Catherine Owens

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IndividualizedEducProgIEPSectionY03Summer2025CO-5262025-238PM.zip

[PLAAFP] Assignment Instructions (1).pdf

Present Levels of Academic Achievement and Functional Performance [PLAAFP]

Assignment Instructions (Maximum Points of 50)

Using the headers in the Georgia Department of Education model IEP (see below),

write a "Present Levels of Academic Achievement and Functional Performance" for

John Doe.

The psychological summary is from the end of third grade and the IEP meeting is

being held at the beginning of fourth grade because Mrs. Doe had surgery and this

was the first available time for her to participate.

Use the example in the Case Study on Sarah Smith as a model. Use the same

format.

Remember, do not a cut and paste from the psychological summary -- include

only information relevant (related) to determine IEP goals. That is, only include

information that support identified deficits and strengths that can be used to

support annual goal determination.

Your submission should not exceed one page in length.

Summary Psychological Report: (only relevant findings to support PLAAFP below - this should be one brief paragraph, only information linked to PLAAFP below)

Eligibility for Special Education Placement: this is a statement

Present Levels of Academic Achievement and Functional Performance

Results of initial/most recent evaluation and results of state and district assessments:

Description of academic, developmental and/or functional strengths: Description of academic, developmental and/or functional needs: Parental concerns regarding their child’s education: Impact of the disability on involvement and progress in the general education curriculum:

Review the PLAAFP Rubric posted in this module to know how you will be evaluated on this assignment.

John Doe Case Study.pdf

Psychological Summary.

Name: John Doe

Sex: Male

Grade: 4

Background

John participates in most classroom activities without significant support. However, there are occasions where he displays inappropriate behavior that interferes with his academic performance. According to his teacher, “If someone does something that he perceives as wrong, he perseverates on it.” For example, if someone acts out in class, that will have him upset for the rest of the day. He becomes inattentive, fails to complete work, refuses to participate in class, and exhibits temper tantrums.

John lives with his parents and has three siblings. He was the product of an uncomplicated pregnancy and delivery. He did, however, exhibit many delays in development. His parents report that John takes the medications Paroxetine and Straterra. He was evaluated by both a psychiatrist and a psychologist with the resulting diagnoses of attention deficit hyperactivity disorder and Asperger’s disorder.

Other information provided by his teachers report that John does not attend to details and follow directions consistently. He is easily distracted in class and does not complete most assignments on time. John has little interest in others and typically does not initiate conversations or contacts with his peers.

John achievement is on grade level in both reading and math. His skills and knowledge in these areas are sufficient for John to perform on grade level and to meet end of grade (EOG) milestones as a Proficient Learner the Georgia Milestone End-of-Grade Assessment (EOG) in third grade. His writing skills are a weakness and he does not preform at grade level expectations. John writes simple sentences and does not construct/write a meaningful paragraph. His overall EOG score in English language arts (ELA) was Developing Learner (Reading score was at grade level-Writing and Language scores depressed his overall score).

Previous Test Results

Achievement Levels:

Wechsler Intelligence Scales for Children: Fifth Edition (WISC-V) an intelligence test that measures intellectual ability

Verbal Score 98 - Average Range Performance Score 112 - High Average Range Full Scale IQ 105 - Average Range

Pragmatic Language Skills Inventory (PLSI) a norm-referenced rating scale designed to assess pragmatic language skills (language skills used in daily interactions with others, includes non-verbal communication)

Pragmatic language quotient of 94 (PLI < 89 suggests Below Average, Poor, and Very Poor) Areas of weakness identified: knowing when to talk and when to listen, understanding classroom rules, taking turns in conversations, initiating conversations, and predicting consequences of one’s behavior

Georgia Milestone End-of-Grade Assessment (EOG) Grade 3 a summative assessment that measures how well students are mastering state-adopted content standards

Content Area Scaled Score Performance Level English/Language Arts 512 Developing Learner Mathematics 570 Proficient Learner Science Not administered this grade Social Studies Not administered this grade

Diagnostic Achievement Battery: Fourth Edition (DAB-4) - Grade 3 an achievement test that measure students’ strengths and weaknesses across important areas of school achievement

Subtest/Composite Grade Equivalent Listening Composite 1.4

Synonyms 2.5

Alphabet/Phonics/Word Identification 3.4

Reading Comprehension 3.8

Punctuation/Capitalization 2.3 Spelling 2.8 Mathematics Reasoning 3.4

Mathematics Calculation 4.0

Asperger Syndrome Diagnostic Scale (ASDS) - Grade 3 a norm referenced rating scale that asks the respondent to note the presence or absence of behavior indicative of Asperger syndrome.

Asperger Syndrome Quotient 111 Probability of Asperger Syndrome – Very Likely

• Talks excessively about favorite topics that hold limited interest to others

• Uses words and phrases repetitively • Frequently asks inappropriate questions • Has few or no friends as school • Displays limited interest in what others say or find interesting • Does not change to match the environment • Exhibits a strong reaction to change in his routine • Exhibits difficulty with handwriting

Eligibility for Special Education: other health impairment, autism and speech - Established at the end of Grade 3 based on the test results presented above.

Information for IEP Meeting - Fall Grade 4

Achievement Testing Woodcock-Johnson Achievement Battery: Fourth Edition an achievement test that measures academic achievement (what children have learned in school)

Subtest Standard Score

Percentile Rank

Classification

Reading Letter-Word Identification 93 30 Average Passage Comprehension 94 42 Average Word Attack 92 31 Average Oral Reading 88 24 Low Average

Sentence Reading Fluency 88 24 Low Average Mathematics Applied Problems 110 75 Average Calculation 93 30 Average Math Fact Fluency 97 50 Average Writing Spelling 89 24 Low Average Writing Samples 79 8 Low Sentence Writing Fluency 69 2 Very Low

State Testing: On the Georgia Milestone End of Grade (EOG) administered at end of Grade 3. In English/Language Arts a score of 525 is necessary to be identified as a Proficient Learner. John earned a 512 in English/Language Arts (Developing Learner). On Mathematics a score of 525 is necessary for the student to be identified as a Proficient Learner and John earned a 570 in this area (Proficient Learner).

Speech Language Deficits were noted in the area of pragmatics (i.e. initiating conversations, maintaining conversations, staying on topic, and interacting appropriately with peers). The Comprehensive Assessment of Spoken Language, second edition (CASL-2) administered at the end of Grade 3 revealed a super linguistic standard score of 95 (Average range) and the Test of Pragmatic Language Skills, second edition (TOPL-2) completed at the end of Grade 3 showed a language quotient of 94 (Average range). Findings from these formal assessments of language skills, however, are not consistent with John’s actual performance in the regular classroom.

Socially appropriate behavior: For the most part John exhibits socially appropriate behavior when interacting with peers and teachers. He has a few friends. He exhibits a number of inappropriate behaviors. He perseverates on an issue if he believes that somebody has done something wrong or when he does not understand a class assignment. John also has occasional temper tantrums. Since the beginning of Grade 4 only two outbursts have been observed. He also displays a short attention span and it takes multiple verbal prompts for him to complete an assignment. Currently, during a 45-minute session, it takes an average of 7 verbal prompts for John to complete an assignment. These inappropriate behaviors affect his ability to turn in assignments and lower his class grades. He needs to stay on task and complete class assignments without multiple verbal prompts from the

teacher. Changes in his routine or his seating in the classroom also contribute to John’s behavioral inappropriateness. He displays anxiety (he worries excessively about what others in the class are doing at any given moment). For example, if someone is the class does something that is not typical, he will tell the teacher what has happened. He is more off task if any of routine changes occur. He perseverates (continues to repeat or prolong something after it is appropriate to do so) on topics and this leads to him ask multiple questions about something that is inappropriate and distracting to him and others.

Writing Skills: John does not write a cohesive paragraph on a single topic. Currently when given a topic, John writes simple sentences that are in the form of a list such as “I like bugs.” and “I like games.” He does not write a paragraph with a topic sentence, three supporting details, and a concluding sentence. He needs to increase his skills in communicating in writing to meet grade level expectations. He also demonstrates below grade level expectations in his writing fluency. When given a writing prompt, currently John writes 28 words in three minutes (Grade 4 expectations 41- 46 in four minutes).

Communication: John continues to demonstrate pragmatic language weaknesses in a social context within the school setting. Baseline data was collected on two different occasions for the following skills. Inconsistencies were noted during each observation; therefore, an average was calculated in order to obtain a baseline. John currently initiates conversation on an average of 4 times in one hour while in a social setting (PE, lunch). He can maintain a conversation by exchanging information with a listener 4 times in one hour. He demonstrates an understanding of social gestures when in a social context approximately 3 times in one hour. It should be noted that on one occasion, John misread a gestural cue by a student that resulted in a physical altercation between him and the other student. Grade 4 is a pivotal point for student’s social and academic life. It is during this time that social cliques begin to form and relational and social bullying and excluding are all too common. Academically, Grade 4 students are expected to be responsible for their own work and to work in groups.

Parent Concerns: Mrs. Doe attended the IEP meeting. She was concerned that John may have a tantrum behavior at school, as this has been a problem at home, and that he has so much trouble in the classroom completing his assignments. She noted that he is currently seeing a local physician and that

he is on medication for attention weaknesses (poor concentration, and impulsivity). At home and in the community, Mrs. Doe notes that she feels that is John shy (being nervous or timid in the company of others) in his interactions with others. She would like to see him initiate and maintain conversations with others on a more frequent basis and have more friends.

PLAAFP Rubric Summer 2024.pdf

PLAAFP Rubric

Criteria Exemplary 10 points

Target 8 points

Acceptable 7 points

Unacceptable 5 points

Criterion Score

Summary of Psychological Report

Summary of psychological report includes only relevant current performance information necessary to respond to the five areas in the PLAAFP section to establish baseline for goals. No unrelated information is included. Eligibility for special education placement is provided.

Summary of psychological report includes most relevant current performance information necessary to respond to the five areas in the PLAAFP section to establish baseline for goals. Some unrelated information is included. Eligibility for special education placement is provided generally.

Summary of psychological report includes some relevant current performance information necessary to respond to the five areas in the PLAAFP section to establish baseline for goals. Much unrelated information is included. Eligibility for special education placement is somewhat provided.

Summary of psychological report does not include only relevant current performance information necessary to respond to the five areas in the PLAAFP section to establish baseline for goals. Appears to be merely a "cut and paste' from psychological report. Unrelated information is included. Eligibility for special education placement is not provided or incorrect.

/10

Results of State/District Testing

Only results of recent state/district assessments relevant current performance information necessary to respond to the five areas in the PLAAFP section to establish a baseline for goals included. No unrelated testing is included.

Most results of recent state/district assessments relevant current performance information necessary to respond to the five areas in the PLAAFP section to establish a baseline for goals is included. Some unrelated testing is included.

Some results of recent state/district assessments relevant current performance information necessary to respond to the five areas in the PLAAFP section to establish a baseline for goals is included. Much unrelated testing is included.

A few of the results of recent state/ district assessments relevant current performance information necessary to respond to the five areas (or less) in the PLAAFP section to establish baseline for goals is included. Most of the testing included is unrelated.

/10

Description of Strengths

All strengths are tied to State/ District testing and written as measurable statements. All information necessary to write goals is included.

Most strengths are tied to State/District testing and written as mostly measurable statements. Most information necessary to write goals is included.

Some strengths are tied to State/District testing and written as somewhat measurable statements. Some information necessary to write goals is included. Some information is omitted.

Few strengths are tied to State /District testing and not written as measurable statements. Much information necessary to write goals is not included or irrelevant. Some information is omitted.

/10

Description of Needs

All needs statements are tied to State/ District testing and strength statements and written as a measurable baseline (starting point for goals). All information necessary to write goals is included.

Most needs statements are tied to State/District testing and strength statements and written as a measurable baseline (starting point for goals). Most information necessary to write goals is included.

Some needs statements are tied to State/District testing and strength statements and written as a measurable baseline (starting point for goals). Some information necessary to write goals is not included.

Few needs statements are tied to State/District testing and strength statements and most not written as a measurable baseline (starting point for goals). Most information necessary to write goals is not included.

/10

Parental Concerns and Impact of the Disability

All parental concern statements directly related to writing goals. Specific statement(s) specifically describing how the "disability" will impact participation in the general education curriculum.

Most parental concern statements directly related to writing goals. General statement(s) describing how his "disability" will impact participation in the general education curriculum.

Some parental concern statements directly related to writing goals. Vague statement(s) describing how the "disability" will impact participation in the general education curriculum.

Few parental concern statements directly related to writing goals. Appear to be merely a "cut and paste" from psychological report. Statement(s) describing how the "disability" will impact participation in the general education curriculum not relevant or incorrect.

/5

Overall Quality of Assignment

Exemplary 5 points

Target 4 points

Acceptable 3 points

Unacceptable 2 points

Criterion Score

Grammar/ Mechanics

Correct use of person first language. No errors in grammar, spelling, capitalization and abbreviations correctly provided. Overall presentation of information easy to read and presented coherently. Adheres to page limit requirement. No cut and paste from psychological report.

Correct use of person first language. a few (one or two) errors in grammar, spelling, capitalization and abbreviations correctly provided. Overall presentation of information readable and presented mostly organized. Mostly adheres to page limit requirement. A few cut and paste from psychological report.

Mostly correct use of a person first language. More than a few (three or more) errors in grammar, spelling, capitalization and abbreviations not correctly provided. Overall presentation of information somewhat readable and presented Somewhat organized. Exceeds page limit requirement by more than a few lines. Much cut and paste from psychological report.

Many errors in use of person first language. Many (four or more) errors in grammar, spelling, capitalization and abbreviations not correctly provided. Overall presentation of information difficult to read and presented somewhat unorganized. Exceeds page limit requirement by more than a half page. Mostly cut and paste from psychological report.

/5

Total /50

IEPSampleForm FINAL revised June 2021.docx

Student Name: ____________________________________________________________Meeting Date: __________________________________________________

Student Name: ____________________________________________________________Meeting Date: __________________________________________________

__________________SCHOOL SYSTEM

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

IEP Meeting Date:

Purpose of IEP Meeting: Initial  Annual Review  Amendment 

Student Name:

Date of Birth:

GTID#

Eligibility Category(s):

Most Recent Eligibility Date(s):

School:

Grade:

School Year:

Parent(s):

Address:

Email:

Phone (home):

(work):

(cell phone):

TEAM MEMBERS IN ATTENDANCE

REQUIRED MEMBERS

ADDITIONAL MEMBERS

Parent:

Name/Title:

Parent:

Name/Title:

Local Education Agency Representative (LEA):

Name/Title:

Special Education Teacher:

Name/Title:

Regular Education Teacher:

Name/Title:

Student (age 18 or if transition is being discussed):

Name/Title:

Agency representative (responsible for transition services):

Name/Title:

I. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Results of initial or most recent evaluation and results of state and district assessments:

Description of academic, developmental and/or functional strengths:

Description of academic, developmental and/or functional needs:

Parental concerns regarding their child’s education:

Impact of the disability on involvement and progress in the general education curriculum (for preschool, how the disability affects participation in appropriate activities):

II. CONSIDERATION OF SPECIAL FACTORS

a) Does the student have behavior which impedes his/her learning or the learning of others?  Yes  No

If yes, consider the appropriateness of developing a Behavior Intervention Plan.

Behavior Intervention Plan developed?  Yes  No

Refer to Behavior Intervention Plan for additional information.

b) Does the student have Limited English proficiency?  Yes  No

If yes, consider the language needs as related to the IEP and describe below.

c) Does the student have blindness/visual impairment?  Yes  No

If yes, provide for instruction in Braille and the use of Braille, unless the IEP Team determines that instruction in Braille is not appropriate for the student after an evaluation of the student’s reading and writing skills, needs, and appropriate reading and writing media, including evaluation of future needs for instruction in Braille or the use of Braille. Describe below.

d) Does the student have communication needs?  Yes  No

If yes, consider the communication needs and describe below.

e) Is the student deaf or hard of hearing?  Yes  No

If yes, consider and describe the student’s language and communication needs, opportunities for direct communication 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. Describe communication needs below.

f) Does the student need assistive technology devices or services?  Yes  No

If yes, describe the type of assistive technology and how it is used. If no, describe how the student’s needs are being met in deficit areas.

g) Does the student require alternative format for instructional materials?  Yes  No

If yes, specify format(s) of materials required below.

 Braille  Large type  Auditory  Electronic text

III. TRANSITION SERVICE PLAN

A transition service plan must be completed no later than entry into 9th grade or by age 16, whichever comes first, or younger, if determined appropriate by the IEP team and updated annually.

Has the team determined that the student needs a transition service plan?  Yes  No

If yes, complete the Transition Service Plan below.

Transition Service Plan

Name:

Date of Initial Transition Program Development:

Projected date of Graduation:

Type of Diploma:

Updates:

Preferences, Strengths, Interests and Course of Study based on Present Levels of Performance and Age-Appropriate Transition Assessments (Areas for consideration include course of study, post-secondary education, vocational training, employment, continuing education, adult services, and community participation.)

Measurable Post-Secondary/Outcome Completion Goals (These goals are to be achieved after graduation. There must be a completion goal for Employment and Education/Training.)

Employment -

Education/Training -

Independent Living (as appropriate) -

Annual Transition Goals (Based on age-appropriate transition assessments, in the spaces below, include measurable Annual Transition Goals and Transition Activities/Services appropriate for the child’s post-secondary preferences, strengths and needs. There must be at least one measurable Annual Transition Goal to help the child reach each of the Measurable Post-Secondary/Outcome Completion Goals.)

Education/Training (Goals based on academics, functional academics, life centered competencies or career/technical or agricultural training needs and job training.)

Transition IEP Goal(s)

Transition Activities/Services

Person/Agency Involved

Date of Completion/ Achieved Outcome

Development of Employment (Goals based on occupational awareness, employment related knowledge and skills and specific career pathway knowledge and skills.)

Transition IEP Goal(s)

Transition Activities/Services

Person/Agency Involved

Date of Completion/ Achieved Outcome

Community Participation (Goals based on knowledge and demonstration of skills needed to participate in the community (e.g., tax forms, voter registration, building permits, social interactions, consumer activities, accessing and using various transportation modes.)

Transition IEP Goal(s)

Transition Activities/Services

Person/Agency Involved

Date of Completion/ Achieved Outcome

Adult Living Skills & Post School Options (Goals based on skills for self-determination, interpersonal interactions, communication, health /fitness, and the knowledge needed to successfully participate in Adult Lifestyles and other Post School Activities (e.g., skills needed to manage a household, maintain a budget and other responsibilities of an adult.)

Transition IEP Goal(s)

Transition Activities/Services

Person/Agency Involved

Date of Completion/ Achieved Outcome

Related Services (Goals based on Related Services that may be required now to help a child benefit from regular and special education and transition services (e.g., speech/language, occupational therapy, counseling, vocational rehabilitation training or the planning for related services that the individual may need access to as an adult.)

Transition IEP Goal(s)

Transition Activities/Services

Person/Agency Involved

Date of Completion/ Achieved Outcome

Daily Living Skills (Goals based on adaptive behaviors related to personal care and well-being to decrease dependence on others.)

Transition IEP Goal(s)

Transition Activities/Services

Person/Agency Involved

Date of Completion/ Achieved Outcome

TRANSFER OF RIGHTS (Required by age 17):

was informed on

of his/her rights, if any, that will transfer at age 18.

Name

Date

RIGHTS WERE TRANSFERRED (Required by age 18):

was informed on

of his/her rights.

Name Date

Student Name:__________________________________________ Meeting Date:____________________________________

Student Name: _________________________________ Meeting Date: _______________________

Georgia Department of Education

August 2007

Page 4 of 8

rev: June 2021

IV. MEASURABLE ANNUAL GOALS

Measurable Annual Goals: Academic and/or functional goals designed to meet the child’s needs that result from the disability to enable the child to be involved in and make progress in the general education curriculum or to meet each of the child’s other educational needs that result from the disability.

Criteria for Mastery

Method of Evaluation

Progress At Reporting Period

1

(date)

2

(date)

3

(date)

4

(date)

1.

2.

3.

4.

REPORT OF STUDENT PROGRESS

When will the parents be informed of the child’s progress toward meeting the annual goals?

V. MEASURABLE ANNUAL GOALS & SHORT TERM OBJECTIVES/BENCHMARKS

Academic and/or functional goals designed to meet the child’s needs that result from the disability to enable the child to be involved in and make progress in the general education curriculum or to meet each of the child’s other educational needs that result from the disability.

MEASURABLE ANNUAL GOAL:______________________________________________________________________________________________________________________________________________

Short term objectives/benchmarks: Measurable, intermediate steps or targeted sub-skills to enable student to reach annual goals.

Criteria for Mastery

Method of Evaluation

Progress At Reporting Period

1

(date)

2

(date)

3

(date)

4

(date)

REPORT OF STUDENT PROGRESS

When will the parents be informed of the child’s progress toward meeting the annual goals?

rev: June 2021

VI. STUDENT SUPPORTS

To advance appropriately toward attaining annual goals; to be involved and progress in the general curriculum; to be educated and participate with other children in academic, nonacademic and extracurricular activities, the following accommodations, supplemental aids and services and/or supports for school personnel will be provided:

Instructional Accommodations

Classroom Testing Accommodations

Supplemental Aids and Services

Supports for School Personnel

VII. ASSESSMENT DETERMINATION FOR DISTRICT AND STATEWIDE ASSESSMENTS FOR GRADES K-12

a) The student will participate in the following regular required assessments (Each state mandated test and subtest must be considered individually and documented below).

Specific Testing Accommodations (Accommodations used for assessment must be consistent with accommodations used for classroom instruction/testing and specified in the IEP. Some accommodations used for instruction may not be allowed for statewide assessment. Refer to the GaDOE Student Assessment Handbook for the only allowable accommodations. Conditional accommodations are only allowable for students who meet eligibility criteria.) All subtests must be considered individually.

Test

Subtest

Setting

Timing/Scheduling

Presentation

Response

None, Standard or Conditional

b) Complete the following steps

c)

d) to determine if the student will participate in the Georgia Alternate Assessment (GAA)

Eligibility Criteria for the Georgia Alternate Assessment 2.0 (GAA)

Step I: Review the Eligibility Criteria for GAA

Prior to reviewing the eligibility criteria for GAA, the Individualized Education Program (IEP) team must understand all assessment options, including the characteristics of each assessment and the potential implications of each assessment choice. The GAA 2.0 is intended for students with the most significant cognitive disabilities. Instruction for these students is based on alternate academic achievement standards, which are aligned to the Georgia Standards of Excellence at a reduced depth, breadth, and complexity. Beginning with students who enroll in ninth grade for the first time on or after the 2020-2021 school year, students who participate in the GAA 2.0 will be eligible for the state-defined alternate diploma rather than the regular high school diploma (SBOE 160-4-2-.48).

According to O.C.G.A § 20-2-281, school districts are required to follow the procedures specified in the applicable test administration materials. As a result, the IEP team must use this form to document its assessment decisions. If GAA is being considered, the IEP team must review the four criteria below and select Yes or No if applicable to the student. To be eligible to participate in GAA, the answer to all four of the questions below must be Yes. If the answer to any of the questions is No, the student is not eligible to participate in GAA and must participate in the Georgia Milestones Assessment System. Each Yes answer requires a justification that contains evidence that the student meets the criteria.

Student Name

Grade

Eligibility Criteria Source of Evidence (check if used) Justification

1. Does the student require intensive, individualized instruction in a variety of instructional settings?

The student needs specialized academic instruction and techniques over a period of time to ensure that he or she can learn, retain information, and transfer skills to other settings.

· Yes

· No

· Present Levels of Academic Achievement and Functional Performance

· Anecdotal Notes and Observations

· Benchmark Data

· Progress Monitoring Data

· Learning Characteristics Inventory

· Other________________

2. Does the student have a significant cognitive disability?

A significant cognitive disability is determined by the IEP team and must be based on evaluation information performed by a qualified evaluation team. The significant cognitive disability must affect the student’s intellectual functioning and be documented as such in the student’s individualized education program (IEP).

· Yes

· No

· Results of Individual Cognitive Ability Test

· Results of Adaptive Behavior Skills Assessment

· Learning Characteristics Inventory

· Other_________________

3. Does the student require specialized supports to access and participate in the grade-level Georgia Standards of Excellence (GSE) that require modifications based on the student’s Present Levels of Academic Achievement and Functional Performance (PLAAFP)?

Access to the grade-level curriculum is mandated by the federal government. A student with a significant cognitive disability requires access to the GSEs through prerequisite skills that are linked to the grade-level curriculum.

· Yes

· No

· Results of Individual Cognitive Ability Test

· Results of Adaptive Behavior Skills Assessment Anecdotal Notes and Observations

· Benchmark Data

· Progress Monitoring Data

· Results of language assessments including English Learner (EL) assessments, if applicable

· Learning Characteristics Inventory

· Other____________

4. Does the student require specialized supports to demonstrate age-appropriate adaptive behavior?

A student with a significant cognitive disability needs specialized support throughout the day in areas such as expressing his or her needs, getting from place to place, eating lunch, negotiating social situations, and/or taking care of personal needs.

· Yes

· No

· Results of Individual Cognitive Ability Test

· Results of Adaptive Behavior Skills Assessment

· Learning Characteristics Inventory

· Other__________________

Eligibility Criteria for the Georgia Alternate Assessment 2.0 (GAA)

Step II: Assurances

The IEP team has participated in training and guidance regarding student participation in state mandated assessments that includes the information below:

Under 34 Code of Federal Regulations (CFR) 300.320(a)(6) and [O.C.G.A § 20-2-281], if the IEP team determines that the student will take GAA, the IEP team may provide additional summary statements of why the student cannot participate in the Georgia Milestones Assessment System, with or without allowable accommodations, and why the alternate assessment is appropriate for the student, including that all of the eligibility criteria are met.

Additional Summary Statements (if necessary):

The decision to administer GAA is based on multiple sources of measurable, objective evidence, including, but not limited to current IEP PLAAFP statements, goals and/or objectives, report cards, progress reports, work samples, teacher observations, Full and Individual Evaluations (FIE), standardized achievement test results, and classroom, district, and statewide assessment results. This decision is not based solely on the student’s previous performance on statewide assessment.

The decision to administer GAA is made by the IEP team, not administratively based on federal accountability requirements which limit the number of students taking an alternate assessment who can be counted as proficient in CCRPI performance calculations. Although GAA is intended for a small number of students, the proficiency cap does not limit the number of students receiving special education services who may take the alternate assessment.

The decision to administer GAA is based on the student’s educational needs and the instruction the student is receiving. This decision is not based solely on the student’s disability category and is not based on the student’s racial or economic background, excessive or extended absences, or amount of time or location of service delivery.

Will the student participate in the Georgia Alternate Assessment (GAA)  Yes  No

VIII. SPECIAL EDUCATION: Instruction/Related Services in General Education Classroom/Early Childhood Setting

Options

Considered

Frequency

Initiation of Services

(mm/dd/yy)

Anticipated Duration

(mm/dd/yy)

Provider Title

Content/Specialty Area(s)

Consultative

Collaborative

Co-teaching

Supportive Services

Related Services

IX. SPECIAL EDUCATION: Instruction/Related Services Outside of the General Education Classroom

Options Considered

Frequency

Initiation of Services

(mm/dd/yy)

Anticipated Duration

(mm/dd/yy)

Provider Title

Content/Specialty Area(s)

Separate Class

Separate School

Home Instruction

Residential

Hospital/Homebound

Supportive Services

Related Services

X. The explanation of the extent, if any, to which the child will not participate with peers without disabilities in the regular class and/or in nonacademic and extracurricular activities:

XI. EXTENDED SCHOOL YEAR

a) Are extended school year services necessary?  Yes  No

If yes, complete the section b and c below.

b) Services

Services

Frequency

Initiation of Services

(mm/dd/yy)

Anticipated Duration

(mm/dd/yy)

Provider Title

Location

c) Goals to be extended or modified:

MEASURABLE ESY GOALS

Measurable Annual Goals: Academic and/or functional goals designed to meet the child’s needs that result from the disability to enable the child to be involved in and make progress in the general education curriculum or to meet each of the child’s other educational needs that result from the disability.

Criteria for Mastery

Method of Evaluation

Progress At Reporting Period

1

(date)

2

(date)

3

(date)

4

(date)

1.

2.

3.

4.

REPORT OF STUDENT PROGRESS

When will the parents be informed of the child’s progress toward meeting the annual goals?

XII. DOCUMENTATION OF NOTICE OF IEP MEETING

Date

Method of Notification

By Whom

1st Notification

Invitation  Phone Call  In Person Reminder notice Other:

2nd Notification

Invitation  Phone Call  In Person Reminder notice Other:

3rd Notification

Invitation Phone Call  In Person Reminder notice Other:

XIII. PARENT PARTICIPATION IN THE IEP PROCESS

The following documents were provided to parent(s):

· Parental Rights in Special Education

· Individualized Education Program (IEP)

· Eligibility Report(s)

· Evaluation

· Other:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

If parent did not attend the meeting, complete below:

On _____________the documents were: Mailed Given In Person  Sent via Student  Other______________

rev: June 2021

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Individualized Educ Prog (IEP) Section Y03 Summer 2025 CO - Present Levels of Academic Achievement and Functional Performance Assignment Instructions and Resources

1. PLAAFP Assignment Instructions

2. John Doe Case Study

3. PLAAFP Rubric

4. IEPSampleForm FINAL revised June 2021