Merrin's IEP

Monroe County Community School CorporationCase Conference Summary/IEP/ITP

Date

Student Name DOB Sex Re-eval Date

Home School/Attending School / Grade ID#

Student Resides with: Phone Caseworker/Agency Representative Phone

Home HomeParent/Guardian Name Name

Work WorkStreet Address Street Address

Emergency EmergencyCity/Zip City/Zip

Legal Guardian: � Natural Parents � Adoptive Parents � DFC

� Natural Mother � Adoptive Mother � Court

� Natural Father � Adoptive Father � Other __________________________________________

Purpose of Case Conference:

� Initial Conference � Annual Case Review � Transition

� Declassification/Reclassification � Causal Relationship � Move in

� IEP Review

Case Conference Committee Members (Indicate role)

Chairperson Special Education Teacher

Student General Education Teacher

Parent

March 5, 2008

Derek Slovin March 2, 1996 Male March 5, 2011

Templeton Elementary 5th

Susan and Larry Slovin

5 Heritage Plaza Drive

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(812) 345- 9768

(812) 545- 8765

Bloomington 47404 (812) 855- 1287

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Rebecca Smith Merrin Rosenberg

Derek Slovin Shari Robin

Susan and Larry Slovin Psychologist: Jillian Katz

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401

(812)349-4756 or (812)349-4757 - FAX=(812)330-7811

Case Conference Summary Page 2

Student Performance

Evaluation procedures, assessments, records or reports utilized to help determine eligibility for special education services.

Cognitive:

Impact on involvement in general education curriculum:

Achievement: Evaluation Data:

Reading: Strengths

Weaknesses


Math: Strengths

Weaknesses


Social Emotional: Strengths

Weaknesses


Communication: Strengths

Weaknesses


Adaptive Behavior: Strengths

Weaknesses


Behavior: Strengths

Weaknesses


Other: Strengths

Weaknesses


WISC-III - Verbal IQ: 95, Performance IQ: 110, Full Scale IQ: 96

Because of average IQ there is no impact on the general education curriculum

Woodcock- Johnson III- Broad Reading: 77, Letter-Word ID: 72, Spelling:52

Student is strong in Decoding/ Word Attack

Student is struggling with Broad Reading, Letter-Word ID, and Spelling

Student may benefit from time in the resource room

Student is strong in Math Calculation

Student could use a little extra help in Math Applied Problems

No impact on general education curriculum

Derek is extremely social with peers

Derek is hyperactive at time, and can't stay on task for a long period of time.

May need preferential seating

Can communicate his feelings whether happy/sad effectively

Has trouble finding appropriate words to complete sentences

May need verbal assistance, allow Derek to communicate by written expression

Can get up, and get dressed for school independently: Good at managing personal care

Has trouble staying seated and still on bus to school

No impact

Follows directions when asked

Argumentative at time

No impact

N/A

N/A

N/A

Derek Slovin


(812)349-4756 or (812)349-4757 - FAX=(812)330-7811


Student input (strengths, interests, concerns):

Parent input (strengths, interests, concerns):

The following health data was discussed

� no known problems � frequent absences/tardies: days present _____ days absent _____

� on medication (specify) � physical concern (specify)

� seizure activity � wears glasses/contacts/hearing aid/prosthesis (circle)

� health plan � other ___________________

Special Factors

1. Does behavior impede student learning or the learning of others? Yes No If YES, team must develop and attach intervention plan2. Does the student have limited English proficiency? Yes No If YES, team must consider language needs3. Is the student blind or visually impaired? Yes No If YES, team must consider appropriate reading and writing media.4. Is the student deaf or hard of hearing? Yes No If YES, team must consider communication needs.5. Does the student require assistive technology devices or services? Yes No If YES, see accommodations and/or related services6. Should the student be considered for an assistive technology evaluation? Yes No If YES, appropriate referral forms must be completed7. “Other”

Based on the case conference committee’s discussion of the data noted above:

� The student is eligible for special education services as defined in Indiana Code

� The student is not eligible for special education services as defined in Indiana Code

Disability Category(ies)1 = primary disability 2 = secondary disability

___ Autism ___ Communication Disorder ___ Dual Sensory Impairment ___ Developmentally Delayed ___ Emotional Handicap___ Hearing Impairment ___ Learning Disability ___ Mild Mental Handicap ___ Moderate Mental Handicap ___ Severe Mental Handicap___ Orthopedic Impairment ___ Other Health Impairment ___ Traumatic Brain Injury ___ Visual Impairment

Does the student require an alternative curriculum? Yes No If YES, explain non-participation in general education curriculum

Can student participate in non-academic and extra curricular activities? Yes No If NO, explain

"I want to become a better speller and writer." "I am really good in math." "I don't want to be separated from my friends."

"I am worried that Derek might have a hearing problem because of his ruptured ear drum."

"I am concerned that Derek might be hyperactive, which makes him lose focus." "I think Derek has pretty good self-managing skills."

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It would benefit Derek to have a Hearing Screen Test

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1

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Derek Slovin


(812)349-4756 or (812)349-4757 -- FAX (812)349-7811

Transition Plan Page 1

Individualized Transition Plan

Name: Social Security Number

School Anticipated final year of school

InitialPlan Date Review Date Review Date Review Date Review Date Review Date

1. Projected Post-School Outcomes:

Post-Secondary Education

Vocational Training

Community Living

Continuing/Adult Ed.

Integrated/Supported Employment

Community Participation

2. Statement of student’s interests and preferences:

3. This student is working toward: � Credit - diploma � Non-credit - certificate of completion � GED

4. Ongoing Adult Services: � NO � YES - what information was given? Date given:

5. I have been informed that at the age of eighteen all rights accorded parents under special education legislation are transferred to the student and are concurrent with the parents’.(Must be completed if student is 17 at the time of conference.)

Student Signature/Date Parent Signature/Date

Derek Slovin


(812)349-4756 or (812)349-4757 -- FAX (812)349-7811

Transition Plan Page 2

6. Statement of Needed Transition Services: (A “statement of needed transition services” describes services the student needs to gain the skills and connections necessary toachieve his or her desired goals):

Transition Services Needed?

YES - See goal/objectivesNO - Explain

IEP must contain goals/objectives related to allareas marked YES

Coordinated Sequential Set ofActivities/objectives

Person Responsible/AgencyLinkages

Instruction � YES

� NO

Related Services � YES

� NO

Community Experience � YES

� NO

Employment/FunctionalVocational Evaluation

� YES

� NO

Daily Living � YES

� NO

Residential � YES

� NO

Other (eg: medical, financial) � YES

� NO

Derek Slovin


(812)349-4756 or (812)349-4757 -- FAX (812)330-7811

IEP Page 1

Goals and Objectives

Student’s Name Identified Need:

Annual Goal

Measurable, Short-term Instructional ObjectivesIncluding Objective Criteria to be reviewed annually

Person(s) Responsible(By Title)

Procedures ofEvaluation

Progress Comments

Person(s) Responsible Procedures for Evaluation Progress

General Education Teacher Gen. Ed A. Observation i. Objective Met

Special Education Teacher Spec. Ed. B. Written/Oral Response ii. Progress made, but objective not yet met

Parent Parent C. Performance iii. Little or no progress

Occupational Therapist OT D. Criterion Referenced Test iv. Met, but not maintained

Physical Therapist PT E. Student Self Assessment v. Other (specify)

Speech/Language Pathologist SLP F. Other (specify):

Hearing Impairment Specialist HI

Vision Impairment Specialist VI

� Progress will be reported on the goals form � Other (Specify)� Progress toward annual goals will be provided at time of report cards; or� Other (Specify)

Derek Slovin

Derek will improve in Reading at the Second grade level

Reading

2.1.1 Demonstrate an an awareness of the sounds that are made bydifferent letters by making less than 5 errors when reading aloud passagesof 20 words

2.2.11 Know and use common word families(such as -ale, -est, -ine, -ock,-ump) when reading unfamiliar words by making less than 5 errors whenreading aloud passages of 20 words

Gen. Ed.Spec. Ed.

Gen. Ed.Spec. Ed.

A, B, D

A, B, D

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(812)349-4756 or (812)349-4757 -- FAX (812)330-7811

IEP Page 1



Annual Goal




Progress Comments











Derek Slovin

Derek will improve writing skills at the pre-primer level.

Writing

K.6.2 Spell independently using an understanding of the sounds of thealphabet and knowledge of letter names by completing weekly 20 wordspelling tests with less than 5 errors.K.4.4 Write phonetically spelled words(words that are written as theysounds) and consonant-vowel-consonant words(demonstrating thealphabetic principle)writing passages of 100 words with less than 25 errors

Gen,. Ed.Spec. Ed.

Gen. Ed.Spec. Ed.

A, B ,D

A, B, D

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(812)349-4756 or (812)349-4757 -- FAX (812)330-7811

IEP Page 1



Annual Goal




Progress Comments











Derek Slovin


(812)349-4756 or (812)349-4757 -- FAX (812)330-7811

IEP Page 1



Annual Goal




Progress Comments











Derek Slovin


(812)349-4756 or (812)349-4757 -- FAX (812)330-7811

IEP Page 1



Annual Goal




Progress Comments











Derek Slovin


(812)349-4756 or (812)349-4757 -- FAX (812)330-7811

IEP Page 1



Annual Goal




Progress Comments











Derek Slovin


(812)349-4756 or (812)349-4757 -- FAX (812)330-7811

IEP Page 1



Annual Goal




Progress Comments











Derek Slovin


(812)349-4756 or (812)349-4757 -- FAX (812)330-7811


Special Education Services/Least Restrictive Environment Any potentially harmful effects of the recommendations must be considered.

Services considered and rejected (indicate reasons)

Services recommended (indicate reasons; location, frequency and length)

Related Services (Note intensity, frequency and location of services)

_____Occupational therapy for a minimum of _____ minutes each � week � month _____ direct, integrated in classroom & community_____consultation _____ other (specify)________________

_____Physical therapy for a minimum of _____ minutes each� week� month _____ direct, integrated in classroom & community_____consultation _____ other (specify)________________

Social Worker Transportation: Attach Transportation Form.

Other

Supplementary aids and services/and/or other factors relevant to proposed services:

Date for Initiation of Services (on or about): , ending date (on or about) following regular school calendar.

Teacher of Record:

Other Teachers of Record for Secondary Disabilities

Full time and part time were considered, but full time would be too restrictive.

Committee recommends part time services in a resource room setting. 5 days a week and 1 hour each day.

March 5, 2008

Merrin Rosenberg

March 4, 2009

N/A

N/A

Derek Slovin


(812)349-4756 or (812)349-4757 -- FAX (812)330-7811

Case Conference Summary 5

Recommended Participation in Statewide or District standardized testing for the _______________ school year.

Indiana M C C S CThis student is not in a standardized testing mandated grade level.This student will fully participate in the standardized testing program without accommodations.This student will not participate in the standardized testing program (Specify reasons below).This student will fully participate in the standardized testing program with accommodations (Specify below).This student will participate in the standardized testing program for diagnostic purposes.This student will be subject to remediation.This student will be subject to retesting.This student will need the following testing accommodations (Specify):

This student’s essential skills will be tested using an alternate assessment (Specify, including why the statewide or district assessment is not appropriate andhow the student will be assessed):

Is extended school year recommended? YES NO

If yes, committee must document the degree of regression; amount of time for recoupment; and the extraordinary, irretrievable educational, emotional or vocational reversals.

If yes, describe the nature of the interventions, include interventions parents can provide to meet student’s needs.

Name(s) of person(s) who will submit a written opinion.

NA

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N/A

Derek Slovin


(812)349-4756 or (812)349-4757 -- FAX (812)330-7811


Student Name:

School:

Parent Permission for Special Education Services

You have the right to request a case conference and/or revoke your written permission for services at any time. If you are prepared to decide at this time, please sign on one ofthe lines below.

I/we agree with the services recommended and give permission for the plan to be implemented:

Parent Signature Date Student Signature (If 18) Date

I/we do not agree with the services recommended.

Parent Signature Date Student Signature (If 18) Date

Parental Rights have been explained and provided:Parent Initials

Derek Slovin

Templeton Elementary


(812)349-4756 or (812)349-4757 -- FAX (812)330-7811


Modifications/Accommodations/Supports to Meet Educational Needs

Pacing Assignments Social Interaction SupportsAllow more time Give directions in small, distinct Peer/cross age tutoringVary activity often steps (written/picture/verbal) Structure activities to create opportunitiesAllow breaks Use written backup for oral directions of social interactionAvoid timed/pressure situations Read or tape record directions to Focus on social process rather thanOther: student activity/end product

Adjust difficulty level Partial participationEnvironment Shorten assignment/fewer items on Cooperative learning groups

Preferential seating page Other:Planned seating: Bus Classroom Reduce paper and pencil tasks

Lunchroom Auditorium Give extra cues or prompts Motivation and ReinforcementAlter physical room arrangement Allow student to record/type or VerbalDefine areas concretely dictate assignment Non-verbalReduce/minimize distractions: Avoid penalizing for spelling errors/ Positive reinforcement

Visual Auditory sloppy papers/penmanship Concrete reinforcementSpatial Movement Student should use cursive/printing Planned motivating sequences of activities

Provide opportunity for separate seating Other: Reinforce initiationTeach positive rules for use of space Offer choicesOther: Self Management/Follow Through Use strengths/interests often

Visual daily schedule Reinforce approximationPresentation of Subject Matter Calendars Response cost

Teach to student’s learning style Daily/Weekly assignment sheets Other:Visual Auditory Model Check often for understanding/reviewTactile Multi Experiential Learning Request parent reinforcement

Review prior to presenting new materials Have student repeat directionsIndividual/small group instruction Encourage use of notebook withUtilize alternate specialized curriculum dividers, or file folders, for organizationTape lectures/discussions for replay Use student sheets to organizeUtilize manipulatives materialEmphasize critical information Design/write/use long termPre-teach vocabulary assignment timelinesMake/use vocabulary files Plan for generalizationOral reading on voluntary basis only Develop organized routineProvide study guides/outlines Schedule regular communication/Encourage feedback from student to check for learning reports between home and schoolOther: Other:

Materials Student AssessmentArrangement of material on page Oral/taped responses Short answerTaped tests and/or other class materials Taped responses Multiple choiceHighlighted tests/study guides Read test to student Modify time frameNotetaking assistance: carbonless or xerox copy of notes of Shorten length Extend time frame regular students, copy of notes from board provided Consider individual progress over timeLarge print/graph paper/lined paper Consider effortSpecial Equipment: Alternative assessment

Word processor Calculator Test administered by:Computer Math facts sheet Other:

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✔ Only read test to student if requested

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Derek Slovin

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Merrin's IEP

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