Jesse+Brown's+IEP

= Individual Education Program Page 1  =|| Student Name Jesse Brown || Meeting Date 1-27-2011 |||||| Purpose of Meeting Initial Eligibility, IEP, Placement Annual Review of IEP Three Year Reevaluation Dismissal from Services Date: _______________________ Parent Request Other: __________________________________________ || 1/27/2011 |||||| Discussed evaluation results/progress/assessment method Yes **____** (Parent/Guardian initial) Copy of evaluation results received Yes **____** (Parent initial) || Indian ||^  ||||||^   || Madison Elementary School || Annual Review Date 1/27/2012 |||||| **Yes (If yes, attach applicable transition pages.)** || Madison Elementary School || Parent/Guardian Name, Address, Phone Susan Wolfe Wyoming Hm: Wk: |||||| Student is eligible for special education or special education and related services as determined by the IEP team Yes No  An annual copy of Parent/Guardian Rights was received and reviewed __Dec 21, 2010_(Date) ________ (Parent/Guardian Initial) || 1/27/2011 ||^  ||||||^   || 1/27/2014 ||  Parent/Guardian Name, Address, Phone Niles Brown 2020 UPS #101 Madison, SD 57042 Hm: 256-1141 Wk: |||||| A copy of the IEP was provided to parent/guardian Yes _______ (Parent/Guardian Initial) || Parent/Guardian Niles Brown |||||| ** Signature ** || Date 1/27/2011 || |||||| || || Jesse Brown |||||| || || Ms. Brown Principal |||||| || || Ms. Jensen |||||| || || Tamara Christensen |||||| || || |||||| || || |||||| || || Mr. Bovill |||||| || || Ms. Art |||||| || || Ms. Hepper |||||| || || Mr, Shay ||||||  || || Disabling Condition 0500-D/B 0505 -ED  0510-CD  0515-HL   0525-SLD 0530-MD 0535-OI  0540 –VL  0545 –D  0550-S/L 0555-OHI 0560-A  0565-TBI  0570-DD A. Minutes per week in Special Education **_300_____** **__Minutes__** **__Services__** B. Minutes per week in Related Services __________ __________ __________ __________  __________ __________  C**. A + B = (Total minutes of Special Education/Related Services)** _**_300______** |||| ** Placement ** 0100 General Class with Modifications 80-100% 0110 Resource Room 40-79% 0120 Self-Contained Classroom 0-39% 0130 Separate Day School 0140 Residential Facility 0150 Home/Hospital 0315 Early Childhood Setting 80-100% 0325 Early Childhood Setting 40-79% 0330 Early Childhood Setting 0-39% 0335 Separate Class 0345 Separate School 0355 Residential Facility 0365 Home 0375 Service Provider Location || ||
 * ** Madison School District **
 * Student Information Management System (SIMS) Number || Age 10 Grade 4 ||||||^  ||
 * ^  || Date of Birth 10-19-2000 ||||||^   ||
 * Male Female || Date Services Begin
 * Ethnicity: (W,B,I,H,A)
 * School of Residence
 * *Transition Planning Needed ** ** No **
 * Attendance Center
 * Date of Eligibility Determination:
 * ===== Three Year Reevaluation Due By:  =====
 * ===== IEP Team Membership =====
 * Parent/Guardian
 * Student
 * Superintendent/Designee
 * General Classroom Teacher
 * Special Ed ucation Teacher
 * Speech/Language Pathologist
 * Evaluator
 * Title Bus Driver
 * Title Art Teacher
 * Title Counselor
 * Title PE Teacher
 * ** Child Count Information (Required Information) **
 * ** Parent/Guardian declines all special education services **
 * Parent/Guardian Signature: _____________________________________________________________________ ** ||

** Present Levels of Academic Achievement and Functional Performance Page 2** Based on evaluation, include 1) ** strengths and weaknesses ( **academic achievement (skill based assessment) and functional performance) in each skill areas affected by the student’s disability, including transition; 2) ** parent input **; and 3) ** how the student’s disability affects the student’s ** ** involvement and progress in the general education curriculum. ** (For a preschool child, how the disability affects his/her participation in appropriate activities.) || ** Student Name: **  ** READING **    The school psychologist has recently diagnosed Jesse, a fourth grader, with a reading disability. Jesse’s achievement results include the following:   - Kaufman Test of Educational Achievement: Reading Standard Score–80    - Kaufman Test of Educational Achievement: Math Standard Score–105    - Curriculum-based measurement: Reads second-grade-level passage with 93 correct words per minute with 4 errors and 70 percent comprehension. - Curriculum-based measurement: Reads third-grade-level passage with 60 correct words per minute with 8 errors and 50 percent comprehension. Jesse will struggle to keeping up with the reading in the regular classroom…his comprehension will prevent him from learning the material expected…slow reader…Jesse refuses to work on skills at home so it will be difficult to catch up. || · **  Strengths & Needs (Academic achievement (skill based assessment) AND functional performance)  ** · ** Transition Areas (strength and needs) (must be in the student’s IEP by age 16)  ** · ** How the student’s disability affects his/her involvement/progress in the general education curriculum  ** · ** Parent input  **
 * Jesse Brown ** || ** IEP Date: **
 * 1/27/2011 ** ||
 * Strengths: ** Jesse likes to be outside…likes reading books about hunting…his teacher from another school has reported that he has more potential than he shows.
 * Strengths: ** Jesse likes to be outside…likes reading books about hunting…his teacher from another school has reported that he has more potential than he shows.
 * Weaknesses ** : He is experiencing extreme difficulty with 4th grade work. He has poor reading skills, which tend to affect his writing, spelling, math, science, and social studies. His classroom teacher reports that he is rarely on task, is very distractible, and does very little homework and of low quality.
 * Transition: N/A **
 * Parent Concerns: ** Jesse does not bring homework home and when he does he refuses to do it!
 * How the student’s disability affects his involvement/progress in the general education curriculum: **
 * * ****  Remember to address:  **
 * ** Consideration of Special Factors Page 3**

If the answer to this question is “yes”, please explain the language needs of the student as these needs relate to the student’s IEP. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ || If the answer to this question is “yes”, what direct instruction will be provided in the student’s mode of communication? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ || If the answer to this question is “yes”, what Braille services will be provided? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ || If yes, what strategies are required to appropriately address this behavior, including positive behavioral interventions and supports? ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ **Assistive Technology Devices and Services?** Yes  No  If yes, what device or service will be provided? **_____________________________________________________________________** **________________________________________________________________________________________________________________________________________________________________________________________________________________________**
 * Is the student limited English proficient?** Yes No
 * **Are there any special communication needs?** Yes No
 * **Does the student require Braille?** Yes No
 * **Does the student’s behavior impede his or her learning or that of others?** Yes  No
 * Physical Education:** Regular  Not Required  Adaptive: Refer to Goals/Goals & Objectives

Describe the monitoring process/frequency necessary for maintenance: __________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________ || 1. Student will be taking state and district wide assessments with or without accommodations. (Accommodations will be determined on page 7.) (Annual goals required) 2. Student will be taking an alternate assessment (The alternate assessment is for students working in the alternate achievement standards) (Annual goal and short term objectives required) a. Does the student meet the significant cognitive disability criteria? (If no, student is not eligible to take the alternate assessment) Yes  No b. Explain the reason why the student cannot participate in the regular assessment. __________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ___________________________________________________________________________________________________
 * Hearing Aid Maintenance**: Not Applicable  Yes: Personnel Responsible for Monitoring ____________________________
 * **__ Assessment __**

c. Explain the reason why the alternate assessment selected is appropriate for this student_____________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________

3. State and/or district-wide assessments are not required at this student’s grade level during the course of this annual IEP. ||  ||  When given a 3rd grade passage Jesse will increase his reading fluency from 60 WPM to 100 WPM on 9 out of 10 consecutive assessments. When given a 3rd grade passage Jesse will increase his reading comprehension from 50% to 90% on 9 out of 10 consecutive assessments. When given a 3rd grade passage Jesse will decrease his reading errors from 8 errors to less than 3 errors on 9 out of 10 consecutive assessments. || **Proc. Code/s** || **Date**   || = Prog. = <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**Code** |||||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**Comments:** <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">P <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">P |||||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">1st qt 65 WPM <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">2nd qt 70 WPM <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">3rd qt 90 WPM || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || ==<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> Code == |||||||||| =<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> Comments:  = || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> |||||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; 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mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**1.____________________________________________________________________** <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**2.____________________________________________________________________** <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**3.____________________________________________________________________** <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**4.____________________________________________________________________** <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**5. ___________________________________________________________________­_** <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> |||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">** Frequency ** <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">** __________ ** <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**________________________________** || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">** Location ** <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**________________________________________** || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">** Begin Date ** <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**________________________________________** || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">** Duration ** <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**________________________________________** || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> |||| ** Frequency ** ==<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> == || ** Location ** ==<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> == || ** Begin Date ** ==<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> == || ** Duration ** ==<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> == || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> 1. Teacher-made tests 6. Work Samples <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> 2. Observations 7. Portfolios <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> 3. Weekly tests 8. Oral Tests <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> 4. Unit tests 9. Data Response <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> 5. Student Conferences 10. Other: |||||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**__ Progress Codes __** <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">** P= ** Progress being made <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">** I= ** Insufficient Progress to meet goal <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">** X= ** Not addressed this Reporting Period <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">** M= ** Met goal |||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">__ Reporting Frequency to Parents __ <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> Quarterly Reports <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> Trimester Reports Other: _______ <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**__ Reporting Method to Parents __** <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> Conferences Report Card <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> Goal Page Copy Other:  || ** Educational Goals and Objectives/Benchmarks ** **Page 5 ___** ** Related Services to Be Provided Page 6 **
 * =<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> Student Name = |||||||||||||| =<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> Title of Personnel Responsible  =
 * =<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> Measurable Annual Goal #_____ =
 * ^  || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">8 || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">1st qt || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">P
 * ^  || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">8 || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">1st qt || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> |||||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">
 * ^  || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">8 || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">1st qt || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> |||||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">
 * ^  || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> |||||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">
 * <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**Short Term Instructional Objectives or Benchmarks** (Required for students who take alternate assessments aligned to alternate achievement standards. || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">** Proc. Code/s ** || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**Date** || =<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> Prog. =
 * <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || ==<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> ==
 * ^  || ==<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> == || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> |||||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">
 * ^  || ==<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> == || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> |||||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> ||
 * ^  || ==<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> == || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> |||||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">
 * <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">
 * ^  || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> |||||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">
 * ^  || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> |||||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">
 * ^  || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> || <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> |||||||||| <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">
 * ==<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> Accommodations/Modifications/Supplementary Aides and Services ==
 * ==<span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;"> Statement of the program modifications or supports for school personnel (as appropriate): ==
 * <span style="mso-element-anchor-horizontal: margin; mso-element-anchor-vertical: paragraph; mso-element-frame-hspace: 9.0pt; mso-element-left: center; mso-element-top: 16.25pt; mso-element-wrap: around; mso-element: frame; mso-height-rule: exactly; tab-stops: 152.1pt;">**__ Procedure Codes (Complete at IEP meeting) __**

|| || || || || || || || || || || || || || || rehabilitation counseling) || || || || || || || || || || || || || || || || || || || || || || || || || || || || || || where, distance, costs, etc.) || || || || || || || === === || === === || === === || only) || || || || || || || || || || || || || || || || || || || || || || || || ||  ** __State/District Assessment Accommodations__ Page 7 **   1.  Student will be taking the assessment without accommodations.   2.   Student will be taking the assessment with the accommodations.   (Only those accommodations identified for instruction on the goal pages can be considered for state and district wide testing. The accommodations selected for use must relate to the students disability.)  Grades 3-4-5-6-7-8-11 Grades 5-7& 9 District Specific Tests  Reading Area(s)  Will be given extra timeto complete. Given extra time to complete. ______________________  ____________________________ ______________________________ ____________________________   ____________________________ ______________________________ ____________________________  ____________________________ ______________________________ ____________________________   Grade 8  Math ** Technology Assessment **  _None______________________ ______________________________ ____________________________  ____________________________ ______________________________ ____________________________  ____________________________ ______________________________ ____________________________  ____________________________ ______________________________ ____________________________ Grades 5-8-11 Science Will have read to him.__________ ______________________________ ____________________________ ____________________________ ______________________________ ____________________________ ____________________________ ______________________________ ____________________________  ** All accommodations documented in the IEP are allowed to be used for students taking the alternate assessment. **     ||    **Least Restrictive Environment** **Page 8**
 * ** Related Service to be Provided ** ||  ** Title of Person Responsible **  ||  ** Amount of Service **  ||  ** Location of Service **  || ** Duration of Service ** (If less than duration of IEP) ||
 * **A. Occupational Therapy**
 * **B. Physical Therapy**
 * **C. Psychological Services**
 * **D. Counseling Services** (including
 * **E. Social Work Services** (in schools)
 * **F. Audiological Services**
 * **G. Recreation Therapy**
 * **H. School Nurse/Health Services**
 * **I. Speech/Language Therapy**
 * **J. Transportation** (Specify when, how often,
 * **K. Orientation and Mobility**
 * **L. Medical Services** ** ( ** Diagnostic Services
 * ** M. Interpreting Services **
 * ** N. Parent Counseling/Training **
 * ** O. Other **
 * ***Teams must consider if the accommodations are approved for the applicable test administration. **
 * ***List the accommodations the student will be taking for each test/test area. **
 * Dakota STEP ** **Write To Learn** **Name:**
 * * Alternate Assessment **

0100 General Classroom with Modifications 80-100% 0110 Resource Room 40-79% 0120 Self-Contained Classroom 0-39% 0130 Separate Day School 0140 Residential Facility 0150 Home/Hospital |||| __ Description of services __ __Amount of service__ __Location of service__ Reading remediation 45 min per day Resource Room Behavior/Study/Social Skills 15 min per day Resource Room || Art Industrial Technology Music |||| Vocational Education Family & Consumer Science Other____________________ || ** Comments ** || Counseling Meals Employment Referrals |||| Recess Health Services Other____________________ || ** Comments ** || Athletics Clubs Groups |||| Recreation Other____________________ || ** Comments ** || // Regular classroom with modifications. Accept. Jesse shows that he should be able to work in the regular classroom due to his ability levels. // // Potential harmful effect: Jesse may not succeed due to his behaviors. // //The team addressed the potential harmful effects of the special education placement.// || ** Extended School Year Page 9** (Refer to IEP Addendum) || ** mm/dd/yy ** ||  **Ending Date** **mm/dd/yy** ||  **Minutes** **Per Week** ||  ****Based on**   ||
 * ** Continuum of Alternative Placements **
 * // 60 minutes per day 300 minutes per week //** ||
 * ** Special Ed **** ucation to be provided: **
 * ** Participation with Non-Disabled Peers (Complete for all students Ages 6-21) ** ||
 * ==== Program Options ====
 * ==== Non-Academic ====
 * ==== Extracurricular ====
 * **// Justification for Placement--An explanation of the extent, if any, to which the child will not participate with non-disabled children in regular classes, and non-academic activities. (Please use accept/reject format for each alternative placement considered.) //**
 * **Extended School Year Services:** needed  not needed  to be determined by (Date) ______/______/______
 * **Goal(s) #** ||  ***Type of Service**  ||  **Beginning Date**
 * Instruction, related services (specify), other (list)
 * Instruction, related services (specify), other (list)
 * Instruction, related services (specify), other (list)
 * Instruction, related services (specify), other (list)
 * Instruction, related services (specify), other (list)
 * Instruction, related services (specify), other (list)
 * Instruction, related services (specify), other (list)
 * Instruction, related services (specify), other (list)
 * Instruction, related services (specify), other (list)
 * Instruction, related services (specify), other (list)
 * Instruction, related services (specify), other (list)


 * Regression/Recoupment, Emerging Skills, or Maintenance of Critical Life Skills

||


 * =__ Parent/Guardian Consent Required For Initial Placement Only __=

“Consent” means that the parent(s)/guardian(s) have been fully informed of all information relevant to the activity for which consent is sought, in the native language, or other mode of communication; the parent(s)/guardian(s) understand and agree in writing to the carrying out of the activity for which consent is sought, and the consent describes that activity and lists any records which will be released and to whom; and the granting of consent by the parent(s)/guardian(s) is voluntary and may be revoked in writing at any time.

__________________________________ ________________________ Parent/Guardian Signature Date || __ Clarifying Comments: __