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SCHOOL AGE INDIVIDUALIZED EDUCATION PROGRAM COVER SHEET (IEP)

School Age
Student Last Name Hughes Student First Name Kendra MI
Student ID# DOB 05/12/1997
Age 17 Grade 12th
Building Pine-Richland High
School
Home District PINE-RICHLAND SCHOOL DISTRICT
Student Address 202 Haymont Drive
Gibsonia, PA 15044
Phone 724-443-1824
Primary Exceptionality Visual Impairment incl. Blindness
Secondary Exceptionality
Primary Guardian Last Name Hughes First Name Patrick
Meeting Date for Current IEP 09/08/2014
Date of Last Implemented IEP 09/09/2013
Last ER Date 10/20/2008 PSSA? Not Applicable
LRE: Inside the regular class 80 percent or more oI the day
Amount of Special
Education:
Itinerant - |01|
Type of Support: Blind or Visually Impaired Support
Add. Services and
Support:
Explanation of Extent: Kendra will not participate with non-disabled children in the regular
education classroom during her vision sessions (32 Iorty-Iive sessions
throughout the IEP year).

Program Modifications and Specially Designed Instruction:
Description Location Frequency Duration
Enlarged print materials including tests, assessments, and study
guides, to Iont size 18 on 8.5" x 11" size paper.
Regular
Education
Classroom
In all academic classes Ior tests. Per
student request Ior worksheets, study
guides, handouts, etc.
06/12/2015

Dome, bar, or other magniIier Regular
Education
Classroom
When Kendra needs to view smaller print. 06/12/2015

PreIerential seating closest to the area oI instruction or activity Regular
Education
Classroom
Daily in all academic classes. 06/12/2015

Ability to move closer to presentations such as a program in
the auditorium Ior better viewing.
Pine Richland
High School
When Kendra determines the need to get
closer to the presentation Ior better
viewing.
06/12/2015

Hard copy oI notes Irom board or overhead, when not available
on Blackboard
Regular
Education
Classroom
When notes are presented on board or
overhead, Kendra needs a copy. Enlarge
the hard copy iI Kendra requests.
06/12/2015

Allow 50 additional time to complete tests and homework
assignments.
Pine Richland
High School
For all tests. Per student request Ior
homework assignments.
06/12/2015

For Scantron tests, Kendra may mark answers directly onto the
test and a teacher will transIer her answers onto the Scantron
sheet (or directly grade the test).
Regular
Education
Classroom
In all academic classes. 06/12/2015


Use oI district iPad to complete school related activities and
assignments.
Pine Richland
High School
Daily in all academic classes 06/12/2015

Related Services:
Type Location Frequency Duration
Vision Services Pine Richland High School 32 Iorty-Iive minute sessions throughout the IEP year 06/12/2015

PINE-RICHLAND SCHOOL DISTRICT
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
School Age

Student's Name: Kendra Hughes
IEP Team Meeting Date (mm/dd/yyyy): 9/8/2014
IEP Implementation Date (Projected Date when Services and Programs Will Begin): 9/9/2014
Anticipated Duration oI Services and Programs: 6/12/2015
Date oI Birth: 5/12/1997
Age: 17
Grade: 12th
Anticipated Year oI Graduation: 2015
Local Education Agency (LEA): PINE-RICHLAND SCHOOL DISTRICT
County oI Residence: Allegheny County
Name and Address oI Parent/Guardian/Surrogate: Phone
(Home):
724-443-1824 Email
(Home):

Mr. and Mrs. Patrick Hughes Phone
(Work):
Email
(Work):

202 Haymont Drive Phone (Cell):

Gibsonia, PA 15044
Other InIormation:
The LEA and parent have agreed to make the Iollowing changes to the IEP without convening an IEP meeting, as documented by:
Date of Revision(s) Participants/Roles IEP Section(s) Amended
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9/8/2014
Date of Revision(s) Participants/Roles IEP Section(s) Amended



Kendra Hughes, 8297687074 5/12/1997 IEP
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9/8/2014
IEP TEAM/SIGNATURES

The Individualized Education Program team makes the decisions about the student`s program and placement. The student`s parent(s), the student`s special education teacher, and a representative Irom
the Local Education Agency are required members oI this team. Signature on this IEP documents attendance, not agreement.

Printed Aame Role Signature
Kendra Hughes Student
Patrick Hughes Parent
Courtney Beatty Vision Services
Stephanie Skrinjar Transition Coordinator
Gary Torso Core Academic Teacher
Nancy Bowman Principal
James McNeil Community Agency Rep.




* The IEP team must invite the student iI transition services are being planned or iI the parents choose to have the student participate.
** II the student is, or may be, participating in the regular education environment
*** As determined by the LEA as needed Ior transition services and other community services
****A teacher oI the giIted is required when writing an IEP Ior a student with a disability who also is giIted.
One individual listed above must be able to interpret the instructional implications oI any evaluation results.

Written input received Irom the Iollowing members:



Transfer of Rights at Age of Majority

For purposes oI education, the age oI majority is reached in Pennsylvania when the individual reaches 21 years oI age. Likewise, Ior purposes oI the Individuals with Disabilities Education Act, the
age oI majority is reached Ior students with disabilities when they reach 21 years oI age.
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9/8/2014
PROCEDURAL SAFEGUARDS NOTICE

I have received a copy oI the Procedural Safeguards Notice during this school year. The Procedural SaIeguards Notice provides inIormation about my rights, including the process Ior disagreeing
with the IEP. The school has inIormed me whom I may contact iI I need more inIormation.

Signature oI Parent/Guardian/Surrogate:
Kendra Hughes, 8297687074 5/12/1997 IEP
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9/8/2014
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I. SPECIAL CONSIDERATIONS THE IEP TEAM MUST CONSIDER BEFORE DEVELOPING THE IEP. ANY FACTORS CHECKED
AS "YES" MUST BE ADDRESSED IN THE IEP.


Is the student blind or visually impaired?

Yes
The IEP must include a description oI the instruction in Braille and the use oI Braille unless the IEP team determines, aIter an evaluation oI the student's reading and
writing skills, needs, and appropriate reading and writing media (including an evaluation oI the student's Iuture needs Ior instruction in Braille or the use oI Braille), that
instruction in Braille or the use oI Braille is not appropriate Ior the student.

No


Is the student deaf or hard of hearing?

Yes
The IEP must include a communication plan to address the Iollowing: language and communication needs; opportunities Ior direct communications with peers and
proIessional personnel in the student`s language and communication mode; academic level; Iull range oI needs, including opportunities Ior direct instruction in the
student`s language and communication mode; and assistive technology devices and services. Indicate in which section oI the IEP these considerations are addressed.
The Communication Plan must be completed and is available at www.pattan.net

No


Does the student have communication needs?

Yes
Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction (SDI), annual goals, etc.)

No


Does the student need assistive technology devices and/or services?

Yes
Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction, annual goals, etc.)

No


Does the student have limited English proficiency?

Yes
The IEP team must address the student`s language needs and how those needs relate to the IEP.

No


Does the student exhibit behaviors that impede his/her learning or that of others?

Yes
The IEP team must develop a Positive Behavior Support Plan that is based on a Iunctional assessment oI behavior and that utilizes positive behavior techniques. Results
oI the Iunctional assessment oI behavior may be listed in the Present Levels section oI the IEP with a clear measurable plan to address the behavior in the Goals and
Specially Designed Instruction sections oI the IEP or in the Positive Behavior Support Plan iI this is a separate document that is attached to the IEP. A Positive Behavior
Support Plan and a Functional Behavioral Assessment Iorm are available at www.pattan.net

No


Other (speciIy):
The IEP team has determined that Braille instruction or the use oI Braille is not appropriate at this time. Kendra uses her vision as her primary sensory channel and
print as her primary learning media.
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II. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE


Include the following information related to the student:

Present levels oI academic achievement (e.g., most recent evaluation oI the student, results oI Iormative assessments, curriculum-based assessments, transition assessments, progress toward current
goals)


Kendra is a 12th grade student at Pine-Richland High School. She participates Iully in the regular education curriculum. Last school year (2013-2014), Kendra received the
Iollowing Iinal grades:
CP English 11: B
Algebra 2: D
Astronomy: A
Chemistry: B
HP US2: C
Comp Anat & Phys: B
Asian Studies: C
Kendra is currently enrolled in the Iollowing classes Ior her senior year: CP Psych, Environmental Science, CP Econ, App Alg & Trig, and CP English 12. She is also enrolled in
the Senior Flex program, leaving halIway through the day to attend a college English course at CCAC.
Teacher Input
Classroom teacher input was requested by Teacher oI the Visually Impaired, Courtney Beatty, in order to determine Kendra's perIormance and any areas oI need. Because it is
early in the school year, input was requested Irom both last year's and this year's teachers.
2013-2014 Teachers: Ms. Bille, Kendra's Anatomy teacher, stated Kendra came to class on time and was prepared. Kendra did not use the iPad during class. Her work was
commensurate with peers, as were her listening, organizational, and study skills. Ms. Bille stated Kendra's strengths were her lab work and participation during discussions. Ms.
Bille had no concerns and stated Kendra was a good student. Ms. Holmgren, Kendra's Chemistry teacher, explained that Kendra did not always come to class on time and
prepared. "OIten she would arrive just as the bell rang or she was not ready to start the class when I was". Kendra never used the iPad in her class. Her work was commensurate
with peers when turned in. Ms. Holmgren explained that towards the end oI the year, she turned in a lot oI late work. Kendra exhibited good listening, organizational, and study
skills Ior the most part. Ms. Holmgren noticed a lack in skills toward the end oI the year. She did not have any concerns related to vision. Ms. Bruno, Kendra's English teacher,
stated Kendra came to class prepared and on time. She did not use the iPad during class. Her work was commensurate with peers. She exhibited good listening, organizational,
and study skills. Ms. Bruno had no concerns. Mr. McCurdy, Kendra's Astronomy teacher, stated Kendra was on time and prepared Ior class. He did not notice Kendra using the
iPad during class. Her work was very comparable to peers. She exhibited good listening, organizational, and study skills. Mr. McCurdy expressed no concerns. Mr. Florijan
stated Kendra's biggest issue was doing and turning in her work. He stated she would have done better in class iI she would have spent more time on her assignments.
2014-2015 Teachers: Mr. Dugger, Kendra's Environmental Science teacher, stated thus Iar she has been on time and prepared Ior class. He has not seen her use the iPad, though
it has only been several days. Kendra has turned in and completed all work and does not seem to be behind or less capable. Mr. Dugger explained that Kendra does a nice job.
Kendra answers when called upon and has been listening Iine in class. Mr. Dugger does not have current concerns, but does ask that Kendra be an advocate in class Ior needed
accommodations. Ms. Tynes, Kendra's Applied Algebra & Trigonometry teacher, states Kendra comes to class on time and homework is attempted daily. Thus Iar, Kendra has
not used the iPad in class. Ms. Tynes explained two occasions where the iPad would have been beneIicial. One occasion required students to show a covered textbook or PDF oI
the textbook. Kendra showed the book on her iPhone rather than the iPad. On another occasion, students were asked to complete a personal reIlection (1" margins and converted
to PDF prior to submission). Kendra typed her reIlection in an e-mail. Ms. Tynes stated Kendra's Algebra 2 skills are in need oI improvement. She has been engaged in classwork
and has asked questions to promote understanding. Ms. Tynes expressed it would be helpIul Ior Kendra to selI-advocate when testing accommodations are needed. Ms. Walker,
Kendra's English teacher, stated thus Iar Kendra has come to class prepared and on time. She has used the iPad to access college application prompts when asked to. So Iar, her
work is above that oI her peers. Kendra participates, considers, and takes notes when requested. Ms. Walker has no concerns.
Testing Scores
Kendra took the Keystone Exams with the Iollowing scores:
Literature (Winter 13-14): 1533 (ProIicient)
Biology (Spring 12-13): 1528 (ProIicient)
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Algebra 1 (Winter (12-13): 1502 (ProIicient)
She also took the SAT in January 2014, with a score oI 1470. Kendra plans to re-take the SAT's this year.




Present levels oI Iunctional perIormance (e.g., results Irom a Iunctional behavioral assessment, results oI ecological assessments, progress toward current goals)


Kendra has a visual diagnosis oI ocular albinism which reduces her visual acuity and causes photophobia (sensitivity to light). Kendra wears contact lenses. She also has glasses,
but on most occasions wears her contact lenses. Previous documentation indicates that Kendra's most recent submitted eye report is dated May 28, 2009. The report states that
Kendra has visual acuities oI 20/40 in each eye. Also stated in the report is that with the aid oI her corrective lenses, her esotropia is well controlled.She receives itinerant vision
services to support additional needs in the academic setting that are related to her visual impairment.
Functional Vision and Learning Media Assessment
In September 2014, a Functional Vision and Learning Media Assessment was completed by Courtney Beatty (Teacher oI Students with Visual Impairments) to determine how
Kendra uses her vision in the academic setting. These assessments are also used to create appropriate goals and accommodations Ior Kendra. A summary oI the results are as
Iollows: During the assessments, Kendra`s eyes appeared red and she stated this was due to irritation with her contacts Iirst thing in the morning. Throughout the assessment,
Kendra`s right eye turned outward on occasion, but when asked to Iocus directly on the assessor, she was able to do so. Kendra's near vision acuity was assessed at 16 inches
using the Sloan Near Vision chart. With correction (contact lenses), Kendra's acuity using both eyes was equivalent 20/50. The usual type text size Ior this acuity is equivalent to
newspaper print, according to the Low Vision Clinic in Philadelphia, PA. Functionally, Kendra is able to identiIy common objects as small as a gluestick (3 inches) up to 10 Ieet
away. Last year, Kendra was assessed with the Lighthouse continuous text card. The most comIortable line Ior her to read measured equivalent to 20/63 to 20/80 acuity. This is
equivalent to 10-12 point Iont. Kendra's distance vision acuity was assessed at 10 Ieet using the LEA numbers chart. Using both eyes with correction, Kendra was able to
accurately identiIy numbers down to the 20/63 line. This is equivalent to text size 1 3/4 inches in height. Functionally, Kendra is able to see items up to 3 inches at 30 Ieet.
However, she is not able to see detail oI these items. She can accurately identiIy detail in items larger than 5 inches. Examples oI these items include a stapler, scissors, tape
dispenser and garbage can.
In assessing Kendra's visual Iields, her responses were consistent and within the typical visual Iield range, indicating no visual Iield loss. Her color vision was tested by having
her match colored markers with 2" colored dots on paper. She matched all colored markers to dots with 100 accuracy, indicating no color blindness. Last year, Kendra's
binocularity (the ability to use her eyes together) was assessed. Her eyes were able to work together on various assessments, including tracking an object moving in various
straight and randomized curvy lines, including moving across midline. There was no latency during tracking activities. Her eyes were able to converge with no issues when an
object in her near viewing range was slowly moved towards her nose. Both eyes maintained Iocus on the object as it moved to her nose. Kendra's visual perception skills were
assessed (including visual discrimination and Iorm perception, Iigure-ground perception, eye-hand coordination, and visual closure). She was able to complete all activities with
no diIIiculty or areas oI concern.
Kendra was asked questions to determine light sensitivity and preIerences. She does not use additional light (such as a lamp) in the classroom or at home. While driving, Kendra
preIers dim or dusk illumination and oIten wears sunglasses. When using digital materials, reading is best in medium or dim lighting. She adjusts with some diIIiculty to changes
in illumination (such as inside to outside), indicating it takes a Iew minutes Ior her to adjust. Kendra used to have transition lenses but since she wears contact lenses now, she
will wear sunglasses when outside. Depending on the environment, she will wear a hat. Kendra Ieels she squints mild to moderately when in bright light and glare. Kendra`s
visual response to light was assessed using a penlight, presented in random order within her central Iields. She responded consistently and accurately, with no concerns.
Kendra Hughes, 8297687074 5/12/1997 IEP
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9/8/2014
A learning media assessment was previously conducted in September oI 2013. This is a process oI systematically gathering objective inIormation to provide a basis Ior selecting
appropriate general learning media (instructional materials and methods) and literacy media (range oI tools Ior reading and writing in print and braille). The Basic Reading
Inventorv (10th Ed.) by Jerry Johns was the assessment tool. Kendra was given word lists to determine her ability to decode words within one second or "at sight". She was also
given the opportunity to go back and re-read or identiIy words that she missed the Iirst time around. Kendra read the regular print word lists Irom grade 10-12 and large print
word list at grade 12. The scoring guide indicated a level oI "independent" on all word lists. Next, Kendra was given two oral reading word passages (one at regular print and one
at large print), both at the grade 12 level. On the regular print passage, she had 10 miscues (independent/instructional level), and read at a rate oI 96 wpm. She scored an
independent/instructional level on comprehension (8/10 questions correct). On the large print version, Kendra had 5 miscues (still at independent/instructional level), and read at
a rate oI 123 wpm. Her comprehension level was independent (scoring 9/10 questions correct). In comparing the regular print versus large print assessments, Kendra's reading
rate was signiIicantly higher on the large print assessment. Her comprehension was higher and her miscues were lower. These results indicate that large print (versus regular
print) is more appropriate Ior Kendra's instructional materials.
Student Interview
Kendra was asked questions as part oI a student interview in September 2014. Her Iavorite classes in school are Chemistry and English, and her least Iavorite is Algebra 2. In the
classroom, she said there are little to no diIIiculties reading inIormation Irom a distance because she sits in the Iront oI the classroom. Kendra uses the iPad in the classroom but
does not use any additional devices (such as a telescope or magniIier). Without adapted materials, she can read Ior 30-45 minutes beIore her eyes become Iatigued. With optimal
adaptations (enlarged/digital text, and ability to invert colors), Kendra can read Ior 1-2 hours beIore her eyes become Iatigued. She Ieels her listening skills are good, with no
issues. When at events where distance vision is required, Kendra said there are no issues with seeing people or objects, but she cannot always see details (such as players`
numbers). She stated she Ieels comIortable while traveling in and around school. Kendra has a good understanding oI her visual impairment. She knows some implications, such
as distance viewing, eye sensitivity, and the need Ior enlarged materials. Kendra`s Iuture educational plans are to attend college with a double major oI early childhood education
and special education. She is currently considering Edinboro, Clarion, Slippery Rock, and IUP. In her Iree time, she enjoys being outside and hanging out with Iriends.
Progress on past IEP goal(s)
Kendra received a district owned iPad in the spring oI 2013 aIter trialing an iPad device Irom September oI 2012 through February oI 2013. Her goals Irom last year's IEP
included the Iollowing:
IEP Goal: Using a digital book reader, Kendra will independentlv search, locate, and download required texts, as well as use accessibilitv features (highlighting, bookmarking,
find/navigation, enable/disable speech, adfusting font si:e/color, and adfusting contrast/color inverting), with no prompts or assistance needed, on 4 out of 5 trials.
Current Progress: Kendra continues to demonstrate independence in the use oI digital book reader apps. She independently adjusts accessibility Ieatures to suit her visual needs
and is able to demonstrate how to adjust Ieatures when asked. Kendra completes digital book reader tasks with no prompts or assistance needed on all trials.
IEP Goal: Using note-taking apps, Kendra will independentlv take notes, either while reading visuallv, reading auditorilv, or listening to lectures, with no prompts or assistance
needed on 4 out of 5 trials.
Current Progress: Kendra has completed a selI-advocacy slide presentation with apps, which have demonstrated her ability to research inIormation, take notes, and organize them
into topics. Kendra preIers to read visually but adjusts the screen with zoom as needed in order to read inIormation presented. She needed 1-2 prompts Ior use oI the Keynote
app, but was able to
take notes independently.




Present levels related to current postsecondary transition goals iI the student's age is 14 or younger iI determined appropriate by the IEP team (e.g., results oI Iormative assessments, curriculum-
based assessments, progress toward current goals)


Kendra completed a student interview in September oI 2014, which asked questions related to her post-secondary goals. Kendra stated she currently wants to pursue early
childhood education with a double major in special education. She is currently enrolled in the Senior Flex program and attends a college course at CCAC.
James McNeil, Irom BBVS (Bureau oI Blindness and Visual Services), will begin working with Kendra in order to assist with the transition out oI high school and into college.
Kendra has contacted OVR to include them in her process oI transition as well.

Kendra Hughes, 8297687074 5/12/1997 IEP
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Parental concerns Ior enhancing the education oI the student




In a phone conversation with Kendra's current TVI (Courtney Beatty) in September oI 2014, Mr. Hughes expressed no current concerns, but that he wants to be sure Kendra is
prepared to enter college.




How the student's disability aIIects involvement and progress in the general education curriculum


Kendra's visual impairment oI ocular albinism reduces her visual acuity and causes photophobia (sensitivity to light). This aIIects her ability to read regular text size and read
inIormation presented at a distance. It also aIIects her ability to see when bright lights/glare is present. Kendra wears contact lenses, but in addition needs specially designed
instruction and program modiIications to access the general education curriculum. Kendra should continue her involvement in the general education curriculum as she has done
in the past. She is to participate in the general education classroom with the specially designed instruction and program modiIications that are included within this IEP. Kendra's
progress in the general education curriculum will not be aIIected with regard to modiIied grading. Kendra will be graded as her peers are graded.




Strengths


Kendra's strengths include: ability to develop strategies to compensate Ior her visual impairment, actively participates with the vision support teacher to evaluate printed material
to determine adaptations needed, cooperative with her teachers, social, active participant in classes, and is able to express her needs when completing academics.




Academic, developmental, and Iunctional needs related to student's disability




Kendra has been diagnosed with ocular albinism. Due to her visual impairment she is in need oI accommodations and specially designed instruction in order to visually access
the general education curriculum which she Iully participates in. She continues to be eligible Ior itinerant vision support services. Kendra needs to increase her selI-advocacy
skills and increase skills in the area oI accessing inIormation & materials independently in order to complete classwork and submit it. This will aid in current and Iuture needs as
she enters into college.


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III. TRANSITION SERVICES - This is required for students age 14 or younger if determined appropriate by the IEP team.
II the student does not attend the IEP meeting, the school must take other steps to ensure that the student`s preIerences and interests are considered. Transition services are a coordinated set oI
activities Ior a student with a disability that is designed to be within a results oriented process, that is Iocused on improving the academic and Iunctional achievement oI the student with a
disability to Iacilitate the student`s movement Irom school to post school activities, including postsecondary education, vocational education, integrated employment (including supported
employment), continuing and adult education, adult services, independent living, or community participation that is based on the individual student`s needs taking into account the student`s
strengths, preIerences, and interests.
POST SCHOOL GOALS - Based on age appropriate assessment, deIine and project the appropriate measurable postsecondary goals that address education and training, employment, and as
needed, independent living. Under each area, list the services/activities and courses oI study that support that goal. Include Ior each service/activity the location, Irequency, projected beginning
date, anticipated duration, and person/agency responsible.
For students in Career and Technology Centers, CIP Code:

Postsecondary Education and Training Goal: AIter graduation Irom High School, Kendra will attend a 4 year college or
university. Currently she is interested in majoring in the education Iield.
Measurable Annual Goal
Yes / No
(Document in Section V)
Courses of Study:
2014-2015 School Year: CP Psych, Environmental Science, CP Economics, App Alg & Trig, CP English 12.
Kendra is also enrolled in a college English course at CCAC.

Service/Activity Location Frequency Projected
Beginning Date
Anticipated
Duration
Person(s)/Agency
Responsible
*Kendra will increase her skills
in accessing materials
independently, as well as
completing and submitting
assignments.
Pine Richland High School Daily 09/09/2014 06/12/2015 PRHS, Teacher oI the
Visually Impaired, Student
Kendra will increase her skills in
the area oI note-taking.
Pine Richland High School Daily 09/09/2014 06/12/2015 PRHS, Teacher oI the
Visually Impaired, Student
Kendra will increase her selI
advocacy skills by advocating Ior
her visual needs with teachers.
Pine Richland High School Daily 09/09/2014 06/12/2015 PRSD, Teacher oI the
Visually Impaired, Parents,
Student
Kendra Hughes, 8297687074 5/12/1997 IEP
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Employment Goal: AIter graduation Irom a 4 year college or university, Kendra will seek competitive employment.
She is currently interested in a career within the Iield oI education.
Measurable Annual Goal
Yes / No
(Document in Section V)
Courses of Study: 2014-2015 School Year: CP Psych, Environmental Science, CP Economics, App Alg & Trig, CP English 12.
Kendra is also enrolled in a college English course at CCAC.
Service/Activity Location Frequency Projected
Beginning Date
Anticipated
Duration
Person(s)/Agency
Responsible
*Kendra will increase her skills in
accessing inIormation/materials
independently.
Pine Richland High School Daily 09/09/2014 06/12/2015 PRHS, Teacher oI the
Visually Impaired, Student
Kendra will increase her
employment skills by completing
activities within the AFB Career
Connect and/or Job Seeker's
Toolkit.
Pine Richland High School At least 4x 09/09/2014 06/12/2015 Teacher oI the Visually
Impaired, Student
Kendra will increase her selI
advocacy skills by advocating Ior
her visual needs with teachers.
Pine Richland High School Daily 09/09/2014 06/12/2015 PRSD, Teacher oI the
Visually Impaired, Parents,
Student
Independent Living Goal, if appropriate: AIter graduation Irom High School, Kendra and her Iamily will determine
when it is appropriate Ior her to access the community independently.
Measurable Annual Goal
Yes / No
(Document in Section V)
Courses of Study:
2014-2015 School Year: CP Psych, Environmental Science, CP Economics, App Alg & Trig, CP English 12.
Kendra is also enrolled in a college English course at CCAC.

Service/Activity Location Frequency Projected
Beginning Date
Anticipated
Duration
Person(s)/Agency
Responsible
Kendra will increase her selI
advocacy skills by advocating Ior
her visual needs with teachers.
Pine Richland High School Daily 09/09/2014 06/12/2015 PRSD, Teacher oI the
Visually Impaired, Parents,
Student
*Kendra will increase her skills
in accessing materials &
inIormation independently.
Pine Richland High School Daily 09/09/2014 06/12/2015 PRHS, Teacher oI the
Visually Impaired, Student
Kendra Hughes, 8297687074 5/12/1997 IEP
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IV. PARTICIPATION IN STATE AND LOCAL ASSESSMENTS
Instructions for IEP Teams:
Please select the appropriate assessment option. InIormation on available testing accommodations may be Iound in the Accommodations Guidelines available on www.education.state.pa.us.
State Assessments
Not Assessed
No statewide assessment is administered at this student`s grade level
No English proIiciency assessment administered because the student is not an English Language Learner.

PSSA (Math administered in grades 3-8; Science administered in grades 4 and 8; Reading administered in grades 3-8; Writing administered in grades 5 and 8; and ELA*)
Tested Subject Without
Accommodations
With
Accommodations
Accommodations to be Provided
Math
Science
Reading
Writing
ELA`
*ELA will replace the Reading and Writing PSSAs in 2014-15 Ior grades 3-8.

Keystone Exam (Replaces the 11th grade PSSA in high school; Student must participate by 11th grade)
Tested Subject Without
Accommodations
With
Accommodations
Accommodations to be Provided
Algebra 1
Literature

Biology

Keystone Project Based Assessment (Available when student is unable to demonstrate proIiciency on a Keystone Exam or Keystone Exam module.)
Tested Subject Without
Accommodations
With
Accommodations
Accommodations to be Provided
Algebra 1
Literature
Biology

Validated Local Assessment (Available when selected as option by LEA)
Tested Subject Without
Accommodations
With
Accommodations
Accommodations to be Provided
Algebra 1
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Tested Subject Without
Accommodations
With
Accommodations
Accommodations to be Provided
Literature
Biology

PASA (Administered in grades 3-8, 11 Ior Reading and Math; Grades 4, 8, 11 Ior Science)
Student will participate in the PASA.

Explain why the student cannot participate in the PSSA or the Keystone Exam Ior Reading/Literature, Math/Algebra 1, Science/Biology, and Composition (The Composition exam will be
available Ior the 2016-17 school year):



Explain why the PASA is appropriate:



Choose how the student's perIormance on the PASA will be documented.

Videotape (preIerred method)

Written narrative notes (requires prior approval in accordance with PDE guidance)

ACCESS for ELLs (Administered in grades K-12)
Domains Without
Accommodations
With
Accommodations
Unable to
Participate
Accommodations to be Provided or Rationale for Inability to Participate in Selected Domains
Listening
Reading
Writing
Speaking

Alternate ACCESS for ELLs (Administered in grades 1-12)
Student will participate in the Alternate ACCESS Ior ELLs.

Explain why the student cannot participate in the ACCESS Ior ELLs:



Explain why the Alternate ACCESS Ior ELLs is appropriate:

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Domains Without
Accommodations
With
Accommodations
Unable to
Participate
Accommodations to be Provided or Rationale for Inability to Participate in Selected Domains
Listening
Reading
Writing
Speaking
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Local Assessments

Local assessment is not administered at this student's grade level; OR

Student will participate in local assessments without accommodations; OR

Student will participate in local assessments with the Iollowing accommodations; OR

Large print Iormat, hand held magniIier, extended time (per student request), separate testing area (per student request), student may mark answers directly into the test booklet
and teacher/proctor will transcribe answers onto the Scantron sheet.

The student will take an alternate local assessment.

Explain why the student cannot participate in the regular assessment:



Explain why the alternate assessment is appropriate:


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V. GOALS AND OB1ECTIVES - Include, as appropriate, academic and Iunctional goals. Use as many copies oI this page as needed to plan appropriately. Specially designed instruction may be
listed with each goal/objective or listed in Section VI.
Short term learning outcomes are required Ior students who are giIted. The short term learning outcomes related to the student's giIted program may be listed under Goals or Short Term Objectives.
MEASURABLE AAAUAL COAL
Include: Condition, Aame, Behavior, and Criteria
(Refer to Annotated IEP for description of these
components)
Describe HOW the
student's progress toward
meeting this goal will be measured
Describe WHEA periodic
reports on progress will be
provided to parents
Report of Progress
Using a variety oI apps, Kendra will independently
access inIormation & materials, as well as complete
and submit assignments, with no prompts or
assistance needed on 4 out oI 5 sessions during a nine
week period.
Vision teacher-created data
collection chart
Quarterly
Goal Specific SDI
SHORT TERM OB1ECTIVES - Required Ior students with disabilities who take alternate assessments aligned to alternate achievement standards (PASA).
Short term objectives / Benchmarks Level of Achievement Method of Evaluation Report of Progress

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VI. SPECIAL EDUCATION / RELATED SERVICES / SUPPLEMENTARY AIDS AND SERVICES / PROGRAM MODIFICATIONS - Include, as appropriate, Ior nonacademic and
extracurricular services and activities.
A. PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION (SDI)

SDI may be listed with each goal or as part oI the table below.

Include supplementary aids and services as appropriate.


For a student who has a disability and is giIted, SDI also should include adaptations, accommodations, or modiIications to the general education curriculum, as appropriate Ior a student
with a disability.
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Modifications and SDI Location Frequency Projected Beginning Date Anticipated Duration
Enlarged print materials including
tests, assessments, and study
guides, to Iont size 18 on 8.5" x
11" size paper.

Regular Education Classroom In all academic classes Ior tests.
Per student request Ior
worksheets, study guides,
handouts, etc.
09/09/2014 06/12/2015
Dome, bar, or other magniIier Regular Education Classroom When Kendra needs to view
smaller print.
09/09/2014 06/12/2015
PreIerential seating closest to the
area oI instruction or activity

Regular Education Classroom Daily in all academic classes. 09/09/2014 06/12/2015
Ability to move closer to
presentations such as a program in
the auditorium Ior better viewing.

Pine Richland High School When Kendra determines the
need to get closer to the
presentation Ior better viewing.
09/09/2014 06/12/2015
Hard copy oI notes Irom board or
overhead, when not available on
Blackboard
Regular Education Classroom When notes are presented on
board or overhead, Kendra needs
a copy. Enlarge the hard copy iI
Kendra requests.
09/09/2014 06/12/2015
Allow 50 additional time to
complete tests and homework
assignments.
Pine Richland High School For all tests. Per student request
Ior homework assignments.
09/09/2014 06/12/2015
For Scantron tests, Kendra may
mark answers directly onto the test
and a teacher will transIer
her answers onto the Scantron
sheet (or directly grade the test).

Regular Education Classroom In all academic classes. 09/09/2014 06/12/2015
Use oI district iPad to complete
school related activities and
assignments.
Pine Richland High School Daily in all academic classes 09/09/2014 06/12/2015
B. RELATED SERVICES - List the services that the student needs in order to beneIit Irom his/her special education program.
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Service Location Frequency Projected Beginning Date Anticipated Duration
Vision Services Pine Richland High School 32 Iorty-Iive minute sessions
throughout the IEP year
09/09/2014 06/12/2015
C. SUPPORTS FOR SCHOOL PERSONNEL - List the staII to receive the supports and the supports needed to implement the student's IEP.
School Personnel to
Receive Support
Support Location Frequency Projected Beginning Date Anticipated Duration
Kendra's teachers The vision support teacher
will be available Ior
consultation about Kendra's
vision needs, and will
inIorm Kendra's teachers oI
any changes in her visual
status and specially designed
instruction.
Pine Richland High School At the start oI the school
year and throughout the
year as requested, as well as
iI a problem arises or iI
Kendra has a change in her
visual status.
09/09/2014 06/12/2015
D. GIFTED SUPPORT SERVICES FOR A STUDENT IDENTIFIED AS GIFTED WHO ALSO IS IDENTIFIED AS A STUDENT WITH A DISABILITY - Support services are required to
assist a giIted student to beneIit Irom giIted education (e.g., psychological services, parent counseling and education, counseling services, transportation to and Irom giIted programs to classrooms in
buildings operated by the school district).
Support Service
Support Service
Support Service
E. EXTENDED SCHOOL YEAR (ESY) - The IEP team has considered and discussed ESY services, and determined that:



Student IS eligible Ior ESY based on the Iollowing inIormation or data reviewed by the IEP team:



OR

As oI the date oI this IEP, student is NOT eligible Ior ESY based on the Iollowing inIormation or data reviewed by the IEP team:

Kendra does not regress and revert to a lower level oI Iunctioning as a result oI an interruption in educational programming. ThereIore, the IEP team has determined
that Kendra does not qualiIy Ior ESY services.


The Annual Goals and, when appropriate, Short Term Objectives Irom this IEP that are to be addressed in the student's ESY Program are:
Kendra Hughes, 8297687074 5/12/1997 IEP
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II the IEP team has determined ESY is appropriate, complete the Iollowing:
ESY Service to be Provided Location Frequency Projected Beginning Date Anticipated Duration


Kendra Hughes, 8297687074 5/12/1997 IEP
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VII. EDUCATIONAL PLACEMENT

A. QUESTIONS FOR IEP TEAM - The Iollowing questions must be reviewed and discussed by the IEP team prior to providing the explanations regarding participation with students
without disabilities.
It is the responsibility oI each public agency to ensure that, to the maximum extent appropriate, students with disabilities, including those in public or private institutions or other
care Iacilities, are educated with students who are not disabled. Special classes, separate schooling or other removal oI students with disabilities Irom the general educational
environment occurs only when the nature or severity oI the disability is such that education in general education classes, EVEN WITH the use oI supplementary aids and
services, cannot be achieved satisIactorily.

What supplementary aids and services were considered?


Vision support services

What supplementary aids and services were rejected?


None

Explain why the supplementary aids and services will or will not enable the student to make progress on the goals and objectives (iI applicable) in this IEP in the
general education class.
As a student with a visual impairment, Kendra qualiIies Ior vision support services. She is in need oI specially designed instruction and program modiIications Ior
progress in the regular education classroom and on IEP goals/objectives.

What beneIits are provided in the general education class with supplementary aids and services versus the beneIits provided in the special education class?
By remaining in the regular ed classroom, Kendra will not need to make-up work Irom missed lessons, and has the ability to interact with non-disabled peers.

What potentially beneIicial eIIects and/or harmIul eIIects might be expected on the student with disabilities or the other students in the class, even with
supplementary aids and services?
None

To what extent, iI any, will the student participate with nondisabled peers in extracurricular activities or other nonacademic activities?
Kendra will participate Iully with non-disabled peers in extracurricular and other nonacademic activities.
Explanation oI the extent, iI any, to which the student will not participate with students without disabilities in the regular education class:
Kendra will not participate with non-disabled children in the regular education classroom during her vision sessions (32 Iorty-Iive sessions throughout the IEP year).
Explanation oI the extent, iI any, to which the student will not participate with students without disabilities in the general education curriculum:
Kendra will always participate with students without disabilities in the general education curriculum.
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B. Type of Support
1. Amount of special education supports
Itinerant: Special education supports and services provided by special education personnel Ior 20 or less oI the school day
Supplemental: Special education supports and services provided by special education personnel Ior more than 20 oI the day but less than 80 oI the school day
Full-Time: Special education supports and services provided by special education personnel Ior 80 or more oI the school day
2. Type of special education supports
Autistic Support
Blind or Visually Impaired Support
DeaI or Hearing Impaired Support
Emotional Support
GiIted Support
Learning Support
LiIe Skills Support
Multiple Disabilities Support
Physical Support
Speech and Language Support
C. Location of student's program
Name oI School District where the IEP will be implemented: PINE-RICHLAND SCHOOL DISTRICT
Name oI School Building where the IEP will be implemented: Pine-Richland High School
Is this school the student`s neighborhood school (i.e., the school the student would attend iI he/she did not have an IEP)?
Yes
No. II the answer is "no," select the reason why not.

Special education supports and services required in the student's IEP cannot be provided in the neighborhood school
Other. Please explain:

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VIII. PENNDATA REPORTING: Educational Environment (Complete either Section A or B; Select only one Educational Environment)
To calculate the percentage oI time inside the regular classroom, divide the number oI hours the student spends inside the regular classroom by the total number oI hours in the school day (including
lunch, recess, study periods). The result is then multiplied by 100.
SECTION A: For Students Educated in Regular School Buildings with Nondisabled Peers - Indicate the percentage of time INSIDE the regular classroom for this student:
Time spent outside the regular classroom receiving services unrelated to the student's disability (e.g., time receiving ESL services) should be considered time inside the regular classroom.
Educational time spent in age-appropriate community-based settings that include individuals with and without disabilities, such as college campuses or vocational sites, should be counted as time
spent inside the regular classroom.
Calculation for this Student:
Column 1 Column 2 Calculation Indicate Percentage Percentage Category
Total hours the student
spends in the regular
classroom per day
Total hours in a typical
school day
(including lunch, recess &
study periods)
(Hours inside regular
classroom hours in
school day) x 100
(Column 1 Column 2) x 100

Section A: The percentage oI
time student spends inside
the regular classroom:
Using the calculation result select the appropriate percentage
category
6.85 7.00 (6.85 7.00) x 100 98.00 of the day
INSIDE the Regular Classroom 80 or More of the Day
INSIDE the Regular Classroom 79-40 of the Day
INSIDE the Regular Classroom Less Than 40 of the Day
SECTION B: This section required only for Students Educated OUTSIDE Regular School Buildings for more than 50 of the day - select and indicate the Name of School or Facility on
the line corresponding with the appropriate selection: (II a student spends less than 50 oI the day in one oI these locations, the IEP team must do the calculation in Section A)
Approved Private School (Non Residential)

Other Public Facility (Non Residential)
Approved Private School (Residential)

Hospital/Homebound
Other Private Facility (Non Residential)

Correctional Facility
Other Private Facility (Residential)

Out oI State Facility
Other Public Facility (Residential)

Instruction Conducted in the Home
EXAMPLES for Section A: How to Calculate PennData Educational Environment Percentages
Column 1 Column 2 Calculation Indicate Percentage

Total hours the student spends in the
regular classroom per day
Total hours in a typical school day
(including lunch, recess & study periods)
(Hours inside regular classroom hours in
school day) x 100
(Column 1 Column 2) x 100
Section A: The percentage oI time student
spends inside the regular classroom:
Example 1 5.5 6.5 (5.5 6.5) x 100 85 85 oI the day (Inside 80 or More oI Day)
Example 2 3 5 (3 5) x 100 60 60 oI the day (Inside 79-40 oI Day)
Example 3 1 5 (1 5) x 100 20 20 oI the day (Inside less than 40 oI Day)

For help in understanding this Iorm, an annotated IEP is available on the PaTTAN website at www.pattan.net Type "Annotated Forms" in the Search Ieature on the website. II you do not have access
to the Internet, you can request the annotated Iorm by calling PaTTAN at 800-441-3215.
Kendra Hughes, 8297687074 5/12/1997 IEP
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MEDICAL ASSISTANCE PROGRAM BILLING CONSENT
9/9/2014
I understand that the school district or intermediate unit identiIied below may charge the School-Based Access Program
("SBAP")-or any public beneIit or insurance program that replaces or supplements the SBAPthe cost oI certain special
education and related services described in my child's IEP. To make these charges to the SBAP, the school district or
intermediate unit will release to the administrator oI that program the name, age, and address oI my child, veriIication oI
Medicaid eligibility Ior my child, a copy oI my child's IEP, a description oI the services provided and the times and dates
during which such services were provided to my child, and the identity oI the provider oI such services. I understand
that such information will not be disclosed, and such charges will not be made, unless I consent to the disclosure. I
understand and agree that the school district or intermediate unit may disclose the information identified above
and may access my child's public benefits or insurance to pay for services under the Individuals with Disabilities
Education Act ("IDEA").

My agreement is subject to the Iollowing understandings:

I understand that my consent is ongoing Irom year-to-year unless and until I withdraw it. I can withdraw my consent in
writing, or orally iI I am unable to write, at any time. My reIusal to consent or my withdrawal oI consent will not relieve
the school oI the obligation to provide, at no cost to me or my Iamily, any service or program to which my child is
entitled under the IDEA or that is necessary to enable my child to receive a Iree appropriate public education as described
in my child`s IEP.

I understand that the school cannot

Require me or my Iamily to sign up Ior or enroll in any public beneIits or insurance program, such as Medicaid, as a
condition oI receiving a Iree appropriate public education Ior my child;

Require me or my Iamily to incur any expense Ior the provision oI a Iree appropriate public education to my child,
including co-payments and deductibles, unless it agrees to pay such expenses on my or my Iamily's behalI;

Cause a decrease in available liIetime coverage or any other insured beneIit;

Cause me or my Iamily to pay Ior services that would otherwise be covered by a public beneIits or insurance program
and that are required Ior my child outside the time that he or she is in school;

Risk the loss oI eligibility Ior home and community-based waivers, based on aggregate health-related expenditures.

I received a copy of this notice on the date indicated next to my signature below.
PINE-RICHLAND SCHOOL DISTRICT
LEA
PINE-RICHLAND SCHOOL DISTRICT
LEA

Kendra Hughes 21878 5/12/1997
Student's Full Name Student ID Date oI Birth

I have read the Notice and I give consent Ior the LEA to share my child`s education and health-related inIormation and bill Medical
Assistance.

,
Parent/Guardian Signature Parent/Guardian Name (print) Date
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