IEP For High School Student On Alternate Curriculum

STUDENT NAME:____________DJ______________________________DATE OF MEETING:______12/7/12 By: Joel
Wright 11/20/12_________________
INDIVIDUALIZED EDUCATION PROGRAM (CONFERENCE SUMMARY REPORT)
DATE OF MOST RECENT EVALUATION:__12____/___7___/___12___DATE OF NEXT

REEVALUATION:__12____/_10_____/_15____
PURPOSE OF CONFERENCE (Check all that apply)

Review of Existing Data Reevaluation ! IEP Review/Revision Manifestation Determination Termination of Placement
Initial Eligibility Initial IEP Transition Graduation Other (e.g. FBA/BIP)________
STUDENT IDENTIFICATION INFORMATION
STUDENT’S ADDRESS (Street, City, State, Zip Code) STUDENT’S DATE OF BIRTH SIS ID NUMBER
2/5/1988 XXX-XX-XXXX
1234 South Street
Champaign, IL 00000
! MALE ETHNICITY LANGUAGE/MODE OF COMMUNICATION CURRENT GRADE LEVEL ANTICIPATED DATE OF HS GRADUATION
African USED BY STUDENT 9 2016
American English
FEMALE
PLACEMENT(To be completed after placement determination) DISABILITY(S) MEDICAID NUMBER
21-60% outside general education Autism Spectrum Disorder XXX-XXX-XXX
! YES NO Placement is in Resident School
RESIDENT DISTRICT SERVING DISTRICT
Champaign Comm. Unit 4 Schools CCUSD4
RESIDENT SCHOOL SERVING SCHOOL
X-Mas High School X-Mas High School
PARENT/GUARDIAN INFORMATION
(1) PARENT’S NAME Educational Surrogate Parent (2) PARENT’S NAME Educational Surrogate Parent
Ms. M
(1) PARENT’S ADDRESS (Street, City, State, Zip Code) (2) PARENT’S ADDRESS (Street, City, State, Zip Code)
1234 South Street
Champaign, IL 00000
(1) PARENT’S TELEPHONE NUMBER (include Area Code) (2) PARENT’S TELEPHONE NUMBER (Include Area Code)
(217) 999-9999
(1) LANGUAGE/MODE OF COMMUNICATION USED BY PARENT(S) (2) LANGUAGE/MODE OF COMMUNICATION USED BY PARENT(S)
English
Yes ! No Interpreter 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. ELIG.
REVIEW IEP REVIEW IEP
Mrs. DJ’s Mom Ms. Scarlet
Parent School Social Worker
Mr. DJ's Dad Mrs. White
Parent Speech-Language Pathologist
DJ
Student Bilingual Specialist
Principal Hornshoe
LEA Representative Interpreter
Mrs. McCreedy Mr. Green (aide)
General Education Teacher Other (specify)
Mr. Blood
Special Education Teacher Other (specify)
Mrs. Peacock
School Psychologist 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

____________12/11/12_________________________________________
Wright 11/20/12_________________
Transfer of Rights - Seventeen-year old student informed of his/her rights that will transfer to the student upon reaching age 18. Yes ! NA
Parent(s) were given a copy of the: Evaluation report and eligibility determination IEP
District’s behavioral intervention policies District’s behavioral intervention procedures (initial IEP only)


Wright 11/20/12_________________
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 team’s analyses of the student’s 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 student’s functioning in the following domains.
Academic Achievement (Current or past academic achievement data pertinent to current educational performance)
2009: Woodcock-Johnson III results (100=norm <70= 2 deviations below norm): Letter-Word ID: 79 Reading Fluency = 75
Comprehension = 63, Broad Reading = 70, Calculation = 77, Math Fluency = 70, Applied Problems = 59, Broad Math =
60, Spelling = 78, Writing Fluency = 75, Writing Samples = 68, Broad Written Language = 69, Academic Applications =
54.
Functional Performance (Current or past functional performance data pertinent to current functional performance)
2 GARS-2 teacher reports (2009) and an ADOS Module 3 (2009) indicated possible to likely autism range. . A
BASC-2 assessment in 2009 identified “externalizing problems.”
ABAS-II (Parent Report) Conceptual SS 72, Social SS 62, Practical SS 46, GAC SS 61.
ABAS-II (Teacher Report) Conceptual SS 59, Social SS 64, Practical SS 49, GAC SS 49.
Cognitive Functioning (Data and other information regarding intellectual ability; how the student takes in information, understands information, and
expresses information)
WISC-IV Results (2009) Verbal Comprehension = 67, Perceptual Reasoning = 53, Working Memory = 54,
Processing Speed = 68, Full Scale IQ = 52.
Communicative Status (Information regarding communicative abilities (language, articulation, voice, fluency) affecting educational performance)
DJ’s speech abilities were assessed with the SPAT-D. He exhibited speech sound errors not appropriate for his age. During a 166
word conversation sample, DJ was 93% fluent. His primary type of disfluency was repetitions. While reading a passage with 179
words, he was 91% fluent. DJ’s disfluencies minimally impact his intelligibility. Based on informal assessment through conversation
and therapy activities, DJ’s voice and language abilities are within functional limits.
For ELL students explain ELL STATUS: Has Linguistic status Changed YES NO
Health (Current or past medical difficulties affecting educational performance)

DJ was born full tem weighing 8 lbs. Developmental milestones were reported to be on time, with the exception of speech
and language development. DJ has not sustained any significant illnesses or injuries. He sustained a forehead laceration
in 2001 that required sutures. DJ underwent dental surgery in 2002 for caries and abscesses. Evaluation in 2003
findings include: mild to moderate cognitive impairment, delayed receptive and expressive language, delayed self-care
skills, weak fine motor skills, ADHD, Oppositional Defiant Disorder with markedly aggressive behavior and characteristics
of a pervasive developmental disorder/ autism spectrum disorder. DJ takes Strattera and Clonidine daily. No other health
concerns are present at this time.
Hearing/Vision (Auditory/visual problems that would interfere with testing or educational performance. Include dates and results of last hearing/vision
test)
DJ passed his hearing and vision screenings in 2009.
Motor Abilities (Fine and gross motor coordination difficulties, functional mobility, or strength and endurance issues affecting educational performance)
OTR/L, 2009: DJ has average fine and visual motor skills for writing. He is physically able to perform self care tasks at
school. He requires reminders to wash hands and wipe his face. He requires constant supervision because of
inappropriate sexual comments and behaviors. He can participate in P.E. without physical assistance or
accommodations/modifications. Bumps into students in hallways. Suggests some possible sensory integration deficits
related to touch and body awareness. Qualifies for OT to address behaviors related to classroom fidgeting, body
awareness, movement in hallways, and sensory aspects of self care tasks.
Wright 11/20/12_________________
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)
BASC-2 rating scales completed by 3 classroom teachers were very consistent in results. All three raters indicated
Externalizing Problems to be more elevated than internalizing problems. All three raters also indicated that Atypicality
was the area of most concern and the Behavioral Symptoms Index was Clinically Significant. All three raters indicate
adaptive scales fell in the At-Risk to Clinically Significant range. Mom’s ratings indicated Atypicality to the most concern
and also rated the Behavioral Symptoms Index in the Clinically Significant range. Adaptive scores fell in the At-Risk to
Clinically Significant range.
Wright 11/20/12_________________
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 student’s 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.
Student’s Strengths:
DJ plans for the future include obtaining his commercial driver’s license, working for and eventually owning a trucking
company, and taking acting and drama classes. Academically, he can orally summarize and retell narratives. He can use
math operations in all four areas up to 2-digits. His functional math skills include making change (with 80% accuracy) and
telling time (with greater than 90% accuracy). He does well in cooking, and has a good knowledge of foods, and has said
that he would like to eat healthier in order to lose weight, and has set this goal for himself.
Parental Educational Concerns/Input

DJ’s mom would like to have him be a better reader, to improve his grades in English, and to participate more in class.
His parents have expressed concerns about his hygiene and toileting at school, and have expressed concern regarding
his social skills. They would like him to continue to be included in academic courses. Case manager and parents have
discussed expanding vocational curriculum to potentially include off-site job training. Math curriculum may become more
embedded in functional life skills (cooking, money). Parents wish to continue academic English curriculum. DJ wishes to
take driver’s ed. Young Adult Program is a possibility, although not judged a necessity at this point.
Student’s Present Level of Academic Achievement (Include strengths and areas needing improvement)
rd
Reading – DJ is currently reading at a 3 grade level according to his AIMSWeb. He can orally retell a narrative, and
write a narrative paragraph on a single topic, including a topic sentence, with 80% accuracy. He uses correct punctuation
and capitalization approximately 50% of the time. DJ can independently write 21 words per minute with 72% accuracy.
Math – DJ can fluently perform single and double-digit operations using all four math operations. (+,-,*,/) He can use the
dollar-up strategy for making purchases, and can provide correct change approximately 80% of the time. He has had
some difficulties with adding and subtracting fractions, with approximately a 50% success rate, although he can orally
name correct fractions using manipulatives 75% of the time. His teachers have identified solving multi-step word
problems as another area of difficulty for him.
Student’s Present Levels of Functional Performance (Include strengths and areas needing improvement)
DJ has made progress in his social and communication skills, but still needs to improve in identifying appropriate social
interactions. He has many self-care skills, but may need to improve a little regarding toileting and hygiene. He has set
himself many positive career and community goals, and would benefit from vocational and transitional planning. He has
greatly reduced the number of inappropriate verbal utterances during social and leisure activities, and has successfully
replaced these with appropriate forms of greeting and conversation. He uses a conversation notebook to assist him with
initiating and maintaining appropriate conversations. His teachers would like him to participate more in his classes, and to
be able to work independently without getting distracted. DJ can dress and bathe himself. He can toilet himself, but
sometimes needs reminders. He does not consistently keep his breath or body free of odor.
DJ has very well thought out, definitive plans for his future, including obtaining his commercial driver’s license, working for
and eventually owning a trucking company, and taking acting and drama classes. He says that he plans to work at
McDonald’s after he turns 15. He will need to perfect certain functional skills (vocational/math) in order to be able to
succeed in future work placement sites.
Wright 11/20/12_________________
Describe the effect of this individual’s disability on involvement and progress in the general education curriculum and the
functional implications of the student’s skills.
• For a preschool child, describe the effect of this individual’s disability on involvement in appropriate activities.
• By age 14#, describe the effect of this individual’s disability on the pursuit of post-secondary expectations (living,
learning, and working).
DJ’s disability affects his ability to apply previously learned materials to new environments. It affects his social skills, his
expressive and receptive language skills, and his ability to interpret social cues. His disability affects his ability to
maneuver and navigate the myriad social situations that most people encounter on a daily basis, including in his
interactions with peers, with teachers, with friends and acquaintances and, should he achieve his future goals, it will affect
his relationships with his co-workers, his employers, and his employees. DJ is currently in pull-out academic math and
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English with several other 9 graders with IEPs. Compared with other students in his classes, DJ performs well,
especially in reading comprehension. He might be able to be in a co-taught setting, if it were not for concerns regarding
his social skills. Social skills are a major area of concern. In 2003, a teacher wrote: “Lack of knowledge of personal
space and lack of knowledge of social skills causes inappropriate physical aggression and inappropriate verbal remarks.”
These issues continue today, although physical aggression is not a high concern, and inappropriate sexual comments
and gestures are.
Wright 11/20/12_________________
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.
AGE-APPROPRIATE TRANSITION ASSESSMENTS

Transition Assessments Assessment Responsible Date Report Goal #
(Including student and family survey/interview) Type Agency/Person Conducted Attached
EMPLOYMENT None needed Survey Case Nov. 2012 N
Manager/Unit 4
EDUCATION None needed Survey Case Nov. 2012 N
Manager/Unit 4
TRAINING None needed Survey Case Nov. 2012 N
Manager/Unit 4
INDEPENDENT LIVING SKILLS None needed Survey Case Nov. 2012 N
Manager/Unit 4
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
After high school, DJ will have gainful employment in the food service industry while he works and studies to obtain his CDL. Once he has his CDL, he
will work full time as a truck driver until he is able to manage or own his own trucking company.
Post-Secondary Education (e.g., community college, 4-year university, technical/vocational/trade school): AND/OR
DJ will take any local community classes in order to help him prepare to obtain his CDL.
Post-Secondary Training (e.g., vocational or career field, vocational training program, independent living skills training, apprenticeship, OJT, job
corps): AND
DJ will enroll in any necessary training programs in order to help him obtain his CDL.
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, DJ will obtain independent living in an apartment in Champaign-Urbana either living alone or with roommates. He will maintain
healthy social relationships. He will manage his own healthy eating and exercise routines. He will manage his own finances.
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
English (pull) English (pull/co-taught) English (pull/co-taught) English (pull/co-taught)
Math (pull) Math (pull) Vocational Training Vocational Training
PE/Health PE/Health PE
PE/Health
Community Based Community Based Community Based
Resource Instruction Instruction Instruction
Drama Drama/Elective Drama/Elective
Food/Nutrition
Music
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Wright 11/20/12_________________
Wright 11/20/12_________________
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.) Provider Agency and Position
Activity Recommendations: Unit 4
Goal #(s) if appropriate
1) Driver’s Education
2) Functional math skills related to working a cashier Date/Year to be Addressed
2013-2014
3) Professional etiquette skills
Date/Year Completed
(If none, indicate “none”)
2016
RELATED SERVICES (e.g., transportation, social services, medical services, technology, support services) Provider Agency and Position
Unit 4
1) Training for MTD buses (transportation) Goal #(s) if appropriate
(If none, indicate “none”)
Date/Year to be Addressed
2013-2014
Date/Year Completed
2016
COMMUNITY EXPERIENCES (e.g., job shadow, work experiences, banking, shopping, transportation, tours Provider Agency and Position
of post-secondary settings) Unit 4
1) Community-Based Instruction that will address vocational and consumer education skills. Goal #(s) if appropriate
2013-2014
(If none, indicate “none”) Date/Year Completed
2016
DEVELOPMENT OF EMPLOYMENT AND OTHER POST-SCHOOL ADULT LIVING Provider Agency and Position
OBJECTIVES (e.g., career planning, guidance counseling, job try-outs, register to vote, adult benefits planning) Unit 4
1) Vocational site training that will develop necessary vocational skills. Goal #(s) if appropriate
2) Career planning that will sample necessary job skills.
2013-2014
Date/Year Completed
2016
(If none, indicate “none”).
APPROPRIATE ACQUISITION OF DAILY LIVING SKILLS AND/OR Provider Agency and Position
FUNCTIONAL VOCATIONAL EVALUATION (e.g., self-care, home repair, home health, money, Unit 4
independent living, / job and career interests, aptitudes and skills) Goal #(s) if appropriate
1) DJ will acquire necessary toileting and self-hygiene skills for independent living. Date/Year to be Addressed
2) DJ will learn necessary financial skills for independently managing a monthly budget. 2013-2014
Date/Year Completed
2016
LINKAGES TO AFTER GRADUATION SUPPORTS/SERVICES (e.g. DRS, DMH, DSCC, PAS, Provider Agency and Position
SASS, SSI, WIC, DHCFS, CILs) Unit 4/SSA
Goal #(s) if appropriate
Connection to SSA/DRS/DSC/Parkland office of disabilities year prior to exiting high school.
2015
Date/Year Completed
2015
HOME-BASED SUPPORT SERVICES PROGRAM
Yes ! No 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 student’s eligibility for home-based services:
Plans for enrolling the student in the program of home-based services:
Plans for developing a plan for the student’s most effective use of home-based services after reaching age 18 and
when no longer receiving special education services:
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Wright 11/20/12_________________
FUNCTIONAL BEHAVIORAL ASSESSMENT (AS APPROPRIATE)

Complete when gathering information about a student’s behavior to determine the need for a Behavioral Intervention Plan.
When used in developing a Behavioral Intervention Plan, the Functional Behavioral Assessment must be reviewed at an IEP
meeting and should be attached to the IEP.
The Functional Behavioral Assessment must include data collected through direct observation of the target behavior. Attach
documentation of data collection.
Participant/Title Participant/Title
Mr. Wright (Student Teacher)
Student’s Strengths – Include a description of behavioral strengths (e.g., ignores inappropriate behavior of peers, positive interactions
with staff, accepts responsibility, etc.)
DJ has many a lot of progress in his social behaviors. In semistructured settings, he has decreased his number of
inappropriate utterances from one every 1.5 minutes to 1 every 10 minutes. He can identify what is appropriate and
inappropriate in a variety of settings. He can identify preferred topics of conversation, preferred activities, and preferred
people with whom to speak with. He can ask appropriately for permission to use the restroom, to be excused from a
situation, and to talk with a friend or acquaintance.
Operational Definition of Target Behavior – Include a description of the frequency, duration and intensity of the behavior.
DJ’s target behavior to decrease is making verbal or non-verbal utterances in different environments. The
operational definition for these behaviors are, “DJ will make one of several non-verbal sounds with his mouth that include
an unvoiced lingual-labial trill (raspberry), a laugh out of context, and a short, shrill yell,” and “DJ will utter a brief, one or
two word exclamation in a raised voice without context, e.g., ‘hello mother,” “yeah, buddy,” or ‘hey, you!’”
Non-examples include greeting an acquaintance in a semi-formal manner, “Hi, Stephen,” or “Hello, Mr. W,”
laughing in a contextually appropriate and polite manner, e.g., at a joke, and mumbling or speaking under his breath.
Setting – Include a description of the setting in which the behavior occurs (e.g., physical setting, time of day, persons involved.)
The behavior occurs most frequently in non-structured environments, such as in the hallway during passing period,
in the cafeteria at lunch, and during recreational time in a classroom. It also will occur with less frequency during class
instructional time.
Antecedents – Include a description of the relevant events that preceded the target behavior.
Antecedents include the presence of a preferred person to talk to, a group of friends, or a peer behaving as a
distractor.
Consequences – Include a description of the result of the target behavior (e.g. removed from classroom and did not complete
assignment. What is the payoff for the student?)
DJ is being reinforced by gaining the attention (e.g., laughing, saying “Ew! Gross!”) of his peers.
Environmental Variables – Include a description of any environmental variables that may affect the behavior (e.g., medication,
weather, diet, sleep, social factors.)
Hypothesis of Behavioral Function - Include a hypothesis of the relationship between the behavior and the environment in which it
occurs.
Across environments, DJ will attempt to get the attention of other students by making obscene noises and saying
vulgar, sexual phrases, in order to make them laugh or respond to him.
Wright 11/20/12_________________
BEHAVIORAL INTERVENTION PLAN (AS APPROPRIATE)
Complete when the team has determined a Behavioral Intervention Plan is needed.
Student’s Strengths – Describe student’s behavioral strengths
DJ has many a lot of progress in his social behaviors. In semistructured settings, he has decreased his number of
inappropriate utterances from one every 1.5 minutes to 1 every 10 minutes. He can identify what is appropriate and
inappropriate in a variety of settings. He can identify preferred topics of conversation, preferred activities, and preferred
people with whom to speak with. He can ask appropriately for permission to use the restroom, to be excused from a
situation, and to talk with a friend or acquaintance.
Target Behavior
Is this behavior a Skill Deficit or a !Performance Deficit
Skill Deficit: The student does not know how to perform the desired behavior.
Performance Deficit: The student knows how to perform the desired behavior, but does not consistently do so.
DJ’s target behavior to decrease is making verbal or non-verbal utterances in different environments. The
operational definition for these behaviors are, “DJ will make one of several non-verbal sounds with his mouth that include
an unvoiced lingual-labial trill (raspberry), a laugh out of context, and a short, shrill yell,” and “DJ will utter a brief, one or
two word exclamation in a raised voice without context, e.g., ‘hello mother,” “yeah, buddy,” or ‘hey, you!’”
Non-examples include greeting an acquaintance in a semi-formal manner, “Hi, Stephen,” or “Hello, Mr. W,”
laughing in a contextually appropriate and polite manner, e.g., at a joke, and mumbling or speaking under his breath.
Hypothesis of Behavioral Function – Include hypothesis developed through the Functional Behavioral Assessment (attach completed
form). What desired thing(s) is the student trying to get? OR What undesired thing(s) is the student trying to avoid?
Across environments, DJ will attempt to get the attention of other students by making obscene noises and saying vulgar,
sexual phrases, in order to make them laugh or respond to him.
Summary of Previous Interventions Attempted – Describe any environmental changes made, evaluations conducted, instructional
strategy or curriculum changes made or replacement behaviors taught.
- Seating away from peers and near the front of class or near teacher or aide.
- Instruction on distinguishing between appropriate/inappropriate interactions in varying contexts.
- Punishment. (Detention, ISS, loss of privileges.)
- Adult supervision during transition periods.
- Scheduled and supervised bathroom breaks.
Replacement Behaviors – Describe which new behaviors or skills will be taught to meet the identified function of the target behavior
(e.g. student will slap his desk to replace striking out at others). Include description of how these behaviors/skills will be taught.
Replacement behaviors taught include context appropriate greetings, i.e., “Hello,” “Hi”, etc., followed by topically
appropriate conversational turns. Special attention will be paid to attending to contextual cues, including whether or not
DJ’s conversation partner is a friend, an acquaintance, or a professional connection.
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Wright 11/20/12_________________
BEHAVIORAL INTERVENTION PLAN (AS APPROPRIATE)
Behavioral Intervention Strategies and Supports
Environment – How can the environment or circumstances that trigger the target behavior be adjusted?
Behavior occurs most often in recreational and leisure settings, or otherwise unstructured settings, especially
transitions. DJ should be given time to prepare for transitions, and should be accompanied by an aide. Positive social
interactions will be encouraged during rec/leisure times through the use of semistructured activities such as games or
listening to music.
In academic settings, behavior most often occurs when DJ either finds the work too difficult, does not know how to
proceed in work, or is distracted by peers. DJ will be taught appropriate replacement behaviors including asking for
help, asking to be excused from the room, and appropriately participating in class discussions.
Instruction and/or Curriculum – What changes in instructional strategies or curriculum would be helpful?
DJ can use his conversation book to facilitate appropriate conversation. He can recognize words and actions as
appropriate (“green”) or inappropriate (“red”). During classroom instruction, he benefits from clear verbal directions and
clear, verbal positive reinforcement. DJ will use a toileting schedule that he can follow independently, although he
needs to be allowed to excuse himself from class in order to do so.
Positive Supports – Describe all additional services or supports needed to address the student’s identified needs that
contribute to the target behavior.
DJ receives social work and speech support. He has aide support in all of his classes, and a staff member will
be present during leisure and transition times during school hours. Positive and consistent behavior support will be
implemented across environments, in his functional classes and in his academic.
Motivators and/or Rewards – Describe how the student will be reinforced to ensure that replacement behaviors are more motivating
than the target behavior.
Appropriate replacement behaviors will be reinforced through natural reinforcers such as having conversations with
peers and friends about preferred topics, meeting new people and making new friends, and arranging preferred social
activities with the assistance of his team and inviting friends to participate with him.
Restrictive Disciplinary Measures – Describe any restrictive disciplinary measures that may be used with the student and any
conditions under which such measures may be used (include necessary documentation and timeline for evaluation.)
DJ will be sent to SPED room 110 for less serious inappropriate behaviors, such as excessive inappropriate verbal
or non-verbal outbursts, or not following direction. If Rooms 110 is unavailable, DJ may be sent to the Assistant Principal’s
Office. In School or Out of School Suspension can be assigned for serious behavior, such as grabbing or groping another
student, writing sexually explicit messages, or fighting.
Crisis Plan – Describe how an emergency situation or behavior crisis will be handled.
Follow the school crisis plan. Parent will be contacted.
Data Collection Procedures and Methods – Describe expected outcomes of the interventions, how data will be collected and
measured, timelines for and criteria to determine success or lack of success of the interventions.
Staff will use event recording and antecedent-consequence recording to track DJ’s behavior across environments.
Interventions will result in 0 inappropriate verbal or non-verbal interactions per day and the increase in positive social
interactions across environments, at least 1 time per class period within six months, and at least 10 times per school day.
Provisions For Coordination with Caregivers – Describe how the school will work with the caregivers to share information, provide
training to caregivers if needed, and how often this communication will take place.
Parents will be contacted in person, by letter, phone, or email if any serious consequences are the result of
inappropriate behavior. Staff should leave messages if mom is not available on the phone.
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Wright 11/20/12_________________
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 student’s progress on annual goals and if the progress is sufficient to achieve the goals by the end of the IEP year:
! Report cards ! 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.
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DJ is currently in pull-out academic math and English with several other 9 graders with IEPs. Compared with other students in h
classes, DJ performs well, especially in reading comprehension. He might be able to be taught in a co-taught setting, if it were no
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for concerns regarding his social skills. DJ is currently reading a 4 grade text in his English class.
GOALS AND OBJECTIVES/BENCHMARKS
The goals and short-term objectives or benchmarks shall meet the student’s educational needs that result from the student’s
disability, including involvement in and progress in the general curriculum, or for preschool students, participation in
appropriate activities.
Goal Statement #__1__of__10___
In English class, after having read a narrative text, DJ will verbally dictate and summarize the story to a teacher, including the mai
idea of the story, and will include at least three main events in correct sequential order. He will successfully complete this task an
100% of its components at least once per week for four consecutive weeks.
Indicate Goal Area: ! Academic Functional Transition Illinois Learning Standard: #_1.B.3a, 1.B.3b
.B.3c__________
Title(s) of Goal Implementer(s) IEP Team
Short-Term Objective/Benchmark for Measuring Progress on the Annual Goal

In English class, after having read a narrative text, DJ will verbally or in writing list three main from the story in correct
sequential order for 3 consecutive trials.
Evaluation Evaluation Schedule for Dates Reviewed/

Criteria Procedures Determining Progress Extent of Progress (Optional)
10 % Accuracy Observation Log Daily
0
3 # of attempts X Data Charts X Weekly
/3
Other (specify) Tests Quarterly
Other (specify) Semester
Other (specify)
In English class, after having read a narrative text, DJ will verbally or in writing identify the theme or main idea of
the story correctly for 3 consecutive trials.

0
# of attempts X Data Charts X Weekly
3/
3
Other (specify)
Wright 11/20/12_________________
REPORTING ON GOALS
Report cards ! Progress reports Parent conference Other (specify)

__________________________
Although he is below grade-level in reading, I recommend retaining him on an academic curriculum, in pull-out or, if possible, co
taught. DJ’s English teacher would like him to summarize, re-tell, and analyze narrative texts, to work independently, an
participate more in class.
Goal Statement #__2__of_10____
In both English and math class, when given an independent task to work on, DJ will initiate work independently within 10 second
of being presented with a cue 90% of the time.
Indicate Goal Area: ! Academic Functional Transition Illinois Learning Standard: #___1.C.3a, 1.C.3d
1.C.3f________

# of attempts Data Charts Weekly
9/
10
Other (specify)

% Accuracy Observation Log Daily
/ # of attempts Data Charts Weekly
Other (specify)

Wright 11/20/12_________________
Other (specify)
Wright 11/20/12_________________
REPORTING ON GOALS

__________________________
DJ has received grades between B and D in his pull-out math classes. Although he is able to perform most single-digit math operations, he ha
struggled with solving and explaining how he has solved math word problems.

Goal Statement #__3__of_10____
In math class, DJ will use an appropriate learned strategy, such as using a calculator, drawing a picture, or restating the problem, t
correctly solve a multi-step math word problem involving division and will explain, either orally or in writing, the steps that he took t
reach his solution. He will successfully complete 100% of this task on 80% of trials.
Indicate Goal Area: ! Academic Functional Transition Illinois Learning Standard: #____Trans math_______

In math class, when given a word problem, DJ will correctly identify by speaking or pointing which operation on a
calculator is the correct one to use. He will accomplish this task 100% of the time.

0
5 # of attempts Data Charts ! Weekly
/5
Other (specify)
In math class, when given a word problem, DJ will orally or in writing restate the problem, and correctly identify
which operation he will use to solve it. He will accomplish this task 80% of the time.

# of attempts Data Charts ! Weekly
4/
5
Other (specify)
Wright 11/20/12_________________

Other (specify)
Wright 11/20/12_________________
REPORTING ON GOALS
Report cards ! Progress reports ! Parent conference Other (specify)

__________________________
DJ is doing well in his Health class, and says that he enjoys it. He does well in cooking, and has a good knowledge of foods, an
has said that he would like to eat healthier in order to lose weight.

When cooking across environments, DJ will be able to plan and prepare a healthy meal for himself, including using the
appropriate utensils, procedures, and ingredients. He will successfully complete this task and 100% of its components for 3
consecutive trials, and will maintain it by completing this task and 100% of its components once per week across
environments.
Indicate Goal Area: Academic ! Functional Transition Illinois Learning Standard: #___Daily Living/Life Skil
________

When cooking, during domestics, DJ will correctly identify which appliance out of oven, stove top, or microwave, to use to
prepare his meal for 3 out of 3 trials.

10 % Accuracy ! Observation Log Daily
0
# of attempts Data Charts ! Weekly
3/
3
Other (specify)
When cooking, either in nutrition class or during in school vocational training, DJ will use divisibility rules of 2, 3, and 4 to
correctly calculate measurements of ingredients he is using.

Other (specify)
Wright 11/20/12_________________
When cooking, during domestics, DJ will correctly identify which appliance out of oven, stove top, or microwave, to
use to prepare his meal for 3 out of 3 trials.

Other (specify)
Wright 11/20/12_________________
REPORTING ON GOALS

__________________________
DJ’s mom would like to have him be a better reader, to improve his grades in English, and to participate more in class. Although h
is below grade-level in reading, I recommend retaining him on an academic curriculum, in pull-out or, if possible, co-taught. DJ
English teacher would like him to summarize, re-tell, and analyze narrative texts, to work independently, at participate more i
class.
In English class, during group discussion, DJ will independently initiate a conversation on the topic or text with a peer and
will maintain this conversation for at least three turns. He will successfully complete this task and all of its components for 9
out of 10 trials, and will successfully complete it at least once per week.
Indicate Goal Area: ! Academic Functional Transition Illinois Learning Standard: #__1.B.3_________

9 # of attempts Data Charts Weekly
/1
0
Other (specify)

Other (specify)

Wright 11/20/12_________________
Other (specify)
Wright 11/20/12_________________
REPORTING ON GOALS

__________________________
DJ currently uses a conversation book. This area is affected by his disability. His current IEP goals include initiating appropriat
interactions, and identifying appropriate topics of conversation.

Using his conversation book in leisure activities across school environments, DJ will initiate a conversation with a friend on
mutually preferred topic and will maintain relevant conversation for at least five turns. He will independently perform this activity a
least once per day for 5 consecutive days.
Indicate Goal Area: Academic ! Functional Transition Illinois Learning Standard: #_____4B______

0
5 # of attempts Data Charts Weekly
/5
Other (specify)

Other (specify)

Wright 11/20/12_________________
Other (specify)
Wright 11/20/12_________________
REPORTING ON GOALS

__________________________
DJ currently uses a conversation book. This area is affected by his disability. His current IEP goals include initiating appropriat
interactions, and identifying appropriate topics of conversation.

Goal Statement #__7__of___10__
In preparation for community-based instruction, DJ will identify one preferred location per week, and will appropriately invite
a friend or peer to accompany him in the activity. He will successfully accomplish this for 4 out of 5 trials.
Indicate Goal Area: Academic ! Functional Transition Illinois Learning Standard: #____4B_______

4/
5
Other (specify)

Other (specify)

Wright 11/20/12_________________
Other (specify)
Wright 11/20/12_________________
REPORTING ON GOALS

__________________________
A major area of need is in social skills, especially initiating and maintaining appropriate conversation, participating in class,
and participating in positive (i.e., healthy, safe, age-appropriate, high-interest) social activities with his peers.

DJ will use context and convention appropriate means to greet people and to initiate conversation. He will accomplish this
task successfully 100% of the time at least once per day for five consecutive days across environments.
Indicate Goal Area: Academic ! Functional Transition Illinois Learning Standard: #_____32C______

During transitional periods between classes, DJ will walk from one class to the next in a timely fashion, engaging in
acceptable social interactions (e.g., “Hi,” high five, fist bump.) with peers 0-2 times, and arriving on his next class on time.

10 % Accuracy X Observation Log X Daily
0
2/
2
Other (specify)
In class, during social group time, DJ will use social story cues to distinguish between friends, acquaintances, and
coworkers by and will identify the appropriate means to address them in a variety of contexts.

Other (specify)

Wright 11/20/12_________________
Other (specify)
Wright 11/20/12_________________
REPORTING ON GOALS

__________________________
A major area of need is in social skills, especially initiating and maintaining appropriate conversation, participating in class,
and participating in positive (i.e., healthy, safe, age-appropriate, high-interest) social activities with his peers.

DJ will use context and convention appropriate means to greet people and to initiate conversation. Appropriate greetings
include “Hi,” “hello,” a handshake, high five, fist bump, etc. He will accomplish this task successfully 100% of the time at
least once per day for five consecutive days across environments.
Indicate Goal Area: ! Academic ! Functional Transition Illinois Learning Standard: #____32C_______

% Accuracy X Observation Log X Daily
2/
2
Other (specify)

Other (specify)

Other (specify)
Wright 11/20/12_________________
REPORTING ON GOALS

__________________________
DJ plans to begin working part-time after he turns 15, and full-time after he graduates from high school. He needs to
perfect his functional math skills in order to be successful and independent in these settings.

In natural environments, DJ will provide correct change for purchases of up to 10 dollars, using denominations of 1, 5, 10, and 2
cents and 1, 5, and 10 dollars. He will successfully accomplish this 90% of the time for four consecutive weeks. Indicate Goa
Area: ! Academic ! Functional Transition Illinois Learning Standard: #___________

90 % Accuracy X Observation Log X Daily
9/
10
Other (specify)

Other (specify)

Wright 11/20/12_________________
Other (specify)


Wright 11/20/12_________________
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
! 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.
Yes No ! NA 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.
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 ! No assistive technology devices and services
! Yes No communication needs
Yes ! No deaf/hard of hearing – languages and communication needs
Yes ! No limited English proficiency – language needs
Yes ! No blind/visually impaired – provision of Braille instruction
! Yes No behavior impedes student’s 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 ! No The student requires accommodations for the IEP to meet her/his linguistic and cultural needs.
If yes, specify any needed accommodations:
Yes ! 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.
Extended time in all classes.
Read assignments/tests aloud to student in all classes.
Reduce/modify assignments in all classes.
Scheduled bathroom breaks with aide supervision.
Check for understanding in all classes.
Use calculator and graphic organizers.
Use of assignment note book.
Reduce written work in all classes.
Use of adapted grading scale in all classes.
Wright 11/20/12_________________
SUPPORTS FOR SCHOOL PERSONNEL
! Yes No Program trainings and/or supports for school personnel are needed for the student to advance appropriately toward attaining
Collaboration time the annual goals, participate in the general curriculum, and be educated and participate with other students in educational
between special activities. If yes, specify what trainings and/or supports are needed, including when appropriate, the information that
education and general clarifies when the trainings and/or supports will be provided, by whom, in what location, etc.
education teachers;
consultaion with autism
team. Autism team will
assist wih transition.
Wright 11/20/12_________________
ASSESSMENT
CLASSROOM-BASED ASSESSMENTS
! Yes No Student requires accommodations to participate in classroom-based assessments.

! Yes No 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: _________
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.
State academic assessments are not administered at this grade level __________
Student will:
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 ! 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 student’s 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.
Extended time in all classes.
Read test aloud in all classes.
Additional directions in all classes.
Use of calculator.
Use of graphic organizers.
Use of math fact tables.
Modified test/quiz in all classes.
Reduced written work/answers in all classes.
Wright 11/20/12_________________
Use of adapted grading scale in all classes.
Wright 11/20/12_________________
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 Minutes Per Week
(Specify content areas, classes, whether or not the child will participate in general physical education, and extracurricular in Setting
and other nonacademic activities.) (Optional)
General Education with Supplementary Aids (as specified in the Supplementary Aids section) Minutes Per Week
(Specify content areas, classes, whether or not the child will participate in general physical education, and extracurricular in Setting
and other nonacademic activities with supports, if applicable.) (Optional)
Special Education and Related Services within the General Education Classroom Minutes Per Week
(Specify content areas and classes in which the child will participate with the provision of special education and related in Setting
services. List each special education and related service that will be provided during each class. )
Electives with aide support for modification of standards/accommodations 750

PE/Health with aide support for modification of standards/accommodations 250
Lunch with aide support for modifications of standards/accommodations 250
PARTICIPATION IN SPECIAL EDUCATION CLASSES/SERVICES

The IEP must address all special education and related services.
Special Education Services – Outside General Education Minutes Per Week
in Setting
A.
ELA/Math with aide support for modifications of standards/accommodations 520
Related Services – Outside General Education Minutes Per Week

in Setting
B.
Speech/Language Services 30
Social Work Services 40
Behavioral Intervention Plan
Transportation
Educational Environment (EE) Calculation (Ages 3-5) Educational Environment (EE) Calculation (Ages 6-21)
_________ 1. Minutes spent in regular early childhood program _____2100____ 1. Total Bell to Bell Minutes
_________ 2. Minutes spent receiving special education and ___590______ 2. Total Number of Minutes Outside of
related services outside regular early childhood the General Education Setting (A+B)
Wright 11/20/12_________________
(A+B)
Wright 11/20/12_________________
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.
! Special education classes, separate schooling, or removal from the regular education environment is required because the nature or severity
Yes No of the student’s disability is such that education in general classes with the use of supplementary aids and services cannot be achieved
satisfactorily.
Explain: Due to deficits in reading, math, and social skills, DJ requires intensive instruction in a pull-out setting. He also requires a class
focusing on functional independence. He also requires supervision during hallway transitions.
________________________________________________________________________________________________________
! Will participate in nonacademic activities with nondisabled peers and have the same opportunity to participate in extracurricular activities as
Yes No nondisabled peers?
If no, explain:____________________________________________________________________________________________________
! Will attend the school he or she would attend if nondisabled?
Yes No If no, explain:____________________________________________________________________________________________________
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 student’s placement, complete the “Placement” section on this cover sheet.
Yes ! 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.
PLACEMENT OPTIONS CONSIDERED POTENTIALLY HARMFUL EFFECT/ TEAM ACCEPTS PLACEMENT

REASONS REJECTED
Special Ed and/or Related Not enough support to meet
Services 20% or less per day learner’s needs. Yes ! No
Special Ed and/or Related Meets learner’s needs.
Services 21-60% of day ! Yes No
Special Ed and/or Related Too restrictive at this time.
Services 60% or more per day Yes ! No
TRANSPORTATION
Check all that apply
! Yes No Special transportation is required to and from schools and/or between schools.
Yes ! No Special transportation is required in and around school buildings.
Yes ! No Specialized equipment (such as special or adapted buses, lifts, and ramps) is required.
Please explain and/or detail transportation plan:
EXTENDED SCHOOL YEAR SERVICES

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 LOCATION AMOUNT/FREQUENCY INITIATION DURATION GOAL(S)
SERVICE(S) OF SERVICES OF OF SERVICES ADDRESSED
SERVICES

IEP For High School Student On Alternate Curriculum

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STUDENT NAME:____________DJ______________________________DATE OF MEETING:______12/7/12 By: Joel

INDIVIDUALIZED EDUCATION PROGRAM (CONFERENCE SUMMARY REPORT)

DATE OF MOST RECENT EVALUATION:__12____/___7___/___12___DATE OF NEXT

PURPOSE OF CONFERENCE (Check all that apply)

Explanation of Procedural Safeguards were provided to/reviewed with the parent(s) on

STUDENT NAME:____________DJ______________________________DATE OF MEETING:______12/7/12 By: Joel

DOCUMENTATION OF EVALUATION RESULTS

Complete for initial evaluations, reevaluations, or a review of an independent or outside evaluation.

Health (Current or past medical difficulties affecting educational performance)

PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Complete for initial IEPs and annual reviews.

Parental Educational Concerns/Input

AGE-APPROPRIATE TRANSITION ASSESSMENTS

POST-SECONDARY OUTCOMES (address by age 14# )

COURSE OF STUDY (address by age 14#)

Math (pull) Math (pull) Vocational Training Vocational Training

TRANSITION SERVICES (address by age 141/2)

If yes, complete the following statements:

Plans for enrolling the student in the program of home-based services:

STUDENT NAME:____________DJ______________________________DATE OF MEETING:______12/7/12 By: Joel

FUNCTIONAL BEHAVIORAL ASSESSMENT (AS APPROPRIATE)

Mr. Wright (Student Teacher)

BEHAVIORAL INTERVENTION PLAN (AS APPROPRIATE)

GOALS AND OBJECTIVES/BENCHMARKS (1)

! Report cards ! Progress reports ! Parent conference Other (specify)

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

Evaluation Evaluation Schedule for Dates Reviewed/

Evaluation Evaluation Schedule for Dates Reviewed/

GOALS AND OBJECTIVES/BENCHMARKS (2)

Report cards ! Progress reports Parent conference Other (specify)

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

Evaluation Evaluation Schedule for Dates Reviewed/

Evaluation Evaluation Schedule for Dates Reviewed/

Evaluation Evaluation Schedule for Dates Reviewed/

GOALS AND OBJECTIVES/BENCHMARKS (3)

! Report cards ! Progress reports ! Parent conference Other (specify)

GOALS AND OBJECTIVES/BENCHMARKS

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

Evaluation Evaluation Schedule for Dates Reviewed/

Evaluation Evaluation Schedule for Dates Reviewed/

Evaluation Evaluation Schedule for Dates Reviewed/

GOALS AND OBJECTIVES/BENCHMARKS (4)

Report cards ! Progress reports ! Parent conference Other (specify)

GOALS AND OBJECTIVES/BENCHMARKS

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

Evaluation Evaluation Schedule for Dates Reviewed/

Evaluation Evaluation Schedule for Dates Reviewed/

Evaluation Evaluation Schedule for Dates Reviewed/

GOALS AND OBJECTIVES/BENCHMARKS (5)

Report cards ! Progress reports ! Parent conference Other (specify)

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

Evaluation Evaluation Schedule for Dates Reviewed/

Evaluation Evaluation Schedule for Dates Reviewed/

Evaluation Evaluation Schedule for Dates Reviewed/

GOALS AND OBJECTIVES/BENCHMARKS (6)

Report cards ! Progress reports ! Parent conference Other (specify)

GOALS AND OBJECTIVES/BENCHMARKS

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

Evaluation Evaluation Schedule for Dates Reviewed/

Evaluation Evaluation Schedule for Dates Reviewed/

Evaluation Evaluation Schedule for Dates Reviewed/

GOALS AND OBJECTIVES/BENCHMARKS (7)

Report cards ! Progress reports ! Parent conference Other (specify)

STUDENT NAME:DJ____________DATE OF MEETING:12/7/12 By: Joel

DATE OF MOST RECENT EVALUATION:12/_7_/_12___DATE OF NEXT

STUDENT NAME:DJ____________DATE OF MEETING:12/7/12 By: Joel

STUDENT NAME:DJ____________DATE OF MEETING:12/7/12 By: Joel

STUDENT NAME:DJ____________DATE OF MEETING:12/7/12 By: Joel

Initiation Date:__/_/ Duration Date: /_/___