Description
Create a 15-20 slide professional development presentation for general education teachers on the topics of IEPs, inclusion, and team teaching. Include a title slide, reference slide, and presenter’s notes.
Address the following within the presentation:
- Provide a synopsis for each section of an IEP.
- Describe an inclusion classroom setting and when it is beneficial for special education students; include specific examples of special education students appropriately and inappropriately placed in an inclusive setting.
- Describe 3-5 team teaching models and include benefits and drawbacks of each.
- Provide and describe three additional team teaching strategies appropriate for modifications in an inclusive setting.
Use the attached IEP templates to inform the assignment. Support your presentation with a minimum of three scholarly resources.
While APA format is not required for the body of the assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines.
EXTRA INFORMATION THAT MAY HELP IN ASSIGNMENT
1. A Guide to the Individualized Education Program
Read “Individualized Education Programs: Process and Procedures for Developing IEPs for Students with Disabilities,” located on the U.S. Department of Education website.
http://www2.ed.gov/parents/needs/speced/iepguide/index.html
2. Inclusion Classrooms and Teachers: A Survey of Current Practices
Read “Inclusion Classrooms and Teachers: A Survey of Current Practices,” by Kilanowski-Press, Foote, and Rinaldo, from the International Journal of Special Education (2010).
http://files.eric.ed.gov/fulltext/EJ909035.pdf
RUBRIC
Professional Development: IEPs, Inclusion, and Team Teaching
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100.0 %Criteria |
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20.0 %Professional Development: IEPs |
No submission. |
Presentation fails to provide synopses of IEP sections. |
Presentation includes inadequate synopses of IEP sections. |
Presentation includes adequate synopses of IEP sections. |
Presentation includes thorough and clear synopses of IEP sections. |
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30.0 %Professional Development: Inclusion |
No submission. |
Presentation fails to include a description of an inclusion classroom setting or rationalization of appropriately and inappropriately placed special education students. |
Presentation includes an insufficient description of an inclusion classroom setting. Rationalization of appropriately and inappropriately placed special education students is provided, but is lacking. |
Presentation includes a detailed description of an inclusion classroom setting. Adequate rationalization of appropriately and inappropriately placed special education students is provided. |
Presentation includes a professional and detailed description of an inclusion classroom setting. Comprehensive and clear rationalization of appropriately and inappropriately placed special education students is provided. |
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35.0 %Professional Development: Team Teaching |
No submission. |
Presentation fails to include descriptions of team teaching models or benefits and drawbacks of each. Descriptions for additional team teaching strategies are not provided. |
Presentation includes inadequate descriptions of team teaching models and inappropriately includes benefits and drawbacks of each. Incomplete descriptions for additional team teaching strategies are provided and are inappropriate for modifications in an inclusive setting. |
Presentation includes adequate descriptions of team teaching models and appropriately includes benefits and drawbacks of each. Descriptions for additional team teaching strategies are provided and are appropriate for modifications in an inclusive setting. |
Presentation includes comprehensive descriptions of team teaching models and appropriately includes benefits and drawbacks of each. Complete descriptions for additional team teaching strategies are provided and are appropriate for modifications in an inclusive setting. |
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5.0 %Layout |
No submission. |
The layout is cluttered, confusing, and does not use spacing, headings and subheadings to enhance the readability. The text is extremely difficult to read with long blocks of text and small point size of fonts, inappropriate contrasting colors, poor use of headings, subheadings, indentations, or bold formatting. No notes that script the presentation are included. |
The layout uses horizontal and vertical white space appropriately. Sometimes the fonts are easy-to-read, but in a few places the use of fonts, italics, bold, long paragraphs, color or busy background detracts and does not enhance readability. Minimal notes are present to script the presentation. |
The layout background and text complement each other and enables the content to be easily read. The fonts are easy-to-read and point size varies appropriately for headings and text. Notes are present to script and facilitate the presentation. |
The layout is visually pleasing and contributes to the overall message with appropriate use of headings, subheadings and white space. Text is appropriate in length for the target audience and to the point. The background and colors enhance the readability of text. Notes are well written and facilitate the delivery of the script in the presentation. |
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5.0 %Mechanics of Writing |
No submission. |
Slide errors are pervasive enough that they impede communication of meaning. |
Some mechanical errors or typos are present, but are not overly distracting to the reader. |
Slides are largely free of mechanical errors, although a few may be present. |
Submission is nearly/completely free of mechanical errors. |
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5.0 %Title and Research Citations Sources |
No submission. |
Contains no title slide, no References section, and no correctly cited references within the body of the presentation. |
Title slide has minor errors. References section includes sources, but they are not cited consistently or correctly. Citations are included within the body of the presentation, but with some errors. |
Title slide has minor errors. References section includes sources, but not consistently cited correctly. References included within the body of the presentation, but with some citation errors. |
Title slide is complete. References section includes correctly cited sources. References within the body of the presentation are included and correctly cited. |
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100 %Total Weightage |
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School District Identifying Information
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
STUDENT NAME:
DATE OF BIRTH:
LOCAL ID #:
PROJECTED DATE IEP IS TO BE IMPLEMENTED:
DISABILITY CLASSIFICATION:
PROJECTED DATE OF ANNUAL REVIEW:
PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS
DOCUMENTATION OF STUDENT’S CURRENT PERFORMANCE AND ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS
EVALUATION RESULTS (INCLUDING FOR SCHOOL-AGE STUDENTS, PERFORMANCE ON STATE AND DISTRICT-WIDE ASSESSMENTS)
ACADEMIC ACHIEVEMENT, FUNCTIONAL PERFORMANCE AND LEARNING CHARACTERISTICS
LEVELS OF KNOWLEDGE AND DEVELOPMENT IN SUBJECT AND SKILL AREAS INCLUDING ACTIVITIES OF DAILY LIVING, LEVEL OF INTELLECTUAL FUNCTIONING,
ADAPTIVE BEHAVIOR, EXPECTED RATE OF PROGRESS IN ACQUIRING SKILLS AND INFORMATION, AND LEARNING STYLE:
STUDENT STRENGTHS, PREFERENCES, INTERESTS:
ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE
PARENT:
SOCIAL DEVELOPMENT
THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT’S RELATIONSHIPS WITH PEERS AND ADULTS; FEELINGS ABOUT SELF; AND SOCIAL ADJUSTMENT TO SCHOOL
AND COMMUNITY ENVIRONMENTS:
STUDENT STRENGTHS:
SOCIAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT:
PHYSICAL DEVELOPMENT
THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT’S MOTOR AND SENSORY DEVELOPMENT, HEALTH, VITALITY AND PHYSICAL SKILLS OR LIMITATIONS WHICH
PERTAIN TO THE LEARNING PROCESS:
STUDENT STRENGTHS:
PHYSICAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT:
New York State Education Department IEP Form
MANAGEMENT NEEDS
THE NATURE (TYPE) AND DEGREE (EXTENT) TO WHICH ENVIRONMENTAL AND HUMAN OR MATERIAL RESOURCES ARE NEEDED TO ADDRESS NEEDS IDENTIFIED
ABOVE:
EFFECT OF STUDENT NEEDS ON INVOLVEMENT AND PROGRESS IN THE GENERAL EDUCATION CURRICULUM OR, FOR A PRESCHOOL STUDENT, EFFECT
OF STUDENT NEEDS ON PARTICIPATION IN APPROPRIATE ACTIVITIES
STUDENT NEEDS RELATING TO SPECIAL FACTORS
BASED ON THE IDENTIFICATION OF THE STUDENT’S NEEDS, THE COMMITTEE MUST CONSIDER WHETHER THE STUDENT NEEDS A PARTICULAR DEVICE OR SERVICE
TO ADDRESS THE SPECIAL FACTORS AS INDICATED BELOW, AND IF SO, THE APPROPRIATE SECTION OF THE IEP MUST IDENTIFY THE PARTICULAR DEVICE OR
SERVICE(S) NEEDED.
Does the student need strategies, including positive behavioral interventions, supports and other strategies to address behaviors that impede the student’s learning or
that of others?
Yes
No
Does the student need a behavioral intervention plan?
No
Yes:
For a student with limited English proficiency, does he/she need a special education service to address his/her language needs as they relate to the IEP?
Yes
No
Not Applicable
For a student who is blind or visually impaired, does he/she need instruction in Braille and the use of Braille?
Yes
No
Not Applicable
Does the student need a particular device or service to address his/her communication needs?
Yes
No
In the case of a student who is deaf or hard of hearing, does the student need a particular device or service in consideration of the student’s language and
communication needs, opportunities for direct communications with peers and professional personnel in the student’s language and communication mode,
academic level, and full range of needs, including opportunities for direct instruction in the student’s language and communication mode?
Yes
No
Not Applicable
Does the student need an assistive technology device and/or service?
Yes
No
If yes, does the Committee recommend that the device(s) be used in the student’s home?
Yes
No
BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE STUDENT IS AGE 15 (AND AT A YOUNGER AGE IF DETERMINED APPROPRIATE)
MEASURABLE POSTSECONDARY GOALS
LONG-TERM GOALS FOR LIVING, WORKING AND LEARNING AS AN ADULT
EDUCATION/TRAINING:
EMPLOYMENT:
INDEPENDENT LIVING SKILLS (WHEN APPROPRIATE):
TRANSITION NEEDS
In consideration of present levels of performance, transition service needs of the student that focus on the student’s courses of study, taking into account the student’s
strengths, preferences and interests as they relate to transition from school to post-school activities:
New York State Education Department IEP Form
MEASURABLE ANNUAL GOALS
THE FOLLOWING GOALS ARE RECOMMENDED TO ENABLE THE STUDENT TO BE INVOLVED IN AND PROGRESS IN THE GENERAL EDUCATION CURRICULUM, ADDRESS
OTHER EDUCATIONAL NEEDS THAT RESULT FROM THE STUDENT’S DISABILITY, AND PREPARE THE STUDENT TO MEET HIS/HER POSTSECONDARY GOALS.
ANNUAL GOALS
CRITERIA
METHOD
SCHEDULE
WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE
MEASURE TO DETERMINE IF
HOW PROGRESS WILL BE
WHEN PROGRESS WILL
END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
GOAL HAS BEEN ACHIEVED
MEASURED
BE MEASURED
REPORTING PROGRESS TO PARENTS
Identify when periodic reports on the student’s progress toward meeting the annual goals will be provided to the student’s parents:
New York State Education Department IEP Form
ALTERNATE SECTION FOR STUDENTS WHOSE IEPS WILL INCLUDE SHORT-TERM INSTRUCTIONAL OBJECTIVES AND/OR BENCHMARKS
(REQUIRED FOR PRESCHOOL STUDENTS AND FOR SCHOOL-AGE STUDENTS WHO MEET ELIGIBILITY CRITERIA TO TAKE THE NEW YORK STATE ALTERNATE ASSESSMENT)
MEASURABLE ANNUAL GOALS
THE FOLLOWING GOALS ARE RECOMMENDED TO ENABLE THE STUDENT TO BE INVOLVED IN AND PROGRESS IN THE GENERAL EDUCATION CURRICULUM OR, FOR A
PRESCHOOL CHILD, IN APPROPRIATE ACTIVITIES, ADDRESS OTHER EDUCATIONAL NEEDS THAT RESULT FROM THE STUDENT’S DISABILITY, AND, FOR A SCHOOL-AGE
STUDENT, PREPARE THE STUDENT TO MEET HIS/HER POSTSECONDARY GOALS.
ANNUAL GOAL
CRITERIA
METHOD
SCHEDULE
WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE
MEASURE TO DETERMINE IF
HOW PROGRESS WILL BE
WHEN PROGRESS WILL
END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
GOAL HAS BEEN ACHIEVED
MEASURED
BE MEASURED
SHORT-TERM INSTRUCTIONAL OBJECTIVES AND/OR BENCHMARKS (INTERMEDIATE STEPS BETWEEN THE STUDENT’S PRESENT LEVEL OF PERFORMANCE AND THE
MEASURABLE ANNUAL GOAL):
ANNUAL GOAL
CRITERIA
METHOD
SCHEDULE
SHORT-TERM INSTRUCTIONAL OBJECTIVES AND/OR BENCHMARKS (INTERMEDIATE STEPS BETWEEN THE STUDENT’S PRESENT LEVEL OF PERFORMANCE AND THE
MEASURABLE ANNUAL GOAL):
ANNUAL GOAL
CRITERIA
METHOD
SCHEDULE
SHORT-TERM INSTRUCTIONAL OBJECTIVES AND/OR BENCHMARKS (INTERMEDIATE STEPS BETWEEN THE STUDENT’S PRESENT LEVEL OF PERFORMANCE AND THE
MEASURABLE ANNUAL GOAL):
(DUPLICATE TABLE/ROWS AS NEEDED)
REPORTING PROGRESS TO PARENTS
Identify when periodic reports on the student’s progress toward meeting the annual goals will be provided to the student’s parents:
New York State Education Department IEP Form
RECOMMENDED SPECIAL EDUCATION PROGRAMS AND SERVICES
SPECIAL EDUCATION PROGRAM/SERVICES
SPECIAL EDUCATION PROGRAM:
SERVICE DELIVERY
RECOMMENDATIONS*
FREQUENCY
DURATION
LENGTH OF
WHERE SERVICE WILL BE
PROVIDED
SESSION
PROVIDED
HOW OFTEN
LOCATION
PROJECTED
BEGINNING/
SERVICE
DATE(S)
RELATED SERVICES:
SUPPLEMENTARY AIDS AND SERVICES/PROGRAM
MODIFICATIONS/ACCOMMODATIONS:
ASSISTIVE TECHNOLOGY DEVICES AND/OR
SERVICES:
SUPPORTS FOR SCHOOL PERSONNEL ON BEHALF
OF THE STUDENT:
*
Identify, if applicable, class size (maximum student-to-staff ratio), language if other than English, group or individual services, direct and/or indirect consultant
teacher services or other service delivery recommendations.
New York State Education Department IEP Form
12-MONTH SERVICE AND/OR PROGRAM – Student is eligible to receive special education services and/or program during July/August:
If yes:
Student will receive the same special education program/services as recommended above.
OR
Student will receive the following special education program/services:
SPECIAL EDUCATION PROGRAM/SERVICES
SERVICE DELIVERY
RECOMMENDATIONS
FREQUENCY
DURATION
LOCATION
No
Yes
PROJECTED
BEGINNING/
SERVICE DATE(S)
Name of school/agency provider of services during July and August:
For a preschool student, reason(s) the child requires services during July and August:
TESTING ACCOMMODATIONS (TO BE COMPLETED FOR PRESCHOOL CHILDREN ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL CHILDREN):
INDIVIDUAL TESTING ACCOMMODATIONS, SPECIFIC TO THE STUDENT’S DISABILITY AND NEEDS, TO BE USED CONSISTENTLY BY THE STUDENT IN THE
RECOMMENDED EDUCATIONAL PROGRAM AND IN THE ADMINISTRATION OF DISTRICT-WIDE ASSESSMENTS OF STUDENT ACHIEVEMENT AND, IN ACCORDANCE
WITH DEPARTMENT POLICY, STATE ASSESSMENTS OF STUDENT ACHIEVEMENT
TESTING ACCOMMODATION
CONDITIONS*
IMPLEMENTATION RECOMMENDATIONS**
NONE
*Conditions – Test Characteristics: Describe the type, length, purpose of the test upon which the use of testing accommodations is conditioned, if applicable.
**Implementation Recommendations: Identify the amount of extended time, type of setting, etc., specific to the testing accommodations, if applicable.
New York State Education Department IEP Form
BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE STUDENT IS AGE 15 (AND AT A YOUNGER AGE, IF DETERMINED APPROPRIATE).
COORDINATED SET OF TRANSITION ACTIVITIES
NEEDED ACTIVITIES TO FACILITATE THE
STUDENT’S MOVEMENT FROM SCHOOL TO
POST-SCHOOL ACTIVITIES
Instruction
Related Services
Community Experiences
Development of Employment and Other Postschool Adult Living Objectives
Acquisition of Daily Living Skills (if applicable)
Functional Vocational Assessment (if applicable)
SERVICE/ACTIVITY
SCHOOL DISTRICT/
AGENCY RESPONSIBLE
PARTICIPATION IN STATE AND DISTRICT-WIDE ASSESSMENTS
(TO BE COMPLETED FOR PRESCHOOL STUDENTS ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL STUDENTS)
The student will participate in the same State and district-wide assessments of student achievement that are administered to general education students.
The student will participate in an alternate assessment on a particular State or district-wide assessment of student achievement.
Identify the alternate assessment:
Statement of why the student cannot participate in the regular assessment and why the particular alternate assessment selected is appropriate for the student:
PARTICIPATION WITH STUDENTS WITHOUT DISABILITIES
REMOVAL FROM THE GENERAL EDUCATION ENVIRONMENT OCCURS ONLY WHEN THE NATURE OR SEVERITY OF THE DISABILITY IS SUCH THAT, EVEN WITH THE USE
OF SUPPLEMENTARY AIDS AND SERVICES, EDUCATION CANNOT BE SATISFACTORILY ACHIEVED.
FOR THE PRESCHOOL STUDENT:
Explain the extent, if any, to which the student will not participate in appropriate activities with age-appropriate nondisabled peers (e.g., percent of the school day
and/or specify particular activities):
FOR THE SCHOOL-AGE STUDENT:
Explain the extent, if any, to which the student will not participate in regular class, extracurricular and other nonacademic activities (e.g., percent of the school day
and/or specify particular activities):
If the student is not participating in a regular physical education program, identify the extent to which the student will participate in specially-designed instruction in
physical education, including adapted physical education:
EXEMPTION FROM LANGUAGE OTHER THAN ENGLISH DIPLOMA REQUIREMENT:
No
Yes – The Committee has determined that the student’s disability
adversely affects his/her ability to learn a language and recommends the student be exempt from the language other than English requirement.
New York State Education Department IEP Form
SPECIAL TRANSPORTATION
TRANSPORTATION RECOMMENDATION TO ADDRESS NEEDS OF THE STUDENT RELATING TO HIS/HER DISABILITY
None.
Student needs special transportation accommodations/services as follows:
Student needs transportation to and from special classes or programs at another site:
PLACEMENT RECOMMENDATION
New York State Education Department IEP Form
NEW YORK CITY
BOARD OF EDUCATION
THIS IEP INCLUDES:
Transitions
Interim Service Plan
CONFERENCE INFORMATION
CSE Case#
INDIVIDUALIZED EDUCATION PROGRAM
–
Home District:
Date:
/
Service District:
/
Type:
STUDENT INFORMATION
Name:
Address:
Phone: (
)
English LAB
Language(s) Spoken/Mode of Communication
Primary Agency with whom student is involved
Name of Contact
*Age as of the date of the conference
NYC ID#
Year
The student requires
Other alerts:
–
Date of Birth
Spanish LAB
Phone: (
PARENT/GUARDIAN INFORMATION
Name:
Address:
Phone (Home): (
)
Preferred Language/ Mode of Communication
SPECIAL MEDICAL/PHYSICAL ALERTS
The student has
medical conditions and/or
–
)
/
/
Year
–
Agency Case#
Relationship to Student
Phone (Work): (
)
–
Interpreter Required
(Refer to Health & Physical Development Page for additional details.)
physical limitations which affect his/her
learning
behavior and/or
medication and/or
Gender
Age:
Grade
Yes
No
participation in school activities.
health care treatment(s) or procedure(s) during the school day.
SUMMARY OF RECOMMENDATIONS
Recommended Services
Eligibility
Yes
Classification of Disability
No
Staffing Ratio
:
Twelve Month School Year
Yes
No
:
Recommended Services for the Twelve Month School Year
Staffing Ratio
:
Other Recommendations (Check all that apply)
Program Accessibility
Related Services
Adaptive Phys. Ed.*
Assistive Technology
Bilingual Instruction
Monolingual Services with ESL
:
*Details are provided in relevant sections of IEP
Monolingual Services without ESL
Special Education Transportation – Comment
Students who are blind or visually impaired:
Students who are deaf or hard of hearing
Braille instruction needed
Language of Instruction
Mode of Communication
Copy for
CSE
Yes
No
Parent
School
Student
Other
Page 1
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
CONFERENCE INFORMATION
Referral Type:
Initial
Triennial
Conference Type:
Annual Review
Requested Review
EPC
CSE Review
Annual Review
CPSE Review
Attendance at Conference
Please note that your signature reflects your participation at the conference and does not necessarily indicate agreement with the
Individualized Education Program.
Signature/Title
Role
Signature/Title
Role
(Indicate if Bilingual)
(Indicate if Bilingual)
Parent/Legal Guardian
District Representative
Parent/Legal Guardian
Special Education Teacher
Or Related Service Provider
General Education Teacher
Parent Member (CPSE/CSE)
Student
Other
Education Evaluator
Other
School Psychologist
Other
School Social Worker
Other
Use an asterisk(*) to signify the participant who interprets the instructional implications of evaluation results.
Use the letter (T) to signify participation by teleconference.
Conference Result
Initiate Service
Modify Service
Change Recommended Service
Indicate Modifications
Projected Date of Initiation of IEP
/
/
Initiation, Duration and Review of IEP
Projected Date of Review of IEP
Duration of Services
Date Notice of Meeting Sent
/
Date of Follow-up (if any)
/
Type of Follow-up
Letter
/
/
Contacts with Parent/Legal Guardian
Date IEP and Notice of Recommendation
Given to Parent
/ /
Telephone
Sent to Parent
/ /
Page 2
No Change
/
/
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ACADEMIC PERFORMANCE AND LEARNING CHARACTERISTICS
Describe the student’s present levels of academic achievement, language development, cognitive development and learning style in English and the other than
English language for LEP students. Discuss how the student’s disability affects his/her involvement and progress in the general curriculum or, for preschool
students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
READING and WRITING
Area
Decoding
Date
/
Test/Evaluation
MATH
Score
Instructional Level
/
Area
Date
Computation
/
/
Problem
Solving
/
/
Reading
Comprehension
/
/
Listening
Comprehension
/
/
/
/
Writing
/
/
/
/
/
/
/
/
/
/
/
/
ACADEMIC MANAGEMENT NEEDS
(Environmental modifications and human/material resources)
Page 3
Test/Evaluation
Score
Instructional Level
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ACADEMIC PERFORMANCE AND LEARNING CHARACTERISTICS
Describe the student’s present levels of academic achievement, language development, cognitive development and learning style in English and the other than
English language for LEP students. Discuss how the student’s disability affects his/her involvement and progress in the general curriculum or, for preschool
students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
ACADEMIC MANAGEMENT NEEDS
(Environmental modifications and human/material resources)
Page 3-1
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ACADEMIC PERFORMANCE AND LEARNING CHARACTERISTICS
Describe the student’s present levels of academic achievement, language development, cognitive development and learning style in English and the other than
English language for LEP students. Discuss how the student’s disability affects his/her involvement and progress in the general curriculum or, for preschool
students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
ACADEMIC MANAGEMENT NEEDS
(Environmental modifications and human/material resources)
Page 3-2
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
SOCIAL/EMOTIONAL PERFORMANCE
Describe the student’s strengths and weaknesses in the area of social and emotional development in English and the other than English language for LEP students.
Consider the degree and quality of the student’s relationships with peers and adults, feelings about self and social adjustment to school and community environments. Discuss
how the student’s disability affects his/her involvement and progress in a general curriculum or, for preschool students, as appropriate, how the student’s disability affects
participation in appropriate activities.
PRESENT PERFORMANCE:
BEHAVIOR AND THE INSTRUCTIONAL PROCESS
Behavior is age appropriate
Describe present levels of support including personnel responsible
for providing behavioral support
Behavior does not seriously interfere with instruction
and can be addressed by the
general education
and/or
special education classroom teacher.
Behavior seriously interferes with instruction and
requires additional adult support.
Behavior requires highly intensive supervision.
SOCIAL/EMOTIONAL MANAGEMENT NEEDS
(Environmental modifications and human/materials resources)
A behavior intervention plan has been developed
Page 4
Yes
No
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
SOCIAL/EMOTIONAL PERFORMANCE
Describe the student’s strengths and weaknesses in the area of social and emotional development in English and the other than English language for LEP students.
Consider the degree and quality of the student’s relationships with peers and adults, feelings about self and social adjustment to school and community environments. Discuss
how the student’s disability affects his/her involvement and progress in a general curriculum or, for preschool students, as appropriate, how the student’s disability affects
participation in appropriate activities.
PRESENT PERFORMANCE:
BEHAVIOR AND THE INSTRUCTIONAL PROCESS
Behavior is age appropriate
Describe present levels of support including personnel responsible
for providing behavioral support
Behavior does not seriously interfere with instruction
and can be addressed by the
general education
and/or
special education classroom teacher.
Behavior seriously interferes with instruction and
requires additional adult support.
Behavior requires highly intensive supervision.
SOCIAL/EMOTIONAL MANAGEMENT NEEDS
(Environmental modifications and human/materials resources)
A behavior intervention plan has been developed
Page 4-1
Yes
No
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
HEALTH AND PHYSICAL DEVELOPMENT
Describe the student’s health and physical development including the degree or quality of the student’s motor and sensory development, health, vitality and physical skills or
limitations which pertain to the learning process, behavior and participation in physical education or other school activities. Discuss how the student’s disability affects his/her
involvement and progress in the general curriculum or, for preschool students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
MEDICAL/HEALTH CARE NEEDS
During the school day, the student requires:
Medication
(if yes, functionality describe the limitations(s).)
Treatment(s) or other health procedure(s)
Yes
No
PHYSICAL NEEDS
The student
does
does not have mobility limitations.
(if yes, functionality describe the limitations(s).)
Yes
No
The student requires:
Accessible program
Yes
No
Yes
No
Yes
No
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Health as a related service
Yes
Adaptive Physical Education
(If yes indicate staffing ratio:
No
: :
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Assistive Technology Device(s)
Assistive Technology Service(s)
Yes
No
(If assistive technology device(s) or service(s) are required, specify in
management needs.)
HEALTH/PHYSICAL MANAGEMENT NEEDS
(Environmental modifications, human/material resources or specialized equipment)
Page 5
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
HEALTH AND PHYSICAL DEVELOPMENT
Describe the student’s health and physical development including the degree or quality of the student’s motor and sensory development, health, vitality and physical skills or
limitations which pertain to the learning process, behavior and participation in physical education or other school activities. Discuss how the student’s disability affects his/her
involvement and progress in the general curriculum or, for preschool students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
MEDICAL/HEALTH CARE NEEDS
During the school day, the student requires:
Medication
(if yes, functionality describe the limitations(s).)
Treatment(s) or other health procedure(s)
Yes
No
PHYSICAL NEEDS
The student
does
does not have mobility limitations.
(if yes, functionality describe the limitations(s).)
Yes
No
The student requires:
Accessible program
Yes
No
Yes
No
Yes
No
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Health as a related service
Yes
Adaptive Physical Education
(If yes indicate staffing ratio:
No
: :
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Assistive Technology Device(s)
Assistive Technology Service(s)
Yes
No
(If assistive technology device(s) or service(s) are required, specify in
management needs.)
HEALTH/PHYSICAL MANAGEMENT NEEDS
(Environmental modifications, human/material resources or specialized equipment)
Page 5-1
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
HEALTH AND PHYSICAL DEVELOPMENT
Describe the student’s health and physical development including the degree or quality of the student’s motor and sensory development, health, vitality and physical skills or
limitations which pertain to the learning process, behavior and participation in physical education or other school activities. Discuss how the student’s disability affects his/her
involvement and progress in the general curriculum or, for preschool students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
MEDICAL/HEALTH CARE NEEDS
During the school day, the student requires:
Medication
(if yes, functionality describe the limitations(s).)
Treatment(s) or other health procedure(s)
Yes
No
PHYSICAL NEEDS
The student
does
does not have mobility limitations.
(if yes, functionality describe the limitations(s).)
Yes
No
The student requires:
Accessible program
Yes
No
Yes
No
Yes
No
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Health as a related service
Yes
Adaptive Physical Education
(If yes indicate staffing ratio:
No
: :
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Assistive Technology Device(s)
Assistive Technology Service(s)
Yes
No
(If assistive technology device(s) or service(s) are required, specify in
management needs.)
HEALTH/PHYSICAL MANAGEMENT NEEDS
(Environmental modifications, human/material resources or specialized equipment)
Page 5-2
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
HEALTH AND PHYSICAL DEVELOPMENT
Describe the student’s health and physical development including the degree or quality of the student’s motor and sensory development, health, vitality and physical skills or
limitations which pertain to the learning process, behavior and participation in physical education or other school activities. Discuss how the student’s disability affects his/her
involvement and progress in the general curriculum or, for preschool students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
MEDICAL/HEALTH CARE NEEDS
During the school day, the student requires:
Medication
(if yes, functionality describe the limitations(s).)
Treatment(s) or other health procedure(s)
Yes
No
PHYSICAL NEEDS
The student
does
does not have mobility limitations.
(if yes, functionality describe the limitations(s).)
Yes
No
The student requires:
Accessible program
Yes
No
Yes
No
Yes
No
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Health as a related service
Yes
Adaptive Physical Education
(If yes indicate staffing ratio:
No
: :
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Assistive Technology Device(s)
Assistive Technology Service(s)
Yes
No
(If assistive technology device(s) or service(s) are required, specify in
management needs.)
HEALTH/PHYSICAL MANAGEMENT NEEDS
(Environmental modifications, human/material resources or specialized equipment)
Page 5-3
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ANNUAL GOALS AND SHORT-TERM OBJECTIVES
There will be
reports of progress per year using the coding system shown below.
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
EXPLANATION OF CODING SYSTEM
METHODS OF MEASURMENT
REPORT OF PROGRESS
PROGRESS TOWARD GOAL
REASONS FOR NOT MEETING GOAL
1. Teacher made Materials
6. Performance Assessment Task
1. Not applicable during this grading period
A. Anticipate meeting goal
2. Standardized Tests
7. Check Lists
2. No progress made
B. Do not anticipate meeting goal
3. Class Activities
8. Verbal Explanations
3. Little progress made
(Note reason)
4. Portfolio(s)
9. Other (specify)
4. Progress made; goal not yet met
C. Goal met
5. Teacher/Provider Observations
5. Goal met
*While a review of your child’s educational program occurs every year please be advised that you have a right to request a review of your child’s program at any time.
1st
1. More time needed
2. Excessive absence or lateness
3. Assignments not completed
4. Other (specify)
2nd
3rd
4th
5th
6th
7th
The student’s performance is approaching his/her promotion criteria as set forth on Page 9 of the IEP:
For students who are not anticipated to meet their annual goals and/or promotion criteria: We recommend that the IEP Team be reconvened:
Use a Y (Yes) or N (No) in the appropriate column
Page 6
8th
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ANNUAL GOALS AND SHORT-TERM OBJECTIVES
There will be
reports of progress per year using the coding system shown below.
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
EXPLANATION OF CODING SYSTEM
METHODS OF MEASURMENT
REPORT OF PROGRESS
PROGRESS TOWARD GOAL
REASONS FOR NOT MEETING GOAL
1. Teacher made Materials
6. Performance Assessment Task
1. Not applicable during this grading period
A. Anticipate meeting goal
2. Standardized Tests
7. Check Lists
2. No progress made
B. Do not anticipate meeting goal
3. Class Activities
8. Verbal Explanations
3. Little progress made
(Note reason)
4. Portfolio(s)
9. Other (specify)
4. Progress made; goal not yet met
C. Goal met
5. Teacher/Provider Observations
5. Goal met
*While a review of your child’s educational program occurs every year please be advised that you have a right to request a review of your child’s program at any time.
1st
1. More time needed
2. Excessive absence or lateness
3. Assignments not completed
4. Other (specify)
2nd
3rd
4th
5th
6th
7th
The student’s performance is approaching his/her promotion criteria as set forth on Page 9 of the IEP:
For students who are not anticipated to meet their annual goals and/or promotion criteria: We recommend that the IEP Team be reconvened:
Use a Y (Yes) or N (No) in the appropriate column
Page 6-1
8th
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ANNUAL GOALS AND SHORT-TERM OBJECTIVES
There will be
reports of progress per year using the coding system shown below.
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
EXPLANATION OF CODING SYSTEM
METHODS OF MEASURMENT
REPORT OF PROGRESS
PROGRESS TOWARD GOAL
REASONS FOR NOT MEETING GOAL
1. Teacher made Materials
6. Performance Assessment Task
1. Not applicable during this grading period
A. Anticipate meeting goal
2. Standardized Tests
7. Check Lists
2. No progress made
B. Do not anticipate meeting goal
3. Class Activities
8. Verbal Explanations
3. Little progress made
(Note reason)
4. Portfolio(s)
9. Other (specify)
4. Progress made; goal not yet met
C. Goal met
5. Teacher/Provider Observations
5. Goal met
*While a review of your child’s educational program occurs every year please be advised that you have a right to request a review of your child’s program at any time.
1st
1. More time needed
2. Excessive absence or lateness
3. Assignments not completed
4. Other (specify)
2nd
3rd
4th
5th
6th
7th
The student’s performance is approaching his/her promotion criteria as set forth on Page 9 of the IEP:
For students who are not anticipated to meet their annual goals and/or promotion criteria: We recommend that the IEP Team be reconvened:
Use a Y (Yes) or N (No) in the appropriate column
Page 6-2
8th
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ANNUAL GOALS AND SHORT-TERM OBJECTIVES
There will be
reports of progress per year using the coding system shown below.
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
EXPLANATION OF CODING SYSTEM
METHODS OF MEASURMENT
REPORT OF PROGRESS
PROGRESS TOWARD GOAL
REASONS FOR NOT MEETING GOAL
1. Teacher made Materials
6. Performance Assessment Task
1. Not applicable during this grading period
A. Anticipate meeting goal
2. Standardized Tests
7. Check Lists
2. No progress made
B. Do not anticipate meeting goal
3. Class Activities
8. Verbal Explanations
3. Little progress made
(Note reason)
4. Portfolio(s)
9. Other (specify)
4. Progress made; goal not yet met
C. Goal met
5. Teacher/Provider Observations
5. Goal met
*While a review of your child’s educational program occurs every year please be advised that you have a right to request a review of your child’s program at any time.
1st
1. More time needed
2. Excessive absence or lateness
3. Assignments not completed
4. Other (specify)
2nd
3rd
4th
5th
6th
7th
The student’s performance is approaching his/her promotion criteria as set forth on Page 9 of the IEP:
For students who are not anticipated to meet their annual goals and/or promotion criteria: We recommend that the IEP Team be reconvened:
Use a Y (Yes) or N (No) in the appropriate column
Page 6-3
8th
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
STUDENT NAME:
DATE OF BIRTH:
LOCAL ID #:
PROJECTED DATE IEP IS TO BE IMPLEMENTED:
DISABILITY CLASSIFICATION:
PROJECTED DATE OF ANNUAL REVIEW:
PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS
DOCUMENTATION OF STUDENT’S CURRENT PERFORMANCE AND ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS
EVALUATION RESULTS (INCLUDING FOR SCHOOL-AGE STUDENTS, PERFORMANCE ON STATE AND DISTRICT-WIDE ASSESSMENTS)
ACADEMIC ACHIEVEMENT, FUNCTIONAL PERFORMANCE AND LEARNING CHARACTERISTICS
LEVELS OF KNOWLEDGE AND DEVELOPMENT IN SUBJECT AND SKILL AREAS INCLUDING ACTIVITIES OF DAILY LIVING, LEVEL OF INTELLECTUAL FUNCTIONING,
ADAPTIVE BEHAVIOR, EXPECTED RATE OF PROGRESS IN ACQUIRING SKILLS AND INFORMATION, AND LEARNING STYLE:
STUDENT STRENGTHS, PREFERENCES, INTERESTS:
ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE
PARENT:
SOCIAL DEVELOPMENT
THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT’S RELATIONSHIPS WITH PEERS AND ADULTS; FEELINGS ABOUT SELF; AND SOCIAL ADJUSTMENT TO SCHOOL
AND COMMUNITY ENVIRONMENTS:
STUDENT STRENGTHS:
SOCIAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT:
PHYSICAL DEVELOPMENT
THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT’S MOTOR AND SENSORY DEVELOPMENT, HEALTH, VITALITY AND PHYSICAL SKILLS OR LIMITATIONS WHICH
PERTAIN TO THE LEARNING PROCESS:
STUDENT STRENGTHS:
PHYSICAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT:
New York State Education Department IEP Form
MANAGEMENT NEEDS
THE NATURE (TYPE) AND DEGREE (EXTENT) TO WHICH ENVIRONMENTAL AND HUMAN OR MATERIAL RESOURCES ARE NEEDED TO ADDRESS NEEDS IDENTIFIED
ABOVE:
EFFECT OF STUDENT NEEDS ON INVOLVEMENT AND PROGRESS IN THE GENERAL EDUCATION CURRICULUM OR, FOR A PRESCHOOL STUDENT, EFFECT
OF STUDENT NEEDS ON PARTICIPATION IN APPROPRIATE ACTIVITIES
STUDENT NEEDS RELATING TO SPECIAL FACTORS
BASED ON THE IDENTIFICATION OF THE STUDENT’S NEEDS, THE COMMITTEE MUST CONSIDER WHETHER THE STUDENT NEEDS A PARTICULAR DEVICE OR SERVICE
TO ADDRESS THE SPECIAL FACTORS AS INDICATED BELOW, AND IF SO, THE APPROPRIATE SECTION OF THE IEP MUST IDENTIFY THE PARTICULAR DEVICE OR
SERVICE(S) NEEDED.
Does the student need strategies, including positive behavioral interventions, supports and other strategies to address behaviors that impede the student’s learning or
that of others?
Yes
No
Does the student need a behavioral intervention plan?
No
Yes:
For a student with limited English proficiency, does he/she need a special education service to address his/her language needs as they relate to the IEP?
Yes
No
Not Applicable
For a student who is blind or visually impaired, does he/she need instruction in Braille and the use of Braille?
Yes
No
Not Applicable
Does the student need a particular device or service to address his/her communication needs?
Yes
No
In the case of a student who is deaf or hard of hearing, does the student need a particular device or service in consideration of the student’s language and
communication needs, opportunities for direct communications with peers and professional personnel in the student’s language and communication mode,
academic level, and full range of needs, including opportunities for direct instruction in the student’s language and communication mode?
Yes
No
Not Applicable
Does the student need an assistive technology device and/or service?
Yes
No
If yes, does the Committee recommend that the device(s) be used in the student’s home?
Yes
No
BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE STUDENT IS AGE 15 (AND AT A YOUNGER AGE IF DETERMINED APPROPRIATE)
MEASURABLE POSTSECONDARY GOALS
LONG-TERM GOALS FOR LIVING, WORKING AND LEARNING AS AN ADULT
EDUCATION/TRAINING:
EMPLOYMENT:
INDEPENDENT LIVING SKILLS (WHEN APPROPRIATE):
TRANSITION NEEDS
In consideration of present levels of performance, transition service needs of the student that focus on the student’s courses of study, taking into account the student’s
strengths, preferences and interests as they relate to transition from school to post-school activities:
New York State Education Department IEP Form
MEASURABLE ANNUAL GOALS
THE FOLLOWING GOALS ARE RECOMMENDED TO ENABLE THE STUDENT TO BE INVOLVED IN AND PROGRESS IN THE GENERAL EDUCATION CURRICULUM, ADDRESS
OTHER EDUCATIONAL NEEDS THAT RESULT FROM THE STUDENT’S DISABILITY, AND PREPARE THE STUDENT TO MEET HIS/HER POSTSECONDARY GOALS.
ANNUAL GOALS
CRITERIA
METHOD
SCHEDULE
WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE
MEASURE TO DETERMINE IF
HOW PROGRESS WILL BE
WHEN PROGRESS WILL
END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
GOAL HAS BEEN ACHIEVED
MEASURED
BE MEASURED
REPORTING PROGRESS TO PARENTS
Identify when periodic reports on the student’s progress toward meeting the annual goals will be provided to the student’s parents:
New York State Education Department IEP Form
ALTERNATE SECTION FOR STUDENTS WHOSE IEPS WILL INCLUDE SHORT-TERM INSTRUCTIONAL OBJECTIVES AND/OR BENCHMARKS
(REQUIRED FOR PRESCHOOL STUDENTS AND FOR SCHOOL-AGE STUDENTS WHO MEET ELIGIBILITY CRITERIA TO TAKE THE NEW YORK STATE ALTERNATE ASSESSMENT)
MEASURABLE ANNUAL GOALS
THE FOLLOWING GOALS ARE RECOMMENDED TO ENABLE THE STUDENT TO BE INVOLVED IN AND PROGRESS IN THE GENERAL EDUCATION CURRICULUM OR, FOR A
PRESCHOOL CHILD, IN APPROPRIATE ACTIVITIES, ADDRESS OTHER EDUCATIONAL NEEDS THAT RESULT FROM THE STUDENT’S DISABILITY, AND, FOR A SCHOOL-AGE
STUDENT, PREPARE THE STUDENT TO MEET HIS/HER POSTSECONDARY GOALS.
ANNUAL GOAL
CRITERIA
METHOD
SCHEDULE
WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE BY THE
MEASURE TO DETERMINE IF
HOW PROGRESS WILL BE
WHEN PROGRESS WILL
END OF THE YEAR IN WHICH THE IEP IS IN EFFECT
GOAL HAS BEEN ACHIEVED
MEASURED
BE MEASURED
SHORT-TERM INSTRUCTIONAL OBJECTIVES AND/OR BENCHMARKS (INTERMEDIATE STEPS BETWEEN THE STUDENT’S PRESENT LEVEL OF PERFORMANCE AND THE
MEASURABLE ANNUAL GOAL):
ANNUAL GOAL
CRITERIA
METHOD
SCHEDULE
SHORT-TERM INSTRUCTIONAL OBJECTIVES AND/OR BENCHMARKS (INTERMEDIATE STEPS BETWEEN THE STUDENT’S PRESENT LEVEL OF PERFORMANCE AND THE
MEASURABLE ANNUAL GOAL):
ANNUAL GOAL
CRITERIA
METHOD
SCHEDULE
SHORT-TERM INSTRUCTIONAL OBJECTIVES AND/OR BENCHMARKS (INTERMEDIATE STEPS BETWEEN THE STUDENT’S PRESENT LEVEL OF PERFORMANCE AND THE
MEASURABLE ANNUAL GOAL):
(DUPLICATE TABLE/ROWS AS NEEDED)
REPORTING PROGRESS TO PARENTS
Identify when periodic reports on the student’s progress toward meeting the annual goals will be provided to the student’s parents:
New York State Education Department IEP Form
RECOMMENDED SPECIAL EDUCATION PROGRAMS AND SERVICES
SPECIAL EDUCATION PROGRAM/SERVICES
SPECIAL EDUCATION PROGRAM:
SERVICE DELIVERY
RECOMMENDATIONS*
FREQUENCY
DURATION
LENGTH OF
WHERE SERVICE WILL BE
PROVIDED
SESSION
PROVIDED
HOW OFTEN
LOCATION
PROJECTED
BEGINNING/
SERVICE
DATE(S)
RELATED SERVICES:
SUPPLEMENTARY AIDS AND SERVICES/PROGRAM
MODIFICATIONS/ACCOMMODATIONS:
ASSISTIVE TECHNOLOGY DEVICES AND/OR
SERVICES:
SUPPORTS FOR SCHOOL PERSONNEL ON BEHALF
OF THE STUDENT:
*
Identify, if applicable, class size (maximum student-to-staff ratio), language if other than English, group or individual services, direct and/or indirect consultant
teacher services or other service delivery recommendations.
New York State Education Department IEP Form
12-MONTH SERVICE AND/OR PROGRAM – Student is eligible to receive special education services and/or program during July/August:
If yes:
Student will receive the same special education program/services as recommended above.
OR
Student will receive the following special education program/services:
SPECIAL EDUCATION PROGRAM/SERVICES
SERVICE DELIVERY
RECOMMENDATIONS
FREQUENCY
DURATION
LOCATION
No
Yes
PROJECTED
BEGINNING/
SERVICE DATE(S)
Name of school/agency provider of services during July and August:
For a preschool student, reason(s) the child requires services during July and August:
TESTING ACCOMMODATIONS (TO BE COMPLETED FOR PRESCHOOL CHILDREN ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL CHILDREN):
INDIVIDUAL TESTING ACCOMMODATIONS, SPECIFIC TO THE STUDENT’S DISABILITY AND NEEDS, TO BE USED CONSISTENTLY BY THE STUDENT IN THE
RECOMMENDED EDUCATIONAL PROGRAM AND IN THE ADMINISTRATION OF DISTRICT-WIDE ASSESSMENTS OF STUDENT ACHIEVEMENT AND, IN ACCORDANCE
WITH DEPARTMENT POLICY, STATE ASSESSMENTS OF STUDENT ACHIEVEMENT
TESTING ACCOMMODATION
CONDITIONS*
IMPLEMENTATION RECOMMENDATIONS**
NONE
*Conditions – Test Characteristics: Describe the type, length, purpose of the test upon which the use of testing accommodations is conditioned, if applicable.
**Implementation Recommendations: Identify the amount of extended time, type of setting, etc., specific to the testing accommodations, if applicable.
New York State Education Department IEP Form
BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE STUDENT IS AGE 15 (AND AT A YOUNGER AGE, IF DETERMINED APPROPRIATE).
COORDINATED SET OF TRANSITION ACTIVITIES
NEEDED ACTIVITIES TO FACILITATE THE
STUDENT’S MOVEMENT FROM SCHOOL TO
POST-SCHOOL ACTIVITIES
Instruction
Related Services
Community Experiences
Development of Employment and Other Postschool Adult Living Objectives
Acquisition of Daily Living Skills (if applicable)
Functional Vocational Assessment (if applicable)
SERVICE/ACTIVITY
SCHOOL DISTRICT/
AGENCY RESPONSIBLE
PARTICIPATION IN STATE AND DISTRICT-WIDE ASSESSMENTS
(TO BE COMPLETED FOR PRESCHOOL STUDENTS ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL STUDENTS)
The student will participate in the same State and district-wide assessments of student achievement that are administered to general education students.
The student will participate in an alternate assessment on a particular State or district-wide assessment of student achievement.
Identify the alternate assessment:
Statement of why the student cannot participate in the regular assessment and why the particular alternate assessment selected is appropriate for the student:
PARTICIPATION WITH STUDENTS WITHOUT DISABILITIES
REMOVAL FROM THE GENERAL EDUCATION ENVIRONMENT OCCURS ONLY WHEN THE NATURE OR SEVERITY OF THE DISABILITY IS SUCH THAT, EVEN WITH THE USE
OF SUPPLEMENTARY AIDS AND SERVICES, EDUCATION CANNOT BE SATISFACTORILY ACHIEVED.
FOR THE PRESCHOOL STUDENT:
Explain the extent, if any, to which the student will not participate in appropriate activities with age-appropriate nondisabled peers (e.g., percent of the school day
and/or specify particular activities):
FOR THE SCHOOL-AGE STUDENT:
Explain the extent, if any, to which the student will not participate in regular class, extracurricular and other nonacademic activities (e.g., percent of the school day
and/or specify particular activities):
If the student is not participating in a regular physical education program, identify the extent to which the student will participate in specially-designed instruction in
physical education, including adapted physical education:
EXEMPTION FROM LANGUAGE OTHER THAN ENGLISH DIPLOMA REQUIREMENT:
No
Yes – The Committee has determined that the student’s disability
adversely affects his/her ability to learn a language and recommends the student be exempt from the language other than English requirement.
New York State Education Department IEP Form
SPECIAL TRANSPORTATION
TRANSPORTATION RECOMMENDATION TO ADDRESS NEEDS OF THE STUDENT RELATING TO HIS/HER DISABILITY
None.
Student needs special transportation accommodations/services as follows:
Student needs transportation to and from special classes or programs at another site:
PLACEMENT RECOMMENDATION
New York State Education Department IEP Form
NEW YORK CITY
BOARD OF EDUCATION
THIS IEP INCLUDES:
Transitions
Interim Service Plan
CONFERENCE INFORMATION
CSE Case#
INDIVIDUALIZED EDUCATION PROGRAM
–
Home District:
Date:
/
Service District:
/
Type:
STUDENT INFORMATION
Name:
Address:
Phone: (
)
English LAB
Language(s) Spoken/Mode of Communication
Primary Agency with whom student is involved
Name of Contact
*Age as of the date of the conference
NYC ID#
Year
The student requires
Other alerts:
–
Date of Birth
Spanish LAB
Phone: (
PARENT/GUARDIAN INFORMATION
Name:
Address:
Phone (Home): (
)
Preferred Language/ Mode of Communication
SPECIAL MEDICAL/PHYSICAL ALERTS
The student has
medical conditions and/or
–
)
/
/
Year
–
Agency Case#
Relationship to Student
Phone (Work): (
)
–
Interpreter Required
(Refer to Health & Physical Development Page for additional details.)
physical limitations which affect his/her
learning
behavior and/or
medication and/or
Gender
Age:
Grade
Yes
No
participation in school activities.
health care treatment(s) or procedure(s) during the school day.
SUMMARY OF RECOMMENDATIONS
Recommended Services
Eligibility
Yes
Classification of Disability
No
Staffing Ratio
:
Twelve Month School Year
Yes
No
:
Recommended Services for the Twelve Month School Year
Staffing Ratio
:
Other Recommendations (Check all that apply)
Program Accessibility
Related Services
Adaptive Phys. Ed.*
Assistive Technology
Bilingual Instruction
Monolingual Services with ESL
:
*Details are provided in relevant sections of IEP
Monolingual Services without ESL
Special Education Transportation – Comment
Students who are blind or visually impaired:
Students who are deaf or hard of hearing
Braille instruction needed
Language of Instruction
Mode of Communication
Copy for
CSE
Yes
No
Parent
School
Student
Other
Page 1
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
CONFERENCE INFORMATION
Referral Type:
Initial
Triennial
Conference Type:
Annual Review
Requested Review
EPC
CSE Review
Annual Review
CPSE Review
Attendance at Conference
Please note that your signature reflects your participation at the conference and does not necessarily indicate agreement with the
Individualized Education Program.
Signature/Title
Role
Signature/Title
Role
(Indicate if Bilingual)
(Indicate if Bilingual)
Parent/Legal Guardian
District Representative
Parent/Legal Guardian
Special Education Teacher
Or Related Service Provider
General Education Teacher
Parent Member (CPSE/CSE)
Student
Other
Education Evaluator
Other
School Psychologist
Other
School Social Worker
Other
Use an asterisk(*) to signify the participant who interprets the instructional implications of evaluation results.
Use the letter (T) to signify participation by teleconference.
Conference Result
Initiate Service
Modify Service
Change Recommended Service
Indicate Modifications
Projected Date of Initiation of IEP
/
/
Initiation, Duration and Review of IEP
Projected Date of Review of IEP
Duration of Services
Date Notice of Meeting Sent
/
Date of Follow-up (if any)
/
Type of Follow-up
Letter
/
/
Contacts with Parent/Legal Guardian
Date IEP and Notice of Recommendation
Given to Parent
/ /
Telephone
Sent to Parent
/ /
Page 2
No Change
/
/
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ACADEMIC PERFORMANCE AND LEARNING CHARACTERISTICS
Describe the student’s present levels of academic achievement, language development, cognitive development and learning style in English and the other than
English language for LEP students. Discuss how the student’s disability affects his/her involvement and progress in the general curriculum or, for preschool
students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
READING and WRITING
Area
Decoding
Date
/
Test/Evaluation
MATH
Score
Instructional Level
/
Area
Date
Computation
/
/
Problem
Solving
/
/
Reading
Comprehension
/
/
Listening
Comprehension
/
/
/
/
Writing
/
/
/
/
/
/
/
/
/
/
/
/
ACADEMIC MANAGEMENT NEEDS
(Environmental modifications and human/material resources)
Page 3
Test/Evaluation
Score
Instructional Level
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ACADEMIC PERFORMANCE AND LEARNING CHARACTERISTICS
Describe the student’s present levels of academic achievement, language development, cognitive development and learning style in English and the other than
English language for LEP students. Discuss how the student’s disability affects his/her involvement and progress in the general curriculum or, for preschool
students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
ACADEMIC MANAGEMENT NEEDS
(Environmental modifications and human/material resources)
Page 3-1
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ACADEMIC PERFORMANCE AND LEARNING CHARACTERISTICS
Describe the student’s present levels of academic achievement, language development, cognitive development and learning style in English and the other than
English language for LEP students. Discuss how the student’s disability affects his/her involvement and progress in the general curriculum or, for preschool
students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
ACADEMIC MANAGEMENT NEEDS
(Environmental modifications and human/material resources)
Page 3-2
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
SOCIAL/EMOTIONAL PERFORMANCE
Describe the student’s strengths and weaknesses in the area of social and emotional development in English and the other than English language for LEP students.
Consider the degree and quality of the student’s relationships with peers and adults, feelings about self and social adjustment to school and community environments. Discuss
how the student’s disability affects his/her involvement and progress in a general curriculum or, for preschool students, as appropriate, how the student’s disability affects
participation in appropriate activities.
PRESENT PERFORMANCE:
BEHAVIOR AND THE INSTRUCTIONAL PROCESS
Behavior is age appropriate
Describe present levels of support including personnel responsible
for providing behavioral support
Behavior does not seriously interfere with instruction
and can be addressed by the
general education
and/or
special education classroom teacher.
Behavior seriously interferes with instruction and
requires additional adult support.
Behavior requires highly intensive supervision.
SOCIAL/EMOTIONAL MANAGEMENT NEEDS
(Environmental modifications and human/materials resources)
A behavior intervention plan has been developed
Page 4
Yes
No
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
SOCIAL/EMOTIONAL PERFORMANCE
Describe the student’s strengths and weaknesses in the area of social and emotional development in English and the other than English language for LEP students.
Consider the degree and quality of the student’s relationships with peers and adults, feelings about self and social adjustment to school and community environments. Discuss
how the student’s disability affects his/her involvement and progress in a general curriculum or, for preschool students, as appropriate, how the student’s disability affects
participation in appropriate activities.
PRESENT PERFORMANCE:
BEHAVIOR AND THE INSTRUCTIONAL PROCESS
Behavior is age appropriate
Describe present levels of support including personnel responsible
for providing behavioral support
Behavior does not seriously interfere with instruction
and can be addressed by the
general education
and/or
special education classroom teacher.
Behavior seriously interferes with instruction and
requires additional adult support.
Behavior requires highly intensive supervision.
SOCIAL/EMOTIONAL MANAGEMENT NEEDS
(Environmental modifications and human/materials resources)
A behavior intervention plan has been developed
Page 4-1
Yes
No
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
HEALTH AND PHYSICAL DEVELOPMENT
Describe the student’s health and physical development including the degree or quality of the student’s motor and sensory development, health, vitality and physical skills or
limitations which pertain to the learning process, behavior and participation in physical education or other school activities. Discuss how the student’s disability affects his/her
involvement and progress in the general curriculum or, for preschool students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
MEDICAL/HEALTH CARE NEEDS
During the school day, the student requires:
Medication
(if yes, functionality describe the limitations(s).)
Treatment(s) or other health procedure(s)
Yes
No
PHYSICAL NEEDS
The student
does
does not have mobility limitations.
(if yes, functionality describe the limitations(s).)
Yes
No
The student requires:
Accessible program
Yes
No
Yes
No
Yes
No
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Health as a related service
Yes
Adaptive Physical Education
(If yes indicate staffing ratio:
No
: :
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Assistive Technology Device(s)
Assistive Technology Service(s)
Yes
No
(If assistive technology device(s) or service(s) are required, specify in
management needs.)
HEALTH/PHYSICAL MANAGEMENT NEEDS
(Environmental modifications, human/material resources or specialized equipment)
Page 5
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
HEALTH AND PHYSICAL DEVELOPMENT
Describe the student’s health and physical development including the degree or quality of the student’s motor and sensory development, health, vitality and physical skills or
limitations which pertain to the learning process, behavior and participation in physical education or other school activities. Discuss how the student’s disability affects his/her
involvement and progress in the general curriculum or, for preschool students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
MEDICAL/HEALTH CARE NEEDS
During the school day, the student requires:
Medication
(if yes, functionality describe the limitations(s).)
Treatment(s) or other health procedure(s)
Yes
No
PHYSICAL NEEDS
The student
does
does not have mobility limitations.
(if yes, functionality describe the limitations(s).)
Yes
No
The student requires:
Accessible program
Yes
No
Yes
No
Yes
No
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Health as a related service
Yes
Adaptive Physical Education
(If yes indicate staffing ratio:
No
: :
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Assistive Technology Device(s)
Assistive Technology Service(s)
Yes
No
(If assistive technology device(s) or service(s) are required, specify in
management needs.)
HEALTH/PHYSICAL MANAGEMENT NEEDS
(Environmental modifications, human/material resources or specialized equipment)
Page 5-1
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
HEALTH AND PHYSICAL DEVELOPMENT
Describe the student’s health and physical development including the degree or quality of the student’s motor and sensory development, health, vitality and physical skills or
limitations which pertain to the learning process, behavior and participation in physical education or other school activities. Discuss how the student’s disability affects his/her
involvement and progress in the general curriculum or, for preschool students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
MEDICAL/HEALTH CARE NEEDS
During the school day, the student requires:
Medication
(if yes, functionality describe the limitations(s).)
Treatment(s) or other health procedure(s)
Yes
No
PHYSICAL NEEDS
The student
does
does not have mobility limitations.
(if yes, functionality describe the limitations(s).)
Yes
No
The student requires:
Accessible program
Yes
No
Yes
No
Yes
No
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Health as a related service
Yes
Adaptive Physical Education
(If yes indicate staffing ratio:
No
: :
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Assistive Technology Device(s)
Assistive Technology Service(s)
Yes
No
(If assistive technology device(s) or service(s) are required, specify in
management needs.)
HEALTH/PHYSICAL MANAGEMENT NEEDS
(Environmental modifications, human/material resources or specialized equipment)
Page 5-2
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
HEALTH AND PHYSICAL DEVELOPMENT
Describe the student’s health and physical development including the degree or quality of the student’s motor and sensory development, health, vitality and physical skills or
limitations which pertain to the learning process, behavior and participation in physical education or other school activities. Discuss how the student’s disability affects his/her
involvement and progress in the general curriculum or, for preschool students, as appropriate, how the student’s disability affects participation in appropriate activities.
PRESENT PERFORMANCE:
MEDICAL/HEALTH CARE NEEDS
During the school day, the student requires:
Medication
(if yes, functionality describe the limitations(s).)
Treatment(s) or other health procedure(s)
Yes
No
PHYSICAL NEEDS
The student
does
does not have mobility limitations.
(if yes, functionality describe the limitations(s).)
Yes
No
The student requires:
Accessible program
Yes
No
Yes
No
Yes
No
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Health as a related service
Yes
Adaptive Physical Education
(If yes indicate staffing ratio:
No
: :
(If yes, functionally describe the condition for which treatment(s) or procedure(s) are required)
Assistive Technology Device(s)
Assistive Technology Service(s)
Yes
No
(If assistive technology device(s) or service(s) are required, specify in
management needs.)
HEALTH/PHYSICAL MANAGEMENT NEEDS
(Environmental modifications, human/material resources or specialized equipment)
Page 5-3
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ANNUAL GOALS AND SHORT-TERM OBJECTIVES
There will be
reports of progress per year using the coding system shown below.
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
EXPLANATION OF CODING SYSTEM
METHODS OF MEASURMENT
REPORT OF PROGRESS
PROGRESS TOWARD GOAL
REASONS FOR NOT MEETING GOAL
1. Teacher made Materials
6. Performance Assessment Task
1. Not applicable during this grading period
A. Anticipate meeting goal
2. Standardized Tests
7. Check Lists
2. No progress made
B. Do not anticipate meeting goal
3. Class Activities
8. Verbal Explanations
3. Little progress made
(Note reason)
4. Portfolio(s)
9. Other (specify)
4. Progress made; goal not yet met
C. Goal met
5. Teacher/Provider Observations
5. Goal met
*While a review of your child’s educational program occurs every year please be advised that you have a right to request a review of your child’s program at any time.
1st
1. More time needed
2. Excessive absence or lateness
3. Assignments not completed
4. Other (specify)
2nd
3rd
4th
5th
6th
7th
The student’s performance is approaching his/her promotion criteria as set forth on Page 9 of the IEP:
For students who are not anticipated to meet their annual goals and/or promotion criteria: We recommend that the IEP Team be reconvened:
Use a Y (Yes) or N (No) in the appropriate column
Page 6
8th
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ANNUAL GOALS AND SHORT-TERM OBJECTIVES
There will be
reports of progress per year using the coding system shown below.
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
EXPLANATION OF CODING SYSTEM
METHODS OF MEASURMENT
REPORT OF PROGRESS
PROGRESS TOWARD GOAL
REASONS FOR NOT MEETING GOAL
1. Teacher made Materials
6. Performance Assessment Task
1. Not applicable during this grading period
A. Anticipate meeting goal
2. Standardized Tests
7. Check Lists
2. No progress made
B. Do not anticipate meeting goal
3. Class Activities
8. Verbal Explanations
3. Little progress made
(Note reason)
4. Portfolio(s)
9. Other (specify)
4. Progress made; goal not yet met
C. Goal met
5. Teacher/Provider Observations
5. Goal met
*While a review of your child’s educational program occurs every year please be advised that you have a right to request a review of your child’s program at any time.
1st
1. More time needed
2. Excessive absence or lateness
3. Assignments not completed
4. Other (specify)
2nd
3rd
4th
5th
6th
7th
The student’s performance is approaching his/her promotion criteria as set forth on Page 9 of the IEP:
For students who are not anticipated to meet their annual goals and/or promotion criteria: We recommend that the IEP Team be reconvened:
Use a Y (Yes) or N (No) in the appropriate column
Page 6-1
8th
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ANNUAL GOALS AND SHORT-TERM OBJECTIVES
There will be
reports of progress per year using the coding system shown below.
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
EXPLANATION OF CODING SYSTEM
METHODS OF MEASURMENT
REPORT OF PROGRESS
PROGRESS TOWARD GOAL
REASONS FOR NOT MEETING GOAL
1. Teacher made Materials
6. Performance Assessment Task
1. Not applicable during this grading period
A. Anticipate meeting goal
2. Standardized Tests
7. Check Lists
2. No progress made
B. Do not anticipate meeting goal
3. Class Activities
8. Verbal Explanations
3. Little progress made
(Note reason)
4. Portfolio(s)
9. Other (specify)
4. Progress made; goal not yet met
C. Goal met
5. Teacher/Provider Observations
5. Goal met
*While a review of your child’s educational program occurs every year please be advised that you have a right to request a review of your child’s program at any time.
1st
1. More time needed
2. Excessive absence or lateness
3. Assignments not completed
4. Other (specify)
2nd
3rd
4th
5th
6th
7th
The student’s performance is approaching his/her promotion criteria as set forth on Page 9 of the IEP:
For students who are not anticipated to meet their annual goals and/or promotion criteria: We recommend that the IEP Team be reconvened:
Use a Y (Yes) or N (No) in the appropriate column
Page 6-2
8th
Student:
NYC ID#
– –
CSE Case# –
Date of Conference: / /
ANNUAL GOALS AND SHORT-TERM OBJECTIVES
There will be
reports of progress per year using the coding system shown below.
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
ANNUAL GOAL:
Progress
/
/
/
/
/
/
/
/
1st
2nd
3rd
4th
5th
6th
7th
8th
Methods of Measurement
Report of Progress
Progress Toward Annual Goal
Reasons for not Meeting Annual Goal
COMMENTS:
EXPLANATION OF CODING SYSTEM
METHODS OF MEASURMENT
REPORT OF PROGRESS
PROGRESS TOWARD GOAL
REASONS FOR NOT MEETING GOAL
1. Teacher made Materials
6. Performance Assessment Task
1. Not applicable during this grading period
A. Anticipate meeting goal
2. Standardized Tests
7. Check Lists
2. No progress made
B. Do not anticipate meeting goal
3. Class Activities
8. Verbal Explanations
3. Little progress made
(Note reason)
4. Portfolio(s)
9. Other (specify)
4. Progress made; goal not yet met
C. Goal met
5. Teacher/Provider Observations
5. Goal met
*While a review of your child’s educational program occurs every year please be advised that you have a right to request a review of your child’s program at any time.
1st
1. More time needed
2. Excessive absence or lateness
3. Assignments not completed
4. Other (specify)
2nd
3rd
4th
5th
6th
7th
The student’s performance is approaching his/her promotion criteria as set forth on Page 9 of the IEP:
For students who are not anticipated to meet their annual goals and/or promotion criteria: We recommend that the IEP Team be reconvened:
Use a Y (Yes) or N (No) in the appropriate column
Page 6-3
8th
Categories: