ࡱ>  =bjbjDD @N&c&cCCCCCT!r$$$$$'&j'l'8،ڌڌڌڌڌڌ$#ٕmC5('&'&5(5(CC$$4kS,S,S,5(C$C$،S,5(،S,S,fw`$ U(\X~DČ0~s7+ssCTp S,5(5(5(+5(5(5(5(5(5(5(s5(5(5(5(5(5(5(5(5( : INVITATION TO A MEETING OF THE Sara Hendrickson INDIVIDUALIZED EDUCATION PROGRAM (IEP) TEAM Form I-1 (Rev. 10/06) JAMAICA SCHOOL DISTRICT [If you need this invitation in a different language or communicated in a different way, or have questions about this invitation, please contact Deana Howard at 555-5555.] Dear Mr. and Mrs. Hawkings, Date Dec 8, 2016 You are a participant on the IEP Team which will meet to address the educational needs of your child, Keesha Hawkings. IEP team meetings must be held at a mutually agreeable time and place. An IEP team meeting has tentatively been scheduled for the following date January 8, 2017, time 1:00 p.m. and location Jamaica High School Conference Room. If these meeting arrangements are not agreeable to you, please call Deanna Howard at 555-5555. You may bring other people who you believe have knowledge or special expertise about your child to the meeting with you. If your child is transferring from a Birth to 3 Early Intervention Program we will, at your request, send to the Birth to 3 coordinator or other representative an invitation to the IEP meeting. The purpose of this IEP team meeting is (check all that apply): EVALUATION AND REEVALUATION % Determine initial eligibility for special education ( Determine continuing eligibility for special education INDIVIDUALIZED EDUCATION PROGRAM (IEP) (if student is eligible) % Develop an initial IEP ( Develop an annual IEP % Review/revise IEP % Transition  the consideration of postsecondary goals and transition services (required for students beginning at age 14) PLACEMENT (if student is eligible) % Determine initial placement ( Determine continuing placement OTHER % Review existing information to determine need for additional assessments or other evaluation materials (meeting optional) % Conduct a manifestation determination (check appropriate boxes under IEP and placement if changes in either are contemplated) % Determine setting for services during disciplinary change in placement (must also check appropriate boxes under IEP & placement) % Specify: _____________________________________________________________________ ____________________________________________________________________________. If transition is checked as one of the purposes of this meeting, your child will be invited to attend. Because you provided your consent we are also inviting representatives from the following agencies who may assist in the transition planning for your child: ( None _________________________________________________________________________________________ Agency Name (if known), and Title/Position _________________________________________________________________________________________ Agency Name (if known), and Title/Position If at any point during this meeting you or other IEP team participants believe that additional time is needed to permit your meaningful involvement, additional time will be provided. Decisions related to the purpose(s) checked above may be made in one meeting or may require more than one meeting, depending on individual circumstances. In addition and upon request you may receive a copy of the IEP teams most recent evaluation report. The following individuals have been appointed as IEP team participants and will attend the meeting: ___Kevin Smith________________________ _______Deanna Howard____________________ Name/Reg. Ed. Teacher Name/Sp. Ed. Teacher ___Carmen Diaz_______________________ _______Jane C. Doe, Psychiatrist______________ Name/LEA Representative Name &Title _____________________________________ ________________________________________ Name & Title Name & Title _____________________________________ ________________________________________ Name & Title Name & Title _____________________________________ ________________________________________ Name & Title Name & Title You and your child have protection under the procedural safeguards (rights) of special education law. The school district must provide you with a copy of your procedural safeguards once a year. ( You received a copy of your procedural safeguard rights in a brochure about parent and child rights earlier this year. If you would like another copy of this brochure, please contact the district at the telephone number above. % A copy of the parent and child rights brochure is enclosed with this invitation. In addition to district staff, you may also contact Daniel Parker, DPI Family Engagement at 608-266-5194 or daniel.parker@dpi.wi.gov if you have questions about your rights. Sincerely, ____Cameron Diaz, High School Principal_______________ Name and Title of District Contact Person REQUEST TO INVITE OTHERS WITH KNOWLEDGE OR SPECIAL EXPERTISE TO AN INDIVIDUALIZED EDUCATION PROGRAM (IEP) MEETING Form I-1-C (New 5/2012) JAMAICA SCHOOL DISTRICT [If you need this notice in a different language or communicated in a different way, or have questions about this notice, please contact Deanna Howard at 555-5555.] Dear Mr. and Mrs. Hawkins, Date December 8, 2016 A purpose of your childs upcoming individualized education program (IEP) meeting is to discuss his / her present level of performance, annual goals, and services needed to achieve those goals. We would like to invite individuals not employed by the school district who work with your child and may assist with planning for your child. We cannot invite the individual(s) unless we receive your written permission. Name, if known Agency ___Jane C. Doe___________________ _______Psychiatrist___________________ ________________________________ ____________________________________ Sincerely, ___Cameron Diaz, Principal_______________________________ Name and Title of District Contact Person -------------------------------------------------------------------------------------------------------------------------------------------- I understand the action proposed by the school district and (Please check the appropriate box below, sign, date and return one copy of this request to the school district) ( I give my consent for all of the above identified individuals or representatives to be invited to my childs IEP meeting. I understand that my consent is voluntary and may be revoked at any time before the identified individuals or representatives have been invited. ( I give my consent for the following above identified individuals or representatives to be invited to my childs IEP meeting _________________________________________________________________. ( I do not give my consent for any of the above identified individuals or representatives to be invited to my childs IEP meeting. __________________________________________ __________________ Signature of parent or legal guardian or adult student Date You and your child have protection under the procedural safeguards (rights) of special education law. The school district must provide you with a copy of your procedural safeguards once a year. Enclosed is a copy or earlier this year you received a copy of your procedural safeguard rights in a brochure about parent and child rights. If you would like another copy of this brochure, please contact the district at the telephone number above. In addition to district staff, you may also contact Daniel Parker, DPI Family Engagement at daniel.parker@dip.wi.gov if you have questions about your rights. INDIVIDUALIZED EDUCATION PROGRAM (IEP) Page____ of____ TEAM MEETING COVER PAGE Form I-3 (Rev. 05/2016) JAMAICA SCHOOL DISTRICT Name of Student Keesha HawkinsDOB 7/18/2002Grade 9WISEid 654321LEAs Student ID 5648-9657Parent or Legal Guardian Mr. and Mrs. HawkinsTelephone (area code/number) 608/666-5236Address 1234 5th St. Milwaukee, WI 12345District of Residence Jamaica School DistrictCurrent District of Placement Jamaica School DistrictFor students transferring between public agencies: Evaluation Report reviewed and adopted (if applicable) by ______________________ on ________________For students transferring between public agencies: IEP reviewed and adopted (if applicable) by _______________ on ___________________ Date of Meeting: January 8, 2017 (month/day/year) PURPOSE OF MEETING (check all that apply): EVALUATION AND REEVALUATION & Evaluation including determination of initial eligibility for special education & Reevaluation including determination of continuing eligibility for special education INDIVIDUALIZED EDUCATION PROGRAM (IEP) (if student is eligible) & Develop an initial IEP ( Annual IEP review & Review/revise IEP & Transition  the consideration of post-secondary goals and transition services (Required for students beginning at age 14.) PLACEMENT (must be determined when the IEP is developed or reviewed/revised) & Determine initial placement ( Determine continuing placement OTHER & Review existing information to determine need for additional assessments or other evaluation materials (IEP team meeting optional) & Conduct a manifestation determination (check appropriate boxes under IEP and PLACEMENT if changes in either are contemplated) Form 1-3 Name of Student ____Keesha Hawkins___________________ Page____ of____ & Determine setting for services during disciplinary change in placement (must check appropriate boxes under IEP & PLACEMENT) & Other. Specify: ________________________________________________________ If a purpose of this meeting is IEP development, review, and/or revision related to the academic, developmental and functional needs of the child, the IEP team considered the results of: Initial or most recent evaluation ( Yes % Not applicable Statewide assessments ( Yes % Not applicable District-wide assessments ( Yes % Not applicable IEP Team Participants Attending or Participating by Alternate Means in the Meeting: Parent/Guardian Mrs. Hawkins Regular education teacher/title: Kevin Smith Science TeacherRegular education teacher/title:Student (if appropriate): Keesha Hawkins Special education teacher/title: Deanna Howard Special education teacherSpecial education teacher/title:LEA Representative/title: Carmen Diaz High School Principal Other: Jane C. Doe PsychiatristOther:Other: Other:Other:  If the parent did not attend or participate in the meeting by other means and did not agree to the time and place of the IEP team meeting, document three efforts to involve the parent: DateMethodResult INDIVIDUALIZED EDUCATION PROGRAM: Page____ of____ Linking Present Levels, Needs, Goals, and Services Form Form I-4 (Rev. 11/2016) JAMAICA SCHOOL DISTRICT Name of Student ____Keesha Hawkins___________________ WISEid __654321_ LEAs Student ID_5648-9657_ INFORMATION ABOUT THE STUDENT, INCLUDING PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE Information about the student, including strengths, effects of the disability / special factors, present level of academic achievement and functional performance, and any concerns must be considered when identifying the students disability-related needs and developing goals and services to address those needs. Include strategies that have been effective in improving the students academic achievement and functional performance and access to general education. Parents are important members of the IEP team and are encouraged to share information throughout the process. The student should be included, whenever appropriate, and encouraged to provide input throughout the process.  Strengths Describe the students strengths (including academic skills, communication skills, social skills, and interests). Keesha is a bright and cheerful girl starting the 9th grade this year. She has positive relationships with both peers and teachers, and her interpersonal skills are high. She also excels academically, achieving a 3.7 grade point average in her 8th grade school year. Keesha is a hard worker, participates well in class, and turns her work in on time. Current Academic Achievement and Functional Performance Academic achievement generally refers to a students performance in academic content areas (e.g., reading, math, written language, etc.). For preschool children, academic achievement generally refers to knowledge and skills such as early language development/communication, early literacy, cognition and general knowledge. Academic achievement statements must include information about student achievement and/or progress compared to grade-level expectations. Sources of information may include state, district-wide, or classroom assessments, rubrics, screeners or other tools (refer to the Evaluation Report, ER-1). The present levels provided must include sufficient information to establish a baseline from which each annual goal is developed.  Describe the students present level of academic achievement (including reading achievement). For preschool children, describe the childs acquisition and use of knowledge and skills (including early language/communication and early literacy). Reading: Keeshas spring 2016 MAP score for reading was a 231, 11 points above the norm; and on her FORWARD exam during the same testing period, she scored a 732 for English/Language Arts, which is in the Advanced range for her grade level. Her Lexile reading score puts her at a 12th grade reading level. Keesha enjoys reading and participates well in class, volunteering to read and answer comprehension questions. Writing/Language Arts: Keeshas Spring 2016 MAP score for English/Language Arts was a 224, 5 points above the norm. Her FORWARD exam score for the same period was a 732, in the Advanced range. Her Language Arts scores show that Keesha does well with reading, comprehension, gathering information, and summarizing complex ideas from her readings. Keesha struggles in the act of writing. Her Obsessive Compulsive Disorder forces her to write, erase, and rewrite her letters over and over until her paper rips. She is able to successfully complete written responses with a word processor or an assistant who writes her words down for her. Science: Keeshas spring 2016 MAP score for Science was a 215, 2 points above the norm for her grade level, and her FORWARD exam score was a 609, which is in the Proficient range. Keesha very much enjoys Science, and participates well in class, contributing to labs and group work during class time. She is not able to write her own notes or complete written work independently because of her OCD in writing letters. Form I-4 Name of Student _______Keesha Hawkins___________________ Page _____ of _____ Functional performance includes activities and nonacademic skills needed for independence, access to instruction and performance at school, in the home, in the community, for leisure time, and for post-secondary and lifelong learning. Some examples include: activities of everyday living, school/work/play habits, and social-emotional behavior (refer to the Evaluation Report, ER-1). The present levels provided must include sufficient information to establish a baseline from which each annual goal is developed. Describe the students present level of functional performance (including impact on reading achievement and access to instruction). For preschool children, describe the child's positive social-emotional skills (including social relationships) and use of appropriate behaviors to meet their needs and the impact on early literacy. Functional Behavior: Keesha is a very capable student who participates in small and large groups during class, communicates well with peers and teachers, and follows basic classroom rules and procedures. She is respectful and polite. She is organized, keeps track of her materials, and turns in her work on time. During the 2015-2016 school year, she recorded 4 absences. Keesha does become frustrated easily when her handwriting and OCD become a problem. She does not always advocate for herself with teachers when she needs help with written work, and this can lead to sadness and frustration, and uncompleted work. Special Factors Special Factors must be considered when developing the individualized education program. The services required to address the needs related to the special factors should be documented in the Program Summary. For example, if a students behavior impedes learning, the positive behavioral interventions, strategies, and supports could include specially designed instruction, related services, supplementary aids and services and/or program modifications and supports for staff. The behavioral needs of the student may be determined through a functional behavioral assessment (FBA).  Does the students behavior impede his/her learning or that of others? ( Yes % No If yes, describe how (document needed services in the Program Summary): Keesha s obsession with perfect handwriting impedes her ability to take notes, focus on lectures and discussions, or complete written work or tests independently. Is the student an English Language Learner (ELL)? % Yes ( No If yes, describe how this factor affects the student s needs related to the IEP: In the case of a child who is blind or visually impaired, does the student need instruction in Braille or the use of Braille? (Attach Determining Braille Needs (ER-3) from the latest evaluation/reevaluation or any updated information.) ( Not Applicable % Yes % No % Cannot be determined at this time If yes, describe needs, including Braille needs: Does the student have communication needs that could impede his/her learning? % Yes ( No a. If yes, describe the communication needs (including speech and language needs): b. If the student is deaf or hard of hearing, describe (a) the students language and communication needs; (b) opportunities for direct communication with peers and professional personnel in the students language and communication mode; and, (c) academic level and full range of needs including opportunities for direct instruction in the students language and communicative mode: Form I-4 Name of Student ______Keesha Hawkins___________________ Page _____ of _____ Does the student need assistive technology services or devices, including any services or devices needed to assist with reading? ( Yes % No If yes, describe the needs (document needed services in the Program Summary): Keesha should use a word processor for written tasks as much as possible, and can also use an audio recording device to record lectures for playing back later. Concerns of the Parent(s)/Family Describe the concerns of the parent(s)/family for enhancing the education of the student. This may include concerns about reading achievement, early language/communication or early literacy skills, other academic areas, social-emotional needs, sensory needs, behavior, the childs future and postsecondary transition, etc.: Mr. and Mrs. Hawkins are concerned that Keeshas OCD will get in the way of her succeeding in upcoming higher level, tougher High School classes that require more note-taking and written work. They want to see her advocate for herself more by asking teachers for help, or asking classmates for copies of notes, etc. Describe the concerns (if any) of the student for enhancing his or her education: Keesha is concerned that her OCD makes her different from her peers, and states that she does not want to draw attention to herself by asking for notes or other help during class. Effects of Disability Review Need for Special Education in the Evaluation Report (ER-1) for information about the students disability-related needs.  Does the students disability adversely affect his or her progress toward meeting grade-level reading standards? For preschoolers, does the disability adversely affect progress toward the Wisconsin Model Early Learning Standards (WMELS) for language development, communication and/or early literacy? % Yes ( No Describe how the student s disability affects his or her access, involvement and progress in the general education curriculum, including how the disability affects reading. For preschool children, describe how the disability affects participation in age-appropriate activities, including language development, communication and/or early literacy. Keeshas Obsessive/Compulsive Disorder affects her ability to complete written work. She is not able to fully focus on lectures because of her obsession with handwriting and the effort expelled in erasing and re-writing her letters. She is not able to complete written work or tests independently due to her compulsion. Her disability does not affect her reading. Form I-4 Name of Student ____Keesha Hawkins___________________ Page _____ of _____ Summary of Disability-Related Needs If the IEP team determines the student has a disability-related need that affects reading (academic or functional), the IEP must include a minimum of one goal to address this need. Each identified disability-related need must have at least one corresponding goal and/or service to address the need. A goal or service may address more than one need. Services include special education, related services, supplementary aids and services, or program modifications or supports for school personnel.  List and number the disability-related needs. Include reading needs, or early literacy needs, and needs due to special factors, if identified. Reference numbered needs in the measurable annual goal statements (add rows, as needed). 1Emotional frustration and management2Self-advocacy3Written work4 Form I-4 Name of Student _______Keesha Hawkins_________________ Page _____ of _____ FAMILY ENGAGEMENT How will school staff engage parent(s)/families in the education of the student (e.g. sharing resources, communicating with parent(s)/families, building upon family strengths, connecting parent(s)/families to learning activities, etc.)? Teachers will call or email parents when concerns arise or when objectives are met. Parents will receive district newsletters quarterly, and they also have access to CANVAS online through the district website to check grades and assignments. Teachers will share progress reports at the end of trimesters and review the IEP annually. Form I-4 Name of Student ____Keesha Hawkins____________________ Page _____ of _____ PARTICIPATION IN GENERAL EDUCATION CURRICULUM Choose one of the following: The IEP team determines whether the student is in the general education curriculum (the same curriculum as for students without disabilities) or the curriculum aligned with alternate achievement standards. Unless a student is expected to take alternate assessments aligned with alternate achievement standards, the student is full time in the general education curriculum. If the student participates in curriculum aligned with alternate achievement standards, include benchmarks or short-term objectives with the measurable annual goals. (Select one below.) ( The student participates full-time in general education curriculum aligned with the general education standards that apply to all students, or for preschoolers, in age-appropriate activities aligned with Wisconsin Model Early Learning Standards (WMELS). % The student participates in curriculum aligned with alternate achievement standards. See Participation Guidelines for Alternate Assessment Form I-7-A. Form I-4 Name of Student _____Keesha Hawkins___________________ Page _____ of _____ MEASURABLE ANNUAL GOALS Each goal must address at least one disability-related need. Develop / revise one or more measurable annual academic or functional goal to: address any lack of expected progress toward the annual goals, if appropriate; address the unique needs of the student that result from the students disability (see section I.F. above); enable the student to progress toward grade-level reading standards, or for preschoolers, WMELS for language development, communication and early literacy; enable the student to be involved in the general education curriculum i.e., the same curriculum as for nondisabled students; enable the student to progress toward meeting grade-level academic standards; and enable the student to be educated and participate with nondisabled students. If the IEP team determines the student has a disability-related need that affects reading (academic or functional), the IEP must include a minimum of one goal to address this need. Before developing annual goals, review the previous IEP goals and progress (document review and student s progress on the I-5, Annual Review of IEP Goals) Previous IEP goals reviewed: ( Yes % No % Not Applicable . Goal #__1__ (The Goal # changes as goals are added. Complete 1 through 5 below for each goal.) Goal Statement: Keesha will identify and manage her feelings (i.e. anger, frustration, anxiety) on a daily basis with 80% frequency as measured by daily progress sheets. Baseline (Students current level of performance from which progress toward this goal will be measured): When Keesha is frustrated by her disorder, she continues to try to write at her seat and sometimes cries. Level of Attainment (Must relate to the baseline measurement and reflect progress): Keesha will recognize that she is frustrated and use one of her pre-designated strategies to manage her feelings. Benchmarks or Short-Term Objectives (Required if student participates in curriculum and assessment aligned with alternate academic achievement standards.): % Not Applicable Objective #1: By the end of trimester 2, Keesha will describe her feelings or mood when asked by her special education teacher in 8 out of 10 instances. Objective #2: By the end of trimester 3, Keesha will choose a pre-designed strategy to manage her frustration in 8 out of 10 instances when her disorder becomes a problem in her written work. Annual goal addresses disability-related need(s) #___1___ of the student. (Needs identified in Section I.F). Procedures for measuring the students progress toward meeting the annual goal from baseline to level of attainment: Monthly charting for objectives one and two. When will reports about the students progress toward meeting the annual goal be provided to parent(s)? (Document reviews and students progress on the I-6, Interim Review of IEP Goals.) End of trimester reports and annual review of IEP. C. Goal #__2__ (The Goal # changes as goals are added. Complete 1 through 5 below for each goal.) 1. Goal Statement: Keesha will demonstrate appropriate age level skills in asking for help at appropriate times with 80% frequency as measured by daily progress sheets. Baseline (Students current level of performance from which progress toward this goal will be measured): When Keesha is frustrated by her disorder, she continues to try to write at her seat and sometimes cries. Level of Attainment (Must relate to the baseline measurement and reflect progress): Keesha will recognize the trigger that is making her frustrated, and will ask the teacher or another student for assistance. Form I-4 Name of Student _____Keesha Hawkins___________________ Page _____ of _____ 2. Benchmarks or Short-Term Objectives (Required if student participates in curriculum and assessment aligned with alternate academic achievement standards.): % Not Applicable Objective #1: By the end of trimester 3, Keesha will ask her teacher for assistance appropriately with 80% frequency when written work is required. Objective #2: By the end of trimester 3, Keesha will ask a peer for assistance appropriately with 80% frequency when written notes are required in class. 3. Annual goal addresses disability-related need(s) #_2, 3_ of the student. (Needs identified in Section I.F). 4. Procedures for measuring the students progress toward meeting the annual goal from baseline to level of attainment: Monthly charting for objectives one and two. 5. When will reports about the students progress toward meeting the annual goal be provided to parent(s)? (Document reviews and students progress on the I-6, Interim Review of IEP Goals.) End of trimester reports and annual review of IEP. PROGRAM SUMMARY Include a statement for each of A, B, C and D below to allow the student to (1) access, be involved in and make progress in the general education curriculum, (2) be educated and participate with other students with and without disabilities to the extent appropriate, (3) participate in extracurricular and other nonacademic activities, and (4) advance appropriately toward attaining the annual IEP goals. Include frequency, amount, location, & duration (if different from projected IEP beginning and ending dates). The services must be stated in the IEP so the level of the LEAs commitment of resources is clear to the parent(s) and other IEP team members. At least one special education service must be specified; include other services, if needed. Projected beginning and ending date(s) of IEP services & modifications from Jan 8, 2017 to Jan 7, 2018. (month/day/year) (month/day/year) A. Supplementary Aids and Services Aids, services, and other supports (accommodations) that are provided in regular education, other educational settings, and in extracurricular and nonacademic settings, to enable students with disabilities to be educated with nondisabled children to the maximum extent appropriate. The amount of time specified for each service must be appropriate to the service and stated in a manner that can be understood by all involved in developing and implementing the IEP. (Review Need for Special Education in the Evaluation Report, ER-1.) For each supplementary aid and service, identify the corresponding annual goal(s). In some situations, there may not be a corresponding goal. In those situations it is acceptable to identify the disability-related need(s). % None neededDescribeFrequency & Amount (describe the circumstances, if appropriate)LocationDurationAddresses Goal(s) #_______ Addresses Need(s) #_______ Use of word processor Extended time for tests Student Note-taker Audio recorder Spec Ed Assistant  For assignments that require written work When written answers are required When notes are required for class lectures When class contains a lecture When written classwork is required Regular Ed room Regular Ed room Regular Ed room Regular Ed room Regular Ed room IEP Term IEP Term IEP Term IEP Term IEP Term 2 1 2 2 1 2, 3 1, 3 2, 3 2, 3 1, 3 B. Special Education / Specially Designed Instruction Adapting, as appropriate to the needs of an eligible student, the content, methodology, or delivery of instruction to address the unique needs of the student that result from the students disability; and ensure access of the student to the general curriculum, so the student can meet the educational standards of the public agency that apply to all students. (Review Need for Special Education in the Evaluation Report, ER-1.) For each special education service, identify the corresponding annual goal(s).DescribeFrequencyAmountLocationDurationAddresses Goal(s) #________    C. Related Services Needed to Benefit from Special Education Transportation and such developmental, corrective, and other supportive services as are required to assist a student with a disability to benefit from special education. Review Need for Special Education in the Evaluation Report, ER-1.) For each related service, identify the corresponding annual goal(s). In some situations, there may not be a corresponding goal. In those situations it is acceptable to identify the disability-related need(s). % None needed DescribeFrequencyAmountLocationDurationAddresses Goal(s) #_______ Addresses Need(s) # ______( Assistive Technology Word Processor and Audio RecorderRegular Ed SettingIEP Term 2 2, 3% Audiology% Counseling% Educational Interpreting% Medical Services for Diagnosis and Evaluation% Occupational Therapy% Orientation and Mobility (For students with Visual Impairments)% Physical Therapy( Psychological Services% Recreation% Rehabilitation Counseling Services% School Health Services% School Nurse Services% School Social Work Services% Speech / Language% Transportation% Other: specify D. Program Modifications or Supports for School Personnel Services or activities for school personnel to meet the needs of the student. Identify the goal(s) or need(s) addressed. ( None needed Describe FrequencyAmountLocationDurationAddresses Goal(s) #_______Addresses Need(s) #_______  Form I-4 Name of Student ______Keesha Hawkins_______________ Page _____ of _____ STUDENT PARTICIPATION Participation in Regular Education Environment (location, including regular education classrooms, extracurricular and nonacademic activities, and workplace settings) ( The student will participate full-time with non-disabled peers in regular education environment, or for preschoolers, with non-disabled peers in age-appropriate settings. If you have indicated in the Program Summary a location other than regular education environment, or age-appropriate settings for preschoolers, you must check the box below and answer Questions 1 and 2. % The student will not participate full-time with non-disabled peers in regular education environment, or for preschoolers, with non-disabled peers in age-appropriate settings. If you have indicated a location other than regular education environment or age-appropriate settings in the Program Summary, you must check this box and answer Questions 1 and 2 below. Describe the extent to which the student will not participate with non-disabled students in the regular education classroom, or age-appropriate settings in the case of a preschooler, including extracurricular and nonacademic activities: Explain why full-time participation with non-disabled peers is not appropriate, or in the case of a preschooler, participation in age-appropriate settings: Ensure any supplementary aids and services needed for the student to participate in the regular education environment, including regular education classrooms, extracurricular and nonacademic activities, and workplace settings, are included in the Program Summary. Participation in Physical Education % Not Applicable (If the student is in a grade-level where physical education is not offered and the student does not require specially designed physical education as part of a free appropriate public education.) ( Regular Physical Education % Specially Designed Physical Education If the IEP team determines the student requires specially designed physical education, there must be a corresponding disability-related need and goal, and this service must be included in the Program Summary with the appropriate frequency and amount. Participation Guidelines for Alternate Assessment Form I-7-A (Rev. 9/15) Name of Student Keesha Hawkins IEP teams are responsible for deciding whether students with disabilities will participate in general education assessments with or without testing accommodations, or in the alternate assessment with or without accommodations.1 In a given year, a student must participate in either all general education assessments or all alternate assessments, not parts of both. Participation CriterionParticipation Criterion DescriptorsAgree (Yes) or Disagree (No)? 1. The student has a significant cognitive disability.Review of student record indicates a disability (i.e. Autism, Intellectual Disability, or Traumatic Brain Injury) that significantly impacts intellectual functioning and adaptive behavior. Adaptive behavior is defined as essential for someone to live independently and to function safely in daily life.Yes / No2. The student is primarily being instructed using the Wisconsin Essential Elements.Goals listed in the IEP for this student are linked to the enrolled grade level Wisconsin Essential Elements and address knowledge and skills that are appropriate and challenging for this student.Yes / No3. The student requires extensive direct individualized instruction and substantial supports to achieve measureable gains in the grade-and age-appropriate curriculum.The student requires extensive, repeated, individualized instruction and support that is not of a temporary nature and uses substantially adapted materials and individualized methods of accessing information in alternative ways to acquire, maintain, generalize, demonstrate and transfer skills across multiple settings.Yes / No When the IEP team concurs that all three of the criteria above accurately characterize a students current educational situation, an alternate assessment should be used to provide a meaningful evaluation of the students current academic achievement. The IEP team determined the student must participate in alternate assessments. Yes / No Decisions for determining participation in the alternate assessment must not be based solely on any of the following: A disability category or label Poor attendance or extended absences Native language/social/cultural or economic difference Expected poor performance on the general education assessment Academic and other services student receives Educational environment or instructional setting Percent of time receiving special education English Language Learner (ELL) status Low reading level/achievement level Anticipated students disruptive behavior Impact of student scores on accountability system Administrator decision Anticipated emotional distress Need for accommodations (e.g., assistive technology/Augmentative and Alternative Communication) to participate in assessment process INDIVIDUALIZED EDUCATION PROGRAM: To be completed for students participating in PARTICIPATION IN DISTRICT-WIDE ASSESSMENTS district-wide assessments Form I-7 District-wide Assessment (Rev. 10/2016) Name of Student__Keesha Hawkins______ District-wide assessments are tests given at the district level and can apply to students in all grade levels (4K-12). District wide assessments include the high school civics test requirement and the assessment for reading readiness. Students with disabilities must be included in district-wide assessments unless the IEP team determines that an alternate to the district-wide assessment is appropriate. Alternate assessments are intended only for students with the most significant cognitive disabilities. If the student will be taking an alternate assessment, the I-7-A Participation Guidelines for Alternate Assessment ( HYPERLINK "http://dpi.wi.gov/sites/default/files/imce/sped/doc/form-i7a.doc" http://dpi.wi.gov/sites/default/files/imce/sped/doc/form-i7a.doc) must be included with the IEP. District-wide assessment(s) the student will takeAre accommodations needed? (yes/no)If yes, describe the accommodations needed MAPSYesWord processor for written work and extra time to completeFORWARD examYesWord processor for written work and extra time to complete Alternate Assessment If the IEP team determines the student will take an alternate assessment, describe why the student cannot participate in the regular assessment and an alternate district-wide assessment is appropriate. Alternate assessment(s) the student will takeDescribe why the student cannot participate in the district-wide assessmentAre accommodations needed? (yes/no)If yes, describe the accommodations needed  Civics Test Under state law, IEP teams may consider whether the high school civics test is appropriate for the student. Completion of the civics test is not required for graduation if the students IEP includes a statement that the civics test requirement is not appropriate for the student. ( It is not appropriate to administer the high school civics test to the student. DETERMINATION AND NOTICE OF PLACEMENT: CONSENT FOR INITIAL PLACEMENT Form P-1 (Rev. 12/08) JAMAICA SCHOOL DISTRICT [If you need this notice in a different language or communicated in a different way, or have questions about this notice, please contact Deanna Howard at 555-5555.] Date of the placement determination: __Jan 8, 2017______ Date parent provided with notice of placement: _Jan 8, 2017 Name of student: __Keesha Hawkins____________ Dear Mr. and Mrs. Hawkins, The IEP developed on January 8, 2017 will be implemented at Jamaica High School in the Jamaica School District/City, with a projected date of implementation on February 8, 2017. Will the child attend the school he/she would attend if nondisabled? ( Yes % No, (If no, explain): List other options considered, if any, related to the placement site (school building or school district), frequency, location, and duration of the special education and related services, supplementary aids and services, program modifications and supports, and the place of those services. List the reason(s) rejected, and description of any other factors relevant to the proposed action: % None ( You previously received a copy of your child s evaluation report and a copy of his/her IEP is enclosed. % A copy of your child s evaluation report and IEP are enclosed. You and your child have protection under the procedural safeguards (rights) of special education law. The school district must provide you with a copy of your procedural safeguards once a year. Previously you received a copy of your procedural safeguard rights in a brochure about parent and child rights. If you would like another copy of this brochure, please contact the district at the telephone number above. In addition to district staff, you may also contact Daniel Parker at daniel.parker@dpi.wi.gov if you have questions about your rights. Sincerely, _______Cameron Diaz, Principal__________________ Name and Title of District Contact Person IEP Case Study Summary Paper Sara Hendrickson The case study I chose for this IEP assignment was for Keesha Hawkins, a bright 9th grade student who has Obsessive Compulsive Disorder in the area of writing. Keesha has a compulsion to write, erase, and rewrite her letters over and over until her paper rips from the overuse. The only information I was given in this case study had to do with Keeshas regular education science teacher, who didnt like to be bothered with or make accommodations for special education students, and her special education teacher, who tried to advocate for the simple services that Keesha needed to be successful. Those services included the use of a computer for her to complete written work on when possible, extended time for tests, and a student note taker during class lectures. She also asked that she be notified a day in advance of written worksheets so that an assistant could attend class and assist Keesha in completing the work. The science teacher refused to make these accommodations, and Keesha ended up being moved into a different general science class. Based on the information given in this case study, I made the assumptions that the parents of Keesha were involved in her education and concerned for her school success, and so would attend the IEP meeting. Keesha is being seen by a psychiatrist, who I made sure to invite to the meeting also. A professional would be able to give us a better insight into OCD in general, and also to Keeshas specific disorder and what steps and accommodations would best help her succeed. As far as I can tell in this case study, Keeshas strengths and academic achievement/functional performance are fairly high. It does say in the communication form that she has superior intelligence and reads at the twelfth-grade level, which led me to make up some pretty high scores for her on the MAP and FORWARD exams. I assumed that she enjoyed class, listened and participated well, and worked well with her peers. 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I showed that the only area that Keesha struggles with is her OCD and the task of writing. This affects her ability to function in class by impeding her ability to take notes during lectures and discussions, and to complete any written work or tests. It also impedes her ability to listen and pay attention during those lectures, because she is so obsessed with perfecting those letters and smoothing out corners, erasing and rewriting numerous times until the paper rips and she has missed all of the information anyway. Keeshas parents are concerned that she will not be able to handle the tougher caseload that High School classes bring while managing her disorder, and wish for her to advocate for herself more. Keesha is concerned that her disorder sets her apart from her peers and is afraid of unwanted attention being drawn to her because of her extra support. In the Summary of Disability-Related Needs, I wanted to make sure that Keeshas emotional state was protected, as a disorder like this is obviously taxing, especially in front of a young girls peers. I listed a need for emotional management to help her to learn how to deal with the frustration that this disorder brings her. I also listed a need for self-advocacy, because in the case study Keesha sat in her desk and continued to struggle with the erasing and rewriting until tears ran down her face and yet she did not ask for assistance. The teacher finally called her up to the desk, and still she only told him she couldnt do the writing. She did not know how to ask for the accommodations that she needed in order to complete the task. Lastly I added a need for written work completion. Although Keesha is academically able to do the work asked of her, the actual writing is where her disability manifests itself. At our school district, students manage their schoolwork and assignments in an online program called Canvas. Keeshas parents could also have access to this program to observe her work and grades throughout the year. Teachers in my program also call or email at least weekly with updates on behaviors and progress, etc. Official reports come at the end of trimesters, and at the Annual IEP Review at the end of the IEP term. Keesha will also participate fully in the general education curriculum, as she is at or above grade level expectations academically. The goals for Keesha is where things started to get tricky, of course. I didnt feel like I could do a specific writing goal, because as I said, even though writing is the problem, academically she is more than capable of doing the work. Her OCD is an emotional disorder, and so I chose to focus on more functional/emotional goals. In Goal #1 I wanted to get to the ground floor of what Keesha is dealing with, and that is her feelings and emotions. Because she is under the care of a psychiatrist, I assume she is working on this with them also. If that were the case, I would attempt to be in contact with that person, or hope that they would attend the IEP meeting so that I could more closely focus the goal on what they are working on. As it is, I decided to write a somewhat general goal about managing her feelings. In the case study it showed that Keesha attempted to do the written work asked of her, but her OCD took over and she sat working on it, with tears in her eyes. So I came up with 2 objectives to help her recognize her frustration and manage her feelings. In the first one, I just want her to work on recognizing and identifying her feelings so that she can describe them to her teacher. This could be done during an OCD moment, but also during a random moment during her school day. The goal is for her to just know what different emotions look and feel like, and recognize them in herself. In the second objective I wanted her to take this a step further, and use a pre-designed list of strategies to choose from when she gets frustrated or her OCD starts to kick in. I chose to stagger these to be completed in each of the second and third trimesters this year so she would have time to practice them before moving on to the next step. This goal aligns with the first need listed in the Summary of Disability-Related Needs, which is emotional frustration and management. This goal will be measured by using a daily progress sheet that Keesha will take to each of her classes during the day. The teachers will be asked to document whether Keesha struggled with her OCD, described her feelings (this need not be done every class, or every day!), or used a strategy to manage frustration during class. In Goal #2 I wanted Keesha to start to use self-advocacy skills, and begin to recognize her state of mind and ask for the help she needs in an age-appropriate way. Currently, when Keesha had a problem with written work during class, she just sat there and kept trying, getting nowhere but more and more upset. With these objectives, I wanted to give Keesha the chance to learn to ask for the help she needs. In the first objective I wrote that Keesha will start to ask her teacher for help when written work is required in class. In the case study it shows that with at least one days notice, a special education assistant will attend class with Keesha to complete the worksheets with her, but we all know that sometimes things dont happen according to plan, and I want her to be able to make her needs known to a teacher who may not think of it first. The second objective is for Keesha to ask a peer for assistance in notetaking or another necessary task during class. If her regular note taker is absent for some reason, she will need to ask someone else to complete that task for her. I want her to be comfortable doing this, and have the words to say when needed. In the Program Summary I added the Supplementary Aids and Services that were listed in the case study, and I added one of my own. Keesha will be able to use a word processor, such as a laptop computer or Chromebook, for as much written work as possible. She will receive extended time to complete her tests when written answers are required because she will need assistance in completing those. During lectures she will have a student who takes notes for her using special carbon paper so that they only have to tear a sheet off for her at the end of class. She also will have access to an audio recorder so that she can record the lectures and discussions to play back and listen to later. This is another way she can have access to the information without having to write anything. Lastly, she will have a special education assistant available to her on days when there are worksheets or other written work required in class that she is not able to do on her word processor. All of these services will be provided in the regular education classrooms and on an as-needed basis. The only Related Services needed for Keesha are the assistive technology aids already described, such as her word processor and audio recorder. Keesha will participate with nondisabled peers in the regular education curriculum, in the regular education classroom, with some assistance from special education services. Keeshas academics show that she is perfectly able to succeed at grade level, and will participate in District-wide assessments and state-wide assessments with her peers, with the extra time allotted for tests, and a word processor available for written work.     Page 2 of 2 Form I-1 Page ____ of ____ Form I-3 1General Education Assessments in Wisconsin refer to content reflective of the Wisconsin Academic Standards. Alternate assessments in Wisconsin assess content reflective of the Wisconsin Essential Elements. Students who are English language learners are required to participate in an annual English language proficiency assessment. 1General Education Assessments in Wisconsin refer to content reflective of the Common Core State Standards and the Wisconsin Model Academic Standards. These assessments include Students identified as English Language Learners are required to participate annually in a language assessment. the Wisconsin Knowledge and Concepts Examination, Smarter Balanced Assessment, ACT Aspire Early High School, ACT WorkKeys and The ACT. Alternate assessments in Wisconsin assess content reflective of the Common Core Essential Elements and the Wisconsin Extended Grade Band Standards. These assessments include the Wisconsin Alternate Assessment for Students with Disabilities and Dynamic Learning Maps. I-7 ACCESS for ELLs/Alt. ACCESS for ELLs Page 2 of 2 1General Education Assessments in Wisconsin refer to content reflective of the Common Core State Standards and the Wisconsin Model Academic Standards. These assessments include Students identified as English Language Learners are required to participate annually in a language assessment. the Wisconsin Knowledge and Concepts Examination, Smarter Balanced Assessment, ACT ASPIRE Early High School, ACT WorkKeys and The ACT. Alternate assessments in Wisconsin assess content reflective of the Common Core Essential Elements and the Wisconsin Extended Grade Band Standards. These assessments include the Wisconsin Alternate Assessment for Students with Disabilities and Dynamic Learning Maps. Form I-7-ACT Aspire Early High School Page 2 of 2 1General Assessments in Wisconsin refer to content reflective of the Wisconsin Academic Standards. 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