IEP

STUDENT NAME:______G.D.
______________________________DATE OF MEETING:______10/26/12____________
INDIVIDUALIZED EDUCATION PROGRAM (CONFERENCE SUMMARY REPORT)

DATE OF MOST RECENT EVALUATION: 1/13/11 DATE OF NEXT REEVALUATION: 1/13/14
PURPOSE OF CONFERENCE (Check all that apply)
Review of Existing Data Initial Eligibility Reevaluation Initial IEP IEP Review/Revision Transition Manifestation Determination Graduation STUDENTS DATE OF BIRTH 6/6/1993 CURRENT GRADE LEVEL G0 DISABILITY(S) Intellectual Disability SERVING DISTRICT CCUSD4 SERVING SCHOOL YAP (Centennial) Termination of Placement Other (e.g. FBA/BIP)________ SIS ID NUMBER 123456789 ANTICIPATED DATE OF HS GRADUATION 6/2012 MEDICAID NUMBER 987654321
STUDENT IDENTIFICATION INFORMATION

STUDENTS ADDRESS (Street, City, State, Zip Code) 604 E Armory Ave Champaign, IL 61820 MALE ETHNICITY LANGUAGE/MODE OF COMMUNICATION 16- white USED BY STUDENT 000-English, Verbal X FEMALE PLACEMENT(To be completed after placement determination) 100% of day outside of regular class YES X NO Placement is in Resident School RESIDENT DISTRICT CCUSD4 RESIDENT SCHOOL Young Adult Program (1) PARENTS NAME Parent Educational Surrogate
PARENT/GUARDIAN INFORMATION
(2) PARENTS NAME Educational Surrogate Parent
D, J and M
(1) PARENTS ADDRESS (Street, City, State, Zip Code) 604 E Armory Ave, Champaign, IL, 61820 (1) PARENTS TELEPHONE NUMBER (include Area Code) (217) 867-5309 (1) LANGUAGE/MODE OF COMMUNICATION USED BY PARENT(S) English Yes No Interpreter (2) PARENTS ADDRESS (Street, City, State, Zip Code)
(2) PARENTS TELEPHONE NUMBER (Include Area Code) (2) LANGUAGE/MODE OF COMMUNICATION USED BY PARENT(S) Yes No Interpreter
PARTICIPANTS
Signature indicates attendance. Check appropriate boxes to indicate which meetings were attended. Anyone serving in a dual role should indicate so on the following lines. If a required participant participates through written input or is excused from all or part of the IEP meeting, the required excusal and written report, as necessary, is attached.
ELIG. REVIEW
IEP
ELIG. REVIEW
IEP
x x x x x x
JD Parent MD Parent GD Student AS LEA Representative S G/R H General Education Teacher MS Special Education Teacher School Psychologist
x x
BH School Social Worker SP Speech-Language Pathologist Bilingual Specialist Interpreter Other (specify) Other (specify) Other (specify)
If the parent(s) did not attend the IEP meeting, document the attempts to contact the parent(s) prior to the IEP meeting.
PROCEDURAL SAFEGUARDS
Explanation of Procedural Safeguards were provided to/reviewed with the parent(s) on ______________3/19/12_______________________ Transfer of Rights - Seventeen-year old student informed of his/her rights that will transfer to the student upon reaching age 18. Parent(s) were given a copy of the: Evaluation report and eligibility determination Yes x NA
x IEP
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________

X Districts behavioral intervention policies Districts behavioral intervention procedures (initial IEP only)
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ DOCUMENTATION OF EVALUATION RESULTS

Complete for initial evaluations, reevaluations, or a review of an independent or outside evaluation. Considering all available evaluation data, record the teams analyses of the students functioning levels. Only those areas which were identified as relevant to the current evaluation must be completed. All other areas should be noted as Not Applicable. Evaluation data may include: parental input, teacher recommendations, physical condition, social or cultural background, adaptive behavior, record reviews, interviews, observations, testing etc. Describe the observed strengths and/or deficits in the students functioning in the following domains. Academic Achievement (Current or past academic achievement data pertinent to current educational performance)
At the domain review IEP, it was determined that academic testing was not required. G was evaluated in 2008 using the Woodcock Johnson III Tests of Achievement. Standard Scores were as follows: (100=average): Letter-Word Identification: 88, Passage Comprehension: 64, Math Calculation: 19, Applied Problems: 47, Spelling: 90. Writing Samples: 68. G showed marked strengths on rote activities involving reading, decoding, and spelling. (Submitted by school psychologist) Functional Performance (Current or past functional performance data pertinent to current functional performance)
Gs functional curriculum includes grocery shopping, working at Subway stocking chips, bussing, and cooking, and she is informally assessed regularly. (Submitted by school psychologist) (At the domain review IEP, it was determined that additional testing was not required).
Cognitive Functioning (Data and other information regarding intellectual ability; how the student takes in information, understands information, and
expresses information)
(Submitted by school psychologist)
(At the domain review IEP, it was determined that additional testing was not required). Most recent testing was in 2008
Communicative Status (Information regarding communicative abilities (language, articulation, voice, fluency) affecting educational performance) (Submitted by speech pathologist) For ELL students explain ELL STATUS: Has Linguistic status Changed YES XNO
N/A
Health (Current or past medical difficulties affecting educational performance)
(submitted by social worker) At the review IEP, it was determined that updating the health history was not needed, but informal update was conducted with J D. The 2008 SDS reported that G was adopted as an infant, and her birth mother might have been developmentally delayed. G was diagnosed with Williams Syndrome in February of 1999 and ADD with Oppositional features in spring of 1999. Gillians current health is described as good. Currently, she takes 72mg of Concerta for ADD and 20mg Prozac to address behavior concerns.
Hearing/Vision (Auditory/visual problems that would interfere with testing or educational performance. Include dates and results of last hearing/vision
test)
G wears glasses and passed her 2009/10 hearing test.
Motor Abilities (Fine and gross motor coordination difficulties, functional mobility, or strength and endurance issues affecting educational performance)
(submitted by OT) At the domain review IEP, it was determined that additional testing was not required. Gillian is independent with self care tasks at school, although she sometimes has the tendency to put too much food in her mouth and to eat too fast. She needs reminders to wipe her face after eating. She displays adequate fine/visual motor ability to perform tasks such as managing fasteners on clothing and writing legibly. She displays no gross motor deficits and does not appear sensitive to noise or touch. However, some sensory strategies have been used in the past as calming techniques when she is anxious or upset. She sometimes picks her fingers until they bleed. She continues to qualify for services to address and assist with self care independence, fine motor tasks and to assist team with calming.

Social/Emotional Status/Social Functioning (Information regarding how the environment affects educational performance (life history, adaptive
behavior, independent functioning, personal and social responsibility, cultural background)
(submitted by social worker) At domain meeting it was determined that an update was not needed, but an informal update was conducted with J D. G resides with her mother and father as she has four siblings. As for the self care adaptive behavior, G is able to shampoo herself, requires help shaving and managing her monthly cycle. She needs reminders to groom herself. After completing school, her parents would like G to have paid employment and live in a group home setting.
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ ELIGIBILITY DETERMINATION (ALL DISABILITIES OTHER THAN SPECIFIC LEARNING DISABILITY)
DETERMINANT FACTORS The determinant factor for the students suspected disability is: Yes Yes Yes X X X No No No Lack of appropriate instruction in reading, including the essential components of reading instruction (Evidence Provided)_______________________________________________________________________ Lack of appropriate instruction in math (Evidence Provided)________________________________________ Limited English Proficiency (Evidence Provided):________________________________________________
If any of the above answers is yes, the student is not eligible for services under IDEA and the team must complete Step 1 and 4 below. If all of the answers are no, complete Steps 1-4. COMPLETE FOR STUDENTS SUSPECTED OF HAVING A DISABILITY UNDER IDEA. STEP 1 - DISABILITY No Disability Identified (Complete Step 4 and write Not Eligible for Special Education Services in the Disability section of the Conference Summary Report page.) X Disability Identified Based on the teams analysis, identify the disability(s): Cognitive Disability Primary Secondary Primary Secondary
Autism (O) X Cognitive Disability (A) Deaf/Blindness (H) Deafness (G) Developmental Delay (3-9) (N) Emotional Disability (K) Hearing Impairment (F)
STEP 2 - ADVERSE EFFECTS
Multiple Disabilities (M) Orthopedic Impairment (C) Other Health Impairment (L) Speech or Language Impairment (I) Traumatic Brain Injury (P) Visual Impairment including Blindness (E)
No Adverse Effect Identified (Complete Step 4 and write Not Eligible for Special Education Services in the Disability section of the Conference Summary Report page.) X Adverse Effect Identified For each disability identified, describe how the disability adversely affects the students educational performance Overall cognitive ability adversely affects the rate of acquisition of new skills. STEP 3 - EDUCATIONAL NEEDS State to what extent the student requires special education and related services to address educational needs. Reading, Math, Language Arts, Following Directions, Daily Living/Functional Skills, Social Skills are all affected by Gs rate of learning and all influence her overall success and independence. STEP 4 - ELIGIBILITY Based on the steps above, the student is entitled to special education and related services. No (Not Eligible) X Yes (Eligible)
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE Complete for initial IEPs and annual reviews. When completing this page, include all areas from the following list that are impacted by the students disability: academic performance, social/emotional status, independent functioning, vocational, motor skills, and speech and language/communication. This may include strengths/weaknesses identified in the most recent evaluation. Students Strengths G is a fast learner with no behavior problems. She is very social and will self-advocate when the need arises. She is always willing to help and motivated to learn. G also engages in several group Recreation and Leisure activities independently and is very social. G is very good at ordering food and finding groceries in the community, and she is good about asking for assistance in the community if she needs it. She can complete most steps to riding the bus independently. G can completely all the steps to shower, brush her teeth, brush her hair, and take her medicine independently. She can follow a recipe with very little prompting (including using the stove, oven, and microwave). Parental Educational Concerns/Input Gs would also like G to be able to (maybe with the aid of some sort of written guide) heat food in the microwave for a reasonable length of time. She would also like to see G get herself up, ready, and to the bus in the morning without prompts. Gs mother also wants her to make more health and price conscious choices when buying food in the community. Students Present Level of Academic Achievement According to data taken from Gs cooking time, G can follow a written recipe with very little prompting. She is also capable of planning her bus route online with some prompts. However, according to interviews and informal assessments, G cannot yet plan her bus route independently, and she also needs prompting to pay for items. This demonstrates a need for continued instruction in the dollar up (or next dollar) strategy, and instruction in planning her bus route more independently. Students Present Levels of Functional Performance Based on an interview with her mother and on observations conducted at school, G engages in several group Recreation and Leisure activities independently. However, the yellow book assessment and interview with Gs mother indicate that G currently does not engage in many appropriate independent leisure activities, and thus a lack of balance in recreation and leisure activities. This indicates a need for skills in independent leisure skills, such as watching a movie alone, which G could gain through basic instruction. Informal teacher interviews and informal assessments reveal that G is very good at ordering food and finding groceries in the community, and she is good about asking for assistance in the community if she needs it. However, her mother indicated that G currently does not have the skills to make health and price conscious choices when purchasing food. This indicates a need for skills in the dollar up strategy and in making healthy and economical decisions, which can be established through classroom and community instruction. According to data taken from Gs cooking time, G can follow a recipe with very little prompting, including using the stove, oven, and microwave. According to an interview with Gs mother and informal assessments, G does not have a sense of how long something should be cooked in the microwave if it is not indicated on a recipe. This demonstrates a need for estimation skills related to cooking time, which can be accomplished through the instruction of a cognitive strategy and the use of a cooking guide. Based in the interview with her mother, although G can prepare several food items, she cannot plan and prepare a full meal. This indicates a need for meal planning skills, which G can gain through instruction on meal planning. According to her mother, G can complete all the steps to showering, brushing her teeth, brushing her hair, and taking her medicine independently. However, her mother indicted G does not apply the self-care skills she has when getting ready in the morning, and she requires prompting to know when to complete hygiene tasks. This indicates a need for the skills to make that distinction, which can come through generalization instruction.
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ G can complete most steps to riding the bus independently, but based on informal assessments and teach interviews, G needs prompting to pull the cord, make adjustments to her bus plan, and make it to the bus stop on time. She also does not have the skills for independently planning her bus route. This demonstrates a need for planning skills and for more independence in the skill, which can be conveyed through continued instruction in bussing and in instruction on planning skills.
Because G is past high school age, her curriculum focus is on the functional skills necessary for inclusion in the community. While the general education curriculum is no longer applicable to G, her current curriculum is preparing her for integration into the community. The nature of Gs skill deficits is such that she still requires functional skills in the ways of becoming more independent at performing cooking and hygiene skills, making healthy and price conscious choices, planning routes and bussing, and planning and participating in recreation activities. These skills would all grant her greater access to the community.
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ SECONDARY TRANSITION

Complete for students age 14 and older, and when appropriate for students younger than age 14. Post-school outcomes should guide the development of the IEP for students age 14 and older.
Transition Assessments
EMPLOYMENT None needed EDUCATION x None needed TRAINING None needed INDEPENDENT LIVING SKILLS None needed
AGE-APPROPRIATE TRANSITION ASSESSMENTS

Assessment Type Responsible Agency/Person
(Including student and family survey/interview) Transition assessment Student Survey Transition Assessment Student Survey Transition assessment Student Survey
Date Conducted
Report Attached
No No
Goal #
Case manager
11/2011
Case manager Case manager
11/2011 11/2011
No No 1-8
POST-SECONDARY OUTCOMES (address by age 14 )

Indicate and project the desired appropriate measurable post-secondary outcomes/goals as identified by the student, parent and IEP team. Goals are based upon age appropriate transition assessments related to employment, education and/or training, and where appropriate, independent living skills.
Employment (e.g., competitive, supported shelter, non-paid employment as a volunteer or training capacity, military): AND G will receive on the job training to maintain full time competitive employment.
Post-Secondary Education (e.g., community college, 4-year university, technical/vocational/trade school): AND/OR N/A Post-Secondary Training (e.g., vocational or career field, vocational training program, independent living skills training, apprenticeship, OJT, job corps): AND G will receive on the job training to maintain full time competitive employment. IF APPLICABLE, Independent Living (e.g., independent living, health/safety, self-advocacy/future planning, transportation/mobility, social relationships, recreation/leisure, financial/income needs): After graduation G will live at home with family until independent living with assistance from adult service agencies. G will participate in community activities with minimal assistance from families or adult service agencies.
COURSE OF STUDY (address by age 14)

Identify a course of study that is a long-range educational plan or multi-year description of the educational program that directly relates to the student's anticipated post-school goals, preferences and interests as described above. Year 1 Age 14/15 Year 2 Age 15/16 Year 3 Age 16/17 Year 4 Age 17/18 Extended Age 18-21
Domestics Training Community Training Rec/Leisure Training Vocational Training
Page 1 of 2
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ TRANSITION SERVICES (address by age 141/2)

Please include, if appropriate, needed linkages for outside agencies, (e.g., DMH, DRS, DSCC, PAS, SASS, SSI, WIC, DHCFS, etc.)
INSTRUCTION (e.g., tutoring, skills training, prep for college entrance exam, accommodations, adult basic ed.) Rec Leisure Training Domestic Training Community Training Vocational Training RELATED SERVICES (e.g., transportation, social services, medical services, technology, support services) Speech Social Work Provider Agency and Position Team Goal #(s) if appropriate 1-8 Date/Year to be Addressed 2012-2013 Date/Year Completed 2013 Provider Agency and Position Team Goal #(s) if appropriate 1-8 Date/Year to be Addressed 2012-2013 Date/Year Completed 2013 Provider Agency and Position Team Goal #(s) if appropriate 1-8 Date/Year to be Addressed 2012-2013 Date/Year Completed 2013 Provider Agency and Position Team Goal #(s) if appropriate 1-8 Date/Year to be Addressed 2012-2013 Date/Year Completed 2013 Provider Agency and Position Team Goal #(s) if appropriate 1-8 Date/Year to be Addressed 2012-2013 Date/Year Completed 2013 Provider Agency and Position Team Goal #(s) if appropriate 1-8 Date/Year to be Addressed 2012-2013 Date/Year Completed 2013
COMMUNITY EXPERIENCES (e.g., job shadow, work experiences, banking, shopping, transportation, tours of post-secondary settings) Community Training Vocational Experience
(If none, indicate none) DEVELOPMENT OF EMPLOYMENT AND OTHER POST-SCHOOL ADULT LIVING OBJECTIVES (e.g., career planning, guidance counseling, job try-outs, register to vote, adult benefits planning) Transition assessment Student and parent survey Student power point presentation (If none, indicate none). APPROPRIATE ACQUISITION OF DAILY LIVING SKILLS AND/OR FUNCTIONAL VOCATIONAL EVALUATION (e.g., self-care, home repair, home health, money, independent living, / job and career interests, aptitudes and skills) Housing, money management/budgeting, self-care, safety, community training, vocational skills, social relationsihps
LINKAGES TO AFTER GRADUATION SUPPORTS/SERVICES (e.g. DRS, DMH, DSCC, PAS, SASS, SSI, WIC, DHCFS, CILs) DSC/CUSR Community Choices Regional Planning (registered for PUNS)
HOME-BASED SUPPORT SERVICES PROGRAM

The student has a developmental disability and may become eligible for the program after reaching age 18 and when no longer receiving special education services. If yes, complete the following statements: Plans for determining the students eligibility for home-based services: Establish connection with home-based agencies for internal assessment. Plans for enrolling the student in the program of home-based services:
Maintain contact with home based agency case managers.
Plans for developing a plan for the students most effective use of home-based services after reaching age 18 and when no longer receiving special education services:
Maintain contact with home based agency case managers.
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ GOALS AND OBJECTIVES/BENCHMARKS (1)

Complete for initial IEPs and annual reviews. (Anyone responsible for implementing the IEP (e.g., goals and objectives/benchmarks, accommodations, modifications and supports) must be notified of her/his specific responsibilities.)
REPORTING ON GOALS
The progress on annual goals will be measured by the short-term objectives/benchmarks. Check the methods that will be used to notify parents of the students progress on annual goals and if the progress is sufficient to achieve the goals by the end of the IEP year: Report cards
X Progress reports
Parent conference
Other (specify) __________________________
CURRENT ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Results of the initial or most recent evaluation and results on district-wide assessments relevant to this goal; performance in comparison to general education peers and standards. When paying in the community, G requires verbal prompting to pay for items using the dollar up strategy.
GOALS AND OBJECTIVES/BENCHMARKS

The goals and short-term objectives or benchmarks shall meet the students educational needs that result from the students disability, including involvement in and progress in the general curriculum, or for preschool students, participation in appropriate activities. Goal Statement # 1 of 8
When paying for items $20 or less in the community, G will use the dollar up strategy independently on 4 consecutive occasions. Indicate Goal Area: Academic X Functional X Transition Illinois Learning Standard: # 6.C.5
Title(s) of Goal Implementer(s) Special Education Teacher
Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal
When paying for items $5 or less in the community, G will use the dollar up strategy independently on 4 consecutive occasions.
Evaluation Criteria Evaluation Procedures Schedule for Determining Progress Dates Reviewed/ Extent of Progress (Optional)
% Accuracy # of attempts Other (specify) Ones only up to $5 4/4
Observation Log Data Charts Tests Other (specify)
Daily Weekly Quarterly Semester Other (specify)
10/16/12
% Accuracy # of attempts Other (specify) Mixed Bills up to $10 4/4
12/18/12
% Accuracy # of attempts Other (specify) Mixed bills up to $20 5/5
3/16/13

REPORTING ON GOALS
X Progress reports
Parent conference
Other (specify) __________________________

Results of the initial or most recent evaluation and results on district-wide assessments relevant to this goal; performance in comparison to general education peers and standards. When in the community, G does not consider health or price when she buys food at restaurants or grocery stores.

When out in the community, G will select a healthy meal (or the ingredients for a healthy meal), scoring 8/10 on the rubric for 3 consecutive trials. Indicate Goal Area: Academic X Functional X Transition Illinois Learning Standard: # 3B.4a. Title(s) of Goal Implementer(s) Special Education Teacher
When out in the community, G will select the type of item at the lowest price independently on 3 consecutive trials.
3/3
% Accuracy # of attempts Other (specify)
11/16/12
When out in the community, G will select a healthy meal (or the ingredients for a healthy meal), scoring 4/5 on the health rubric for 3 consecutive trials.
3/3
3/1613

REPORTING ON GOALS
X Progress reports
Parent conference
Other (specify) __________________________

Results of the initial or most recent evaluation and results on district-wide assessments relevant to this goal; performance in comparison to general education peers and standards. G can perform group recreational skills, but she does not have a lot of skills (outside of a puzzle) that she can do on her own. She cannot perform this skill.

During down time while alone, G will watch a DVD, completing all 10 steps of the task analysis correctly for 3 consecutive trials Indicate Goal Area:
Academic
X Functional
Transition
Illinois Learning Standard: #26.A.5
Title(s) of Goal Implementer(s) Special Education Teacher Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal
During down time while alone, G will watch a DVD, completing 5/10 steps of the task analysis correctly for 3 consecutive trials
5/10
% Accuracy # of steps Other (specify)
11/16
During down time while alone, G will watch a DVD, completing all 8/10 steps of the task analysis correctly for 3 consecutive trials
8/10
3/16

REPORTING ON GOALS
X Progress reports
Parent conference
Other (specify) __________________________

Results of the initial or most recent evaluation and results on district-wide assessments relevant to this goal; performance in comparison to general education peers and standards. While G can use a microwave, she needs verbal prompting for how long to heat something where verbal directions are not available.

When reheating food, G will use a microwave estimation guide to microwave food without recipe directions for 3/3 trials. Indicate Goal Area:
Academic
X Functional
Transition
Illinois Learning Standard: # 1.B.5a
Title(s) of Goal Implementer(s) Special Education Teacher
When reheating food, G will use a microwave estimation guide to microwave popcorn, water and microwave baking without recipe directions for 3/3 trials.
1/1
11/16
When reheating food, G will use a microwave estimation guide to microwave leftovers without recipe directions for 3/3 trials.
1 /1
3/16

REPORTING ON GOALS
X Progress reports
Parent conference
Other (specify) __________________________

Results of the initial or most recent evaluation and results on district-wide assessments relevant to this goal; performance in comparison to general education peers and standards. G can complete all hygiene activities independently, but she needs prompting to be reminded to do them.

Before school, G will get herself up, get dressed, brush her teeth, brush her hair, take her medication, and get on the bus without prompting for all days for a week. Indicate Goal Area:
Academic
X Functional
Transition
Illinois Learning Standard: # 1B.5a.
Before school, G will get dressed, brush her teeth, and brush her hair without prompting for all days for a week.
5/5
11/16
Before school, G will get dressed, brush her teeth, brush her hair, and take her medicine without prompting for all days for a week.
5/5
3/16

REPORTING ON GOALS
X Progress reports
Parent conference
Other (specify) __________________________

Results of the initial or most recent evaluation and results on district-wide assessments relevant to this goal; performance in comparison to general education peers and standards. G can make several dishes in the oven and stove, While she can plan to shop for dishes, she does not make healthy choices or plan entire meals.

G will plan and prepare 2 breakfasts, 2 lunches, and 2 dinners independently for 3 out of 3 occasions. Indicate Goal Area: Academic X Functional Transition Illinois Learning Standard: # 1.A.5a
Title(s) of Goal Implementer(s) Special Education Teachers Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal
G will plan and prepare 2 breakfasts independently.

Evaluation Criteria Evaluation Procedures
Schedule for Determining Progress
Dates Reviewed/ Extent of Progress (Optional)
1/1
10/16
G will plan and prepare 2 lunches independently.

1/1
12/16
G will plan and prepare 2 dinners independently.

1/1
3/16

REPORTING ON GOALS
X Progress reports
Parent conference
Other (specify) __________________________

Results of the initial or most recent evaluation and results on district-wide assessments relevant to this goal; performance in comparison to general education peers and standards. G can complete 12/15 steps independently.

When going to a location by bus, G will get on at the correct location and get off at the correct location independently on all occasions for 3 consecutive days Indicate Goal Area:
Academic
X Functional
Transition
Illinois Learning Standard: #1B.5a.
When going to a location by bus, G will get on at the correct location independently
2/2
11/16/12
When going to a location by bus, G will get off at the correct location independently
2 /2
3/16/12

REPORTING ON GOALS
x Progress reports
Parent conference
Other (specify) __________________________

Results of the initial or most recent evaluation and results on district-wide assessments relevant to this goal; performance in comparison to general education peers and standards. G needs several prompts when planning a bus route.

While preparing to go into the community (to work, a store, or a restaurant), G will use the computer to plan a bus route, completing 10/10 steps correctly for 3 consecutive trials. Indicate Goal Area:
Academic
X Functional
Transition
Illinois Learning Standard: # 1.B.5a
While preparing to go into the community (to work, a store, or a restaurant), G will use the computer to plan a bus route, completing 10/10 steps correctly for 3 consecutive trials.
11/16
While preparing to go into the community (to work, a store, or a restaurant), G will use the computer to plan a bus route, completing 10/10 steps correctly for 3 consecutive trials.
3/16
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ EDUCATIONAL ACCOMMODATIONS AND SUPPORTS

Complete for initial IEPs and annual reviews. (Anyone responsible for implementing the educational accommodations must be notified of her/his specific responsibilities). TRANSITION
X Yes X Yes
No
NA
Consideration of service needs, goals, and support/services is required (by age 14 , the team must address transition service needs). If yes, complete the Transition Services section of the IEP. Consideration of Home-Based Support Services Program for Mentally Disabled Adults for eighteen-year-old student is required. If yes, complete the Home-Based Support Services Program section of the IEP.
No
NA
CONSIDERATION OF SPECIAL FACTORS Check the boxes to indicate if the student requires any supplementary aids and/or services due to the following factors. For any box checked yes, specify the special factors in the Supplementary Aids, Accommodations and Modifications section listed below.
Yes
X No
No
X Yes
Yes Yes Yes
X No X No X No
No
X Yes
assistive technology devices and services communication needs deaf/hard of hearing languages and communication needs limited English proficiency language needs blind/visually impaired provision of Braille instruction behavior impedes students learning or that of others. If yes, the team must consider strategies, including positive behavioral interventions and supports to address behavior. This may include a Functional Behavioral Assessment and/or a Behavioral Intervention Plan. If, so attach any completed forms.
LINGUISTIC AND CULTURAL ACCOMMODATIONS

Yes
X No
Yes
The student requires accommodations for the IEP to meet her/his linguistic and cultural needs. If yes, specify any needed accommodations:
No
Special education and related services will be provided in a language or mode of communication other than or in addition to English. If yes, specify any needed accommodations:
SUPPLEMENTARY AIDS, ACCOMMODATIONS, AND MODIFICATIONS

Specify what aids, accommodations, and modifications are needed for the child to make progress toward annual goals, to progress in the general education curriculum, participate in extracurricular and other non-academic activities, and to be educated and participate with other children with disabilities and/or nondisabled children (e.g., accommodations for daily work, environmental accommodations, moving from class to class, etc.). Supplementary aids, accommodations, and modifications must be based upon peer-review research to the extent practicable.
Restating Directions and clarifying for understanding Color coded measuring cups and simplified recipes Frequent praise Small step directions
SUPPORTS FOR SCHOOL PERSONNEL

X Yes No Program trainings and/or supports for school personnel are needed for the student to advance appropriately toward attaining the annual goals, participate in the general curriculum, and be educated and participate with other students in educational activities. If yes, specify what trainings and/or supports are needed, including when appropriate, the information that clarifies when the trainings and/or supports will be provided, by whom, in what location, etc.
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ ASSESSMENT

CLASSROOM-BASED ASSESSMENTS
X Yes X Yes No No Student requires accommodations to participate in classroom-based assessments. Student requires alternate assessment/methods to participate in classroom-based assessments
DISTRICT-WIDE ASSESSMENTS
District does not administer district-wide assessments
District does not administer district-wide assessments at this grade level: ___G0__
Student will:
Participate in the entire district-wide assessment with no accommodations Participate in the entire district-wide assessment with accommodations Participate in part(s) of the district wide assessment (specify) Participate in the district-wide alternate assessment
STATE ACADEMIC ASSESSMENTS

The State academic assessments are the Illinois Standards Achievement Test (ISAT) at grades 3-8 and the Prairie State Achievement Exam (PSAE) at grade 11, Illinois Measure of Annual Growth in English (IMAGE) in grades 3-8 and 11 (for English Language Learner (ELL) students), and Illinois alternate Assessment (IAA) in grades 3-8 and 11.
X
Student will:
State academic assessments are not administered at this grade level ___G0____
Participate in the ISAT/PSAE/IMAGE with no accommodations Participate in the ISAT/PSAE/IMAGE with accommodations Participate in the IAA
If the student will participate in the IAA, the following were met:
The ISAT/PSAE/IMAGE is not appropriate (specify) The IAA participation guidelines were met The alternate assessment selected is appropriate for the student (explain)
STATE ASSESSMENT OF LANGUAGE PROFICIENCY

The State assessment of language proficiency is Assessing Comprehension and Communication in English State to State (ACCESS) in grades K-12
Yes X No ENGLISH LANGUAGE LEARNER (ELL). If NO, skip to next section
Student will:
participate in the ACCESS with no accommodations participate in the ACCESS with accommodations
ASSESSMENT ACCOMMODATIONS
If the student is participating in any of the above assessment(s) with accommodations, specify the needed accommodations (e.g., extended time, alternate setting, auditory testing) necessary to measure the students academic achievement and functional performance. The accommodations should be appropriate for that particular assessment and reflective of those already identified for the student in the Supplementary Aids, Accommodations, and Modifications section.
N/A
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ EDUCATIONAL SERVICES AND PLACEMENT

Initiation Date:______/_______/______ Duration Date: ______/_______/_______
PARTICIPATION IN GENERAL EDUCATION CLASSES The IEP must address all content areas, classes, and specify if the student will participate in general physical education. General Education with No Supplementary Aids
(Specify content areas, classes, whether or not the child will participate in general physical education, and extracurricular and other nonacademic activities.)
Minutes Per Week in Setting (Optional)
none
General Education with Supplementary Aids (as specified in the Supplementary Aids section)
(Specify content areas, classes, whether or not the child will participate in general physical education, and extracurricular and other nonacademic activities with supports, if applicable.)
Minutes Per Week in Setting (Optional)
none
Special Education and Related Services within the General Education Classroom
(Specify content areas and classes in which the child will participate with the provision of special education and related services. List each special education and related service that will be provided during each class. )
Minutes Per Week in Setting
none
PARTICIPATION IN SPECIAL EDUCATION CLASSES/SERVICES The IEP must address all special education and related services. Special Education Services Outside General Education Young Adult Program- Community Training, Rec/leisure training, Domestics, and Vocational Minutes Per Week in Setting 1890
Related Services Outside General Education 23-Speech/Language Services 28-Behavioral Intervention Plan 24-Social Work Services 25-Transportation (Special) 02-Aide
Minutes Per Week in Setting 30 30
Educational Environment (EE) Calculation (Ages 3-5) _________ 1. Minutes spent in regular early childhood program _________ 2. Minutes spent receiving special education and related services outside regular early childhood (A+B)
Educational Environment (EE) Calculation (Ages 6-21) __1950_ 1. Total Bell to Bell Minutes __1950_ 2. Total Number of Minutes Outside of the General Education Setting (A+B)

EDUCATIONAL SERVICES AND PLACEMENT EDUCATIONAL ENVIRONMENT CONSIDERATIONS
To the maximum extent appropriate, all students shall be educated and participate with students who are non-disabled. Provide an explanation of the extent, if any, to which the student will not participate in general education classes and activities. X Special education classes, separate schooling, or removal from the regular education environment is required because the nature or severity Yes No of the students disability is such that education in general classes with the use of supplementary aids and services cannot be achieved satisfactorily. Explain:________________________________________________________________________________________________________ X Yes X Yes No Will participate in nonacademic activities with nondisabled peers and have the same opportunity to participate in extracurricular activities as nondisabled peers? If no, explain:____________________________________________________________________________________________________ Will attend the school he or she would attend if nondisabled? If no, explain:____________________________________________________________________________________________________
No
PLACEMENT CONSIDERATIONS
When determining the placement, consider any potentially harmful effect either on the student or the quality of services that he/she needs. After determining the students placement, complete the Placement section on this cover sheet. Yes X NA For a child who is deaf, hard or hearing, blind or visually impaired, parents have been informed of existence of the Illinois School for the Deaf or the Illinois School for the Visually Impaired, and other local schools that provide similar services. POTENTIALLY HARMFUL EFFECT/ REASONS REJECTED TEAM ACCEPTS PLACEMENT
PLACEMENT OPTIONS CONSIDERED
Over 60% of day outside of general education Less than 60% of day outside of general education
Sufficiently meets needs/doesnt allow for interactions w/gen ed peers Needs not met and individualized, not realistic environment. TRANSPORTATION
X Yes
No
X No
Yes
Check all that apply
X Yes
Yes Yes
No
X No X No
Special transportation is required to and from schools and/or between schools. Special transportation is required in and around school buildings. Specialized equipment (such as special or adapted buses, lifts, and ramps) is required.
CCUSD 4 will provide curb to curb transportation to and from school
EXTENDED SCHOOL YEAR SERVICES

X Yes No Extended school year services are needed. The IEP team must document the consideration of the need for extended school year services and the basis for the determination.
If yes, the IEP must indicate the type, amount and duration of services to be provided.
SPECIAL EDUCATION SERVICE(S)
LOCATION
AMOUNT/FREQUENCY OF SERVICES
INITIATION OF SERVICES
DURATION OF SERVICES
GOAL(S) ADDRESSED
Functional Life Skills
Central?
960 minutes
6/12/13
7/13/13
1-8
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ ADDITIONAL NOTES/INFORMATION
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ REPORT OF PROGRESS ON ANNUAL GOALS (OPTION 1)

Specify the extent to which the students progress is sufficient to enable the student to achieve the goals by the end of the IEP year. Districts may use this page to report on student progress OR may use the option two page that would include data charts to indicate a students progress. Students Name G Date 10/16/13 Staff Name MS Title case manager Report Card Progress Report Parent Conference
REPORT OF PROGRESS: GOAL NUMBER MEASURABLE ANNUAL GOAL Completed Making Expected Progress Not Making Expected Progress ADDITIONAL COMMENTS
Type of Report 1
X 1
2 2
3 3
4 Quarter 4 Quarter
When in the community, G does not consider health or price when she buys food at restaurants or grocery stores.
(This is where I would state her progress towards the goals, but I dont have this page)
During down time while alone, G will watch a DVD, completing all 10 steps of the task analysis correctly for 3 consecutive trials When reheating food, G will use a microwave estimation guide to microwave food without recipe directions for 3/3 trials. Before school, G will get herself up, get dressed, brush her teeth, brush her hair, take her medication, and get on the bus without prompting for all days for a week. G will plan and prepare 2 breakfasts, 2 lunches, and 2 dinners independently for 3 out of 3 occasions. When going to a location by bus, G will get on at the correct location and get off at the correct location independently on all occasions for 3 consecutive days
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ 8 While preparing to go into the community (to work, a store, or a restaurant), G will use the computer to plan a bus route, completing 10/10 steps correctly for 3 consecutive trials.
STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ REPORT OF PROGRESS ON ANNUAL GOALS (OPTION 2)

Specify the extent to which the students progress is sufficient to enable the student to achieve the goals by the end of the IEP year. Districts may use this page to report on student progress OR may use the option one page. Students Name Date Staff Name Title
GOAL NUMBER MEASURABLE ANNUAL GOAL
Type of Report Report Card Progress Report Parent Conference

REPORT OF PROGRESS (INSERT DATA CHARTS)
1 1
2 2
3 3
4 Quarter 4 Quarter

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STUDENT NAME:______G.D.

INDIVIDUALIZED EDUCATION PROGRAM (CONFERENCE SUMMARY REPORT)

STUDENT IDENTIFICATION INFORMATION

STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________

STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ DOCUMENTATION OF EVALUATION RESULTS

(Submitted by school psychologist)

Health (Current or past medical difficulties affecting educational performance)

G wears glasses and passed her 2009/10 hearing test.

STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________

STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________

STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________

STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ SECONDARY TRANSITION

AGE-APPROPRIATE TRANSITION ASSESSMENTS

Case manager Case manager

POST-SECONDARY OUTCOMES (address by age 14 )

COURSE OF STUDY (address by age 14)

STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ TRANSITION SERVICES (address by age 141/2)

HOME-BASED SUPPORT SERVICES PROGRAM

STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________

STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ GOALS AND OBJECTIVES/BENCHMARKS (1)

Other (specify) __________________________

CURRENT ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

GOALS AND OBJECTIVES/BENCHMARKS

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal

% Accuracy # of attempts Other (specify) Ones only up to $5 4/4

Observation Log Data Charts Tests Other (specify)

Daily Weekly Quarterly Semester Other (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal

% Accuracy # of attempts Other (specify) Mixed Bills up to $10 4/4

Observation Log Data Charts Tests Other (specify)

Daily Weekly Quarterly Semester Other (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal

% Accuracy # of attempts Other (specify) Mixed bills up to $20 5/5

Observation Log Data Charts Tests Other (specify)

Daily Weekly Quarterly Semester Other (specify)

STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ GOALS AND OBJECTIVES/BENCHMARKS (2)

Other (specify) __________________________

CURRENT ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

GOALS AND OBJECTIVES/BENCHMARKS

% Accuracy # of attempts Other (specify)

Observation Log Data Charts Tests Other (specify)

Daily Weekly Quarterly Semester Other (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal

% Accuracy # of attempts Other (specify)

Observation Log Data Charts Tests Other (specify)

Daily Weekly Quarterly Semester Other (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal

STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ GOALS AND OBJECTIVES/BENCHMARKS (3)

Other (specify) __________________________

CURRENT ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

GOALS AND OBJECTIVES/BENCHMARKS

Illinois Learning Standard: #26.A.5

% Accuracy # of steps Other (specify)

Observation Log Data Charts Tests Other (specify)

Daily Weekly Quarterly Semester Other (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal

% Accuracy # of attempts Other (specify)

Observation Log Data Charts Tests Other (specify)

Daily Weekly Quarterly Semester Other (specify)

Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal

STUDENT NAME:______G.D.______________________________DATE OF MEETING:______10/26/12____________ GOALS AND OBJECTIVES/BENCHMARKS (4)

Other (specify) __________________________

CURRENT ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12 DOCUMENTATION OF EVALUATION RESULTS

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12 SECONDARY TRANSITION

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12 TRANSITION SERVICES (address by age 141/2)

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12 GOALS AND OBJECTIVES/BENCHMARKS (1)

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12 GOALS AND OBJECTIVES/BENCHMARKS (2)

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12 GOALS AND OBJECTIVES/BENCHMARKS (3)

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12 GOALS AND OBJECTIVES/BENCHMARKS (4)

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12 GOALS AND OBJECTIVES/BENCHMARKS (5)

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12 GOALS AND OBJECTIVES/BENCHMARKS (6)

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12 GOALS AND OBJECTIVES/BENCHMARKS (7)

STUDENT NAME:G.D.__________DATE OF MEETING:10/26/12 GOALS AND OBJECTIVES/BENCHMARKS (8)