Seton Hill University

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Age

Student'sName:

JackieSWallace

IEPTeamMeetingDate(mm/dd/yyyy):
IEPImplementationDate(ProjectedDatewhenServicesandProgramsWillBegin):
AnticipatedDurationofServicesandPrograms:
DateofBirth:

6/18/1997

Age:
Grade:

18

10th

AnticipatedYearofGraduation:

2015

LocalEducationAgency(LEA):
CountyofResidence:
NameandAddressofParent/Guardian/Surrogate:

SetonHillUniversity
LuzerneCounty

Phone
(Home):

7125560121

Email
(Home):

jwallace0121@home.iep

Phone
(Work):

7124559121

Email
(Work):

Mr.JoseDWallace

1322RiverRoad

Leaderton,PA18123

NameandAddressofParent/Guardian/Surrogate:

Mrs.JoyceBWallace

1322RiverRoad

May2014

Phone
(Cell):

Phone
(Home):

7125560121

Email
(Home):

jwallace0121@home.iep

Phone
(Work):

7125559121

Email
(Work):

Phone
(Cell):

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JackieSWallace,SHU56121

Leaderton,PA18123

OtherInformation:

JohniscurrentlyafourthgraderatEvansElementarySchool.He
receiveslearningsupportservicesforlanguageartsandmath
reinforcement.Johncurrentlyreceivesallofhismathinstruction
intheregulareducationclassroomand30minutesofmath
reinforcementinthelearningsupportclassroom.Allother
academicsandspecialsarereceivedintheregulareducation
classroom.Johnisacooperativeandfriendlystudent.He
completesclassworkandhomework.

TheLEAandparenthaveagreedtomakethefollowingchangestotheIEPwithoutconveninganIEPmeeting,asdocumentedby:

Date of Revision(s)

Participants/Roles

IEP Section(s) Amended

May2014

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JackieSWallace,SHU56121
IEP TEAM/SIGNATURES

TheIndividualizedEducationProgramteammakesthedecisionsaboutthestudentsprogramandplacement.Thestudentsparent(s),thestudentsspecialeducationteacher,andarepresentativefrom
theLocalEducationAgencyarerequiredmembersofthisteam.SignatureonthisIEPdocumentsattendance,notagreement.

Printed Name

Role

Signature

JoyceWallace

Mother

JackieSWallace

Student

JoseWallace

Father

NormanFSimpson

RegularEducationTeacher

*
TheIEPteammustinvitethestudentiftransitionservicesarebeingplannedoriftheparentschoosetohavethestudentparticipate.
** Ifthestudentis,ormaybe,participatingintheregulareducationenvironment
*** AsdeterminedbytheLEAasneededfortransitionservicesandothercommunityservices
****AteacherofthegiftedisrequiredwhenwritinganIEPforastudentwithadisabilitywhoalsoisgifted.
Oneindividuallistedabovemustbeabletointerprettheinstructionalimplicationsofanyevaluationresults.

Writteninputreceivedfromthefollowingmembers:
Allparticipantssignedthefollowingforms.

Transfer of Rights at Age of Majority

Forpurposesofeducation,theageofmajorityisreachedinPennsylvaniawhentheindividualreaches21yearsofage.Likewise,forpurposesoftheIndividualswithDisabilitiesEducationAct,the
ageofmajorityisreachedforstudentswithdisabilitieswhentheyreach21yearsofage.

May2014

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JackieSWallace,SHU56121
PROCEDURAL SAFEGUARDS NOTICE

IhavereceivedacopyoftheProcedural Safeguards Noticeduringthisschoolyear.TheProceduralSafeguardsNoticeprovidesinformationaboutmyrights,includingtheprocessfordisagreeing

withtheIEP.TheschoolhasinformedmewhomImaycontactifIneedmoreinformation.

SignatureofParent/Guardian/Surrogate:

May2014

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JackieSWallace,SHU56121

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?

TheIEPmustincludeadescriptionoftheinstructioninBrailleandtheuseofBrailleunlesstheIEPteamdetermines,afteranevaluationofthestudent'sreadingand
Yes
writingskills,needs,andappropriatereadingandwritingmedia(includinganevaluationofthestudent'sfutureneedsforinstructioninBrailleortheuseofBraille),that
instructioninBrailleortheuseofBrailleisnotappropriateforthestudent.

No
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Is the student deaf or hard of hearing?

TheIEPmustincludeacommunicationplantoaddressthefollowing:languageandcommunicationneeds;opportunitiesfordirectcommunicationswithpeersand
Yes
professionalpersonnelinthestudentslanguageandcommunicationmode;academiclevel;fullrangeofneeds,includingopportunitiesfordirectinstructioninthe
studentslanguageandcommunicationmode;andassistivetechnologydevicesandservices.IndicateinwhichsectionoftheIEPtheseconsiderationsareaddressed.
TheCommunicationPlanmustbecompletedandisavailableatwww.pattan.net

No

Does the student have communication needs?

StudentneedsmustbeaddressedintheIEP(i.e.,presentlevels,speciallydesignedinstruction(SDI),annualgoals,etc.)
Yes

No

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

StudentneedsmustbeaddressedintheIEP(i.e.,presentlevels,speciallydesignedinstruction,annualgoals,etc.)
Yes

No

Does the student have limited English proficiency?

TheIEPteammustaddressthestudentslanguageneedsandhowthoseneedsrelatetotheIEP.
Yes

No

Does the student exhibit behaviors that impede his/her learning or that of others?
TheIEPteammustdevelopaPositiveBehaviorSupportPlanthatisbasedonafunctionalassessmentofbehaviorandthatutilizespositivebehaviortechniques.Results
Yes
ofthefunctionalassessmentofbehaviormaybelistedinthePresentLevelssectionoftheIEPwithaclearmeasurableplantoaddressthebehaviorintheGoalsand
SpeciallyDesignedInstructionsectionsoftheIEPorinthePositiveBehaviorSupportPlanifthisisaseparatedocumentthatisattachedtotheIEP.APositiveBehavior
SupportPlanandaFunctionalBehavioralAssessmentformareavailableatwww.pattan.net

No

Other(specify):

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JackieSWallace,SHU56121

May2014

Includethefollowinginformationrelatedtothestudent:
Presentlevelsofacademicachievement(e.g.,mostrecentevaluationofthestudent,resultsofformativeassessments,curriculum-based
assessments,transitionassessments,progresstowardcurrentgoals)
Presentlevelsoffunctionalperformance(e.g.,resultsfromafunctionalbehavioralassessment,resultsofecologicalassessments,
progresstowardcurrentgoals)
Presentlevelsrelatedtocurrentpostsecondarytransitiongoalsifthestudentsageis14oryoungerifdeterminedappropriatebytheIEP
team(e.g.,resultsofformativeassessments,curriculum-basedassessments,progresstowardcurrentgoals)
Parentalconcernsforenhancingtheeducationofthestudent
Howthestudentsdisabilityaffectsinvolvementandprogressinthegeneraleducationcurriculum
Strengths
Academic,developmental,andfunctionalneedsrelatedtostudentsdisability

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JackieSWallace,SHU56121
II. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Include the following information related to the student:

Presentlevelsofacademicachievement(e.g.,mostrecentevaluationofthestudent,resultsofformativeassessments,curriculum-basedassessments,transitionassessments,progresstowardcurrent
goals)
Math

Intheregulareducationclassroom,Johnisbeinginstructedusingthe4thgradeEverydayMathematicscurriculum.Withthesupportofan
instructionalassistantJohnreceivesmathinstructionintheregulareducationclassroom,andforabout30minutesperdayJohnreceivessmall
groupinstructioninthelearningsupportclassroomtoreinforcemathconceptstaughtinclass.Curriculumbasedassessmentswereperformedusing
the4thgradeEverydayMathematicscurriculum.Johnisdevelopingmanyofthefourthgrademathskills.
AccordingtotheEverydayMathematicscurriculumgrade4,JohnreachedthefollowinggoalsforUnit1and2.
Geometry:
-Drawquadrangles
-Drawparallelandinterestinglines,linesegments,andrays
-Name,drawandidentifypropertiesofpolygons
-Drawandmarkrightangles
Operations&Computation:
-Solveadditionandsubtractionfacts,untimed
-Addandsubtractmulti-digitnumberswithandwithoutregrouping
Data&Chance:
-Interpretatallychartandfindthemaximum,minimum,range,modeandmedianforasetofdata
-Constructabargraph
AccordingtothefourthgradeEverydayMathematicscurriculum,Johndidnotmakeadequateprogressonthefollowinggoal,butisapproaching
thegoal.Heshowsevidenceofworkingtowardthestandard.
-Useletterstonamelines,rays,andlinesegments
ReadingandLanguageArts
Johncurrentlyreceivesallreadingandlanguageartsinstructioninthelearningsupportclassroom.Johnisinstructedusingtheregularfourthgrade
curriculum,withmodificationsandadaptationsasnecessary.Hereceivesaweeklyspellinglist,whichistakenfromtheregulareducation
curriculum,thoughhehas15wordseachweekratherthan20words.Johncompletesallhomeworkassignmentsandprepareswellforassessments.
Hecompletesallclasswork,thoughheoftenrequiresextendedtime.Hetendstoworkataslowerpacethanmanyofhispeers.Johntendstoget
anxiouswhenpresentedwithanewtaskandoftenasksmanyquestionstoclarifydirections.
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JackieSWallace,SHU56121

AtthebeginningoftheyearJohnsinstructionallevelinreadingwastestedatLevelMofFountasandPinnell,whichisapproachingthefourth
gradestandardforthebeginningoffourthgrade.However,basedonclassroomperformanceandotherobservations,Johnisbeinginstructedina
guidedreadinggroupwithFountasandPinnellmaterialsalevelO.Johnparticipatesindiscussionsduringguidedreadinggroupandmakesrelevant
contributionstoourdicussions.Heisabletoidentifysetting,genre,charactersandtheauthorspurposeinreferencetomaterialsthatarereadin
class.Johnstillrequirespromptsandsupportwhenaskedtosummarizeinformation,especiallywhenheisaskedtowritetheinformationonpaper
andnotjustverbalizetheinformation.Johnreceiveda14/20onthefirstquarterreadingbehnchmark,whichwasgiventohimatthethirdgrade
level.
Johnreads102wordscorrectperminute(wcpm)atthefourthgradelevel.Johntendstoreadabitrobotically,thereforesupporthasbeenworking
withhimonaddingsomeexpressionduringreading.Wehavebeenworkingonphrasingandpayingcloseattentiontoendmarkstoimprove
expressivereadingskills.Johnreceiveda14/20onthefirstquarterreadingbehnchmark,whichwasgiventohimatthethirdgradelevel.

IEPprogresssummary
Math
AccordingtoIEPprogressreportsinJuneof2010,whenJohnisgivenlevel3mathcomputationproblemsheisabletocalculate14digitscorrect
perminute.Whengivenlevel3mathcomputationproblemsinSeptemberof2010,Johncancalculate12digitscorrectperminute.WhenJohnis
givenlevel4mathcomputationproblemsheisabletocalculate10digitscorrectperminute.InJuneof2010,whenJohnisgivenlevel3math
applicationandconceptskillproblems,Johncansolve19/24problems(79%accuracy).Whengivenlevel3mathapplicationandconceptskill
problemsinSeptemberof2010,Johncansolve13/24problems(54%accuracy).
ReadingandLanguageArts
AccordingtoIEPprogressreports,whengivenanunfamiliarpassageatthefourthgradelevel,Johnreadsanaverageof102wordscorrectper
minutewith2orlesserrors.JohnhasmethisIEPfluencygoal,thereforeafluencygoalwillnotbeincludedinthisnewIEP.Althoughagoalwill
notbeincluded,JohnwillcontinuetobemonitoredforfluencyonabiweeklybasisusingDIBELS,duringtargettime.
Johncanidependentlycompleteagraphicorganizerpriortowriting.Hecanindependentlycomposeanappropriatetopicsenteneon2/4
opportunities.Johncanidependentlywrite2detailsentencesonagiventopicon3/4opportunities.Hestillrequiresassistancetocomposean
appropriateconcludingsetence.Ohaverage,Johnearnedthefollowingscoresonhiswritingpieces:Focus(2/4),Content(3/4),Organization(2/4),
Style(2/4),Conventions(2/4).Progresswillcontinuedtobemonitoredwithawritinggoal.
Afterindependentlyreadingastoryattheendofthirdgrade,Johncananswerliteralcomprehensionquestionswithapproximately90%accuracy
andinferentialcomprehensionquestionswithapproximately85%accuracy.Progresswillcontinuedtobemonitoredwithacomprehensiongoal.

May2014

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JackieSWallace,SHU56121

Presentlevelsoffunctionalperformance(e.g.,resultsfromafunctionalbehavioralassessment,resultsofecologicalassessments,progresstowardcurrentgoals)

Johnsfunctionalperformanceinallareasisageappropriate.

Presentlevelsrelatedtocurrentpostsecondarytransitiongoalsifthestudent'sageis14oryoungerifdeterminedappropriatebytheIEPteam(e.g.,resultsofformativeassessments,curriculumbasedassessments,progresstowardcurrentgoals)
IEPmeeting,theschoolmusttakeotherstepstoensurethatthestudentspreferencesandinterestsareconsidered.Transitionservicesarea

coordinatedsetofactivitiesforastudentwithadisabilitythatisdesignedtobewithinaresultsorientedprocess,thatisfocusedonimprovingthe
academicandfunctionalachievementofthestudentwithadisabilitytofacilitatethestudentsmovementfromschooltopostschoolactivities,
includingpostsecondaryeducation,vocationaleducation,integratedemployment(includingsupportedemployment),continuingandadult
education,adultservices,independentliving,orcommunityparticipationthatisbasedontheindividualstudentsneedstakingintoaccountthe
studentsstrengths,preferences,andinterests.

Parentalconcernsforenhancingtheeducationofthestudent

TherearenoparentalconcernsforJohnseducationatthistime.

Howthestudent'sdisabilityaffectsinvolvementandprogressinthegeneraleducationcurriculum

JohnwasidentifiedasastudentwithSpecificLearningDisabilityinBasicReadingskills,ReadingComprehension,WrittenExpressionand
Mathematicscalculationthroughthere-evaluationreportdated.JohnsneedsintheareasofLanguageArtswouldaffecthisinvolvementand
progressinthegeneraleducationclassroom.DuetoJohnsneedsinLanguageArts,hewouldbenefitfromsmallgroupinstructiontoreinforcethe
readingandlanguageskillstaughtintheclassroom.DuetoJohnsMathematicneeds,hewouldbenefitfromsmallgroupinstructiontoreinforce
mathskillstaughtintheclassroom.

Strengths

-Friendlyandcooperative
-Completesclassworkandhomework
-Asksforhelpwhenneeded
-Helpfularoundtheclassroom

Academic,developmental,andfunctionalneedsrelatedtostudent'sdisability
-Math Computations

-Math application and concept skill problems

-Work more independently

May2014

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JackieSWallace,SHU56121
III. TRANSITION SERVICES - This is required for students age 14 or younger if determined appropriate by the IEP team.

IfthestudentdoesnotattendtheIEPmeeting,theschoolmusttakeotherstepstoensurethatthestudentspreferencesandinterestsareconsidered.Transitionservicesareacoordinatedsetof
activitiesforastudentwithadisabilitythatisdesignedtobewithinaresultsorientedprocess,thatisfocusedonimprovingtheacademicandfunctionalachievementofthestudentwitha
disabilitytofacilitatethestudentsmovementfromschooltopostschoolactivities,includingpostsecondaryeducation,vocationaleducation,integratedemployment(includingsupported
employment),continuingandadulteducation,adultservices,independentliving,orcommunityparticipationthatisbasedontheindividualstudentsneedstakingintoaccountthestudents
strengths,preferences,andinterests.
POST SCHOOL GOALS-Basedonageappropriateassessment,defineandprojecttheappropriatemeasurablepostsecondarygoalsthataddresseducationandtraining,employment,andas
needed,independentliving.Undereacharea,listtheservices/activitiesandcoursesofstudythatsupportthatgoal.Includeforeachservice/activitythelocation,frequency,projectedbeginning
date,anticipatedduration,andperson/agencyresponsible.
For students in Career and Technology Centers, CIP Code:

Postsecondary Education and Training Goal:

Measurable Annual Goal

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Yes /
No
(Document in Section V)
Courses of Study:

Service/Activity

Location

Frequency

Projected
Beginning Date

Anticipated
Duration

Person(s)/Agency
Responsible

Employment Goal:

Measurable Annual Goal

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Yes /
No
(Document in Section V)
Courses of Study:

Service/Activity

Location

Frequency

Projected
Beginning Date

Anticipated
Duration

Person(s)/Agency
Responsible

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JackieSWallace,SHU56121
Independent Living Goal, if appropriate:

Measurable Annual Goal

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Yes /
No
(Document in Section V)
Courses of Study:

Service/Activity

Location

Frequency

Projected
Beginning Date

Anticipated
Duration

Person(s)/Agency
Responsible

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JackieSWallace,SHU56121

IV. PARTICIPATION IN STATE AND LOCAL ASSESSMENTS

Instructions for IEP Teams:
Pleaseselecttheappropriateassessmentoption.InformationonavailabletestingaccommodationsmaybefoundintheAccommodationsGuidelinesavailableonwww.education.state.pa.us.
State Assessments
Not Assessed
Nostatewideassessmentisadministeredatthisstudentsgradelevel
NoEnglishproficiencyassessmentadministeredbecausethestudentisnotanEnglishLanguageLearner.

PSSA(Mathadministeredingrades3-8;Scienceadministeredingrades4and8;Readingadministeredingrades3-8;Writingadministeredingrades5and8;andELA*)
Tested Subject Without
With
Accommodations to be Provided
Accommodations Accommodations
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Math
Science
Reading
Writing
ELA*

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*ELAwillreplacetheReadingandWritingPSSAsin2014-15forgrades3-8.

Keystone Exam(Replacesthe11thgradePSSAinhighschool;Studentmustparticipateby11thgrade)
Tested Subject Without
With
Accommodations to be Provided
Accommodations Accommodations
Algebra 1
Literature
Biology

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Keystone Project Based Assessment (AvailablewhenstudentisunabletodemonstrateproficiencyonaKeystoneExamorKeystoneExammodule.)

Tested Subject Without
With
Accommodations to be Provided
Accommodations Accommodations
Algebra 1
Literature
Biology

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Validated Local Assessment(AvailablewhenselectedasoptionbyLEA)

Tested Subject Without
With
Accommodations to be Provided
Accommodations Accommodations

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JackieSWallace,SHU56121
Tested Subject
Algebra 1
Literature
Biology

Without
With
Accommodations to be Provided
Accommodations Accommodations
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PASA(Administeredingrades3-8,11forReadingandMath;Grades4,8,11forScience)
StudentwillparticipateinthePASA.

ExplainwhythestudentcannotparticipateinthePSSAortheKeystoneExamforReading/Literature,Math/Algebra1,Science/Biology,andComposition(TheCompositionexamwillbe
availableforthe2016-17schoolyear):

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ExplainwhythePASAisappropriate:

Choosehowthestudent'sperformanceonthePASAwillbedocumented.

Videotape(preferredmethod)

Writtennarrativenotes(requirespriorapprovalinaccordancewithPDEguidance)

ACCESS for ELLs (Administered in grades K-12)

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

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Alternate ACCESS for ELLs (Administered in grades 1-12)

StudentwillparticipateintheAlternateACCESSforELLs.

ExplainwhythestudentcannotparticipateintheACCESSforELLs:

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JackieSWallace,SHU56121

ExplainwhytheAlternateACCESSforELLsisappropriate:

Domains
Listening
Reading
Writing
Speaking

May2014

Without
With
Unable to
Accommodations Accommodations Participate
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Accommodations to be Provided or Rationale for Inability to Participate in Selected Domains

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JackieSWallace,SHU56121
Local Assessments

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Localassessmentisnotadministeredatthisstudent'sgradelevel;OR
Studentwillparticipateinlocalassessmentswithoutaccommodations;OR
Studentwillparticipateinlocalassessmentswiththefollowingaccommodations;OR

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Thestudentwilltakeanalternatelocalassessment.

Explainwhythestudentcannotparticipateintheregularassessment:

Explainwhythealternateassessmentisappropriate:

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JackieSWallace,SHU56121
V. GOALS AND OBJECTIVES-Include,asappropriate,academicandfunctionalgoals.Useasmanycopiesofthispageasneededtoplanappropriately.Speciallydesignedinstructionmaybe
listedwitheachgoal/objectiveorlistedinSectionVI.
Shorttermlearningoutcomesarerequiredforstudentswhoaregifted.Theshorttermlearningoutcomesrelatedtothestudent'sgiftedprogrammaybelistedunderGoalsorShortTermObjectives.

MEASURABLE ANNUAL GOAL

Include: Condition, Name, Behavior, and Criteria
(Refer to Annotated IEP for description of these components)
Reading Comprehension:

Describe HOW the

student's progress toward
meeting this goal will be measured
Progress will be measured using data
collection and teacher observation.

Describe WHEN periodic

reports on progress will be
provided to parents
Quarterly progress reports will be sent
home.

After independently reading a passage at the 4.0-5.0 grade level,

John will answer literal comprehension questions with 90%
accuracy and inferential comprehension questions with 85%
accuracy on 4 out of 5 consecutive weekly probes
Report of Progress

Goal Specific SDI

SHORT TERM OBJECTIVES-Requiredforstudentswithdisabilitieswhotakealternateassessmentsalignedtoalternateachievementstandards(PASA).

Short term objectives / Benchmarks

May2014

Level of Achievement

Method of Evaluation

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JackieSWallace,SHU56121

MEASURABLE ANNUAL GOAL

Include: Condition, Name, Behavior, and Criteria
(Refer to Annotated IEP for description of these components)
Reading Comprehension:

Describe HOW the

student's progress toward
meeting this goal will be measured
Progress will be measured using data
collection and teacher observation.

Describe WHEN periodic

reports on progress will be
provided to parents
Quarterly progress reports will be sent
home.

After independently reading a passage at the 4.0-5.0 grade level,

John will answer literal comprehension questions with 90%
accuracy and inferential comprehension questions with 85%
accuracy on 4 out of 5 consecutive weekly probes
Report of Progress

Goal Specific SDI

Bytheendoftheschoolyear,thestudentwillbeableusegraphicorganizers,andcompareandcontrastsettings,characters,andeventsandusethe
informationtodrawconclusionswith80%accuracyonclassroomassignments.

Bytheendoftheschoolyear,thestudentwillbeabletocalculate21/24level3mathapplicationwith87%accuracy

SHORT TERM OBJECTIVES-Requiredforstudentswithdisabilitieswhotakealternateassessmentsalignedtoalternateachievementstandards(PASA).

Short term objectives / Benchmarks

May2014

Level of Achievement

Method of Evaluation

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JackieSWallace,SHU56121
VI. SPECIAL EDUCATION / RELATED SERVICES / SUPPLEMENTARY AIDS AND SERVICES / PROGRAM MODIFICATIONS-Include,asappropriate,fornonacademicand
extracurricularservicesandactivities.
A. PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION (SDI)

SDImaybelistedwitheachgoaloraspartofthetablebelow.

Includesupplementaryaidsandservicesasappropriate.

Forastudentwhohasadisabilityandisgifted,SDIalsoshouldincludeadaptations,accommodations,ormodificationstothegeneraleducationcurriculum,asappropriateforastudent
withadisability.

Modifications and SDI

Location

Frequency

Projected Beginning Date

Anticipated Duration

B. RELATED SERVICES-Listtheservicesthatthestudentneedsinordertobenefitfromhis/herspecialeducationprogram.

Service

Location

Frequency

Projected Beginning Date

Anticipated Duration

C. SUPPORTS FOR SCHOOL PERSONNEL-Listthestafftoreceivethesupportsandthesupportsneededtoimplementthestudent'sIEP.

School Personnel to
Receive Support

Support

Location

Frequency

Projected Beginning Date

Anticipated Duration

D. GIFTED SUPPORT SERVICES FOR A STUDENT IDENTIFIED AS GIFTED WHO ALSO IS IDENTIFIED AS A STUDENT WITH A DISABILITY-Supportservicesarerequiredto
assistagiftedstudenttobenefitfromgiftededucation(e.g.,psychologicalservices,parentcounselingandeducation,counselingservices,transportationtoandfromgiftedprogramstoclassroomsin
buildingsoperatedbytheschooldistrict).

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JackieSWallace,SHU56121

Support Service

Support Service

Support Service

E. EXTENDED SCHOOL YEAR (ESY) - The IEP team has considered and discussed ESY services, and determined that:

StudentISeligibleforESYbasedonthefollowinginformationordatareviewedbytheIEPteam:

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TheAnnualGoalsand,whenappropriate,ShortTermObjectivesfromthisIEPthataretobeaddressedinthestudent'sESYProgramare:

IftheIEPteamhasdeterminedESYisappropriate,completethefollowing:

OR
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AsofthedateofthisIEP,studentisNOTeligibleforESYbasedonthefollowinginformationordatareviewedbytheIEPteam:

ESY Service to be Provided

Location

Frequency

Projected Beginning Date

Anticipated Duration

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JackieSWallace,SHU56121
VII. EDUCATIONAL PLACEMENT

A. QUESTIONS FOR IEP TEAM-ThefollowingquestionsmustbereviewedanddiscussedbytheIEPteampriortoprovidingtheexplanationsregardingparticipationwithstudents

withoutdisabilities.

Itistheresponsibilityofeachpublicagencytoensurethat,tothemaximumextentappropriate,studentswithdisabilities,includingthoseinpublic
orprivateinstitutionsorothercarefacilities,areeducatedwithstudentswhoarenotdisabled.Specialclasses,separateschoolingorotherremoval
ofstudentswithdisabilitiesfromthegeneraleducationalenvironmentoccursonlywhenthenatureorseverityofthedisabilityissuchthat
educationingeneraleducationclasses,EVENWITHtheuseofsupplementaryaidsandservices,cannotbeachievedsatisfactorily.

Whatsupplementaryaidsandserviceswereconsidered?

Whatsupplementaryaidsandserviceswererejected?

Explainwhythesupplementaryaidsandserviceswillorwillnotenablethestudenttomakeprogressonthegoalsandobjectives(if
applicable)inthisIEPinthegeneraleducationclass.

Whatbenefitsareprovidedinthegeneraleducationclasswithsupplementaryaidsandservicesversusthebenefitsprovidedinthe
specialeducationclass?

Whatpotentiallybeneficialeffectsand/orharmfuleffectsmightbeexpectedonthestudentwithdisabilitiesortheotherstudentsinthe
class,evenwithsupplementaryaidsandservices?

Towhatextent,ifany,willthestudentparticipatewithnondisabledpeersinextracurricularactivitiesorothernonacademicactivities?

Explanationoftheextent,ifany,towhichthestudentwillnotparticipatewithstudentswithoutdisabilitiesintheregulareducationclass:

Explanationoftheextent,ifany,towhichthestudentwillnotparticipatewithstudentswithoutdisabilitiesinthegeneraleducationcurriculum:

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JackieSWallace,SHU56121
B. Type of Support

1. Amount of special education supports

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Itinerant:Specialeducationsupportsandservicesprovidedbyspecialeducationpersonnelfor20%orlessoftheschoolday

2. Type of special education supports

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Supplemental:Specialeducationsupportsandservicesprovidedbyspecialeducationpersonnelformorethan20%ofthedaybutlessthan80%oftheschoolday
Full-Time:Specialeducationsupportsandservicesprovidedbyspecialeducationpersonnelfor80%ormoreoftheschoolday

AutisticSupport
BlindorVisuallyImpairedSupport
DeaforHearingImpairedSupport
EmotionalSupport
GiftedSupport
LearningSupport
LifeSkillsSupport
MultipleDisabilitiesSupport
PhysicalSupport
SpeechandLanguageSupport

C. Location of student's program

NameofSchoolDistrictwheretheIEPwillbeimplemented:

NameofSchoolBuildingwheretheIEPwillbeimplemented:

Isthisschoolthestudentsneighborhoodschool(i.e.,theschoolthestudentwouldattendifhe/shedidnothaveanIEP)?

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Yes
No.Iftheansweris"no,"selectthereasonwhynot.

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Specialeducationsupportsandservicesrequiredinthestudent'sIEPcannotbeprovidedintheneighborhoodschool
Other.Pleaseexplain:

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JackieSWallace,SHU56121
VIII. PENNDATA REPORTING: Educational Environment (Complete either Section A or B; Select only one Educational Environment)
Tocalculatethepercentageoftimeinsidetheregularclassroom,dividethenumberofhoursthestudentspendsinsidetheregularclassroombythetotalnumberofhoursintheschoolday(including
lunch,recess,studyperiods).Theresultisthenmultipliedby100.
SECTION A: For Students Educated in Regular School Buildings with Nondisabled Peers - Indicate the percentage of time INSIDE the regular classroom for this student:
Timespentoutsidetheregularclassroomreceivingservicesunrelatedtothestudent'sdisability(e.g.,timereceivingESLservices)shouldbeconsideredtimeinsidetheregularclassroom.
Educationaltimespentinage-appropriatecommunity-basedsettingsthatincludeindividualswithandwithoutdisabilities,suchascollegecampusesorvocationalsites,shouldbecountedastime
spentinsidetheregularclassroom.
Calculation for this Student:
Column1
Totalhoursthestudent
spendsintheregular
classroomperday

Column2

Calculation

Totalhoursinatypical
schoolday
(includinglunch,recess&
studyperiods)

IndicatePercentage

(Hoursinsideregular
classroomhoursin
SectionA:Thepercentageof
schoolday)x100=%
timestudentspendsinside
(Column1Column2)x100
theregularclassroom:
=%

PercentageCategory
Usingthecalculationresultselecttheappropriatepercentage
category
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% of the day

()x100=%

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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:(Ifastudentspendslessthan50%ofthedayinoneoftheselocations,theIEPteammustdothecalculationinSectionA)
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ApprovedPrivateSchool(NonResidential)

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ApprovedPrivateSchool(Residential)

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OtherPrivateFacility(NonResidential)

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OtherPrivateFacility(Residential)

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OtherPublicFacility(Residential)

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OtherPublicFacility(NonResidential)
Hospital/Homebound
CorrectionalFacility
OutofStateFacility
InstructionConductedintheHome

EXAMPLES for Section A: HowtoCalculatePennDataEducationalEnvironmentPercentages

Column1

Column2

Calculation

IndicatePercentage
SectionA:Thepercentageoftimestudent
spendsinsidetheregularclassroom:
85%oftheday(Inside80%orMoreofDay)

Totalhoursthestudentspendsinthe
regularclassroomperday

Totalhoursinatypicalschoolday
(includinglunch,recess&studyperiods)

(Hoursinsideregularclassroomhoursin
schoolday)x100=%
(Column1Column2)x100=%

Example1

5.5

6.5

(5.56.5)x100=85%

Example2

(35)x100=60%

60%oftheday(Inside79-40%ofDay)

Example3

(15)x100=20%

20%oftheday(Insidelessthan40%ofDay)

Forhelpinunderstandingthisform,anannotated IEPisavailableonthePaTTANwebsiteatwww.pattan.netType"AnnotatedForms"intheSearchfeatureonthewebsite.Ifyoudonothaveaccess
totheInternet,youcanrequesttheannotatedformbycallingPaTTANat800-441-3215.
May2014

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