iep guidance document sample - hart.k12.ky.us iep - rachel vi.docx  · web viewaccording to the...

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KDE IEP IEP Guidance Document Sample 1 Individual Education Program (IEP) Kentucky County Public Schools 500 Main Street Riverview, KY 40000 Plan Information Meeting Date: 05/15/12 Start Date: 05/15/12 End Date: 05/14/13 Special Ed Status: Active Special Education Setting: 40-80% of day in general ed. program Primary Disability: Visual Impairment Student Information Student Name: Rachel Lucinda Martinez DOB: 1/1/96 Student Number: 123456 Address: 101 South High Street, Riverview 40000 District of Residence: Kentucky County School of Attendance: Kentucky County High School Grade: 10 Gender : F Race (Ethnicity Code): Hispanic Present Level of Academic Achievement and Functional Performance Present Levels of Academic Achievement and Functional Performance, including how the disability affects the student’s involvement and progress in the general curriculum: (For preschool children include the effect on participation in appropriate activities; Beginning in the child’s 8 th grade year or when the child has reached the age of 14, a statement of transition is included.) Communication Status Performance commensurate with similar age peers Academic Performance Performance commensurate with similar age peers According to the Re-evaluation Report dated 5/3/2012, progress monitoring, curriculum assessment, work samples, and teacher observations, Rachel’s basic reading and listening comprehension are in the average range. She demonstrates average to above average writing abilities on class assignments, research projects, formal and

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Page 1: IEP Guidance Document Sample - hart.k12.ky.us IEP - Rachel VI.docx  · Web viewAccording to the Re-evaluation Report dated 5/3/2012, progress monitoring, curriculum assessment, work

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Individual Education Program (IEP)Kentucky County Public Schools

500 Main StreetRiverview, KY 40000

Plan InformationMeeting Date: 05/15/12

Start Date: 05/15/12

End Date: 05/14/13

Special Ed Status: Active Special Education Setting: 40-80% of day in general ed. program

Primary Disability: Visual Impairment

Student InformationStudent Name: Rachel Lucinda Martinez DOB: 1/1/96 Student Number: 123456Address: 101 South High Street, Riverview 40000

District of Residence: Kentucky County

School of Attendance: Kentucky County High School

Grade: 10

Gender: F

Race (Ethnicity Code): Hispanic

Present Level of Academic Achievement and Functional PerformancePresent Levels of Academic Achievement and Functional Performance, including how the disability affects the student’s involvement and progress in the general curriculum:

(For preschool children include the effect on participation in appropriate activities; Beginning in the child’s 8th grade year or when the child has reached the age of 14, a statement of transition is included.)

Communication Status Performance commensurate with similar age peers

Academic Performance Performance commensurate with similar age peers

According to the Re-evaluation Report dated 5/3/2012, progress monitoring, curriculum assessment, work samples, and teacher observations, Rachel’s basic reading and listening comprehension are in the average range. She demonstrates average to above average writing abilities on class assignments, research projects, formal and informal assessments.

Given standardized math assessments (PLAN and Kaufman Test of Educational Achievement, Second Edition), summative and formative assessment, analysis of work samples, and teacher observation, Rachel’s math calculation and math reasoning skills are well below average. Given the impact of her visual impairment, Rachel struggles to reason abstractly and quantitatively. She struggles to visualize graphical representation of complex math concepts. She struggles to visualize complete math expressions in their entireties. Rather, she focuses on small segments of a problem rather than whole. When presented with a novel math concept such asvarious functions, she does not make connections with previous learning. She quickly applies a known rule or routine and attempts to calculate a response. She does not make sense of the quantities, exploring strategies or alternate solutions (e.g., consider representations of the problem, consider related problems, consider simpler forms of the problem, or refer to previously completed example problems). Rachel

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requires teacher modeling and numerous practices to master a concept and specific instruction to generalize and apply concepts to real world situations. Error analysis of classwork and homework reveal that Rachel chooses an appropriate math strategy with 60% accuracy. She solves math equations for linear and quadratic equations with 30% accuracy. While Rachel efficiently uses a graphing calculator to complete a computational problem (90% accuracy), she struggles to construct a graphic representation of an absolute value function such as determining the output from the domain (40% accuracy). Rachel uses a variety of low vision supports during math class including magnification for the graphing calculator, raised line paper and graph paper. To develop an understanding of math concepts, she needs concrete experiences such as models, manipulatives, and life items. According to teacher report and class observation, Rachel rarely volunteers during class discussion or asks clarifying questions, but she will seek teacher assistance before or after school. Deficits in math calculation and reasoning impact performance in math class, homework assignments, in classes requiring math applications and in real world scenarios.

Health, Vision, Hearing, Motor Ability Performance commensurate with similar age peers

According to an eye medical examination dated 2/15/12, Rachel has a visual diagnosis of Retinopathy of Prematurity (ROP), which limits blood vessel development in premature infants that can lead to bleeding, scarring, and retinal detachment. Rachel’s secondary diagnosis is myopia which is a refractive error of nearsightedness. Rachel’s distance visual acuity with best correction is 20/400 in her right eye and 20/200 in her left eye. She wears glasses at all times. Her full field of vision is approximately 70-80 degrees with both eyes. (A normal field of vision is 180 degrees.) The eye report states that Rachel is legally blind due to acuity and a constricted field of view and further states that Rachel’s visual prognosis is considered uncertain at this time.

Rachel is under the care of a neurologist, because she experiences migraine headaches infrequently (approximately once a month). In the event of a migraine, Rachel reports that she is unable to read print passages and complete written assignments. Rachel has a Health Plan on file related to her migraines.

Orientation & Mobility: Rachel uses a long white cane for travel in unfamiliar indoor areas and when traveling outdoors to compensate for her visual field loss and decreased visual acuity. A relative strength is that she travels independently inside familiar environments including school and her immediate neighborhood (90% accuracy) as measured by her Orientation and Mobility Specialist. A relative weakness is independent travel experience in unfamiliar environments within the community. She is making progress in street crossings at lighted intersections, however she continues to need adult prompts to determine when it is safe to cross (independent street crossing 80% in 10 trials). She has been introduced to route planning using the city’s numbering system (20% accuracy) and map reading (20% accuracy). She needs further instruction in independent street crossing at lighted intersections, route planning using the city’s numbering system, and map reading. Rachel’s restricted visual field, decreased visual acuity and lack of community travel experience negatively impact her ability to travel safely and independently across settings.

Social and Emotional Status Performance commensurate with similar age peers

General Intelligence Performance commensurate with similar age peers

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Transition Needs Not an area of concern at this time (Checking this box is not an option when the student is in the 8th

Grade or 14 years or older because transition must be addressed for these students) Instruction Related Service Community Experience Employment Daily Living Skills Post School Adult Living Objectives Functional Vocational Evaluation

Rachel is a 16 year old 10th grader. She is scheduled to graduate in May of 2014 with a diploma as documented in her Multiyear Course of Study. As a 10th grader she has completed required coursework and she is on track for graduation within four years. Rachel demonstrates good work habits including timely assignment completion, organization of notes and study materials and equipment, and frequent participation in class discussion. She works well in a group. She is a member of the newspaper and yearbook staff.

The following information is gained from Rachel’s Individual Learning Plan, Transition Survey, Student Interview and Career Scope:

Rachel wants to attend a 4-year college starting initially at KY Community and Technical College (KCTC).

Rachel wants to work as a writer, perhaps for a radio or television station. Rachel works well in a group, but she prefers to complete independent tasks in a quiet

environment. Rachel has an interest and talent in vocal music.

Rachel demonstrates Transition Needs in four areas: Instruction, Related Services, Community Experiences and Employment.

Transition Needs: InstructionReading and written language are areas of strength for Rachel. Progress monitoring, classroom assessment and standardized assessment identify significant challenges in math, particularly math reasoning (see baseline data in the Academic Performance section above). Deficits in math impact successful completion of high school coursework (math, science) and potentially math requirements in the college setting.

Braille is a relatively new area of instruction for Rachel and she is making satisfactory progress in code recognition (see baseline data in the Functional Vision Learning Media Assessment section). Future skill development is warranted for code recognition, code rules, reading fluency and Braille writing. Rachel needs continued instruction in Braille to provide alternate media to print given her uncertain visual prognosis and difficulties with vision when experiencing migraines.

When given adapted materials or equipment in a small group setting, Rachel successfully uses the adapted materials and equipment. She requires adult assistance to identify and access reading materials for school use and for leisure reading. Rachel is hesitant to make requests for accommodations or assistance in school (large group) and the community for fear of drawing attention to her eye condition (see baseline data in the Functional Vision/Learning Media Assessment section). Accessing materials and self-determination skills are fundamental to Rachel’s successful transition to college and career. Deficits in materials access and self-determination will negatively impact Rachel’s ability to function independently across high school settings, a college campus and in employment settings.

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Transition Needs: Related ServicesWhile Rachel is an independent traveler on the high school campus, she requires orientation to new settings (see baseline data in the Health, Vision section). She needs continued instruction for independent traveling within the community, for participation in extracurricular activities, for future employment and college campus travel.Decreased visual acuity and loss of visual field adversely affects Rachel’s ability to travel safely and independently in unfamiliar environments.

Transition Needs: Community ExperienceAccording to her Individual Learning Plan (ILP) and the Functional Vision/Learning Media Assessment, Rachel’s community experience is limited to her high school friends and high school programming. In order to successfully transition to college and career preparation, she needs an introduction to adult services, as well as community and college opportunities (baseline 0% for adult service awareness). Rachel has a picture identification card from her high school, yet no other form of picture identification which is needed for community volunteer opportunities, employment, and college enrollment. She needs a state identification card. Rachel will benefit from an exploration of services offered by the Office for the Blind. Further, Rachel needs to explore participation in community and college programs that provide post-secondary supports and opportunities (e.g., volunteer opportunities, leisure activities, college, career, and work experiences). A limited awareness of community and college opportunities and adult services can negatively impact Rachel’s successful post-secondary transition.

Transition Needs: EmploymentGiven strengths in written language, Rachel is interested in a career in writing in television or radio (see Individual Learning Plan—ILP). She attributes this employment interest to a recent television documentary highlighting an individual with a disability employed as a television writer. At present, she has limited awareness of careers for writers. She will benefit from research in careers related to writing. Rachel may gain insight to employment opportunities given the opportunity to network with an adult mentor who is blind/visually impaired and employed in the writing field. Rachel is interested in exploring the various ways colleges offer coursework including campus based class versus web-based classes. In total, Rachel has limited knowledge of college training options and employment opportunities. This narrow understanding may negatively impact her successful transition to college enrollment and completion and career exploration.

Functional Vision/Learning Media Assessment Not an area of concern at this time

In a Functional Vision/Learning Media Assessment (FVLMA) dated April 16, 2012, Rachel’s primary medium is print with her auditory channel as secondary. She identifies 12-14 point size standard print, bold, black, isolated letters on a white background at a distance of 4-6 inches. Rachel copies 2-3 inch size letters from the board when sitting at a distance 10 feet. Due to her visual acuity and visual field loss, Rachel prefers to sit on the right side of the room when copying materials from the board.

Compensatory or Functional Academic Skills, Including Communication Modes:Rachel requires high contrast materials. She prefers materials that are written in 16-18 point print size using a yellow overlay. Given the results of an informal reading inventory, Rachel reads independently on 10th grade passage when using large print and colored overlays. Rachel’s silent reading rate is 115 words per minute (wpm) with adaptations. The average silent reading rate for students with normal vision at 10th grade is 210-224 wpm. As the passage length increases, Rachel’s reading speed decreases.

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Thus, Rachel needs extended time and short 1-2 minute breaks when reading lengthy assignments (greater than 20 minutes) or an auditory output option. The results of a listening comprehension assessment indicate that Rachel performs at the independent level at grade 10. She uses a typoscope (signature guide) for signing her signature.

Rachel has participated in Braille instruction for the past year. Given progress monitoring results, Rachel mastered 100% of whole word signs, 53% of short form words, and 50% of part word signs in reading and writing in Literary Braille. She enjoys Braille instruction and prefers to select her own reading materials. Rachel is proficient in the use of the Braille writer. Rachel needs continued instruction in Braille due to the nature of Retinopathy of Prematurity and prognosis of her eye condition.

Use of Assistive Technology:Rachel benefits from electronic text and/or auditory output of text for lengthy reading passages. Rachel demonstrates good basic computer skills using built in accessibility features. Following keyboarding instruction in 10th grade, she is able to prepare assignments via word processing. She types 20 words per minute. Rachel’s handwriting is legible. She needs bold-lined paper, bold-lined graph paper and additional writing space. She prefers that writing on a white board be blue or black print to provide a greater contrast. Progress monitoring data indicate proficiency in the use and maintenance of technology and equipment (100% on 5/5 occasions). Rachel prefers large print on worksheets and handouts (16-18 points). She benefits from a bar magnifier, hand held video magnifier or desktop Closed Circuit TV (CCTV) for reading material when enlarged copies are not available. Rachel is a proficient user of the hand held video magnifier and desktop CCTV. Rachel benefits from a reader when completing material under time constraints or when longer passages are presented as her eyes fatigue and reading rate become slower. Rachel requires a scribe for transferring answers to an electronic answer sheet (bubble sheet).

Sensory Efficiency Skills:Rachel is learning Braille as a secondary medium. She demonstrates good tactual skills and is making progress in Braille instruction (see discussion in Compensatory in Functional Academic section). When asked about a vision device needed for a given task, she selects and uses an appropriate device (see discussion in Self-Determination).

Self-Determination:Currently, teaching staff provides all of Rachel’s educational materials including textbooks and adapted materials. An essential skill for college and career readiness is independently accessing reading materials from various resources. At present, she is not familiar with accessing print or auditory materials for educational purposes (0% proficiency). Per progress monitoring data, Rachel requires prompting to explain her eye condition and request needed adaptations in the classroom setting (3/3 occasions). Rachel needs continued development of self-advocacy skills to inform others about her eye condition and to independently access modifications and accommodations.

Of the 9 areas of Expanded Core Curriculum, the following areas are not areas of concern at this time:Social Interaction Skills, Independent Living Skills, Recreation and Leisure Skills. Orientation and Mobility is discussed under the Health, Vision, and Motor Abilities section. Career Education is discussed under the Transition Needs section of the IEP.

Competence in reading and writing in Braille, accessing reading materials for classes and leisure reading, educating others about her eye condition and identifying needed accommodations across settings negatively impact Rachel’s independence in the school and community.

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Consideration of Special Factors for IEP Development(The ARC must address each question below and consider these issues in the review and revision of the

IEP)Does the child’s behavior impede his/her learning or that of others?

Yes NoIf Yes, include appropriate strategies, such as positive behavioral interventions and supports in the statement of device and services below.

Does the child have limited English proficiency? Yes No

If Yes, what is the relationship of language needs to the IEP?

Is the child blind or visually impaired? Yes No If Yes, the team must consider: Is instruction in Braille needed? Yes No Is use of Braille needed? Yes No Will Braille be the student’s primary mode of communication? Yes No (See evaluation data for supporting evidence)

Does the child have communication needs? Yes No If Yes, please specify below: See Present Levels for Communication Status Other (Specify):

Is the child deaf or hard of hearing? Yes No If Yes, the team must consider: The child’s language and communication needs; Describe:

See Present Levels for Communication Status Other (Specify):

Opportunities for direct communications with peers and professional personnel in the child’s language and communication mode, academic level and full range of needs; Describe:

Any necessary opportunities for direct instruction in the child’s language and communication mode. Describe:

Are assistive technology devices and services necessary in order to implement the child’s IEP? Yes No

If Yes, include appropriate devices in the ‘Statement of Devices/Services’ below.

Statement of Devices/Services: If the ARC answered Yes to any of the above, include a statement of services and or devices to be provided to address the above special factors.

See Specially Designed Instruction See Supplemental Aids and Services See Behavior Intervention Plan Other (Specify):

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Measurable Annual Goals and BenchmarksAnnual Measurable Goal (#1):Given 10 math reasoning problems requiring the application of varying mathematical strategies weekly, Rachel will analyze the problem, consider options for expression, create a representations of the problem with 80% accuracy in 4/5 consecutive work samples.

Method of Measurement:Indirect: Work Samples, RubricDirect: Observation

Specially Designed Instruction:Review of previously learned mathematical strategies for application and generalizationInstruction in creating varied representations of a problemInstruction in creating and using models, manipulatives and real life experiences to express a problemInstruction in matching mathematical strategies to individual math problemInstruction in a step by step process for solving equations (e.g., analysis, conjecture, solution generation; consideration of analogous problems, monitor, evaluate, adjustment)Instruction in identifying alternate approaches for solving an equation

This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the area(s) of:

Education/training Employment Independent living

Benchmarks/Short Term Instructional Objectives1. Rachel will identify the varying types of representations to communicate the meaning of a given

problem in 4/5 consecutive work samples.2. Given alternate approaches and strategies in solving equations, Rachel will choose the

appropriate strategy. 3. Rachel will identify and apply a step by step process for solving an equation. 4. Rachel will solve equations using varied mathematical strategies.

Annual Measurable Goal (#2):Given a 50 word grade level passage written in contracted Braille with short form words, part-word signs, and Dot 5 words, Rachel will tactually decipher the rules of the Braille code and read the passage aloud with 90% accuracy on 4/5 occasions.

Method of Measurement:Indirect: Work samplesDirect: Checklist

Specially Designed Instruction:

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Direct instruction Braille rules of short form words, part-word signs, Dot 5 words

This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the area(s) of:

Education/training Employment Independent living

Benchmarks/Short Term Instructional Objectives1. Rachel will tactually read sentences with short form words.2. Rachel will tactually read sentences with part-word signs.3. Rachel will tactually read sentences with Dot 5 words.

Annual Measurable Goal (#3):Given a 50 word grade level passage, Rachel will write the passage in the contracted Braille code using short form words, part-word signs, and Dot 5 words with 90% accuracy on 4/5 occasions.

Method of Measurement:Indirect: Work samplesDirect: Checklist

Specially Designed Instruction:Direct instruction Braille rules of short form words, part-word signs, Dot 5 words

This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the area(s) of:

Education/training Employment Independent living

Benchmarks/Short Term Instructional Objectives1. Rachel will write sentences using short form words.2. Rachel will write sentences using the part-word signs.3. Rachel will write sentences using Dot 5 words.

Annual Measurable Goal (#4):Given an assignment to use specific classroom textbooks or materials, Rachel will independently research resources or potential vendors, locate the desired material and download or prepare an order with 80% accuracy 3/4 occasions.

Method of Measurement:Indirect: Checklist, Work sample

Specially Designed Instruction:Direct instruction in accessing alternate formats of text, scanning products and placing an order.

This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the area(s) of:

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Education/training Employment Independent living

Benchmarks/Short Term Instructional Objectives1. Given computer/internet access to research available format of texts, Rachel will locate textbooks

for each high school class using the course description, and ISBN number of text.2. Rachel will use a computer and Internet to download textbooks or novels in digital format.3. Rachel will use a computer and Internet to prepare an order for materials (e.g., large print, ASCII)

Annual Measurable Goal (#5):Given formal and informal opportunities, Rachel will independently educate others about her eye condition and identify needed accommodations for a given setting with 80% accuracy on 5/6 occasions.

Method of Measurement:Indirect: Checklists, rubric, work samples

Specially Designed Instruction:Direct instruction in understanding her eye report and IEPDirect instruction in self-advocacy strategy

This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the area(s) of:

Education/training Employment Independent living

Benchmarks/Short Term Instructional Objectives1. Rachel will identify and access accommodations for a structured classroom situation.2. Rachel will identify and access accommodations for a non-structured setting (e.g., assembly,

yearbook staff activity, library research)3. Rachel will prepare a presentation explaining her vision condition and post-secondary goals for

her next IEP meeting (e.g., Power Point, handout, brochure).4. Given school visits from universities and colleges, Rachel will prepare questions and inquire

about disability supports.

Annual Measurable Goal (#6):When traveling in unfamiliar territories, Rachel will demonstrate 4/4 steps to safely and independently cross the street at lighted intersections over 3 consecutive lessons.

Method of Measurement:Direct: Checklist

Specially Designed Instruction:Direct instruction in recognition of traffic patterns and traffic movement, structure of intersectionsDirect instruction in the use of long white caneDirect instruction in use of enlarged maps

This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the

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area(s) of:

Education/training Employment Independent living

Benchmarks/Short Term Instructional Objectives1. Rachel will identify/distinguish parallel and perpendicular traffic surges.2. Rachel will identify intersection shape (T, plus, Y, offset).3. Rachel will correctly analyze traffic patterns & identify turning cars.

Annual Measurable Goal (#7):When presented with the task of locating an unfamiliar destination, Rachel will utilize the city’s numbering system and an enlarged map to safely and independently plan, travel and locate the destination with 90% accuracy on 4/4 occasions.

Method of Measurement:Direct: Checklist

Specially Designed Instruction:Direct instruction in community numbering systemDirect instruction in use of enlarged maps

This annual goal will reasonably enable the student to meet the student’s postsecondary goal in the area(s) of:

Education/training Employment Independent living

Benchmarks/Short Term Instructional Objectives1. Rachel will locate the central dividing line for north/south and east/west streets on an enlarged

map.2. Rachel will distinguish odd and even sides of the street.3. Rachel will locate specific destinations by address.

Reporting Progress Concurrent with the issuance of Report Cards Other, specify

Supplementary Aids and ServicesStatement of Supplementary Aids and Services, to be provided to the child on behalf of the child.

Long white caneLarge print materialsBold-lined paper with glare reduction, bold-lined graph paperHigh contrast materials, yellow overlays or typoscopeUse of blue or black print “only” for white board presentationsBraille reading materials

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Bar magnifier, hand held video magnifier or desktop CCTV when large print materials are not availableElectronic text and/or auditory outputGraphing calculator with low vision deviceReader in the event that auditory output of text is not availableScribe for electronic answer sheet (bubble form)Computer with internet accessPreferred seating at the right side of the classroom for demonstrations, presentations and copying materials from the boardThe ability to move about the classroom for best viewingExtended time for assignments involving reading and writingShort break (1-2 minutes) during reading periods of greater than 20 minutesFading verbal prompts/cues

Accommodations for Administration of State Assessments and Assessments in the ClassroomIn order to justify appropriateness of accommodations for any state mandated tests, the testing accommodations must be used consistently as part of routine instruction and classroom assessment as well as meet all additional requirements established by the Inclusion of Special Populations in the State-Required Assessment and Accountability Programs,703 KAR 5:070 document.

ARC determined no accommodations needed.

Readers ScribesParaphrasingReinforcement and behavior modification strategiesPrompting/cueing Use of technologyManipulatives BrailleInterpreters Extended timeOther: specify

Rachel needs electronic text or auditory materials, or large print materials with a yellow overlay to reduce glare if assessment is on white paper. She requires an auditory output of the assessment when experiencing migraines or eye fatigue. A reader is necessary only when auditory output of text is not available. A scribe is needed only in the event of an electronic answer sheet (bubble sheet) or migraine.

Student has been determined eligible for participation in the Alternate Assessment Program. Complete the Participation Guidelines for the KY Alternate Assessment form if selecting this checkbox. If determined eligible for the Alternate Assessment, the ARC must determine if the student is Dimension A or Dimension B.

Dimension A Dimension B

Program Modifications/Supports for school personnel that will be providedSupports for school personnel:

At the beginning of the year and with any teacher change (trimester schedule), the vision teacher will provide training for the special education teacher and regular class teachers regarding Rachel’s Supplementary Aids and Services. The vision teacher will provide monthly consultation sessions with the

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special education and regular class teachers regarding implementation of the Supplementary Aids and Services.

Rachel requires an adult sighted guide for exiting the building during emergency events.

Not needed at this time

Least Restrictive Environment (LRE) and General EducationExplain the extent, if any, to which the student will not participate in general education (content area):

Special Education: Math, Expanded Core Curriculum (Braille, Self-Determination, Orientation & Mobility)

Regular Class: English, Social Studies, Science, Electives

Special Education Services

Type of Service

Anticipated Frequency and Duration of ServiceService

Provider(by

Position)

Location(e.g., Regular Classroom, Resource

Room, Separate Class)

Service Minutes

(Per Service

Frequency)

Service Frequenc

y(Number of times provided

per Service Period)

Service Period(Daily,

Weekly, Monthly, Annually)

Start Date

End Date

Special Educatio

n

50 minutes 1.0 Daily 5/15/12 5/14/13 Special Education Teacher

Resource for Math

Special Educatio

n

50 minutes 4 times Weekly 5/15/12 5/14/13 Teacher of the Visually Impaired

Resource for ECC – Braille, Self-Determination

Related Services

Type of Service

Anticipated Frequency and Duration of ServiceService

Provider(by

Position)

Location(e.g.,

Regular Classroom, Resource

Room, Separate

Service Minutes

(Per Service

Frequency)

Service Frequency(Number of times provided

per Service Period)

Service Period(Daily,

Weekly, Monthly, Annually)

Start Date

End Date

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Class)Orientation

and Mobility Services

50 minutes 1 time Weekly 5/15/12 5/14/13 Orientation & Mobility Specialist

School and Communityfor O & M

Extended School YearAre extended school year services required for this student? Yes No More data needed

If the ARC determines ESY services are to be provided, describe the service and indicate to which annual goal or goals the service is related. If the ARC determines no ESY services are to be provided, please document the reason(s) for this decision.

Progress monitoring does not indicate a regression/recoupment delay for Rachel.

Transition Service Needs(Beginning in the child’s 8th grade year or when the child has reached the age of 14 and thereafter)

What transition assessments were used to determine the child’s preference and interests? (Check all that apply)

Student Interview Student Survey Student Portfolio Vocational Assessments Interest Inventory Parent Interview Career Awareness Career Aptitude ILP Other:

Does the student’s Individual Learning Plan (ILP) include the student’s course of study?

No If No, do not proceed with development of IEP until ILP is initiated, including the child’s course of study.

Yes (See student’s attached course of study to include current school year through graduation or exiting special education)

Do transition service needs focus on child’s course of study and are they addressed in Present Levels?

No Yes

Postsecondary Goal(s)(By age 16, or younger if appropriate, and thereafter)

(Postsecondary Goal(s) Related to Education/Training, Employment, and if needed, Independent Living:

Education/Training and Employment: Upon graduation from high school, Rachel’s goal is to attend a community college (KCTC) and major in writing to become a writer for the television or radio industry.

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Transition Service Agency Responsible Provide information post-secondary opportunities (e.g., KSB

summer programming, INSIGHT program) Completion of coursework leading to a diploma. Provide contact information for the Office for the Blind and

invite representative from OFB to the next annual review. Contact disability office at KCTC to explore supports (O &

M) Site visit to KCTC Provide assistance for obtaining State Identification Card Provide information for accessing a mentor in chosen field of

interest Career awareness and exploration via the ILP

KCHS staff

KCHS Staff KCHS staff

KCHS staff KCHS staff KCHS Staff KCHS Staff KCHS Staff

Transfer of Rights at Age of MajorityIf applicable, one year before the student reaches age 18 the student and parent have been informed of the student’s rights under Part B of the Individuals with Disabilities Education Act, if any, that will transfer on reaching the age of majority.

Date student was first informed of the transfer of rights: 5/15/12