Collaberative Learning

Order Description

This is a CLC assignment.

As a CLC, design a comprehensive IEP that evaluates appropriate individualized education goals in Math and English Language Arts supported by research-based instructional strategies and the issues surrounding a 13-year-old male student diagnosed with Duchenne muscular dystrophy. Use the IEP template provided.

Issues to include:
1.Educational goals and objectives
2.Information about the disease and its progression
3.How the disease affects progress in Math and English Language Arts
4.Accommodations needed for Math and English Language Arts
5.Accommodations needed for physical and gross motor activities
6.Other educational needs, including assistive equipment, software, assessments
7.Applicable skills that should be taught
8.Other specific support this student may need

APA format is not required, but solid academic writing is expected.
Special Education Department
¬¬¬¬¬¬¬¬¬¬¬¬¬Individualized Education Program (IEP)
Student Name: Student Data/Cover Sheet (Form A-1) IEP Meeting Date:
Student ID: DOB:

Demographic Information

Student Number:
Student Name: Birthdate: Gender: Grade:
Student Address:
Home Phone:
City, State, Zip:

Parent 1 Name:
Parent 1 Relationship:
Parent 1 Address:
Home Phone:
City, State, Zip:
Work Phone:
Parent 1 Email:

Parent 2 Name:
Parent 2 Relationship:
Parent 2 Address:
Home Phone:
City, State, Zip:
Work Phone:
Parent 2 Email:

Primary Language of Home:
Primary Language Survey Date:
Primary Language Survey Results: Language of Instruction:
Home District:
Attendance District: Service Coordinator:
Home School: Attending School:
Vision Screened On: Results: Hearing Screened On: Results:
Meeting Date: Anticipated Duration of IEP:
To Re-evaluation Due:
Current Evaluation:
Special Education Primary Category #1:
Special Education Eligibility Category #2:
Special Education Eligibility Category #3:
For Students with SLD only, the following area(s) of eligibility was/were previously determined:

Level of Services: (A)
Type: of Meeting:

Date Meeting Notice Sent to the Parent(s): Date Procedural Safeguards given to the Parent(s):

Special Education Department
¬¬¬¬¬¬¬¬¬¬¬¬¬Individualized Education Program (IEP)
Student Name: Student Data/Cover Sheet (Form A-2) IEP Meeting Date:
Student ID: DOB:

The following persons participated in the conference and/or the development of the IEP. Additionally, parents have been given a copy of their rights regarding the student’s placement in special education and understand that they have the right to request a review of their child’s IEP at any time.

Position/Relation to Student Participant Date (MM/DD/YY)

*If during the IEP year the student turns 16, if the student is not present at the IEP meeting, the service coordinator must review the IEP with the student and obtain the student’s signature and the date of this review.

Special Education Department
¬¬¬¬¬¬¬¬¬¬¬¬¬Individualized Education Program (IEP)
Student Name: Student Data/Cover Sheet (Form B) IEP Meeting Date:
Student ID: DOB:
PRESENT LEVELOF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Section 1: Current IEP Information

Goal Number Written:

Summarize special education services the student is receiving:

Section 2: Evaluation Information
Areas of Eligibility:

Special Education Primary Category:
Special Education Eligibility Category #2:
Special Education Eligibility Category #3:
For students with SLD only, the following area(s) of eligibility was previously determined:

Section 3: Present Level of Academic Achievement
READING
WRITING
MATH

Student Name: Present Level of Academic Achievement and IEP Meeting Date:
Student ID: Functional Performance (Form B) DOB:
Parent’s Input on Student’s Current Academic Achievement:

Current Classroom-Based Data:

State and District Assessments:

Section 4: Functional Performance
Social Emotional and Behavior:
Student Name: Present Level of Academic Achievement and IEP Meeting Date:
Student ID: Functional Performance (Form B) DOB:
Parent’s Input and Student’s Current Functional Achievement:

Summary of Work Habits:
Section 5: Summary of Educational Needs

Special Education Department
Individualized Education Program (IEP)
Student Name: Considerations Form (Form C) IEP Meeting Date:
Student ID: DOB:

ADDITIONAL DOCUMENTATION/CONSIDERATION OF SPECIAL FACTORS

Considered NotIncluded
Needed

Individual Transition Plan

Statement of Transfer of Parental Rights at Age of Majority

For a student whose behavior impedes his/her learning, or that of
others, positive behavior interventions, strategies, and supports have
been considered.

Statement of Language Needs in the Case of a Child with Limited English
Proficiency

Statement of Provisions of Instruction in Braille & User of Braille for a
Visually Impaired Child

Statement of the Language of Needs, Opportunities for Direct Communication
with Peers in the Child’s Language and Communication Mode

Statement of Required Assistive Technology Devices and Services

Statement of Communication Needs for a Child with a Disability

Statement of Health Concerns

Special Education Department
Individualized Education Program (IEP)

Student Name: Student Goals and Performance Objectives IEP Meeting Date:
Student ID: Progress Report DOB:

Skill Area:
Standard:

Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:
Standard:

Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:

Student Name: Student Goals and Performance Objectives IEP Meeting Date:
Student ID: Progress Report DOB:

Skill Area:
Standard:

Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:

Student Name: Student Goals and Performance Objectives IEP Meeting Date:
Student ID: Progress Report DOB:

Skill Area:
Standard:

Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:
Standard:

Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:

Student Name: Student Goals and Performance Objectives IEP Meeting Date:
Student ID: Progress Report DOB:

Special Education Department
Individualized Education Program (IEP)
Student Name: Accommodations (Form E) IEP Meeting Date:
Student ID: DOB:
ACCOMODATIONS
Date given to Genera Ed. Teacher: Service Coordinator:
Accommodations

Accommodations Type Location

Legend for Type and Location Fields
Type:
1 = Class work / assignments 2 = Assessments / tests 3 = Both class work / assignments / assessments.
Location:
A = All Subjects B = Language Arts / English C = Reading D = Spelling E = Math
F = Science G = Social Studies H = Health I = Electives J = Physical Ed.
K = Lunch L = Transition / Vocation M = Library N = Title 1 Special / Exploratory
Parental Communication

IEP Team Consideration for Extended School Year
Consideration for eligibility:

Eligible for ESY:
Written explanation as to why ESY is or is not needed:

Special Education Department
Individualized Education Program (IEP)
Student Name: Accommodations (Form F) IEP Meeting Date:
Student ID: DOB:

ASSESSMENT

Rationale:
¬¬¬¬
State Assessments

Standard Accommodation(s):

¬¬¬District Assessments

Standard Accommodation(s):

CURRENT STATE STANDARDIZED TEST (i.e. AIMS, PSSA) RESULTS

Testing Area Test Results Grade Semester Year
Reading
Writing
Math
Science

Special Education Department
Individualized Education Program (IEP)
Student Name: Services and Environment (Form I) IEP Meeting Date:
Student ID: DOB:

SPECIAL EDUCATION SERVICES TO BE PROVIDED
Special Education Program(s) Necessary to Meet Special Education Goals and Objectives during the school calendar year.
**The child is in need of specially designed instruction in the following areas:
Special Education Services Instructional Setting / Location Start Date Frequency Provider Duration / End Date

RELATED SERVICES
Educationally Relevant Related Services Are Listed Below
Special Education Services Instructional Setting / Location Start Date Frequency Provider Duration / End Date

Clarification:
SUPPLEMENTARY AIDS / ASSISTIVE TECHNOLOGY AND SERVICE FOR STUDENTS
Educationally Relevant Supplementary Aides / Assistive Technology and Services Are Listed Below.

SUPPORTS FOR SCHOOL PERSONNEL
Supports For School Personnel Are Listed Below

Clarification:

LEAST RESTRICTIVE ENVIRONMENT

Provide an explanation of the extent, if any, to which the student will NOT participate with non-disabled students in the general curricular, extracurricular and nonacademic activities, and program options. §300.347(a)(4):

Consider any potential harmful effects of this placement for the child or on the quality of services that he or she needs §300.552 (a-b):

Reason for Different Services School:

Collaberative Learning

Order Description

This is a CLC assignment.

As a CLC, design a comprehensive IEP that evaluates appropriate individualized education goals in Math and English Language Arts supported by research-based instructional strategies and the issues surrounding a 13-year-old male student diagnosed with Duchenne muscular dystrophy. Use the IEP template provided.

Issues to include:
1.Educational goals and objectives
2.Information about the disease and its progression
3.How the disease affects progress in Math and English Language Arts
4.Accommodations needed for Math and English Language Arts
5.Accommodations needed for physical and gross motor activities
6.Other educational needs, including assistive equipment, software, assessments
7.Applicable skills that should be taught
8.Other specific support this student may need

APA format is not required, but solid academic writing is expected.
Special Education Department
¬¬¬¬¬¬¬¬¬¬¬¬¬Individualized Education Program (IEP)
Student Name: Student Data/Cover Sheet (Form A-1) IEP Meeting Date:
Student ID: DOB:

Demographic Information

Student Number:
Student Name: Birthdate: Gender: Grade:
Student Address:
Home Phone:
City, State, Zip:

Parent 1 Name:
Parent 1 Relationship:
Parent 1 Address:
Home Phone:
City, State, Zip:
Work Phone:
Parent 1 Email:

Parent 2 Name:
Parent 2 Relationship:
Parent 2 Address:
Home Phone:
City, State, Zip:
Work Phone:
Parent 2 Email:

Primary Language of Home:
Primary Language Survey Date:
Primary Language Survey Results: Language of Instruction:
Home District:
Attendance District: Service Coordinator:
Home School: Attending School:
Vision Screened On: Results: Hearing Screened On: Results:
Meeting Date: Anticipated Duration of IEP:
To Re-evaluation Due:
Current Evaluation:
Special Education Primary Category #1:
Special Education Eligibility Category #2:
Special Education Eligibility Category #3:
For Students with SLD only, the following area(s) of eligibility was/were previously determined:

Level of Services: (A)
Type: of Meeting:

Date Meeting Notice Sent to the Parent(s): Date Procedural Safeguards given to the Parent(s):

Special Education Department
¬¬¬¬¬¬¬¬¬¬¬¬¬Individualized Education Program (IEP)
Student Name: Student Data/Cover Sheet (Form A-2) IEP Meeting Date:
Student ID: DOB:

The following persons participated in the conference and/or the development of the IEP. Additionally, parents have been given a copy of their rights regarding the student’s placement in special education and understand that they have the right to request a review of their child’s IEP at any time.

Position/Relation to Student Participant Date (MM/DD/YY)

*If during the IEP year the student turns 16, if the student is not present at the IEP meeting, the service coordinator must review the IEP with the student and obtain the student’s signature and the date of this review.

Special Education Department
¬¬¬¬¬¬¬¬¬¬¬¬¬Individualized Education Program (IEP)
Student Name: Student Data/Cover Sheet (Form B) IEP Meeting Date:
Student ID: DOB:
PRESENT LEVELOF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Section 1: Current IEP Information

Goal Number Written:

Summarize special education services the student is receiving:

Section 2: Evaluation Information
Areas of Eligibility:

Special Education Primary Category:
Special Education Eligibility Category #2:
Special Education Eligibility Category #3:
For students with SLD only, the following area(s) of eligibility was previously determined:

Section 3: Present Level of Academic Achievement
READING
WRITING
MATH

Student Name: Present Level of Academic Achievement and IEP Meeting Date:
Student ID: Functional Performance (Form B) DOB:
Parent’s Input on Student’s Current Academic Achievement:

Current Classroom-Based Data:

State and District Assessments:

Section 4: Functional Performance
Social Emotional and Behavior:
Student Name: Present Level of Academic Achievement and IEP Meeting Date:
Student ID: Functional Performance (Form B) DOB:
Parent’s Input and Student’s Current Functional Achievement:

Summary of Work Habits:
Section 5: Summary of Educational Needs

Special Education Department
Individualized Education Program (IEP)
Student Name: Considerations Form (Form C) IEP Meeting Date:
Student ID: DOB:

ADDITIONAL DOCUMENTATION/CONSIDERATION OF SPECIAL FACTORS

Considered NotIncluded
Needed

Individual Transition Plan

Statement of Transfer of Parental Rights at Age of Majority

For a student whose behavior impedes his/her learning, or that of
others, positive behavior interventions, strategies, and supports have
been considered.

Statement of Language Needs in the Case of a Child with Limited English
Proficiency

Statement of Provisions of Instruction in Braille & User of Braille for a
Visually Impaired Child

Statement of the Language of Needs, Opportunities for Direct Communication
with Peers in the Child’s Language and Communication Mode

Statement of Required Assistive Technology Devices and Services

Statement of Communication Needs for a Child with a Disability

Statement of Health Concerns

Special Education Department
Individualized Education Program (IEP)

Student Name: Student Goals and Performance Objectives IEP Meeting Date:
Student ID: Progress Report DOB:

Skill Area:
Standard:

Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:
Standard:

Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:

Student Name: Student Goals and Performance Objectives IEP Meeting Date:
Student ID: Progress Report DOB:

Skill Area:
Standard:

Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:

Student Name: Student Goals and Performance Objectives IEP Meeting Date:
Student ID: Progress Report DOB:

Skill Area:
Standard:

Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:
Standard:

Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:

Student Name: Student Goals and Performance Objectives IEP Meeting Date:
Student ID: Progress Report DOB:

Special Education Department
Individualized Education Program (IEP)
Student Name: Accommodations (Form E) IEP Meeting Date:
Student ID: DOB:
ACCOMODATIONS
Date given to Genera Ed. Teacher: Service Coordinator:
Accommodations

Accommodations Type Location

Legend for Type and Location Fields
Type:
1 = Class work / assignments 2 = Assessments / tests 3 = Both class work / assignments / assessments.
Location:
A = All Subjects B = Language Arts / English C = Reading D = Spelling E = Math
F = Science G = Social Studies H = Health I = Electives J = Physical Ed.
K = Lunch L = Transition / Vocation M = Library N = Title 1 Special / Exploratory
Parental Communication

IEP Team Consideration for Extended School Year
Consideration for eligibility:

Eligible for ESY:
Written explanation as to why ESY is or is not needed:

Special Education Department
Individualized Education Program (IEP)
Student Name: Accommodations (Form F) IEP Meeting Date:
Student ID: DOB:

ASSESSMENT

Rationale:
¬¬¬¬
State Assessments

Standard Accommodation(s):

¬¬¬District Assessments

Standard Accommodation(s):

CURRENT STATE STANDARDIZED TEST (i.e. AIMS, PSSA) RESULTS

Testing Area Test Results Grade Semester Year
Reading
Writing
Math
Science

Special Education Department
Individualized Education Program (IEP)
Student Name: Services and Environment (Form I) IEP Meeting Date:
Student ID: DOB:

SPECIAL EDUCATION SERVICES TO BE PROVIDED
Special Education Program(s) Necessary to Meet Special Education Goals and Objectives during the school calendar year.
**The child is in need of specially designed instruction in the following areas:
Special Education Services Instructional Setting / Location Start Date Frequency Provider Duration / End Date

RELATED SERVICES
Educationally Relevant Related Services Are Listed Below
Special Education Services Instructional Setting / Location Start Date Frequency Provider Duration / End Date

Clarification:
SUPPLEMENTARY AIDS / ASSISTIVE TECHNOLOGY AND SERVICE FOR STUDENTS
Educationally Relevant Supplementary Aides / Assistive Technology and Services Are Listed Below.

SUPPORTS FOR SCHOOL PERSONNEL
Supports For School Personnel Are Listed Below

Clarification:

LEAST RESTRICTIVE ENVIRONMENT

Provide an explanation of the extent, if any, to which the student will NOT participate with non-disabled students in the general curricular, extracurricular and nonacademic activities, and program options. §300.347(a)(4):

Consider any potential harmful effects of this placement for the child or on the quality of services that he or she needs §300.552 (a-b):

Reason for Different Services School: