MBI Annual Review IEP Meetings 3/10/17, 11(44 AM

MBI Annual Review IEP Meetings

* Required

1. First Name *

2. Last Name *

3. Student ID Number *

4. Grade Level for 2016-2017 *

Mark only one oval.

4
5

5. Grade Level for 2017-2018 *

Mark only one oval.

4
5

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MBI Annual Review IEP Meetings 3/10/17, 11(44 AM

6. Primary Disability *
Mark only one oval.

EMD (Educable Mentally Handicapped)

SLD (Specific Learning Disability)
OHI (Other Health Impairment)
TMD/PMD (Trainable Mentally Handicapped/Profoundly Mentally Handicapped)
ED (Emotionally Handicapped)
OD (Orthopedically Handicapped)
TBI (Traumatic Brain Injury)
VD (Visually Handicapped)
HD (Hearing Handicapped)
AUT (Autism)
SP (Speech Handicapped)

7. Current Case Manager

8. Date of Meeting *

Example: December 15, 2012 11:03 AM

9. Names of Participants *

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MBI Annual Review IEP Meetings 3/10/17, 11(44 AM

10. Area of Service *

Check all that apply.

Core Replacement Math (Self-Contained)- Direct - Special Education Classroom - 105

minutes
Core Replacement ELA (Self-Contained)- Direct - Special Education Classroom - 120
minutes
Resource ELA - Direct - 40 minutes
Resource Math - Direct - 45 minutes
Intervention Reading - Indirect - General Ed - 90 Minutes Daily - 450 Minutes per week -
Two semesters
Intervention Math - Indirect - General Ed - 60 Minutes Daily - 300 Minutes per week - Two
semesters
Consult Reading - Indirect - Progress Monitoring - Every 2 Weeks - No minutes recorded
Consult Math - Indirect - Progress Monitoring - Every 2 Weeks - No minutes recorded
Resource ELA - Direct - 60 minutes

11. English Language Arts - 2016 - 2017 Current Placement and Curriculum *
Choose the highest level completed by the end of this school year.
Mark only one oval.

Grade 3 - Core Replacement - Reading Mastery

Grade 3 - General Education - ELA
Grade 4 - Core Replacement - Corrective Reading
Grade 4 - Core Replacement - Language X
Grade 4 - General Education - ELA
Grade 5 -Core Replacement - Corrective Reading
Grade 5 - Core Replacement - Language X
Grade 5 - General Education - ELA
Other

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MBI Annual Review IEP Meetings 3/10/17, 11(44 AM

12. English Language Arts - 2017-2018 Proposed Placement and Curriculum *

Honors courses do not have co-teaching services.
Mark only one oval.

Grade 4 - Core Replacement - Corrective Reading

Grade 4 - Core Replacement - Language X
Grade 4 - General Education - ELA
Grade 5 - Core Replacement - Corrective Reading
Grade 5 - Core Replacement - Language X
Grade 4 - Pre-teach Re-teach
Grade 5 - Pre-teach Re-teach
Other

13. Math - 2016 -2017 Placement and Curriculum *

Choose the highest level completed by the end of this school year.
Mark only one oval.

Grade 5 - Core Replacement - Connecting Math Concepts

Grade 5 - General Education - Math - Everyday Math
Grade 4 - Core Replacement - Connecting Math Concepts
Grade 4 - General Education - Math - Everyday Math
Grade 3 - Core Replacement - Connecting Math Concepts
Grade 3 - General Education - Math - Everyday Math
Other

14. Math - 2017 -2018 Proposed Placement and Curriculum *

Choose the highest level completed by the end of this school year.
Mark only one oval.

Grade 5 - Core Replacement - Connecting Math Concepts

Grade 5 - General Education - Math - Everyday Math
Grade 4 - Core Replacement - Connecting Math Concepts
Grade 4 - General Education - Math - Everyday Math
Other

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MBI Annual Review IEP Meetings 3/10/17, 11(44 AM

15. Accommodations to the General Curriculum *

Please check all that apply.
Check all that apply.

Audio Amplification Device

Braille
Calculator
Extended time for assignments
Extended time for quizzes and tests - 150%
Extended time for quizzes and tests - 200%
Extended time for quizzes and tests - 300%
Graphic Organizers
Large Print
Magnification Devices
Multiple or frequent breaks
Notes from a Peer
Oral Administration
Peer Buddy
Preferential Seating
Recorded Books
Screen Reader
Scribe
Sign Language
Small Group Setting for Quizzes and Exams
Speech to Text
Tactile Graphics
Talking Materials
Use of Manipulatives
Visual Cues
Word Processor
Custom - frequent monitoring of understanding of directions and procedures
Custom - ask student to repeat procedures when there is a change in routine
Custom - redirection to task
Custom - clarification of directions
Other:

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MBI Annual Review IEP Meetings 3/10/17, 11(44 AM

16. Modifications to the General Curriculum

If no modifications will be applied, please omit this question.

17. Speech Services *

Mark only one oval.

Yes
No

18. Social Skills Services *

Mark only one oval.

Yes - Required
No - Not Required

19. Does this student have a BIP (Behavior Intervention Plan)? *

Mark only one oval.

Yes
No

20. Counseling Services *

Mark only one oval.

RBHS
Waccamaw Mental Health
None required

21. Is the student currently receiving homebound services? *

Mark only one oval.

Yes
No

Other:

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MBI Annual Review IEP Meetings 3/10/17, 11(44 AM

22. Occupational Therapy *

Mark only one oval.

Yes - Required
No - Not Required

Other:

23. Physical Therapy *

Mark only one oval.

Yes - Required
No - Not Required

Other:

24. Does the student receive ESOL services?

Mark only one oval.

Yes
No

25. Will this student require adult support? *

Check all that apply.

Yes
No
If yes, list reason below in other:

Other:

26. Special Needs Transportation *

Mark only one oval.

Yes
No

27. Extended School Year - ESY *

Mark only one oval.

Yes - Required
No - Not Required
Other:

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MBI Annual Review IEP Meetings 3/10/17, 11(44 AM

28. Will this student be taking the SC-ALT at the end of the 2015-2016 school year? *
Mark only one oval.

Yes
No

29. Spring MAP Reading Percentile

30. Spring MAP Language Percentile

31. Spring MAP Math Percentile

32. SC Ready 2016 ELA

Mark only one oval.

Exceeds
Meets
Approaches
Does Not Meet

33. SC Ready 2016 Writing

Mark only one oval.

Exceeds
Meets
Approaches
Does Not Meet

34. SC Ready 2016 Math

Mark only one oval.

Exceeds
Meets
Approaches
Does Not Meet

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MBI Annual Review IEP Meetings 3/10/17, 11(44 AM

35. PASS 2016 Science

Mark only one oval.

Exemplary
Met
Not Met

36. PASS 2016 Social Studies

Mark only one oval.

Exemplary
Met
Not Met

37. Notes:

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