALL of the criteria below must be true.

Yes  No

The student demonstrates significant cognitive deficits and poor adaptive skill levels (as determined by that student’s comprehensive evaluation) that prevent participation in the standard academic curriculum or achievement of the academic content standards, even with accommodations and modifications.

 Yes  No The student requires extensive direct instruction in both academic and functional skills in multiple settings to accomplish the application and transfer of those skills.

 Yes  No The student’s inability to complete the standard academic curriculum is neither the result of excessive or extended absences nor is primarily the result of visual, auditory, or physical disabilities, emotional- behavioral disabilities, specific learning disabilities, or social, cultural, or economic differences.

 The student MEETS the criteria for having a significant cognitive disability.

 The student will receive instruction on the Alternate Academic Standards.

 The student DOES NOT MEET the criteria for having a significant cognitive disability.

STATE- OR DISTRICTWIDE ASSESSMENT FOR STUDENTS WITH A SIGNIFICANT COGNITIVE DISABILITY

Indicate any assessments the student will complete during the current year, specifying the edition, if applicable. NOTE: The IEP Committee may not remove the requirements for English Learners to be assessed in all four (4) domains of the ELPT. If the student is unable to participate in fewer than four (4) domains, the ELPT score will be based on the remaining domains in which it is possible to assess the student.

PK K-2 3 4 5 6 7 8 9 10 11 12

Kindergarten Readiness Assessment

Third Grade MAAP ELA Assessment MAAP-A (ELA) MAAP-A (Mathematics) MAAP-A (Science) MAAP-A EOC (English II) MAAP-A EOC (Algebra I) MAAP-A EOC (Biology) English Language Proficiency Test (ELPT)

ACT (American College Test)

Other: Other:

Grade Level

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: _______________ Public Agency/School District:________________________________

Student’s Name: ___________________________________________ MSIS:____________________________

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of

PARTICIPATION IN STATEWIDE ASSESSMENT PROGRAM STATE- OR DISTRICTWIDE ASSESSMENTS FOR STUDENTS WITHOUT A SIGNIFICANT COGNITIVE DISABILITY Indicate any assessments the student will complete during the current year, specifying the edition, if applicable. NOTE: The IEP Committee may not remove the requirement for English Learners to be assessed in all four domains of the ELPT, if the student is unable to participate in fewer than four. The ELPT score will be based on the remaining domains in which it is possible to assess the student.*

Grade Level PK K-2 3 4 5 6 7 8 9 10 11 12

Kindergarten Readiness Assessment Third Grade MAAP ELA Assessment MAAP (English Language Arts/Literacy) MAAP (Mathematics) MAAP (Science) MAAP-EOC (Algebra I) MAAP-EOC (Biology I) MAAP-EOC (English II) MAAP-EOC (U.S. History) MS-CPAS2 ACT (American College Test) English Language Proficiency Test (ELPT)* Other:

STATE- OR DISTRICTWIDE TEST ACCESSIBILITY / ACCOMMODATIONS Refer to the current Mississippi Testing Accommodations Manual, and/or American College Test (ACT) Accommodations for Students with Disabilities for information regarding testing accommodations. All accommodations used for statewide testing must also be used during the student’s classroom instruction and assessments. Presentation Accommodations Code Test(s)

Response Accommodations Code Test(s)

Timing and Scheduling Accommodations Code Test(s)

Setting Accommodations Code Test(s)

Test A. MKAS2/Kindergarten

Readiness B. Third Grade MAAP ELA

Assessment C. MAAP (ELA) D. MAAP (Math) E. MAAP (Science)

F. MAAP-A (ELA) G. MAAP-A (Math) H. MAAP-A (Science) I. ELPT J. MAAP-EOC (Algebra I) K. MAAP-EOC (Biology I) L. MAAP-EOC (English II)

M. MAAP-EOC (US History) N. ACT O. MS-CPAS2 P. Other: Q. Other: R. Other:

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev.1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

INDIVIDUAL TRANSITION PLAN Beginning at age 14, or younger if appropriate, a Transition Plan must be completed with consideration of the student’s needs, preferences, and interests. This plan must be updated annually.

Postsecondary Goals Specify appropriate measurable postsecondary goals as identified by the student, parent(s), and IEP Committee. Postsecondary goals are based upon age-appropriate transition assessments related to employment, education and/or training, and, where appropriate, independent living sk ills.

Related IEP

Goal(s) # Education/Training (Required)

Employment (Required)

Independent Living (If Appropriate)

Age-Appropriate Transition Assessments Transition Assessment (including student and

family survey or interview) Assessment Type Responsible

Agency/Person Date

Conducted Report

Attached

Education/Training (Required) Employment (Required) Independent Living (If Appropriate)

Transition Services Transition services may include instruction, related services, community experiences, development of employment and other post-school adult living objectives, and acquisition of daily living skills to be provided before graduation to support the student in achieving his or her postsecondary goals. Instruction (e.g., accommodations, tutoring, sk ills training, prep for college exams) List the activities the school, student, parent(s), and any outside agency or agencies will do to help the student reach the stated postsecondary goal(s). Specify any outside agency or agencies that will provide transition services.

Related Services (e.g., parent(s), technology, transportation, medical services, supported services) List the activities the school, student, parent(s), and any outside agency or agencies will do to help the student reach the stated postsecondary goal(s). Specify any outside agency or agencies that will provide transition services.

Community Experiences (e.g., job shadowing, supported employment, bank ing, shopping, touring postsecondary institutions) List the activities the school, student, parent(s),and any outside agency or agencies will do to help the student reach the stated postsecondary goal(s). Specify any outside agency or agencies that will provide transition services.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

Development Of Employment Objectives and Functional Vocational Evaluation (e.g., career planning, guidance counseling, job and career interests, aptitudes and sk ills) List the activities the school, student, parent(s), and any outside agency or agencies will do to help the student reach the stated postsecondary goal(s). Specify any outside agency or agencies that will provide transition services.

Exit Options Exit options must be reviewed with the parent and the student, as appropriate, before completing this section. Check the exit option determined appropriate for the student.  Traditional Diploma

Career and Technical Endorsement Academic Endorsement Distinguished Academic Endorsement

 High School Equivalency (GED)

The student was invited to the IEP meeting.  Yes  No

List any agencies/person(s) (a) currently involved with the student or family, (b) ab le to provide needed information to the IEP Comm ittee, and/or (c) likely to become involved in providing support or services after the student exits high school and transitions to the community, employment, and/or postsecondary education/training. Written parental consent must be obtained before inviting any agencies/person(s) likely to be responsible for providing/paying for transition services.  Education/Training:  Employment:  Independent Living:

Interagency Linkages (Participating Agencies)

Student’s Invitation to the IEP Committee Meeting

Alternate Diploma is an option ONLY available to students that meet the criteria for Significant Cognitive Disabilities.

Certificate of Completion

Course of Study Select the course of study that supports the Student's postsecondary goal(s).

List the activities the school, parent(s), and any outside agency or agencies will do to help the student reach the stated postsecondary goal(s). Specify any outside agency or agencies that will provide transition services.

Architecture and Construction Arts, Media, and Communications

Law, Public Safety, and Security Manufacturing Marketing

Education and Training

Acquisition of Daily Living Skills and Other Post-School Adult Living Objectives (e.g., self-care, home repair, health and safety, money management, registering to vote, adult benefits planning, independent living).

Additional Options (SCD only) Supported Employment Daily Living Activities Customized Employment

Agriculture, Food and Natural Resources

Business Management and Administration

Government and Public Administration Health Science Hospitality and Tourism Human Services Information Technology

Transportation, Distribution, and Logistics

Other

Science, Technology, Engineering and Mathematics

Finance

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

PLACEMENT CONSIDERATIONS AND LEAST RESTRICTIVE ENVIRONMENT (LRE) DETERMINATION Placement Option(s) Considered

 Yes  No Is this placement based on the student’s educational needs documented in this IEP? 3CFR300.114

If No, explain ___________________________________________________________________________________

 Yes  No Is the student able to be satisfactorily educated in the general education environment for the entire school day? 34CFR300.114

If No, explain ___________________________________________________________________________________

 Yes  No If removal from the regular environment is necessary, is it based on the nature and severity of the student’s disability and not the need for modifications in the general curriculum? 34CFR300.114

If No, explain ___________________________________________________________________________________

 Yes  No Is the educational placement as close as possible to the student’s home? 34CFR200.116(b)(3)

If No, explain ___________________________________________________________________________________

 Yes  No Is the educational placement in the school the student would attend if the student did not have a disability? 34CFR300.116(c)

If No, explain ___________________________________________________________________________________

Consideration: The IEP team considered all placement options and related services in conjunction with discussing any needed supplementary aids and services, accommodations/modifications, assistive technology and/or accessible materials, and supports for school personnel as well as potential harmful effects on the student.(300.116(d)) The IEP team also considered the potential harmful effects of the placement of the child and whether it would impede the ability of the child or other children to learn.

Placement Decision Check the selected Placement Decision in the section below.

Preschool Age LRE Environment (Least restrictive to most restrictive) (Check one for students ages 3-5)

 Early childhood setting  Early childhood special education  Part-time early childhood/Part-time early childhood special education

Home  Itinerant services outside the home

Residential facility Separate school

School Age LRE Environment (Least restrictive to most restrictive) (Check one for students ages 6-20)

 Inside general education with no supplementary aids and services  Inside general education with supplementary aids and services—includes itinerant instruction and resource

room instructional support  Special classes—full- or part-time self-contained  Separate school—residential or day treatment  Home instruction  Correctional facilities  Parentally placed in private schools

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

Special Transportation Is special transportation needed in the selected LRE?  Yes  No

MSIS Classification for LRE Time Student Receives Special Education Outside of the General Education Classroom

Preschool LRE Classification (Check one below for students ages 3-5)  PC/Home  PE/Residential Facility  PF/Separate School  PG/Separate Class  PH/Service Provider

Location

 PI/Regular program ten (10) or more hours per week and served in the regular program

 PJ/Regular program ten (10) or more hours per week and s erved in another location  PK/Regular program less than ten (10) hours per week and s erved in the regular

program  PL/Regular program less than ten (10) hours per week and s erved in another location

School-age LRE Classification (Check one below for students ages 6-21)  SA/Inside general education class 80% or more of the day  SB/Inside general education class 40% to 79% of the day  SC/Inside general education class less than 40% of the day  SD/Separate School  SF/Residential Facility  SH/Home-Hospital  SI/Correctional Facilities  SJ/Parentally Placed in Private Schools

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/20/2020 Mississippi Department of Education–Office of Special Education Page of .

EXTENDED SCHOOL YEAR (ESY)  This student attends a twelve- (12) month program. Determination of ESY Decision Determination Date:

All of the following criteria used in determining eligibility must be considered: Regression-Recoupment: Refers to a student’s loss of skill(s) on IEP objective(s) after at least two (2) breaks in instruction without regaining the documented level of skill(s) prior to the break within the specified period. Critical Point of Instruction 1: Refers to the need to maintain a student’s critical skill to prevent a loss of general education class time or an increase in special education service time. Critical Point of Instruction 2: Refers to a point in the acquisition or maintenance of a critical skill during which a lengthy break in instruction would lead to a significant loss of progress. Extenuating Circumstances: Refers to special situations that jeopardize the student’s receipt of a FAPE unless ESY services are provided.  Consideration: The IEP Committee considered all criteria when determining the student’s eligibility for receiving ESY

services. NOTE: Although ESY services typically focus on existing annual goals or STIO/Bs, the IEP Committee may determine the child needs to master a new goal or objective to be able to master or maintain the critical sk ill identified as the basis for ESY services. Only in this situation may the IEP Committee write a new goal and/or objective to address this critical sk ill.

 This student’s situation MEETS criteria for ESY Services based on____________________________________. (Indicate criteria that qualified student)

 This student’s situation MEETS criteria for ESY Services, but the parent/guardian does not accept the service.  This student’s situation DOES NOT MEET the criteria for ESY Services. Measurable Annual Goals or Short-Term Instructional Objectives/Benchmarks (STIO/Bs) These must be existing measurable annual goals or STIO/Bs except for situations as described in the note above.

TA MOM Report of Progress

CLP PAG

TA = Transition

Activity

Method of Measurement (MoM) Report of Progress OBS = Observation CRT = Criterion Referenced Test CBM = Curriculum-Based Measure

WS = Work Samples D/P = Demonstration/Performance Other:

CLP = Current Level of Performance PAG = Progress on Annual Goal See Annual Goal page for codes

week(s) or A Progress Report will be given to parents every

at the end of the student’s ESY services on

Date(s) progress report given to parent

Types of Service # of Weeks

Duration/ Frequency

Area (See Special Education

and Related Services page for code)

Location Start Date End Date

Educational Services Related Services** Transportation Other: Other: ** Any related services provided (except transportation) must have a corresponding measurable annual goal or STIO/Bs.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .Pa

SIGNATURE PAGE FOR IEP

INITIAL OR ANNUAL SIGNATURES

WRITTEN PARENTAL PERMISSION FOR INITIAL PLACEMENT

My rights and t hose of my child, as outlined in the Procedural Safeguards Notice, have been fully explained to me. I understand that my child has a disability, and I know my child’s eligibility category. I hereby give consent for my child to receive special education services as recorded on this Individualized Education Program (IEP).

Parent/Guardian Signature: Date:

PROCEDURAL SAFEGUARDS NOTICE

I have received a copy of the Procedural Safeguards Notice, and my rights and those of my child have been fully explained. The public agency has informed me of whom I may contact if I need additional information.

Parent/Guardian Signature: Date:

ACKNOWLEDGEMENT OF STATE TESTING

ACKNOWLEDGEMENT OF REQUIREMENTS FOR PARTICIPATION IN THIRD GRADE MAAP ELA ASSESSMENT

I understand that if my child does not meet the minimum cut score on the Mississippi Academic Assessment Program (English Language Arts) he or she will be required to participate in the Alternative Third Grade MAAP ELA Assessment.

Parent/Guardian Signature: Date:

ACKNOWLEDGEMENT OF REQUIREMENTS FOR PARTICIPATION IN HIGH SCHOOL SUBJECT AREA TESTS

I have had the Mississippi Statewide Assessment System fully explained to me. I understand that all students will be assessed in some way, but only students who meet the graduation requirements under State Board Policy Chapter 36, Rules 36.4 and 36. 5 will be eligible to receive a traditional high school diploma.

Parent/Guardian Signature: Date:

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Year: Public Agency/School District:

Student’s Name: MSIS:

Rev. 1/15/2020 Mississippi Department of Education–Office of Special Education Page of .

ACKNOWLEGEMENT OF EXIT OPTIONS (Sign the appropriate option determined by the IEP Committee)

I understand that to be awarded a Traditional High School Diploma, my child must meet the graduation requirements set forth in State Board Policy, Chapter 36, Rules 36.2, 36.3, 36.4 and 36. 5.

Parent/Guardian Signature: Date:

I understand that the Alternate Diploma is an exit option available to students identified by their IEP committee as having a Significant Cognitive Disability. I understand that to be awarded the Alternate Diploma, my child must meet the graduation requirements under State Board Policy, Chapter 78, Rule 78.1. I also understand that the Alternate Diploma is not the equivalent of a Traditional High School Diploma.

Parent/Guardian Signature: Date:

I understand that the Certificate of Completion is an acknowledgement of my student’s participation in and completion of an Individualized Education Program (IEP). The Certificate of Completion is not the equivalent of a Traditional High School Diploma. Students that exit with a Certificate of Completion will have limited access to postsecondary training opportunities, will not be allowed to enroll in the military, and may have limited employment opportunities. I also understand that my child has the right to a Free Appropriate Public Education (FAPE) through age 20.

Parent/Guardian Signature: Date:

(Signature of student beginning one (1) year before the student reaches the age of majority)

I have been informed of my rights under Part B of the Individuals with Disabilities Education Improvement Act (IDEA) of 2004, as amended, that will transfer to me when I reach the age of majority (21 years of age).

Student’s Signature: Date:

Transfer of Rights

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  • SIGNIFICANT COGNITIVE DISABILITY (SCD) DETERMINATION
  • To be classified as a student having a significant cognitive disability, ALL of the criteria below must be true.
  • STATE- OR DISTRICTWIDE ASSESSMENT FOR STUDENTS WITH A SIGNIFICANT COGNITIVE DISABILITY
  • Indicate any assessments the student will complete during the current year, specifying the edition, if applicable.
  • 2 pages Form.pdf
    • SIGNIFICANT COGNITIVE DISABILITY (SCD) DETERMINATION
    • To be classified as a student having a significant cognitive disability, ALL of the criteria below must be true.
    • STATE- OR DISTRICTWIDE ASSESSMENT FOR STUDENTS WITH A SIGNIFICANT COGNITIVE DISABILITY
    • Indicate any assessments the student will complete during the current year, specifying the edition, if applicable.
  • Untitled
  1. Age:
  2. Primary Eligibility:
  3. Ethnicity:
  4. Secondary Eligibility:
  5. Grade:
  6. School:
  7. ParentGuardian Names:
  8. Address:
  9. Phone Number:
  10. Email:
  11. Initial Written Parental Permission for Initial Placement must be signed before implementation: Off
  12. Annual: Off
  13. NameRow1:
  14. PositionRow1:
  15. NameRow1_2:
  16. PositionRow1_2:
  17. NameRow2:
  18. PositionRow2:
  19. NameRow2_2:
  20. PositionRow2_2:
  21. NameRow3:
  22. PositionRow3:
  23. NameRow3_2:
  24. PositionRow3_2:
  25. NameRow4:
  26. PositionRow4:
  27. NameRow4_2:
  28. PositionRow4_2:
  29. NameRow5:
  30. PositionRow5:
  31. NameRow5_2:
  32. PositionRow5_2:
  33. NameRow1_3:
  34. PositionRow1_3:
  35. NameRow1_4:
  36. PositionRow1_4:
  37. NameRow2_3:
  38. PositionRow2_3:
  39. NameRow2_4:
  40. PositionRow2_4:
  41. NameRow3_3:
  42. PositionRow3_3:
  43. NameRow3_4:
  44. PositionRow3_4:
  45. NameRow4_3:
  46. PositionRow4_3:
  47. NameRow4_4:
  48. PositionRow4_4:
  49. The IEP meeting was conducted via alternate means of technology: Off
  50. Video Conferencing: Off
  51. Conference Call: Off
  52. NA: Off
  53. Functional Behavioral Assessment FBA: Off
  54. Assistive Technology Assessment: Off
  55. Occupation or Physical Therapy Evaluation: Off
  56. List other evaluationsfollowups: Off
  57. Review: Off
  58. Revise: Off
  59. Amend: Off
  60. ESY: Off
  61. NameRow1_5:
  62. NameAgency Representative:
  63. NameRow2_5:
  64. NameGeneral Educator:
  65. NameRow3_5:
  66. NameSpecial Educator:
  67. NameRow4_5:
  68. NameParentGuardian:
  69. NameRow5_3:
  70. NameParentGuardian_2:
  71. NameRow6:
  72. NameStudent:
  73. NameRow1_6:
  74. PositionRow1_5:
  75. NameRow1_7:
  76. PositionRow1_6:
  77. NameRow2_6:
  78. PositionRow2_5:
  79. NameRow2_7:
  80. PositionRow2_6:
  81. NameRow3_6:
  82. PositionRow3_5:
  83. NameRow3_7:
  84. PositionRow3_6:
  85. NameRow4_6:
  86. PositionRow4_5:
  87. NameRow4_7:
  88. PositionRow4_6:
  89. Video Conferencing_2: Off
  90. Conference Call_2: Off
  91. NA_2: Off
  92. Functional Behavioral Assessment FBA_2: Off
  93. Assistive Technology Assessment_2: Off
  94. Occupation or Physical Therapy Evaluation_2: Off
  95. List other evaluationsfollowups_2: Off
  96. Check to verify that all changes were made in the IEP: Off
  97. Baseline data to determine the annual goal must include a a data source b a clear description of the observable target sk ill or behavior c the condition under which the target sk ill or behavior can be observed and d the current rate of performance based on baseline data:
  98. undefined_3: Off
  99. undefined_4: Off
  100. undefined_5: Off
  101. undefined_6: Off
  102. undefined_7:
  103. Communication: Off
  104. PreAcademic: Off
  105. Cognitive: Off
  106. undefined_8: Off
  107. Other_8:
  108. GrossFine Motor Skills: Off
  109. AdaptiveDaily Living Skills: Off
  110. undefined_9: Off
  111. Other_9:
  112. MOMRow1:
  113. ShortTerm Instructional ObjectivesBenchmarks STIOB1:
  114. ShortTerm Instructional ObjectivesBenchmarks STIOB2:
  115. ShortTerm Instructional ObjectivesBenchmarks STIOB3:
  116. ShortTerm Instructional ObjectivesBenchmarks STIOB4:
  117. ShortTerm Instructional ObjectivesBenchmarks STIOB5:
  118. Other_10:
  119. Date of ReportRow1:
  120. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow1:
  121. PAGRow1:
  122. Date of ReportRow2:
  123. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow2:
  124. PAGRow2:
  125. Date of ReportRow3:
  126. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow3:
  127. PAGRow3:
  128. Date of ReportRow4:
  129. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow4:
  130. PAGRow4:
  131. Date of ReportRow5:
  132. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow5:
  133. PAGRow5:
  134. Date of ReportRow6:
  135. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow6:
  136. PAGRow6:
  137. Date of ReportRow7:
  138. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow7:
  139. PAGRow7:
  140. Progress Notes: Off
  141. Report Cards: Off
  142. Goals Sheets: Off
  143. Other_11: Off
  144. Page_4:
  145. Baseline data to determine the annual goal must include a a data source b a clear description of the observable target sk ill or behavior c the condition under which the target sk ill or behavior can be observed and d the current rate of performance based on baseline data_2:
  146. undefined_10: Off
  147. undefined_11: Off
  148. Communication_2: Off
  149. Social: Off
  150. Emotional: Off
  151. Behavioral: Off
  152. GrossFine Motor Skills_2: Off
  153. Adaptive Daily Living Skills: Off
  154. Career and Technical Educational Employment: Off
  155. undefined_12: Off
  156. Other_13:
  157. Other_14: Off
  158. Other_15:
  159. Goal Row1_2:
  160. Measurable Annual GoalRow1_2:
  161. TARow1:
  162. MOMRow1_2:
  163. ShortTerm Instructional ObjectivesBenchmarks STIOB1_2:
  164. ShortTerm Instructional ObjectivesBenchmarks STIOB2_2:
  165. ShortTerm Instructional ObjectivesBenchmarks STIOB3_2:
  166. ShortTerm Instructional ObjectivesBenchmarks STIOB4_2:
  167. ShortTerm Instructional ObjectivesBenchmarks STIOB5_2:
  168. Other_16:
  169. Date of ReportRow1_2:
  170. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow1_2:
  171. PAGRow1_2:
  172. Date of ReportRow2_2:
  173. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow2_2:
  174. PAGRow2_2:
  175. Date of ReportRow3_2:
  176. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow3_2:
  177. PAGRow3_2:
  178. Date of ReportRow4_2:
  179. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow4_2:
  180. PAGRow4_2:
  181. Date of ReportRow5_2:
  182. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow5_2:
  183. PAGRow5_2:
  184. Date of ReportRow6_2:
  185. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow6_2:
  186. PAGRow6_2:
  187. Date of ReportRow7_2:
  188. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow7_2:
  189. PAGRow7_2:
  190. Date of ReportRow8:
  191. Current Level of Performance CLP for Report of Progress Describe the students current performance on the annual goal based on progress on STIOBs using the identified methods of measurement OBS CRT CBM WS DP etc Include performance on each unmastered objective in each report of progressRow8:
  192. PAGRow8:
  193. Progress Notes_2: Off
  194. Report Cards_2: Off
  195. Goals Sheets_2: Off
  196. Other_17: Off
  197. Page_5:
  198. Does the student need assistive technology services or devices to maintain or improve functional capabilities Yes No Does the student need assistive technology assessment Yes No:
  199. NA_3: Off
  200. Evaluation Date:
  201. NA_4: Off
  202. Is direct instruction in the students language and communication mode needed:
  203. NA_5: Off
  204. Date Completed:
  205. Date developed:
  206. Implementation Date:
  207. NA_6: Off
  208. What is the students native language:
  209. If not why:
  210. Page_6:
  211. ServiceRow1:
  212. AreaRow1:
  213. LocationRow1:
  214. Start DateRow1:
  215. End DateRow1:
  216. DurationFrequencyRow1:
  217. ServiceRow2:
  218. AreaRow2:
  219. LocationRow2:
  220. Start DateRow2:
  221. End DateRow2:
  222. DurationFrequencyRow2:
  223. ServiceRow3:
  224. AreaRow3:
  225. LocationRow3:
  226. Start DateRow3:
  227. End DateRow3:
  228. DurationFrequencyRow3:
  229. ServiceRow4:
  230. AreaRow4:
  231. LocationRow4:
  232. Start DateRow4:
  233. End DateRow4:
  234. DurationFrequencyRow4:
  235. ServiceRow5:
  236. AreaRow5:
  237. LocationRow5:
  238. Start DateRow5:
  239. End DateRow5:
  240. DurationFrequencyRow5:
  241. ServiceRow1_2:
  242. AreaRow1_2:
  243. LocationRow1_2:
  244. Start DateRow1_2:
  245. End DateRow1_2:
  246. DurationFrequencyRow1_2:
  247. ServiceRow2_2:
  248. AreaRow2_2:
  249. LocationRow2_2:
  250. Start DateRow2_2:
  251. End DateRow2_2:
  252. DurationFrequencyRow2_2:
  253. ServiceRow3_2:
  254. AreaRow3_2:
  255. LocationRow3_2:
  256. Start DateRow3_2:
  257. End DateRow3_2:
  258. DurationFrequencyRow3_2:
  259. ServiceRow4_2:
  260. AreaRow4_2:
  261. LocationRow4_2:
  262. Start DateRow4_2:
  263. End DateRow4_2:
  264. DurationFrequencyRow4_2:
  265. ServiceRow5_2:
  266. AreaRow5_2:
  267. LocationRow5_2:
  268. Start DateRow5_2:
  269. End DateRow5_2:
  270. DurationFrequencyRow5_2:
  271. ServiceRow1_3:
  272. AreaRow1_3:
  273. Start DateRow1_3:
  274. End DateRow1_3:
  275. ServiceRow2_3:
  276. AreaRow2_3:
  277. Start DateRow2_3:
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  279. ServiceRow3_3:
  280. AreaRow3_3:
  281. Start DateRow3_3:
  282. End DateRow3_3:
  283. ServiceRow4_3:
  284. AreaRow4_3:
  285. Start DateRow4_3:
  286. End DateRow4_3:
  287. ServiceRow5_3:
  288. AreaRow5_3:
  289. Start DateRow5_3:
  290. End DateRow5_3:
  291. ServiceRow1_4:
  292. AreaRow1_4:
  293. Start DateRow1_4:
  294. End DateRow1_4:
  295. ServiceRow2_4:
  296. AreaRow2_4:
  297. Start DateRow2_4:
  298. End DateRow2_4:
  299. ServiceRow3_4:
  300. AreaRow3_4:
  301. Start DateRow3_4:
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  303. ServiceRow4_4:
  304. AreaRow4_4:
  305. Start DateRow4_4:
  306. End DateRow4_4:
  307. ServiceRow5_4:
  308. AreaRow5_4:
  309. Start DateRow5_4:
  310. End DateRow5_4:
  311. ServiceRow1_5:
  312. AreaRow1_5:
  313. LocationRow1_5:
  314. Start DateRow1_5:
  315. End DateRow1_5:
  316. ServiceRow2_5:
  317. AreaRow2_5:
  318. LocationRow2_5:
  319. Start DateRow2_5:
  320. End DateRow2_5:
  321. ServiceRow3_5:
  322. AreaRow3_5:
  323. LocationRow3_5:
  324. Start DateRow3_5:
  325. End DateRow3_5:
  326. ServiceRow4_5:
  327. AreaRow4_5:
  328. LocationRow4_5:
  329. Start DateRow4_5:
  330. End DateRow4_5:
  331. Other_20:
  332. Other_21:
  333. Other_22:
  334. Other_23:
  335. Page_7:
  336. EducationTraining Required:
  337. Related IEP Goals EducationTraining Required:
  338. Employment Required:
  339. Related IEP Goals Employment Required:
  340. Independent Living If Appropriate:
  341. Related IEP Goals Independent Living If Appropriate:
  342. Assessment TypeEducationTraining Required:
  343. Responsible AgencyPersonEducationTraining Required:
  344. Date ConductedEducationTraining Required:
  345. Report AttachedEducationTraining Required:
  346. Assessment TypeEmployment Required:
  347. Responsible AgencyPersonEmployment Required:
  348. Date ConductedEmployment Required:
  349. Report AttachedEmployment Required:
  350. Assessment TypeIndependent Living If Appropriate:
  351. Responsible AgencyPersonIndependent Living If Appropriate:
  352. Date ConductedIndependent Living If Appropriate:
  353. Report AttachedIndependent Living If Appropriate:
  354. List the activities the school student parent and any outside agency or agencies will do to help the student reach the stated postsecondary goals Specify any outside agency or agencies that will provide transition services:
  355. List the activities the school student parent and any outside agency or agencies will do to help the student reach the stated postsecondary goals Specify any outside agency or agencies that will provide transition services_2:
  356. List the activities the school student parent and any outside agency or agencies will do to help the student reach the stated postsecondary goals Specify any outside agency or agencies that will provide transition services_3:
  357. Page_10:
  358. List the activities the school student parent and any outside agency or agencies will do to help the student reach the stated postsecondary goals Specify any outside agency or agencies that will provide transition services_4:
  359. List the activities the school student parent and any outside agency or agencies will do to help the student reach the stated postsecondary goals Specify any outside agency or agencies that will provide transition services_5:
  360. EducationTraining:
  361. undefined_36: Off
  362. Employment:
  363. undefined_37: Off
  364. Independent Living:
  365. undefined_38: Off
  366. Page_11:
  367. If No explain:
  368. If No explain_2:
  369. If No explain_3:
  370. If No explain_4:
  371. If No explain_5:
  372. Page_12:
  373. Is special transportation needed in the selected LRE Yes No:
  374. Page_13:
  375. undefined_39: Off
  376. Determination Date:
  377. undefined_40:
  378. Measurable Annual Goals or ShortTerm Instructional ObjectivesBenchmarks STIOB These must be existing measurable annual goals or STIOBs except for situations as described in the note aboveRow1:
  379. TARow1_2:
  380. MOMRow1_3:
  381. CLPRow1:
  382. PAGRow1_3:
  383. Measurable Annual Goals or ShortTerm Instructional ObjectivesBenchmarks STIOB These must be existing measurable annual goals or STIOBs except for situations as described in the note aboveRow2:
  384. TARow2:
  385. MOMRow2:
  386. CLPRow2:
  387. PAGRow2_3:
  388. Measurable Annual Goals or ShortTerm Instructional ObjectivesBenchmarks STIOB These must be existing measurable annual goals or STIOBs except for situations as described in the note aboveRow3:
  389. TARow3:
  390. MOMRow3:
  391. CLPRow3:
  392. PAGRow3_3:
  393. Measurable Annual Goals or ShortTerm Instructional ObjectivesBenchmarks STIOB These must be existing measurable annual goals or STIOBs except for situations as described in the note aboveRow4:
  394. TARow4:
  395. MOMRow4:
  396. CLPRow4:
  397. PAGRow4_3:
  398. Other_30:
  399. undefined_41:
  400. undefined_42:
  401. parent:
  402. of WeeksEducational Services:
  403. Duration FrequencyEducational Services:
  404. Area See Special Education and Related Service pages for codeEducational Services:
  405. LocationEducational Services:
  406. Start DateEducational Services:
  407. End DateEducational Services:
  408. of WeeksRelated Services:
  409. Duration FrequencyRelated Services:
  410. Area See Special Education and Related Service pages for codeRelated Services:
  411. LocationRelated Services:
  412. Start DateRelated Services:
  413. End DateRelated Services:
  414. of WeeksTransportation:
  415. Duration FrequencyTransportation:
  416. Area See Special Education and Related Service pages for codeTransportation:
  417. LocationTransportation:
  418. Start DateTransportation:
  419. End DateTransportation:
  420. Other_31:
  421. of WeeksOther:
  422. Duration FrequencyOther:
  423. Area See Special Education and Related Service pages for codeOther:
  424. LocationOther:
  425. Start DateOther:
  426. End DateOther:
  427. Other_32:
  428. of WeeksOther_2:
  429. Duration FrequencyOther_2:
  430. Area See Special Education and Related Service pages for codeOther_2:
  431. LocationOther_2:
  432. Start DateOther_2:
  433. End DateOther_2:
  434. Page_14:
  435. Page_15:
  436. Page_16:
  437. Month1:
  438. Year1:
  439. Day1:
  440. Month2:
  441. Day2:
  442. Year2:
  443. Describe changes in services and supports in the IEP:
  444. Month4:
  445. Day4:
  446. Year4:
  447. Month5:
  448. Day5:
  449. Year5:
  450. Month6:
  451. Day6:
  452. Year6:
  453. Other Evaluations:
  454. OtherEval:
  455. OtherType: Off
  456. Other_Type_Desc:
  457. Frequency:
  458. TypeProg:
  459. Other_19:
  460. Other_18:
  461. Group1: Off
  462. Text4:
  463. Group3: Off
  464. Group2: Off
  465. Group4: Off
  466. Group5: Off
  467. Group6: Off
  468. Group7: Off
  469. Group8: Off
  470. Group9: Off
  471. Group12: Off
  472. Group13: Off
  473. Group18: Off
  474. Group19: Off
  475. Group20: Off
  476. Group21: Off
  477. Group22: Off
  478. Review Revised Dates:
  479. Group23: Off
  480. Text18:
  481. Check Box11: Off
  482. Check Box12: Off
  483. Check Box13: Off
  484. Check Box14: Off
  485. Check Box15: Off
  486. Check Box16: Off
  487. Check Box18: Off
  488. Group29: Off
  489. Group40: Off
  490. Group41: Off
  491. Group42: Off
  492. Group43: Off
  493. Group44: Off
  494. Group45: Off
  495. Group46: Off
  496. Group47: Off
  497. Group38: Off
  498. Group39: Off
  499. Group50: Off
  500. This students situation DOES NOT MEET the criteria for ESY Services: Off
  501. This students situation MEETS criteria for ESY Services but the parentguardian does not accept the service: Off
  502. This students situation MEETS criteria for ESY Services based on: Off
  503. Consideration The IEP Committee considered all criteria when determining the students eligibility for receiving ESY: Off
  504. Month3:
  505. Day3:
  506. Year3:
  507. PKMKAS2 Kindergarten Readiness Assessment:
  508. K2MKAS2 Kindergarten Readiness Assessment:
  509. 3MKAS2 Kindergarten Readiness Assessment:
  510. 4MKAS2 Kindergarten Readiness Assessment:
  511. 5MKAS2 Kindergarten Readiness Assessment:
  512. 6MKAS2 Kindergarten Readiness Assessment:
  513. 7MKAS2 Kindergarten Readiness Assessment:
  514. 8MKAS2 Kindergarten Readiness Assessment:
  515. 9MKAS2 Kindergarten Readiness Assessment:
  516. 10MKAS2 Kindergarten Readiness Assessment:
  517. 11MKAS2 Kindergarten Readiness Assessment:
  518. 12MKAS2 Kindergarten Readiness Assessment:
  519. PKThird Grade MAAP ELA Assessment_2:
  520. K2Third Grade MAAP ELA Assessment:
  521. 3Third Grade MAAP ELA Assessment:
  522. 4Third Grade MAAP ELA Assessment:
  523. 5Third Grade MAAP ELA Assessment:
  524. 6Third Grade MAAP ELA Assessment:
  525. 7Third Grade MAAP ELA Assessment:
  526. 8Third Grade MAAP ELA Assessment:
  527. 9Third Grade MAAP ELA Assessment:
  528. 10Third Grade MAAP ELA Assessment:
  529. 11Third Grade MAAP ELA Assessment:
  530. 12Third Grade MAAP ELA Assessment:
  531. PKMAAP English Language ArtsLiteracy:
  532. K2MAAP English Language ArtsLiteracy:
  533. 3MAAP English Language ArtsLiteracy:
  534. 4MAAP English Language ArtsLiteracy:
  535. 5MAAP English Language ArtsLiteracy:
  536. 6MAAP English Language ArtsLiteracy:
  537. 7MAAP English Language ArtsLiteracy:
  538. 8MAAP English Language ArtsLiteracy:
  539. 9MAAP English Language ArtsLiteracy:
  540. 10MAAP English Language ArtsLiteracy:
  541. 11MAAP English Language ArtsLiteracy:
  542. 12MAAP English Language ArtsLiteracy:
  543. PKMAAP Mathematics:
  544. K2MAAP Mathematics:
  545. 3MAAP Mathematics:
  546. 4MAAP Mathematics:
  547. 5MAAP Mathematics:
  548. 6MAAP Mathematics:
  549. 7MAAP Mathematics:
  550. 8MAAP Mathematics:
  551. 9MAAP Mathematics:
  552. 10MAAP Mathematics:
  553. 11MAAP Mathematics:
  554. 12MAAP Mathematics:
  555. PKMAAP Science:
  556. K2MAAP Science:
  557. 3MAAP Science:
  558. 4MAAP Science:
  559. 5MAAP Science:
  560. 6MAAP Science:
  561. 7MAAP Science:
  562. 8MAAP Science:
  563. 9MAAP Science:
  564. 10MAAP Science:
  565. 11MAAP Science:
  566. 12MAAP Science:
  567. PKMAAPEOC Algebra I:
  568. K2MAAPEOC Algebra I:
  569. 3MAAPEOC Algebra I:
  570. 4MAAPEOC Algebra I:
  571. 5MAAPEOC Algebra I:
  572. 6MAAPEOC Algebra I:
  573. 7MAAPEOC Algebra I:
  574. 8MAAPEOC Algebra I:
  575. 9MAAPEOC Algebra I:
  576. 10MAAPEOC Algebra I:
  577. 11MAAPEOC Algebra I:
  578. 12MAAPEOC Algebra I:
  579. PKMAAPEOC Biology I:
  580. K2MAAPEOC Biology I:
  581. 3MAAPEOC Biology I:
  582. 4MAAPEOC Biology I:
  583. 5MAAPEOC Biology I:
  584. 6MAAPEOC Biology I:
  585. 7MAAPEOC Biology I:
  586. 8MAAPEOC Biology I:
  587. 9MAAPEOC Biology I:
  588. 10MAAPEOC Biology I:
  589. 11MAAPEOC Biology I:
  590. 12MAAPEOC Biology I:
  591. PKMAAPEOC English II:
  592. K2MAAPEOC English II:
  593. 3MAAPEOC English II:
  594. 4MAAPEOC English II:
  595. 5MAAPEOC English II:
  596. 6MAAPEOC English II:
  597. 7MAAPEOC English II:
  598. 8MAAPEOC English II:
  599. 9MAAPEOC English II:
  600. 10MAAPEOC English II:
  601. 11MAAPEOC English II:
  602. 12MAAPEOC English II:
  603. PKMAAPEOC US History:
  604. K2MAAPEOC US History:
  605. 3MAAPEOC US History:
  606. 4MAAPEOC US History:
  607. 5MAAPEOC US History:
  608. 6MAAPEOC US History:
  609. 7MAAPEOC US History:
  610. 8MAAPEOC US History:
  611. 9MAAPEOC US History:
  612. 10MAAPEOC US History:
  613. 11MAAPEOC US History:
  614. 12MAAPEOC US History:
  615. PKMSCPAS2:
  616. K2MSCPAS2:
  617. 3MSCPAS2:
  618. 4MSCPAS2:
  619. 5MSCPAS2:
  620. 6MSCPAS2:
  621. 7MSCPAS2:
  622. 8MSCPAS2:
  623. 9MSCPAS2:
  624. 10MSCPAS2:
  625. 11MSCPAS2:
  626. 12MSCPAS2:
  627. PKACT American College Test_2:
  628. K2ACT American College Test:
  629. 3ACT American College Test:
  630. 4ACT American College Test:
  631. 5ACT American College Test:
  632. 6ACT American College Test:
  633. 7ACT American College Test:
  634. 8ACT American College Test:
  635. 9ACT American College Test:
  636. 10ACT American College Test:
  637. 11ACT American College Test:
  638. 12ACT American College Test:
  639. PKEnglish Language Proficiency Test ELPT_2:
  640. K2English Language Proficiency Test ELPT:
  641. 3English Language Proficiency Test ELPT:
  642. 4English Language Proficiency Test ELPT:
  643. 5English Language Proficiency Test ELPT:
  644. 6English Language Proficiency Test ELPT:
  645. 7English Language Proficiency Test ELPT:
  646. 8English Language Proficiency Test ELPT:
  647. 9English Language Proficiency Test ELPT:
  648. 10English Language Proficiency Test ELPT:
  649. 11English Language Proficiency Test ELPT:
  650. 12English Language Proficiency Test ELPT:
  651. Other_3:
  652. PKOther_3:
  653. K2Other:
  654. 3Other:
  655. 4Other:
  656. 5Other:
  657. 6Other:
  658. 7Other:
  659. 8Other:
  660. 9Other:
  661. 10Other:
  662. 11Other:
  663. 12Other:
  664. Presentation AccommodationsRow1:
  665. CodeRow1:
  666. TestsRow1:
  667. Presentation AccommodationsRow2:
  668. CodeRow2:
  669. TestsRow2:
  670. Presentation AccommodationsRow3:
  671. CodeRow3:
  672. TestsRow3:
  673. Response AccommodationsRow1:
  674. CodeRow1_2:
  675. TestsRow1_2:
  676. Response AccommodationsRow2:
  677. CodeRow2_2:
  678. TestsRow2_2:
  679. Response AccommodationsRow3:
  680. CodeRow3_2:
  681. TestsRow3_2:
  682. Timing and Scheduling AccommodationsRow1:
  683. CodeRow1_3:
  684. TestsRow1_3:
  685. Timing and Scheduling AccommodationsRow2:
  686. CodeRow2_3:
  687. TestsRow2_3:
  688. Timing and Scheduling AccommodationsRow3:
  689. CodeRow3_3:
  690. TestsRow3_3:
  691. Setting AccommodationsRow1:
  692. CodeRow1_4:
  693. TestsRow1_4:
  694. Setting AccommodationsRow2:
  695. CodeRow2_4:
  696. TestsRow2_4:
  697. Setting AccommodationsRow3:
  698. CodeRow3_4:
  699. TestsRow3_4:
  700. Other_4:
  701. Other_5:
  702. Other_6:
  703. BYear3:
  704. BDay3:
  705. BMonth3:
  706. AltOther:
  707. POther_2:
  708. POther_3:
  709. POther_4:
  710. POther 5:
  711. POther 6:
  712. Group10: Off
  713. undefinedSIG2: Off
  714. undefinedSIG3: Off
  715. undefinedSIG: Off
  716. PAGE_X2:
  717. School Year:
  718. Students Name:
  719. MSIS:
  720. Public AgencySchool District:
  721. Group111: Off
  722. Levels of performance should reflect the following and include current data sources 1 the students current performance in math and reading 2 the strengths both academic and functional of the student 3 a description of the students social behavioral andor emotional sk ills 4 the students interests 5 the students preferences 6 If the student is 14 years or older how the students level of academic and functional achievement will affect the pursuit of postsecondary goals If preschool include developmentally appropriate activities:
  723. Include any concerns of the parent and as appropriate the student for enhancing his or her education:
  724. Check Box100: Off
  725. Check Box101: Off
  726. Check Box102: Off
  727. Check Box103: Off
  728. Check Box104: Off
  729. Check Box106: Off
  730. Check Box107: Off
  731. Check Box111: Off
  732. Check Box112: Off
  733. Check Box113: Off
  734. Check Box110: Off
  735. Check Box114: Off
  736. Check Box116: Off
  737. Check Box108: Off
  738. Check Box115: Off
  739. TextOtherCOS:
  740. Check Box1152: Off
  741. Check Box1082: Off
  742. Check Box1142: Off
  743. The student MEETS the criteria for having a significant cognitive disability: Off
  744. The student will receive instruction on the Alternate Academic Standards: Off
  745. The student DOES NOT MEET the criteria for having a significant cognitive disability: Off
  746. PKMkas:
  747. 1MKAS:
  748. 2MKAS:
  749. 3MKAS:
  750. 4MKAS:
  751. 5MKAS:
  752. 6MKAS:
  753. 7MKAS:
  754. 8MKAS:
  755. 9MKAS:
  756. 10MKAS:
  757. 11MKAS:
  758. PKThird Grade MAAP ELA Assessment:
  759. K2 57 yrsThird Grade MAAP ELA Assessment:
  760. 3 8 yrsThird Grade MAAP ELA Assessment:
  761. 4 9 yrsThird Grade MAAP ELA Assessment:
  762. 5 10 yrsThird Grade MAAP ELA Assessment:
  763. 6 11 yrsThird Grade MAAP ELA Assessment:
  764. 7 12 yrsThird Grade MAAP ELA Assessment:
  765. 8 13 yrsThird Grade MAAP ELA Assessment:
  766. 9 14 yrsThird Grade MAAP ELA Assessment:
  767. 10 15 yrsThird Grade MAAP ELA Assessment:
  768. 11 16 yrsThird Grade MAAP ELA Assessment:
  769. 12 17 18 yrsThird Grade MAAP ELA Assessment:
  770. PKMAAPA ELA:
  771. K2 57 yrsMAAPA ELA:
  772. 3 8 yrsMAAPA ELA:
  773. 4 9 yrsMAAPA ELA:
  774. 5 10 yrsMAAPA ELA:
  775. 6 11 yrsMAAPA ELA:
  776. 7 12 yrsMAAPA ELA:
  777. 8 13 yrsMAAPA ELA:
  778. 9 14 yrsMAAPA ELA:
  779. 10 15 yrsMAAPA ELA:
  780. 11 16 yrsMAAPA ELA:
  781. 12 17 18 yrsMAAPA ELA:
  782. PKMAAPA Math:
  783. K2 57 yrsMAAPA Math:
  784. 3 8 yrsMAAPA Math:
  785. 4 9 yrsMAAPA Math:
  786. 5 10 yrsMAAPA Math:
  787. 6 11 yrsMAAPA Math:
  788. 7 12 yrsMAAPA Math:
  789. 8 13 yrsMAAPA Math:
  790. 9 14 yrsMAAPA Math:
  791. 10 15 yrsMAAPA Math:
  792. 11 16 yrsMAAPA Math:
  793. 12 17 18 yrsMAAPA Math:
  794. PKMAAPA Science:
  795. K2 57 yrsMAAPA Science:
  796. 3 8 yrsMAAPA Science:
  797. 4 9 yrsMAAPA Science:
  798. 5 10 yrsMAAPA Science:
  799. 6 11 yrsMAAPA Science:
  800. 7 12 yrsMAAPA Science:
  801. 8 13 yrsMAAPA Science:
  802. 9 14 yrsMAAPA Science:
  803. 10 15 yrsMAAPA Science:
  804. 11 16 yrsMAAPA Science:
  805. 12 17 18 yrsMAAPA Science:
  806. PKMAAPA EOC English II:
  807. K2 57 yrsMAAPA EOC English II:
  808. 3 8 yrsMAAPA EOC English II:
  809. 4 9 yrsMAAPA EOC English II:
  810. 5 10 yrsMAAPA EOC English II:
  811. 6 11 yrsMAAPA EOC English II:
  812. 7 12 yrsMAAPA EOC English II:
  813. 8 13 yrsMAAPA EOC English II:
  814. 9 14 yrsMAAPA EOC English II:
  815. 10 15 yrsMAAPA EOC English II:
  816. 11 16 yrsMAAPA EOC English II:
  817. 12 17 18 yrsMAAPA EOC English II:
  818. PKMAAPA EOC Algebra I:
  819. K2 57 yrsMAAPA EOC Algebra I:
  820. 3 8 yrsMAAPA EOC Algebra I:
  821. 4 9 yrsMAAPA EOC Algebra I:
  822. 5 10 yrsMAAPA EOC Algebra I:
  823. 6 11 yrsMAAPA EOC Algebra I:
  824. 7 12 yrsMAAPA EOC Algebra I:
  825. 8 13 yrsMAAPA EOC Algebra I:
  826. 9 14 yrsMAAPA EOC Algebra I:
  827. 10 15 yrsMAAPA EOC Algebra I:
  828. 11 16 yrsMAAPA EOC Algebra I:
  829. 12 17 18 yrsMAAPA EOC Algebra I:
  830. PKMAAPA EOC Biology:
  831. K2 57 yrsMAAPA EOC Biology:
  832. 3 8 yrsMAAPA EOC Biology:
  833. 4 9 yrsMAAPA EOC Biology:
  834. 5 10 yrsMAAPA EOC Biology:
  835. 6 11 yrsMAAPA EOC Biology:
  836. 7 12 yrsMAAPA EOC Biology:
  837. 8 13 yrsMAAPA EOC Biology:
  838. 9 14 yrsMAAPA EOC Biology:
  839. 10 15 yrsMAAPA EOC Biology:
  840. 11 16 yrsMAAPA EOC Biology:
  841. 12 17 18 yrsMAAPA EOC Biology:
  842. PKEnglish Language Proficiency Test ELPT:
  843. K2 57 yrsEnglish Language Proficiency Test ELPT:
  844. 3 8 yrsEnglish Language Proficiency Test ELPT:
  845. 4 9 yrsEnglish Language Proficiency Test ELPT:
  846. 5 10 yrsEnglish Language Proficiency Test ELPT:
  847. 6 11 yrsEnglish Language Proficiency Test ELPT:
  848. 7 12 yrsEnglish Language Proficiency Test ELPT:
  849. 8 13 yrsEnglish Language Proficiency Test ELPT:
  850. 9 14 yrsEnglish Language Proficiency Test ELPT:
  851. 10 15 yrsEnglish Language Proficiency Test ELPT:
  852. 11 16 yrsEnglish Language Proficiency Test ELPT:
  853. 12 17 18 yrsEnglish Language Proficiency Test ELPT:
  854. PKACT American College Test:
  855. K2 57 yrsACT American College Test:
  856. 3 8 yrsACT American College Test:
  857. 4 9 yrsACT American College Test:
  858. 5 10 yrsACT American College Test:
  859. 6 11 yrsACT American College Test:
  860. 7 12 yrsACT American College Test:
  861. 8 13 yrsACT American College Test:
  862. 9 14 yrsACT American College Test:
  863. 10 15 yrsACT American College Test:
  864. 11 16 yrsACT American College Test:
  865. 12 17 18 yrsACT American College Test:
  866. Other:
  867. PKOther:
  868. K2 57 yrsOther:
  869. 3 8 yrsOther:
  870. 4 9 yrsOther:
  871. 5 10 yrsOther:
  872. 6 11 yrsOther:
  873. 7 12 yrsOther:
  874. 8 13 yrsOther:
  875. 9 14 yrsOther:
  876. 10 15 yrsOther:
  877. 11 16 yrsOther:
  878. 12 17 18 yrsOther:
  879. Other_2:
  880. PKOther_2:
  881. K2 57 yrsOther_2:
  882. 3 8 yrsOther_2:
  883. 4 9 yrsOther_2:
  884. 5 10 yrsOther_2:
  885. 6 11 yrsOther_2:
  886. 7 12 yrsOther_2:
  887. 8 13 yrsOther_2:
  888. 9 14 yrsOther_2:
  889. 10 15 yrsOther_2:
  890. 11 16 yrsOther_2:
  891. 12 17 18 yrsOther_2:
  892. PageX:
  893. Check Box105: Off
  894. Check Box105B: Off
  895. Include any concerns of the parent xx0:
  896. Measurable Annual Goal Newname:
  897. Goal First Row:
  898. Date Review Revised X:
  899. Other_Area_19:
  900. of:
  901. Page_1:
  902. Page_2:
  903. Page_3:
  904. Page:
  905. Rev1:
  906. Rev2: Off
  907. Rev3: Off
  908. Rev4: Off
  909. Rev5: Off
  910. Rev6:
  911. Rev7: Off
  912. Rev8: Off
  913. Rev9: Off
  914. Rev10: Off
  915. Rev11:
  916. Rev12: Off
  917. Rev13: Off
  918. Rev14: Off
  919. Rev15:
  920. Rev16:
  921. Rev17:
  922. Rev18:
  923. Rev19:
  924. Rev20:
  925. Rev21:
  926. Rev22:
  927. Rev23:
  928. Rev24:
  929. Rev25:
  930. Rev26:
  931. Rev27:
  932. Rev28:
  933. Rev29:
  934. Rev30:
  935. Rev31:
  936. Rev32:
  937. Rev33:
  938. Rev34:
  939. Rev35:
  940. Rev36:
  941. Rev37:
  942. Rev38:
  943. Rev39:
  944. Rev40:
  945. Rev41:
  946. Rev42:
  947. Rev43:
  948. Rev44:
  949. Rev45:
  950. Rev46: Off
  951. Rev47: Off
  952. Rev48: Off
  953. Rev49: Off
  954. Rev50:
  955. Rev51: Off
  956. Rev52:
  957. Rev53:
  958. LK1:
  959. LK2: Off
  960. LK3: Off
  961. LK4: Off
  962. LK5: Off
  963. LK6:
  964. LK7: Off
  965. LK8: Off
  966. LK9: Off
  967. LK10: Off
  968. LK11:
  969. LK12: Off
  970. LK13: Off
  971. LK14: Off
  972. LK15:
  973. LK16:
  974. LK17:
  975. LK18:
  976. LK19:
  977. LK20:
  978. LK21:
  979. LK22:
  980. LK23:
  981. LK24:
  982. LK25:
  983. LK26:
  984. LK27:
  985. LK28:
  986. LK29:
  987. LK30:
  988. LK31:
  989. LK32:
  990. LK33:
  991. LK34:
  992. LK35:
  993. LK36:
  994. LK37:
  995. LK38:
  996. LK39:
  997. LK40:
  998. LK41:
  999. LK42:
  1000. LK43:
  1001. LK44:
  1002. LK45:
  1003. LK46: Off
  1004. LK47: Off
  1005. LK48: Off
  1006. LK49: Off
  1007. LK50:
  1008. LK51: Off
  1009. LK52:
  1010. LK53:
  1011. LK1A:
  1012. LK2A: Off
  1013. LK3A: Off
  1014. LK4A: Off
  1015. LK5A: Off
  1016. LK6A:
  1017. LK7A: Off
  1018. LK8A: Off
  1019. LK9A: Off
  1020. LK10A: Off
  1021. LK11A:
  1022. LK12A: Off
  1023. LK13A: Off
  1024. LK14A: Off
  1025. LK15A:
  1026. LK16A:
  1027. LK17A:
  1028. LK18A:
  1029. LK19A:
  1030. LK20A:
  1031. LK21A:
  1032. LK22A:
  1033. LK23A:
  1034. LK24A:
  1035. LK25A:
  1036. LK26A:
  1037. LK27A:
  1038. LK28A:
  1039. LK29A:
  1040. LK30A:
  1041. LK31A:
  1042. LK32A:
  1043. LK33A:
  1044. LK34A:
  1045. LK35A:
  1046. LK36A:
  1047. LK37A:
  1048. LK38A:
  1049. LK39A:
  1050. LK40A:
  1051. LK41A:
  1052. LK42A:
  1053. LK43A:
  1054. LK44A:
  1055. LK45A:
  1056. LK46A: Off
  1057. LK47A: Off
  1058. LK48A: Off
  1059. LK49A: Off
  1060. LK50A:
  1061. LK51A: Off
  1062. LK52A:
  1063. LK53A:
  1064. 6lk1a2:
  1065. 6lk2a2: Off
  1066. 6lk57a2: Off
  1067. 6lk3a2: Off
  1068. 6lk4a2: Off
  1069. 6lk5a2: Off
  1070. 6lk6a2: Off
  1071. 6lk7a2: Off
  1072. 6lk8a2: Off
  1073. 6lk9a2: Off
  1074. 6lk10a2: Off
  1075. 6lk11a2:
  1076. 6lk12a2: Off
  1077. 6lk13a2:
  1078. 6lk14a2:
  1079. 6lk15a2:
  1080. 6lk16a2:
  1081. 6lk17a2:
  1082. 6lk18a2:
  1083. 6lk19a2:
  1084. 6lk20a2:
  1085. 6lk21a2:
  1086. 6lk22a2:
  1087. 6lk23a2:
  1088. 6lk24a2:
  1089. 6lk25a2:
  1090. 6lk26a2:
  1091. 6lk27a2:
  1092. 6lk28a2:
  1093. 6lk29a2:
  1094. 6lk30a2:
  1095. 6lk31a2:
  1096. 6lk32a2:
  1097. 6lk33a2:
  1098. 6lk34a2:
  1099. 6lk35a2:
  1100. 6lk36a2:
  1101. 6lk37a2:
  1102. 6lk38a2:
  1103. 6lk39a2:
  1104. 6lk40a2:
  1105. 6lk41a2:
  1106. 6lk42a2:
  1107. 6lk43a2:
  1108. 6lk44a2:
  1109. 6lk45a2:
  1110. 6lk46a2:
  1111. 6lk47a2:
  1112. 6lk48a2: Off
  1113. 6lk49a2: Off
  1114. 6lk50a2: Off
  1115. 6lk51a2: Off
  1116. 6lk52a2:
  1117. 6lk53a2: Off
  1118. 6lk54a2:
  1119. 6lk55a2:
  1120. 6lk1:
  1121. 6lk2: Off
  1122. 6lk57: Off
  1123. 6lk3: Off
  1124. 6lk4: Off
  1125. 6lk5: Off
  1126. 6lk6: Off
  1127. 6lk7: Off
  1128. 6lk8: Off
  1129. 6lk9: Off
  1130. 6lk10: Off
  1131. 6lk11:
  1132. 6lk12: Off
  1133. 6lk13:
  1134. 6lk14:
  1135. 6lk15:
  1136. 6lk16:
  1137. 6lk17:
  1138. 6lk18:
  1139. 6lk19:
  1140. 6lk20:
  1141. 6lk21:
  1142. 6lk22:
  1143. 6lk23:
  1144. 6lk24:
  1145. 6lk25:
  1146. 6lk26:
  1147. 6lk27:
  1148. 6lk28:
  1149. 6lk29:
  1150. 6lk30:
  1151. 6lk31:
  1152. 6lk32:
  1153. 6lk33:
  1154. 6lk34:
  1155. 6lk35:
  1156. 6lk36:
  1157. 6lk37:
  1158. 6lk38:
  1159. 6lk39:
  1160. 6lk40:
  1161. 6lk41:
  1162. 6lk42:
  1163. 6lk43:
  1164. 6lk44:
  1165. 6lk45:
  1166. 6lk46:
  1167. 6lk47:
  1168. 6lk48: Off
  1169. 6lk49: Off
  1170. 6lk50: Off
  1171. 6lk51: Off
  1172. 6lk52:
  1173. 6lk53: Off
  1174. 6lk54:
  1175. 6lk55:
  1176. 6lk1a:
  1177. 6lk2a: Off
  1178. 6lk57a: Off
  1179. 6lk3a: Off
  1180. 6lk4a: Off
  1181. 6lk5a: Off
  1182. 6lk6a: Off
  1183. 6lk7a: Off
  1184. 6lk8a: Off
  1185. 6lk9a: Off
  1186. 6lk10a: Off
  1187. 6lk11a:
  1188. 6lk12a: Off
  1189. 6lk13a:
  1190. 6lk14a:
  1191. 6lk15a:
  1192. 6lk16a:
  1193. 6lk17a:
  1194. 6lk18a:
  1195. 6lk19a:
  1196. 6lk20a:
  1197. 6lk21a:
  1198. 6lk22a:
  1199. 6lk23a:
  1200. 6lk24a:
  1201. 6lk25a:
  1202. 6lk26a:
  1203. 6lk27a:
  1204. 6lk28a:
  1205. 6lk29a:
  1206. 6lk30a:
  1207. 6lk31a:
  1208. 6lk32a:
  1209. 6lk33a:
  1210. 6lk34a:
  1211. 6lk35a:
  1212. 6lk36a:
  1213. 6lk37a:
  1214. 6lk38a:
  1215. 6lk39a:
  1216. 6lk40a:
  1217. 6lk41a:
  1218. 6lk42a:
  1219. 6lk43a:
  1220. 6lk44a:
  1221. 6lk45a:
  1222. 6lk46a:
  1223. 6lk47a:
  1224. 6lk48a: Off
  1225. 6lk49a: Off
  1226. 6lk50a: Off
  1227. 6lk51a: Off
  1228. 6lk52a:
  1229. 6lk53a: Off
  1230. 6lk54a:
  1231. 6lk55a: