IEP NickFlinstone SLD Gr2

Bethel District 3900 Bethel Drive St.
Paul, MN 55112
Nick Flinstone Student ID: 11111 State ID: 000120034567 Evaluation Date: 5/31/2007 Meeting Date: 12/11/2007 IEP Effective Date: 1/4/2008 - 1/3/2009 Federal Setting: II. Regular Ed setting 40% to 79% Primary Disability: Specific Learning
INDIVIDUAL INTERAGENCY INTERVENTION PLAN (IIIP)
Initial Plan
Continuing (Annual) Plan
Significant Change
Demographic Information X IEP (Individual Education Plan) through the IIIP Process
This plan meets the requirements of and serves as
IFSP (Individual Family Service Plan) Initial Part B IEP for Children Turning 3 ISP (Individual Service Plan) Significant Change of Attached IEP
X None
Plans coordinated
Multi Agency Plan of Care IFCSP (Ind. Family Community Support Plan) ICSP (Individual Community Support Plan) Nursing Care Plans CADI (Com. Alternatives for Disabled Ind.) Plan CAC (Community Alternative Care) Plan Home Care Services Plans TBI (Traumatic Brain Injury) Plan IHP (Individual Habilitation Plan) ITP (Individual Treatment Plan) IPE (Individual Plan for Employment) Corrections Out-of-Home Placement Other
________ Flinston e __________________________________________________ X Male 6/18/2000 Female 02 Black, not Hispanic First Name M.I. Last Name ____________________ ____________________ _________ __________________________________________________ English English Date of Birth Gender Grade Race/Ethnicity _______________________________________________________ 111-2200012003456 11111 Bethel Park Elementary ___________________________________________________ 3333 7 Primary Language at Home Primary Language Ray/Tanya Flinstone ____________________ ____________________ ____________________ ________________________________________ Soc. Emerson Circle State ID# Other ID# School Name 8642 Sec. # 987-654-3210
Nick ___________________________________________
St. Paul Parent/Guardian Name Parent/Guardian Street Address
________________________________________________________________
MN
55112
________________________________________ Home Phone ________________________________________ _______ ____________ ________________________________________ City State Zip Work Phone Bethel School 0012 ____________________________________ __________________________ ________________________________________ District Relationship Email Other _________________________________________________________________ Resident School Royal County District Name _________________________________________________________________ Serving School District Name _________________________________________________________________ Resident County Name ________________________________________ District # 26 ________________________________________ District # ________________________________________ County #
________________________________________________________________
This form is available in several languages, Braille, or other formats. Contact the IIIP Manager for an alternate format. 5/14/2008 7:24:53 AM
IIIEP Page 2
Student: Nick Flinstone
Plan Date 1/4/2008

________________________________________ County #
_________________________________________________________________ Serving County Name
IIIEP Page 3
Plan Date 1/4/2008

________________________________________ Date of Referral
________________________________________________________________ (Initial Plan only) Referral By _______________________________________________________ Diagnosis Code: DSM-IV Presenting Concerns and/or Diagnosis:
__________________________________________________ or ICD9
Core: Family/Student Considerations

12/11/2007 IIIP Meeting Date: ___________________ __________________________
Parent(s) description of child/students strengths: Nicks dad, Ray, said Nick likes school. He isnt coming home frustrated as he had in the past. Nick is more apt to try and is picking up more academics than he had previously. Parent(s) description of child/students concerns/needs: Nick has a difficult time following two or more step directions, frequently one step directions need to be repeated. Nick continues to have difficulty with academic tasks. Student description of needs, preferences and interests (by age 14, or earlier if appropriate): Services or information needed by family and/or student: None
1/3/2009 Projected IIIP Review Date:
IIIEP Page 4
Plan Date 1/4/2008
Description of Child/Student
Address the following areas as required: For children ages three through 21, include how the disability affects involvement and progress in the general curriculum. For preschool children, describe how the disability affects participation in appropriate activities. Describe how the disability impacts secondary transition planning. (*Required for ages birth to three **Required for transition planning ages 14-21).
X Background Information
*Physical / Motor Development *Basic Senses Including Hearing & Vision *Self Help Skills *Academic Performance / Cognitive Development / Intellectual Functioning *Social / Emotional / Behavioral Development *Communication Environmental (Basic Needs) *Current Health & Medical Status Adaptive Development Participation in Age Appropriate Activities Community Access / Use / Participation Legal Representation Progress / Participation in Regular Education Curriculum Intellectual Functioning Area: Background Information
X Academic Functioning
Communication Skills Sensory Status Health / Physical Status Motor Functioning Emotional / Social / Behavioral Functioning Functional Skills X **Progress / Participation in Regular Education Curriculum **Transition: Home Living **Transition: Recreation & Leisure **Transition: Community Participation **Transition: Employment **Transition: Postsecondary Other
Strengths/Current Status: Nick has received special education services in Early Childhood Special Education under the disability label of Developmentally Delayed and speech impairment. He was reevaluated in the St. Paul, ISD #00 in 4/2007 at which time he qualified for special education services under the disability label of Specific Learning Disability Services. In the Fall of 2007, Nick entered the Bethel School District (#12) and is being reevaluated due to questions about his disability category. Concerns/Needs: There are no special education needs in this area.
Area: Academic Functioning Strengths/Current Status: Nick enjoys learning. He is pleased with himself when he is successful at the task. He has made progress in the areas of math and reading, but academics continue to be very difficult for him. Nicks objectives for reading were at a readiness level. He was able to identify 19 of 26 letters (73%) and knew the letter sounds of 18 letters (69%). The letters Nick identified were not the same as the letters he knew the sounds for. If Nick isnt certain of the letter name he visualizes and recites the alphabet then is able to identify the letter name. Nick read 11 of 30 pre-primer words (36%) and read 6 of 10 (60%) of the CVC words. Nicks Written language skills are showing improvement. He is able to print all the letters with 100% accuracy when presented with a visual model. Without a model, Nick prints 20 of the 26 letters (80%). Nick spells CVC words with a short a letter sound with 70% accuracy. Although Nick did not master his objectives, he continues to make progress, but at a slower rate. Math is the area that Nick is able to work the most independently. He is able to compute addition facts to 10 and subtraction facts under 10. He is not able to count to 100 without support when changing to a new decade number. Nick is able to tell time to the hour but not the half hour. When presented with various coins, Nick guesses at
IIIEP Page 5

the name and value.
Plan Date 1/4/2008
Concerns/Needs: Nick needs to increase his reading decoding, fluency and comprehension skills. He needs to increase his math computational and functional skills. He needs to write a simple sentence that conveys a simple thought.
IIIEP Page 6
Plan Date 1/4/2008
Description of Child/Student (continued)
Area:
Progress / Participation in Regular Education Curriculum
Strengths/Current Status: Nick is a nice child who works hard when the material is at his instructional level. Grade level curriculum is extremely difficult for Gabriel to complete, assignments are modified and paraprofessional support is provided in the classroom. Nick did not take the MAP reading, math and science tests that were completed in the Fall. Nicks weekly spelling is graded on correctly getting the beginning letter sounds of the words, he has shown great improvement with this but is easily distracted with the larger group activity. Because of the difficulty Gabriel has focusing during the large group spelling time, tests are given to him separately by the paraprofessional that is working in the room. Concerns/Needs: Nicks assignments need to be modified to his instructional level, and paraprofessional support needs to be available to help him with directions, help with attending to task and completing assignments.
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Plan Date 1/4/2008
Goals/Outcomes and Objectives/Indicators

Goal #1
Area: Academic Performance Goal #1: Nick will increase his reading decoding, comprehension skills from a readiness level to a PrePrimer level. Nick will increase his ability from not writing a short sentence that conveys a simple thought to being able to write a short sentence that conveys a simple thought. Short Term Objectives or Benchmarks Objective #1: When presented with the letters of the alphabet, Nick will state the letter names with 100% accuracy as measured by bimonthly samples by his special education teacher. Objective #2: When given a list of 10 CVC words, Nick will read the words with 90% accuracy as measured by bimonthly samples by his special education teacher. Objective #3: After listening to a short story from a first grade level, Nick will answer factual and inferential questions with 80% accuracy as measured by bimonthly samples by his special education teacher. Objective #4: Given a list of Pre-Primer words, Nick will read with 80% accuracy as measured by bimonthly samples by his special education teacher. Objective #5: When given a topic, Nick will correctly write a sentence that stays to topic and conveys a simple thought as measured by his special education teacher 3 out of 4 opportunities.
Goal #2
Area: Academic Performance Goal #2: Nick will increase his math functional and computational skills from not adding and subtracting basic facts and not telling time to the hour, identifying coins and adding coins of like value to adding and subtracting basic facts and telling time to the hour, identifying coins and adding coins of like value. Short Term Objectives or Benchmarks Objective #1: Given 10 addition problems with sums to 18, Nick will answer with 80% accuracy as measured by random samples by his special education teacher. Objective #2: Given 10 subtraction problems with minutes less than 18, Nick will answer with 80% accuracy as measured by random samples by his special education teacher. Objective #3: Given various coins, Nick will identify the coin by name and state its value with 80% accuracy as measured by random samples by his special education teacher. Objective #4: Given 4 coins of like value, Nick will add the coin combinations with 80% accuracy as measured by random samples by his special education teacher.
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Plan Date 1/4/2008
Objective #5: Given 5 analogue clocks, Nick will tell time to the half hour with 80% accuracy as measured by random samples by his special education teacher.
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Plan Date 1/4/2008
Special Education Services

Instruction _______________________________________ Math Service Special Ed _______________________________________ Bethel ISD #12 Service Location
_______________________________________
40, 10 ___________________________ 1 / Daily Direct, Indirect Min./Sess.

____________________________________
1/4/2008 1/3/2009
Katie Raisanen Service Agency Providing

_______________________________________ Service Provider Name
246 Johns Ave S. _______________________________________ Bethel ISD #12 _______________________________________

Address
___________________________ ____________________________________ 987-654-1230 #/mo) Frequency (#/wk, Start Date End Date ___________________________ ____________________________________ Telephone Email St. Paul MN ___________________________ ______________ 55112 __________________ City State Zip
___________________________________________________________________ Payment Source Authorization Signature
Instruction Reading and Written _____________________________________________________________________________________________________________ Language _ Special Ed _______________________________________ Bethel ISD #12 Service Location
_______________________________________ Service

____________________________________
1/4/2008 1/3/2009
Katie Raisanen Service Agency Providing


Address
Para Support in Mainstream _____________________________________________________________________________________________________________

_ Service General Ed _______________________________________

____________________________________
Bethel ISD #12 Service Location

_______________________________________
1/4/2008 1/3/2009
To Be Determined Agency Providing Service

246 Johns Ave S. _______________________________________ Bethel ISD #12

Address
IIIEP Page 10
Plan Date 1/4/2008
_______________________________________ ___________________________________________________________________ Payment Source Authorization Signature This plan must specify services the person needs that are not available and the actions needed to obtain or develop these services. Action taken, if needed:
IIIEP Page 11
Plan Date 1/4/2008
ESY Services
ESY- Classroom _____________________________________________________________________________________________________________
_ Service Special Ed _______________________________________
180, 0 ___________________________ 4 / Week Direct, Indirect Min./Sess.

____________________________________

_______________________________________
6/23/2008 7/31/2008


Address
___________________________ ____________________________________ Frequency (#/wk, #/mo) Start Date End Date ___________________________ ____________________________________ Telephone Email St. Paul MN ___________________________ ______________ 55112 __________________ City State Zip
ESY- Paraprofessional Support _____________________________________________________________________________________________________________

_ Service Special Ed _______________________________________

____________________________________

_______________________________________
6/23/2008 7/31/2008


Address
ESY- Transportation _____________________________________________________________________________________________________________

_ Service General Ed _______________________________________

____________________________________

_______________________________________
6/23/2008 7/31/2008

246 Johns Ave S. _______________________________________ Bethel ISD #12

Address
IIIEP Page 12
Plan Date 1/4/2008
_______________________________________ Payment Source
__________________________________________________________________ Authorization Signature
IIIEP Page 13
Plan Date 1/4/2008
Extended School Year

Student Name: __________________________________________________ D.O.B.: Bethel Park Elementary 12/11/2007 ____________________ School: __________________________________________________ Date of Determination: Katie ____________________ Raisanen X Reviewer Name: __________________________________________________ Eligible:______ YES ______ NO
Nick Flinstone
6/18/2000
X ___YES ___NO A. Is the student likely to experience a significant regression of a skill or acquired knowledge
specified in the IEP goal(s) that will require more than the length of the break to recoup?
The team shall consider the following areas to determine the students need for Extended School Year services. (If student qualifies for ESY at least one of items A, B, C or D must be answered. For all students, items E and/or F must be answered.)
X ___YES ___NO B. Self-Sufficiency: Will a break in special educational programming prevent the student
from achieving/maintaining a reasonable degree of independence on skills critical to overall disability-specific needs. Because of the nature of this/these skill(s) and the pupils age and level of development, a break would significantly impact the students self-sufficience. Identify the goals and objectives and add comments as appropriate. 1. Basic self-help, toileting, eating, feeding and dressing. 2. Muscular Control 3. Physical Mobility 4. Impulse Control 5. Personal Hygiene 6. Development of stable relations with peers and adults 7. Basic Communication 8. Functional academic competency, for example: basic reading, writing, concepts, time and money, numerical or temporal relationships 9. Vocational Skills C. Does the student require special education services to benefit from the regular education summer program? 1. Special education services will be required for the student to benefit from a targeted service program if selected for the program. Targeted service programs include K-2 academic program and the 6th or 9th grade leadership program. 2. Special education services will be required for the student to benefit from a community education class (if Registered for a class). 3. Special education services will be required for the student to benefit from Basic Skills Test practice classes (if student is registered for a class). 4. Special education services will be required for the student to benefit from Credit Makeup (if student is registered for a class)
X ___YES ___NO X ___YES ___NO X ___YES ___NO X ___YES ___NO X ___YES ___NO X ___YES ___NO X ___YES ___NO X ___YES ___NO X ___YES ___NO X ___YES ___NO X
___YES ___NO
X ___YES ___NO X ___YES ___NO X ___YES ___NO X
IIIEP Page 14
Plan Date 1/4/2008
___YES ___NO D. Given the unique needs of the student and/or special circumstances that have prevented the student from Receiving benefit from his/her education program during the school year, does the student require special Education services on the basis of a free, appropriate, public education (FAPE) during the break in special Education programming? (Use comment area to explain) X ___YES ___NO E. Does the team have enough information to complete the ESY decisions? If the answer is no, identify when the team will meet again to discuss ESY determination or to identify goals and objectives for ESY under the comments section below.
IIIEP Page 15
Plan Date 1/4/2008
Extended School Year (continued) X ___YES ___NO F. The team agrees that the student does qualify for ESY, and the parent(s) agrees/agree
that the student will Participate. ___YES ___NO G. Comments:
IIIEP Page 16
Plan Date 1/4/2008
Additional Information Required for Ages 3-21

Federal Setting Federal Setting:
II:
II. Regular Ed setting 40% to 79%
Progress Reporting Frequency and method(s) to be used for reporting progress to parents: Written quarterly reports Adaptations May be assigned alternative assignments Length of assignments will be shortened Student will repeat or paraphrase directions to demonstrate understanding Teacher stand near student when giving instruction Assistive Adaptations Assistive technology was discussed but determined unnecessary at this time. Least Restrictive Environment (LRE)/Most Integrated Setting Explanation If the student is not able to participate full time with students without disabilities in the regular classroom and in extra-curricular and non-academic activities, provide a statement explaining the extent of nonparticipation: Nicks academic skills are significantly discrepant from grade level curriculum. He is very easily distracted and needs a quiet environment where he can receive instruction, practice skills and ask questions about the new skills, when needed. This plan allows Nick the individualized instruction that he requires to progress academically but still allows him to spend time with his general education peers.
Special Considerations
Special Considerations The IEP team must consider the following factors during the IEP process. The present level of performance must specifically address all of the factors that apply to the student. Is the student visually impaired or legally blind? (IEP must document consideration of instruction and use of X Braille). Yes No Does the student have limited English proficiency? (IEP must document language considerations.) X No Yes Is the student Deaf or Hard of Hearing? (IEP must document consideration of language/communication needs, opportunities with peers, and direct instruction in language/communication mode.) X No Yes Does behavior impede learning of self or of others? (IEP must document consideration of strategies including positive behavioral interventions and supports to address that behavior.) X No Yes Is student on a regulated procedure that requires a Conditional Behavior Plan (i.e. time out, restraint, etc.) If yes, complete behavior plan X No Yes
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Plan Date 1/4/2008
Does student have a health procedure plan X No Yes Does student have an evacuation plan? (If yes, attach to IEP) X No Yes Does student require special education transportation? X No Yes
MINNESOTA COMPREHENSIVE BASIC STANDARDS ASSESSMENT ASSESSMENT Address for MCAs administered during the students Address only in IEPs for students in grade 8 by 2004annual IEP Year. Not applicable at this time Will participate without accommodations Will participate with accommodations listed: (Modifications are not allowed.) X Alternate Assessment Document IEP team rationale: Joanna is reading at a pre-primer level. She needs the alternative reading test to test her at the appropriate level and to get a better understanding of how much actual growth she has made in a year. Joanna will take the ELL test in math with a small group and the test read to her by the computer or an adult. 05 or additional administrations. XNot applicable at this time Will participate without accommodations or modifications Will participate with accommodations listed: Will participate with modifications listed: (Modifications are not allowed first time in grade 8.) Alternate Assessment Document IEP team rationale:
DISTRICT INITIATED SYSTEM ASSESSMENT Address each time a student is in a grade being
assessed by the district. Not applicable at this time Will participate without accommodations X Will participate with accommodations listed: The student will have the mathematics and science assessment read out loud. (for MCA and BST a script will be used) Student will take all assessments in an individual or small group setting. Student will be allowed extended time on all assessments. Alternate Assessment Document IEP team rationale and list alternate assessments:
State
Individual*Exempt**
Reading: Math: Writing:
Date Passed
Check the appropriate box to indicate the level the student will attempt. *If the modification is to alter the districts passing level, enter the test score expected to be achieved. **If the student is exempt, the goals on the IEP will be the criteria for awarding the diploma.
IIIEP Page 18
Plan Date 1/4/2008
IIIP PLANNING MEETING ATTENDANCE
Tanya/Ray _____________________________________ Parent/Guardian _________________________________________________________ Flinstone __________ Allison Team Teacher Schmidt _____________________________________ _________________________________________________________
__________
Mackenzie White _____________________________________ Classroom Teacher _________________________________________________________

__________
Teacher Specific Learning Disability Katie _____________________________________ _________________________________________________________ Raisanen __________ Susan Thompson _____________________________________ Special Education Teacher _________________________________________________________
__________

IEP NickFlinstone SLD Gr2

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Bethel District 3900 Bethel Drive St.

INDIVIDUAL INTERAGENCY INTERVENTION PLAN (IIIP)

Continuing (Annual) Plan

St. Paul Parent/Guardian Name Parent/Guardian Street Address

Student: Nick Flinstone

Plan Date 1/4/2008

_________________________________________________________________ Serving County Name

Student: Nick Flinstone

Plan Date 1/4/2008

Core: Family/Student Considerations

1/3/2009 Projected IIIP Review Date:

Student: Nick Flinstone

Plan Date 1/4/2008

Student: Nick Flinstone

Plan Date 1/4/2008

Student: Nick Flinstone

Plan Date 1/4/2008

Description of Child/Student (continued)

Progress / Participation in Regular Education Curriculum

Student: Nick Flinstone

Plan Date 1/4/2008

Goals/Outcomes and Objectives/Indicators

Student: Nick Flinstone

Plan Date 1/4/2008

Student: Nick Flinstone

Plan Date 1/4/2008

Special Education Services

40, 10 ___________________________ 1 / Daily Direct, Indirect Min./Sess.

Katie Raisanen Service Agency Providing

246 Johns Ave S. _______________________________________ Bethel ISD #12 _______________________________________

___________________________________________________________________ Payment Source Authorization Signature

40, 10 ___________________________ 1 / Daily Direct, Indirect Min./Sess.

Katie Raisanen Service Agency Providing

246 Johns Ave S. _______________________________________ Bethel ISD #12 _______________________________________

___________________________________________________________________ Payment Source Authorization Signature

Para Support in Mainstream _____________________________________________________________________________________________________________

30, 0 ___________________________ 2 / Daily Direct, Indirect Min./Sess.

Bethel ISD #12 Service Location

To Be Determined Agency Providing Service

246 Johns Ave S. _______________________________________ Bethel ISD #12

Student: Nick Flinstone

Plan Date 1/4/2008

Student: Nick Flinstone

Plan Date 1/4/2008

180, 0 ___________________________ 4 / Week Direct, Indirect Min./Sess.

Bethel ISD #12 Service Location

To Be Determined Agency Providing Service

246 Johns Ave S. _______________________________________ Bethel ISD #12 _______________________________________

___________________________________________________________________ Payment Source Authorization Signature

ESY- Paraprofessional Support _____________________________________________________________________________________________________________

120, 0 ___________________________ 4 / Week Direct, Indirect Min./Sess.

Bethel ISD #12 Service Location

To Be Determined Agency Providing Service

246 Johns Ave S. _______________________________________ Bethel ISD #12 _______________________________________

___________________________________________________________________ Payment Source Authorization Signature

ESY- Transportation _____________________________________________________________________________________________________________

0, 0 ___________________________ 4 / Week Direct, Indirect Min./Sess.

Bethel ISD #12 Service Location

To Be Determined Agency Providing Service

246 Johns Ave S. _______________________________________ Bethel ISD #12

Student: Nick Flinstone

Plan Date 1/4/2008

_______________________________________ Payment Source

246 Johns Ave S. _ Bethel ISD #12 _

246 Johns Ave S. _ Bethel ISD #12 _

246 Johns Ave S. _ Bethel ISD #12 _

246 Johns Ave S. _ Bethel ISD #12 _

X _YES _NO X _YES _NO X _YES _NO X

Mackenzie White _ Classroom Teacher _____________________