Individualized Education Plan: Notice to Diploma Assignment

Normal School Division

IEP MEETING NOTICE

Date:

To:

Susie and Robert Jones_______

and

Michael______________________________________

Parent(s)/Adult Student Student (if appropriate or if transition will be discussed)

You are invited to attend an IEP meeting regarding Michael Jones

Student’s Name

PURPOSE OF MEETING (check all that apply): · IEP Development or Review · IEP Amendment · Transition: Postsecondary Goals, Transition Services · Manifestation Determination · Other: ________________________________________________________________________________

The meeting has been scheduled for:

Date Time Location

Meetings are scheduled at a mutually agreed upon place and time by you and the school division. If you are unable to attend this meeting you may request participation through other means. If you are unable to attend this meeting, please contact:

IEP Case Manager (Your name goes here)		Title		Phone

You and the school division may invite individuals to participate in the IEP team meeting who have knowledge or expertise about the student’s educational needs. The determination of the knowledge or special expertise shall be made by the party who invited the individual. If the division intends to invite a representative of an agency that is likely to be responsible for providing or paying for transition services to the IEP meeting, written consent of the parent or adult student is required.

Below is a list of the participants (by name and position) the division will be inviting to attend the IEP meeting: (list at least 5 attendees)

Normalville School Division

INDIVIDUALIZED EDUCATION PROGRAM

COVER PAGE

Student Name_____________________________________________________________________________

Student ID Number_18412____________________________________________________Grade__________

DOB ____/____/____ Age ________ Disability(ies) ______________________________________________

Parent(s) Name_____________________________________________________Email_____________________________

Home Address_______________________________________________________________________________

Primary (____)______________________

Date of IEP meeting…………………...…………………….……………………….....……..._____/_____/_____

Date parent notified of IEP meeting………………………………..……………………...….._____/_____/_____

This IEP will be reviewed no later than ………..…………………….……………..…………_____/_____/_____

Most recent eligibility date…………………………….…………………………………….…._____/_____/_____

Next re-evaluation, including eligibility, must occur before ………..……..…………..…..….._____/_____/_____

Copy of IEP given to parent (Name) ________________________________________(Date)_____/_____/_____

IEP Teacher/Manager___________________________________ Phone Number (____)______________________

The Individualized Education Plan (IEP) that accompanies this document is meant to support the positive process and team approach. The IEP is a working document that outlines the student’s vision for the future, strengths and needs. The IEP is not written in isolation. The intent of an IEP is to bring together a team of people who understand and support the student in order to come to consensus on a plan and an appropriate and effective education for the student. No two teams are alike and each team will arrive at different answers, ideas and supports and services to address the student’s unique needs. The student and his/her family members are vital participants, as well as teachers, assistants, specialists, outside service providers, and the principal. When all team members are present, the valuable information shared supports the development of a rich student profile and education plan.

PARTICIPANTS INVOLVED:

The list below indicates that the individual participated in the development of this IEP and the placement decision; it does not authorize consent. Parent consent is indicated on the “Prior Notice” page.

NAME OF PARTICIPANT POSITION

_____________________________________________________ ____________________________________

_____________________________________________________ ____________________________________

_____________________________________________________ ____________________________________

_____________________________________________________ ____________________________________

_____________________________________________________ ____________________________________

_____________________________________________________ ____________________________________

_____________________________________________________ ____________________________________

_____________________________________________________ ____________________________________ INDIVIDUALIZED EDUCATION PROGRAM

FACTORS FOR IEP TEAM CONSIDERATION

Student Name______________________________________________________________ Date ____/____/____

Student ID Number__18412_________________________________________

During the IEP meeting, the following factors must be considered by the IEP team. Best practice suggests that the IEP team document that the factors were considered and any decision made relative to each. The factors are addressed in other sections of the IEP if not documented on this page You will apply the information you learned about Michael to the questions below. Be thorough in this section. Each question should be addressed in this section. Do not refer them to the PLOP or any other area of the IEP. You must fill in each section.

1. Results of the initial or most recent evaluation of the student;

______________________________________________________________________________________________________________

2. The strengths of the student;

______________________________________________________________________________________________________________

3. The academic, developmental, and functional needs of the student;

______________________________________________________________________________________________________________

4. The concerns of the parent(s) for enhancing the education of their child;

______________________________________________________________________________________________________________

5. The communication needs of the student;

______________________________________________________________________________________________________________

6. The student’s needs for benchmarks or short-term objectives;

______________________________________________________________________________________________________________

7. Whether the student requires assistive technology devices and services. When considering whether assistive technology is required, the IEP team may refer to the Virginia Assistive Technology Resource Guide to facilitate the discussions about goals and objectives, areas of difficulty, and whether AT devices or services are needed, and whether accessible instructional materials in alternate formats are needed. ______________________________________________________________________________________________________________

8. In the case of a student whose behavior impedes his or her learning or that of others, consider the use of positive behavioral interventions, strategies, and supports to address that behavior;

______________________________________________________________________________________________________________

9. In the case of a student with limited English proficiency, consider the language needs of the student as those needs relate to the student’s IEP;

___________________________________________________________________________________________________

10. In the case of a student who is blind or is visually impaired, provide for instruction in Braille and the use of Braille unless the IEP team determines after an evaluation of the student’s reading and writing skills, needs, and appropriate reading and writing media, including an evaluation of the student’s future needs for instruction in Braille or the use of Braille, that instruction in Braille or the use of Braille is not appropriate for the student. When considering that Braille is not appropriate for the child the IEP team may use the Functional Vision and Learning Media Assessment for Students who are Pre-Academic or Academic and Visually Impaired in Grades K-12 (FVLMA) or similar instrument; and

___________________________________________________________________________________________________

11. In the case of a student who is deaf or hard of hearing, consider the student’s language and communication needs, opportunities for direct communications with peers and professional personnel in the student’s language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the student’s language and communication mode. The IEP team may use the Virginia Communication Plan when considering the student's language and communication needs and supports that may be needed.

___________________________________________________________________________________________________

INDIVIDUALIZED EDUCATION PROGRAM

PRESENT LEVEL OF ACADEMIC ACHEIVEMENT AND FUNCTIONAL PERFORMANCE

Student Name__________________________________________________________ Date____/____/____

Student ID Number____18412_________________________________________________

The Present Level of Academic Achievement and Functional Performance summarize the results of assessments that identify the student’s interests, preferences, strengths and areas of need, including assistive technology and/or accessible materials. It also describes the effect of the student’s disability on his or her involvement and progress in the general education curriculum, and for preschool children, as appropriate, how the disability affects the student’s participation in appropriate activities. This includes the student’s performance and achievement in academic areas such as writing, reading, mathematics, science, and history/social sciences. It also includes the student’s performance in functional areas, such as self-determination, social competence, communication, behavior and personal management. Test scores, if included, should be self-explanatory or an explanation should be included, and the Present Level of Academic Achievement and Functional Performance should be written in objective measurable terms, to the extent possible. There should be a direct relationship among the desired goals, the Present Level of Academic Achievement and Functional Performance, and all other components of the IEP.

_______________________________________________________________________________________________

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

PRESENT LEVEL OF ACADEMIC ACHEIVEMENT AND FUNCTIONAL PERFORMANCE, continued

Student Name________________________________________________________ Date ____/____/____

Student ID Number___18412_______________________________

PRESENT LEVEL OF ACADEMIC ACHEIVEMENT AND FUNCTIONAL PERFORMANCE, continued.

TRANSITION INDIVIDUALIZED EDUCATION PROGRAM (IEP)

TRANSITION INDIVIDUALIZED EDUCATION PROGRAM (IEP)

DIPLOMA, AND TRANSITION STATUS

Student Name________________________________________________________ Date ____/____/____

Student ID Number 18412

DIPLOMA STATUS: Discuss at least annually, more often as appropriate. This student is a candidate for a(n): [ ] Advanced Studies Diploma [ ] Standard Diploma [ ] Modified Standard Diploma* [ ] Applied Studies Diploma [ ] Certificate of Program Completion [ ] GED Certificate (General Educational Development [ ] GAAHD (General Achievement Adult High School Diploma) [ ] Not discussed at this time Projected Graduation/Exit Date: ________________ Is the student projected to graduate/exit school this year? ___No ___Yes If yes, inform the student and parents that a Summary of Performance will be provided prior to graduating/exiting school. * NOTE: The Modified Standard Diploma will not be an option for students with disabilities who enter the ninth grade for the first time beginning in 2013-2014. (*Use of local courses of study planning guide that includes the graduation requirements is recommended.) NOTE: Special education and related services end upon receiving an Advanced Studies Diploma, Advanced Technical Diploma, Standard Diploma, or Technical Diploma. If the student receives a Modified Standard Diploma, Special Diploma, Certificate of Program Completion, a GAD or a GED Certificate, the student remains entitled to a free appropriate public education through age 21. If the student will graduate with an advanced or standard diploma during the term of the IEP, prior written notice on page 28 must be completed. Summary of Performance Will the student be graduating with a Standard, Technical, or higher level diploma or exceeding the age of eligibility this year? ___No ___Yes If yes, a Summary of Performance must be provided to the student prior to graduating or exceeding the age of eligibility.

Interagency Release of Information Form Is there a current signed (by parent or adult student) release of confidential information on file with the school? ___No ___Yes If No, discuss form for transition planning with student and family

THIS IS THE END OF THE FIRST ASSIGNMENT.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

MEASURABLE ANNUAL GOALS, PROGRESS REPORT

Student Name_______________________________________________________ Date____/____/____

Student ID Number___18412_____________________________

Make sure your goals are MEASURABLE. Do not confuse annual goals with learning objectives. These are annual goals, meaning they are for the school year. See the objectives below that will coordinate with this annual goal. For example, if this is an annual goal for math, the objectives below will help Michael achieve this annual goal.

For this assignment you need 3 annual goals, each with 4 objectives.

# _____ MEASURABLE ANNUAL GOAL:

The IEP team considered the need for short-term objectives/benchmarks.

X Short-term objectives/benchmarks are included for this goal. (Required for students participating in the VAAP)

Short-term objectives/benchmarks are not included for this goal.

How will progress toward this annual goal be measured? (check all that apply)
____ Classroom Participation ____ Checklist ____ Class work ____ Homework	____ Observation ____ Special Projects ____ Tests and Quizzes ____ Written Reports	____ Criterion-referenced test:_________________________ ____ Norm-referenced test: ___________________________ ____ Other: ________________________________________
Progress on this goal will be reported to the parent or adult student using the following codes. Attach comments using progress report comment form located in section two.
Anticipated Date of Progress Report*
Actual Date of Progress Report
Progress Code
SP -The student is making Sufficient Progress to achieve this annual goal within the duration of this IEP.		IP -The student has demonstrated Insufficient Progress to meet this annual goal and may not achieve this goal within the duration of this IEP.
ES - The student demonstrates Emerging Skill but may not achieve this goal within the duration of this IEP.		NI -The student has Not been provided Instruction on this goal.
M -The student has Mastered this annual goal.

* Progress reports will be provided at least as often as parents are informed of the progress of children without disabilities.

TRANSITION INDIVIDUALIZED EDUCATION PROGRAM (IEP)

SHORT TERM OBJECTIVES OR BENCHMARKS, as determined by IEP Team

(Required for students participating in the VAAP)

Student Name__________________________________________________________ Date____/____/____

Student ID Number 18412 Goal # _____

Short Term Objectives or Benchmarks, as needed

Note that these are short term goals, and not annual goals. These will be more specific in nature and will need to be observable and measurable. These objectives/benchmarks will help Michael achieve the annual goal you stated above.

Objective/Benchmark #___

Objective/Benchmark #___

Objective/Benchmark #___

Objective/Benchmark #___

TRANSITION INDIVIDUALIZED EDUCATION PROGRAM (IEP)

MEASURABLE ANNUAL GOALS, PROGRESS REPORT, continued

Student Name_______________________________________________________ Date____/____/____

Student ID Number 18412

# _____ MEASURABLE ANNUAL GOAL:

The IEP team considered the need for short-term objectives/benchmarks.

X Short-term objectives/benchmarks are included for this goal. (Required for students participating in the VAAP)

Short-term objectives/benchmarks are not included for this goal.

How will progress toward this annual goal be measured? (check all that apply)
____ Classroom Participation ____ Checklist ____ Class work ____ Homework	____ Observation ____ Special Projects ____ Tests and Quizzes ____ Written Reports	____ Criterion-referenced test:_________________________ ____ Norm-referenced test: ___________________________ ____ Other: ________________________________________
Progress on this goal will be reported to the parent or adult student using the following codes. Attach comments using progress report comment form located in section two.
Anticipated Date of Progress Report*
Actual Date of Progress Report
Progress Code
SP -The student is making Sufficient Progress to achieve this annual goal within the duration of this IEP.		IP -The student has demonstrated Insufficient Progress to meet this annual goal and may not achieve this goal within the duration of this IEP.
ES - The student demonstrates Emerging Skill but may not achieve this goal within the duration of this IEP.		NI -The student has Not been provided Instruction on this goal.
M -The student has Mastered this annual goal.

* Progress reports will be provided at least as often as parents are informed of the progress of their children without disabilities.

TRANSITION INDIVIDUALIZED EDUCATION PROGRAM (IEP)

SHORT TERM OBJECTIVES OR BENCHMARKS, as determined by IEP Team

(Required for students participating in the VAAP)

Student Name__________________________________________________________ Date____/____/____

Student ID Number 18412 Goal # _____

Short Term Objectives or Benchmarks, as needed

Objective/Benchmark #___

Objective/Benchmark #___

Objective/Benchmark #___

Objective/Benchmark #___

TRANSITION INDIVIDUALIZED EDUCATION PROGRAM (IEP)

MEASURABLE ANNUAL GOALS, PROGRESS REPORT, continued

Student Name_______________________________________________________ Date____/____/____

Student ID Number 18412

# _____ MEASURABLE ANNUAL GOAL:

The IEP team considered the need for short-term objectives/benchmarks.

X Short-term objectives/benchmarks are included for this goal. (Required for students participating in the VAAP)

Short-term objectives/benchmarks are not included for this goal.

How will progress toward this annual goal be measured? (check all that apply)
____ Classroom Participation ____ Checklist ____ Class work ____ Homework	____ Observation ____ Special Projects ____ Tests and Quizzes ____ Written Reports	____ Criterion-referenced test:_________________________ ____ Norm-referenced test: ___________________________ ____ Other: ________________________________________
Progress on this goal will be reported to the parent or adult student using the following codes. Attach comments using progress report comment form located in section two.
Anticipated Date of Progress Report*
Actual Date of Progress Report
Progress Code
SP -The student is making Sufficient Progress to achieve this annual goal within the duration of this IEP.		IP -The student has demonstrated Insufficient Progress to meet this annual goal and may not achieve this goal within the duration of this IEP.
ES - The student demonstrates Emerging Skill but may not achieve this goal within the duration of this IEP.		NI -The student has Not been provided Instruction on this goal.
M -The student has Mastered this annual goal.

* Progress reports will be provided at least as often as parents are informed of the progress of their children without disabilities.

TRANSITION INDIVIDUALIZED EDUCATION PROGRAM (IEP)

SHORT TERM OBJECTIVES OR BENCHMARKS, as determined by IEP Team

(Required for students participating in the VAAP)

Student Name__________________________________________________________ Date____/____/____

Student ID Number 18412 Goal # _____

Short Term Objectives or Benchmarks, as needed

Objective/Benchmark #___

Objective/Benchmark #___

Objective/Benchmark #___

Objective/Benchmark #___

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

SERVICES – LEAST RESTRICTIVE ENVIRONMENT – PLACEMENT

ACCOMMODATIONS/MODIFICATIONS

Student Name_________________________________________________________ Date____/____/____

Student ID Number___18412________________________________

This student will be provided access to general education classes, special education classes, other school services and activities including nonacademic activities and extracurricular activities, and education related settings:

___ with no accommodations/modifications

___ with the following accommodations/modifications

Accommodations/modifications provided as part of the instructional and testing/assessment process will allow the student equal opportunity to access the curriculum and demonstrate achievement. Accommodations/modifications also provide access to nonacademic and extracurricular activities and educationally related settings. Accommodations/modifications based solely on the potential to enhance performance beyond providing equal access are inappropriate.

Accommodations may be in, but not limited to, the areas of time, scheduling, setting, presentation and response including assistive technology and/or accessible materials. The impact of any modifications listed should be discussed.

ACCOMMODATIONS/MODIFICATIONS (list, as appropriate)

Accommodation(s)/Modification(s)	Frequency	Location (name of school *)	Instructional Setting	Duration m/d/y to m/d/y

* IEP teams are required to identify the specific school site (public or private) when the parent expresses concerns about the location of the services or refuses the proposed site. A listing of more than one anticipated location is permissible, if the parents do not indicate that they will object to any particular school or state that the team should identify a single school.

Supports for School Personnel: (Describe supports such as equipment, consultation, or training for school staff to meet the unique needs for the student) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

SERVICES – LEAST RESTRICTIVE ENVIRONMENT – PLACEMENT, Continued

PARTICIPATION IN THE STATE AND DIVISIONWIDE ACCOUNTABILITY/ASSESSMENT SYSTEM

Student Name________________________________________________________ Date ____/____/____

Student ID Number___18412_______________________________

_____________________________________________________________________________________________

This student’s participation in state and divisionwide assessments must be discussed annually. During the duration of this IEP: For this chart, erase the one that is not your answer and only leave the one you are choosing. When complete, each square should only contain either a YES or a NO, not both.

Will the student be at a grade level or enrolled in a course for which the student must participate in a state and/or divisionwide assessment? If yes, continue to next question.	Yes No
Based on the Present Level of Academic Achievement and Functional Performance, is this student being considered for participation in the Virginia Standards of Learning (SOL)Assessments (select appropriate content area) Reading Math Science History/Social Science Grade 8 Writing	Yes No
Based on the Present Level of Academic Achievement and Functional Performance, is this student being considered for participation in the Special Permission Request Virginia Substitute Evaluation Program (VSEP)? If yes, complete the “VSEP Participation Criteria” for each content area considered. (Grades 3-8 only) Reading Math Science History/Social Science Grade 8 Writing	Yes No
Does the student meet the VSEP participation criteria? If yes, determine for specific content area. Reading Math Science History/Social Science Grade 8 Writing Special permission for eligible students with disabilities in grades 3-8. refer to VDOE’s Students with Disabilities: Guidelines for Assessment Participation for guidance.	Yes No
Based on the Present Level of Academic Achievement and Functional Performance, is this student being considered for participation in the Virginia Alternate Assessment Program (VAAP), which is based on Aligned Standards of Learning? If yes, complete the “VAAP Participation Criteria”.	Yes No
Does the student meet VAAP participation criteria?	Yes No

If “yes” to any of the above, check the assessment(s) chosen and attach (or maintain in student’s educational record) the assessment page(s), which will document how the student will participate in Virginia’s accountability system and any needed accommodations and/or modifications.

State Assessments:

___ SOL Assessments and retake (SOL) Reading Math Science History/Social Science Writing

___ Virginia Substitute Evaluation Program* (VSEP) Reading Math Science History/Social Science Writing

___ Virginia Grade Level Alternative* (VGLA) Reading Math Science History/Social Science Writing

___ Virginia Alternate Assessment Program** (VAAP)

___ Other State Approved Substitute(s): ______________________________

*Refer to Procedures for Determining Participation in the Assessment Component of Virginia’s Accountability and the Procedural Manuals for VSEP and/or VGLA.

** Refer to Virginia Alternate Assessment Program (VAAP) Participation Criteria and Procedural Manual.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

PARTICIPATION IN THE STATE AND DIVISIONWIDE ACCOUNTABILITY/ASSESSMENT SYSTEM (continued)

Student Name________________________________________________________ Date ____/____/____

Student ID Number____18412______________________________

PARTICIPATION IN STATEWIDE ASSESSMENTS

Test	Assessment Type* (SOL, VSEP,VAAP)	Accommodations**	If yes, list accommodation(s)
Reading	_______________________________________ Not Assessed at this Grade Level	Yes No
Math	_______________________________________ Not Assessed at this Grade Level	Yes No
Science	_______________________________________ Not Assessed at this Grade Level	Yes No
History/SS	_______________________________________ Not Assessed at this Grade Level	Yes No
Writing	_______________________________________ Not Assessed at this Grade Level	Yes No

* Students with disabilities are expected to participate in all content area assessments that are available to students without disabilities. The IEP Team determines how the student will participate in the accountability system.

** Accommodation(s) must be based upon those the student generally uses during classroom instruction and assessment, including assistive technology and/or accessible materials. For the accommodations that may be considered, refer to VDOE’s Students with Disabilities: Guidelines for Assessment Participation for guidance.

Divisionwide Assessment (list): __________________________________________________________________________________________________________________________________________________________________________________________

EXPLANATION FOR NON-PARTICIPATION IN REGULAR STATE OR DIVISION-WIDE ASSESSMENTS

If an IEP team determines that a student must take an alternate assessment instead of a regular state assessment, explain in the space below why the student cannot participate in this regular assessment; why the particular assessment selected is appropriate for the student, including that the student meets the criteria for the alternate assessment; and how the student’s nonparticipation in the regular assessment will impact the child’s promotion; or other matters. Refer to the VDOE’s Students with Disabilities: Guidelines for Assessment Participation for guidance.

Alternate/Alternative Assessments Participation Criteria is attached or maintained in the student’s educational record.

THIS IS THE END OF THE SECOND ASSIGNMENT.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

SERVICES – LEAST RESTRICTIVE ENVIRONMENT – PLACEMENT, Continued

Student Name________________________________________________________ Date____/____/____

Student ID Number _____18412______________________________

Least Restrictive Environment (LRE)

When discussing the least restrictive environment and placement options, the following must be considered:

· To the maximum extent appropriate, the student is educated with children without disabilities.

· Special classes, separate schooling or other removal of the student from the regular educational environment occurs only when the nature or severity of the disability is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily.

· The student’s placement should be as close as possible to the child’s home and unless the IEP of the student with a disability requires some other arrangement, the student is educated in the school that he or she would attend if he or she did not have a disability.

· In selecting the LRE, consideration is given to any potential harmful effect on the student or on the quality of services that he/she needs.

· The student with a disability shall be served in a program with age-appropriate peers unless it can be shown that for a particular student with a disability, the alternative placement is appropriate as documented by the IEP.

Free Appropriate Public Education (FAPE)

When discussing FAPE for this student, it is important for the IEP team to remember that FAPE may include, as appropriate:

· Educational Programs and Services · Proper Functioning of Hearing Aids · Assistive Technology and/or accessible materials · Transportation

· Nonacademic and Extracurricular Services and Activities · Physical Education · Extended School Year Services (ESY) · Length of School Day

SERVICES :

Identify the service(s), including frequency, duration and location that will be provided to or on behalf of the student in order for the student to receive a free appropriate public education. These services are the special education services and as necessary, the related services, supplementary aids and services based on peer-reviewed research to the extent practicable, assistive technology and/or accessible materials, supports for personnel*, accommodations and/or modifications* and extended school year services* the student will receive that will address area(s) of need as identified by the IEP team. Address any needed transportation and physical education services including accommodations and/or modifications. * These services are listed on the “Accommodations/Modifications” page and “Extended School Year Services” page, as needed.

Service(s)	Frequency	**School/location Instructional Setting (classroom)	Duration m/d/y to m/d/y

** IEP teams are required to identify the specific school site (public or private) when the parent expresses concerns about the location of the services or refuses the proposed site. A listing of more than one anticipated location is permissible, if the parents do not indicate that they will object to any particular school or state that the team should identify a single school.

SERVICES – LEAST RESTRICTIVE ENVIRONMENT – PLACEMENT, Continued

Student Name_________________________________________________ Date____/____/____

Student ID Number ____18412_______________________________

PLACEMENT

No single model for the delivery of services to any population or category of children with disabilities is acceptable for meeting the requirement for a continuum of alternative placements. All placement decisions shall be based on the individual needs of each student. The team may consider placement options in conjunction with discussing any needed supplementary aids and services, accommodations/modifications, assistive technology and/or accessible materials, and supports for school personnel. In considering the placement continuum options, check those the team discussed. Then, describe the placement selected in the PLACEMENT DECISION section below. Determination of the Least Restrictive Environment (LRE) and placement may be one or a combination of options along the continuum.

PLACEMENT CONTINUUM OPTIONS CONSIDERED: (check all that have been considered):

· general education class(es) · special class(es) · special education day school · state special education program / school · Public residential facility · Private residential facility · Homebound · Hospital · Other ____________________________

Based upon identified services and the consideration of least restrictive environment (LRE) and placement continuum options, describe in the space below the placement. Additionally, summarize the discussions and decision around LRE and placement. This must include an explanation of why the student will not be participating with students without disabilities in the general education class(es), programs, and activities. Attach additional pages as needed.

Explanation of Placement Decision:

TRANSITION INDIVIDUALIZED EDUCATION PROGRAM (IEP)

EXTENDED SCHOOL YEAR SERVICES (ESY)

Student Name_________________________________________________________ Date____/____/____

Student ID Number 18412___________________________

Summarize the IEP team’s discussions and decision about ESY:

If ESY services are to be provided identify which goals in the current IEP will be addressed by the ESY services:

Identify the Extended School Year services needed to meet these goals:

Service(s)	Frequency	Location (name of school **)	Instructional Setting	Duration m/d/y to m/d/y

** IEP teams are required to identify the specific school site (public or private) when the parent expresses concerns about the location of the services or refuses the proposed site. A listing of more than one anticipated location is permissible, if the parents do not indicate that they will object to any particular school or state that the team should identify a single school. TRANSITION INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student Name_______________________________________________________ Date____/____/____

Student ID Number 18412

MEASURABLE POST SECONDARY GOALS and TRANSITION SERVICES

(To be developed no later than the IEP to be in effect at age 14, or earlier, if appropriate)

DOCUMENTATION OF TRANSITION ASSESSMENTS

Are the postsecondary goals based upon age-appropriate formal and informal transition assessments? ___No ___Yes

If yes, identify these assessments in the Present Level of Academic Achievement and Functional Performance or indicate which age-appropriate transition assessments were conducted for the development of measurable postsecondary goals and transition activities, as well as the date they were conducted:

Formal and informal Assessments (list name of assessment and date administered):

(Research to identify assessments that could be used to determine ability/skill levels, interests, aptitudes, etc)

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

MEASURABLE POSTSECONDARY EMPLOYMENT GOAL:

Describe how the student’s courses of study support attainment of this postsecondary goal:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Transition Activities/Services (including activities that link the student to adult services)	Responsible Individual/ Describe Responsibilities	Date to be Completed
Instruction Considered, but not appropriate at this time |_|
Related Services Considered, but not appropriate at this time |_|
Community Experiences Considered, but not appropriate at this time |_|
Employment Considered, but not appropriate at this time |_|
Functional Vocational Evaluation Considered, but not appropriate at this time |_|
Daily Living Skills Considered, but not appropriate at this time |_|
Adult Living Considered, but not appropriate at this time |_|
OTHER

MEASURABLE POSTSECONDARY EDUCATION GOAL(S) (e.g., higher education, and continuing/adult education):

Describe how the student’s courses of study support attainment of this postsecondary goal:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Transition Activities/Services (including activities that link the student to adult services)	Responsible Individual/ Describe Responsibilities	Date to be Completed
Instruction Considered, but not appropriate at this time |_|
Related Services Considered, but not appropriate at this time |_|
Community Experiences Considered, but not appropriate at this time |_|
Employment Considered, but not appropriate at this time |_|
Functional Vocational Evaluation Considered, but not appropriate at this time |_|
Daily Living Skills Considered, but not appropriate at this time |_|
Adult Living Considered, but not appropriate at this time |_|
OTHER

MEASURABLE POST SECONDARY TRAINING GOAL(S) (e.g., career and technical education, military service, on-the-job training, apprenticeship):

Describe how the student’s courses of study support attainment of this postsecondary goal:

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Transition Activities/Services (including activities that link the student to adult services)	Responsible Individual/ Describe Responsibilities	Date to be Completed
Instruction Considered, but not appropriate at this time |_|
Related Services Considered, but not appropriate at this time |_|
Community Experiences Considered, but not appropriate at this time |_|
Employment Considered, but not appropriate at this time |_|
Functional Vocational Evaluation Considered, but not appropriate at this time |_|
Daily Living Skills Considered, but not appropriate at this time |_|
Adult Living Considered, but not appropriate at this time |_|
OTHER

MEASURABLE INDEPENDENT LIVING/COMMUNITY PARTICIPATION GOAL(S):

Describe how the student’s courses of study support attainment of this postsecondary goal:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Transition Activities/Services (including activities that link the student to adult services)	Responsible Individual/ Describe Responsibilities	Date to be Completed
Instruction Considered, but not appropriate at this time |_|
Related Services Considered, but not appropriate at this time |_|
Community Experiences Considered, but not appropriate at this time |_|
Employment Considered, but not appropriate at this time |_|
Functional Vocational Evaluation Considered, but not appropriate at this time |_|
Daily Living Skills Considered, but not appropriate at this time |_|
Adult Living Considered, but not appropriate at this time |_|
OTHER

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

PRIOR NOTICE AND PARENT CONSENT

Student Name__________________________________________________________ Date____/____/____

Student ID Number____18412_______________________________

PRIOR NOTICE

The school division proposes to implement this IEP. This proposed IEP will allow the student to receive a free appropriate public education in the least restrictive environment. This decision is based upon a review of current records, current assessments and the student’s performance as documented in the Present Level of Academic Achievement and Functional Performance. Other options considered, if any, and the reason(s) for rejection are attached, or can be found in the Placement Decision section of this IEP. Additionally, other factors, if any that are relevant to this proposal are attached. Parent and adult student rights are explained in the Procedural Safeguards. If you, the parent(s) and adult student, need another copy of the Procedural Safeguards or need assistance in understanding this information please contact ________________________________ at (___) ____________ or e-mail ________________________________ or

________________________________ at (___) ____________ or e-mail ________________________________ .

____ Parent(s) initials here indicate that the parent(s) has read the above prior notice and attachments, if any, before giving permission to implement this IEP.

PARENT/ADULT STUDENT CONSENT: Indicate your response by checking the appropriate space and sign below.

___ I give permission to implement this IEP.

___ I do not give permission to implement this IEP.

____________________________________________________ ____/____/____

Parent Signature Date