INDIVIDUALIZED EDUCATION PROGRAM (IEP) Students Name:

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Students Name: IEP Team Meeting Date (mm/dd/yy): *ntici"ated Durati$n $+ Ser'ices and Pr$grams: Date $+ (irth: *ge: /rade: ) 0 0 0! )/! / . Jecarra White 1 /1/1! 1 / )/1! ,/! /1-

School Age

IEP Im"#ementati$n Date (Pr$%ected Date &hen Ser'ices and Pr$grams Wi## (egin):

*ntici"ated 1ear $+ /raduati$n: 2$ca# Educati$n *gency (2E*): 3$unty $+ 4esidence:

Name and *ddress $+ Parent//uardian/Surr$gate:

Ph$ne (5$me): Ph$ne (W$r6):

7ther In+$rmati$n:

The 2E* and "arent ha'e agreed t$ ma6e the +$##$&ing changes t$ the IEP &ith$ut c$n'ening an IEP meeting8 as d$cumented 9y:

Date of Revi io!( )

Pa"tici#a!t $Role

IEP Sectio!( ) A%e!&e&

Page 1 of 19

May 2013

IEP TEAM$SIGNATURES The Indi'idua#i:ed Educati$n Pr$gram team ma6es the decisi$ns a9$ut the students "r$gram and "#acement; The students "arent(s)8 the students s"ecia# educati$n teacher8 and a re"resentati'e +r$m the 2$ca# Educati$n *gency are re<uired mem9ers $+ this team; Signature $n this IEP d$cuments attendance8 n$t agreement; Role Parent//uardian/Surr$gate Parent//uardian/Surr$gate Student= 4egu#ar Educati$n Teacher== S"ecia# Educati$n Teacher 2$ca# Ed *gency 4e" 3areer/Tech Ed 4e"=== 3$mmunity *gency 4e" Teacher $+ the /i+ted==== P"i!te& Na%e Sig!at'"e

= The IEP team must in'ite the student i+ transiti$n ser'ices are 9eing "#anned $r i+ the "arents ch$$se t$ ha'e the student "artici"ate; == I+ the student is8 $r may 9e8 "artici"ating in the regu#ar educati$n en'ir$nment === *s determined 9y the 2E* as needed +$r transiti$n ser'ices and $ther c$mmunity ser'ices ==== * teacher $+ the gi+ted is re<uired &hen &riting an IEP +$r a student &ith a disa9i#ity &h$ a#s$ is gi+ted; 7ne indi'idua# #isted a9$'e must 9e a9#e t$ inter"ret the instructi$na# im"#icati$ns $+ any e'a#uati$n resu#ts; Written in"ut recei'ed +r$m the +$##$&ing mem9ers:

T"a! fe" of Right at Age of Ma(o"it) >$r "ur"$ses $+ educati$n8 the age $+ ma%$rity is reached in Pennsy#'ania &hen the indi'idua# reaches 01 years $+ age; 2i6e&ise8 +$r "ur"$ses $+ the Indi'idua#s &ith Disa9i#ities Educati$n *ct8 the age $+ ma%$rity is reached +$r students &ith disa9i#ities &hen they reach 01 years $+ age;

PROCEDURAL SA*EGUARDS NOTICE

I ha'e recei'ed a c$"y $+ the Procedural Safeguards Notice during this sch$$# year; The Procedural Safeguards Notice "r$'ides in+$rmati$n a9$ut my rights8 inc#uding the "r$cess +$r disagreeing &ith the IEP; The sch$$# has in+$rmed me &h$m I may c$ntact i+ I need m$re in+$rmati$n; Signature $+ Parent//uardian/Surr$gate:

MEDICAL ASSISTANCE PROGRAM +ILLING NOTICE (A##lica,le o!l) to #a"e!t -ho have co! e!te& to the "elea e of ,illi!g i!fo"%atio! to Me&ical A i ta!ce #"og"a% )
I understand that the sch$$# may charge the Sch$$#?(ased *ccess Pr$gram (@S(*PA)B$r any "r$gram that re"#aces $r su""#ements the S(*PBthe c$st $+ certain s"ecia# educati$n and re#ated ser'ices descri9ed in my chi#ds IEP; T$ ma6e these charges t$ the S(*P8 the sch$$# &i## re#ease t$ the administrat$r $+ that "r$gram the name8 age8 and address $+ my chi#d8 'eri+icati$n $+ Medicaid e#igi9i#ity +$r my chi#d8 a c$"y $+ my chi#ds IEP8 a descri"ti$n $+ the ser'ices "r$'ided and the times and dates during &hich such ser'ices &ere "r$'ided t$ my chi#d8 and the identity $+ the "r$'ider $+ such ser'ices; I understand that such information will not be disclosed and such charges will not be made unless I consent to the disclosure! I ac6n$&#edge that I ha'e "r$'ided &ritten c$nsent t$ disc#$se such in+$rmati$n; I understand that my c$nsent is $ng$ing +r$m year?t$?year un#ess and unti# I &ithdra& it; I can &ithdra& my c$nsent in &riting8 $r $ra##y i+ I am una9#e t$ &rite8 at any time; My re+usa# t$ c$nsent $r my &ithdra&a# $+ c$nsent &i## n$t re#ie'e the sch$$# $+ the $9#igati$n t$ "r$'ide8 at n$ c$st t$ me $r my +ami#y8 any ser'ice $r "r$gram t$ &hich my chi#d is entit#ed under the Indi'idua#s &ith Disa9i#ities Educati$n *ct (@IDE*A) $r that is necessary t$ ena9#e my chi#d t$ recei'e a +ree a""r$"riate "u9#ic educati$n as descri9ed in my chi#ds IEP; I understand that the sch$$# cann$tB 4e<uire me $r my +ami#y t$ sign u" +$r $r enr$## in any "u9#ic 9ene+its $r insurance "r$gram8 such as Medicaid8 as a c$nditi$n $+ recei'ing a +ree a""r$"riate "u9#ic educati$n +$r my chi#dC 4e<uire me $r my +ami#y t$ incur any eD"ense +$r the "r$'isi$n $+ a +ree a""r$"riate "u9#ic educati$n t$ my chi#d8 inc#uding c$?"ayments and deducti9#es8 un#ess it agrees t$ "ay such eD"enses $n my $r my +ami#ys 9eha#+C 3ause a decrease in a'ai#a9#e #i+etime c$'erage $r any $ther insured 9ene+itC 3ause me $r my +ami#y t$ "ay +$r ser'ices that &$u#d $ther&ise 9e c$'ered 9y a "u9#ic 9ene+its $r insurance "r$gram and that are re<uired +$r my chi#d $utside the time that he $r she is in sch$$#C 4is6 the #$ss $+ e#igi9i#ity +$r h$me and c$mmunity?9ased &ai'ers8 9ased $n aggregate hea#th?re#ated eD"enditures;

I. SPECIAL CONSIDERATIONS T/E IEP TEAM MUST CONSIDER +E*ORE DEVELOPING T/E IEP. AN0 *ACTORS C/EC1ED AS 20ES3 MUST +E ADDRESSED IN T/E IEP. I the t'&e!t ,li!& o" vi 'all) i%#ai"e&4 1es The IEP must inc#ude a descri"ti$n $+ the instructi$n in (rai##e and the use $+ (rai##e un#ess the IEP team determines8 a+ter an e'a#uati$n $+ the students reading and &riting s6i##s8 needs8 and a""r$"riate reading and &riting media (inc#uding an e'a#uati$n $+ the students +uture needs +$r instructi$n in (rai##e $r the use $+ (rai##e)8 that instructi$n in (rai##e $r the use $+ (rai##e is n$t a""r$"riate +$r the student; N$ E N$ I the t'&e!t &eaf o" ha"& of hea"i!g4 1es The IEP must inc#ude a c$mmunicati$n "#an t$ address the +$##$&ing: #anguage and c$mmunicati$n needsC $""$rtunities +$r direct c$mmunicati$ns &ith "eers and "r$+essi$na# "ers$nne# in the students #anguage and c$mmunicati$n m$deC academic #e'e#C +u## range $+ needs8 inc#uding $""$rtunities +$r direct instructi$n in the students #anguage and c$mmunicati$n m$deC and assisti'e techn$#$gy de'ices and ser'ices; Indicate in &hich secti$n $+ the IEP these c$nsiderati$ns are addressed; The 3$mmunicati$n P#an must 9e c$m"#eted and is a'ai#a9#e at &&&;"attan;net E N$ N$

Doe the t'&e!t have co%%'!icatio! !ee& 4 1es Student needs must 9e addressed in the IEP (i;e;8 "resent #e'e#s8 s"ecia##y designed instructi$n (SDI)8 annua# g$a#s8 etc;) E N$ N$

Doe the t'&e!t !ee& a i tive tech!olog) &evice a!&$o" e"vice 4 1es Student needs must 9e addressed in the IEP (i;e;8 "resent #e'e#s8 s"ecia##y designed instructi$n8 annua# g$a#s8 etc;) E N$ N$

Doe the t'&e!t have li%ite& E!gli h #"oficie!c)4 1es The IEP team must address the students #anguage needs and h$& th$se needs re#ate t$ the IEP; E N$ N$

Doe the t'&e!t e5hi,it ,ehavio" that i%#e&e hi $he" lea"!i!g o" that of othe" 4 1es The IEP team must de'e#$" a P$siti'e (eha'i$r Su""$rt P#an that is 9ased $n a +uncti$na# assessment $+ 9eha'i$r and that uti#i:es "$siti'e 9eha'i$r techni<ues; 4esu#ts $+ the +uncti$na# assessment $+ 9eha'i$r may 9e #isted in the Present 2e'e#s secti$n $+ the IEP &ith a c#ear measura9#e "#an t$ address the 9eha'i$r in the /$a#s and S"ecia##y Designed Instructi$n secti$ns $+ the IEP $r in the P$siti'e (eha'i$r Su""$rt P#an i+ this is a se"arate d$cument that is attached t$ the IEP; * P$siti'e (eha'i$r Su""$rt P#an and a >uncti$na# (eha'i$ra# *ssessment +$rm are a'ai#a9#e at &&&;"attan;net E N$ N$

Other (specify):

II. PRESENT LEVELS O* ACADEMIC AC/IEVEMENT AND *UNCTIONAL PER*ORMANCE I!cl'&e the follo-i!g i!fo"%atio! "elate& to the t'&e!t6 Present #e'e#s $+ academic achie'ement (e;g;8 m$st recent e'a#uati$n $+ the student8 resu#ts $+ +$rmati'e assessments8 curricu#um?9ased assessments8 transiti$n assessments8 "r$gress t$&ard current g$a#s) Present #e'e#s $+ +uncti$na# "er+$rmance (e;g;8 resu#ts +r$m a +uncti$na# 9eha'i$ra# assessment8 resu#ts $+ ec$#$gica# assessments8 "r$gress t$&ard current g$a#s) Present #e'e#s re#ated t$ current "$stsec$ndary transiti$n g$a#s i+ the students age is 1- $r y$unger i+ determined a""r$"riate 9y the IEP team (e;g;8 resu#ts $+ +$rmati'e assessments8 curricu#um?9ased assessments8 "r$gress t$&ard current g$a#s) Parenta# c$ncerns +$r enhancing the educati$n $+ the student 5$& the students disa9i#ity a++ects in'$#'ement and "r$gress in the genera# educati$n curricu#um Strengths *cademic8 de'e#$"menta#8 and +uncti$na# needs re#ated t$ students disa9i#ity Present #e'e#s $+ academic achie'ement (e;g;8 m$st recent e'a#uati$n $+ the student8 resu#ts $+ +$rmati'e assessments8 curricu#um?9ased assessments8 transiti$n assessments8 "r$gress t$&ard current g$a#s) *+ter $9ser'ati$ns in the c#assr$$m and recent assessments8 Jecarras "resent #e'e#s $+ "er+$rmance ha'e 9een 9e#$& a'erage +$r her grade; 7n math assessments such as the FeyMath and 3(M8 Jecarra sc$red (e#$& *'erage in c$m"aris$n t$ her grade; During the FeyMath8 she her s6i##s in Numerati$n8 *#ge9ra8 /e$metry8 Measurement8 Data *na#ysis and Pr$9a9i#ity8 Menta# 3$m"utati$n and Estimati$n8 *dditi$n and Su9tracti$n8 >$undati$ns $+ Pr$9#em S$#'ing8 and *""#ied Pr$9#em S$#'ing; These nine su9tests +e## under three main areas $+ the FeyMath assessment inc#uding (asic 3$nce"ts8 7"erati$ns8 and *""#icati$ns; In e'ery su9test8 Jecarra sc$red (e#$& *'erage eDce"t Numerati$n &here she sc$red *'erage; 7n the (asic 3$nce"ts area8 Jecarra sc$red a standard sc$re $+ G, and in the ) th "ercenti#e; She sc$red a standard sc$re $+ G, in the 7"erati$ns area8 and $nce again in the ) th "ercenti#e; 7n the *""#icati$ns area $+ the FeyMath8 Jecarra sc$red a standard sc$re $+ G. and in the . th "ercenti#e; 7'era## $n the FeyMath assessment8 she sc$red a standard sc$re $+ GH and in the . th "ercenti#e; She t$$6 an$ther assessment ca##ed the 3(M8 3urricu#um (ased Measurement8 and sc$red (e#$& (enchmar6 $n this assessment as &e##; 5er s6i##s in 3$m"utati$n (*dditi$n and Su9tracti$n) and 3$nce"ts and *""#icati$ns &ere measured; 7n each "r$9e8 $r test8 Jecarra sc$red (e#$& (enchmar6; In her math c#ass e'ery day8 the students ta6e a math +#uency test; It c$ntains - $ne?digit additi$n and su9tracti$n "r$9#ems; Jecarra is sti## $n 2e'e# * (the #$&est #e'e#); Strengths 7+ten times8 Jecarra has an eDce##ent attitude t$&ards #earning8 and &ants t$ "#ease her teachers; She has 9een c$nsistent#y turning in h$me&$r6 a+ter enc$uragement +r$m teachers t$ d$ s$; She is 'ery eDcited and "r$ud $+ herse#+ &hen she d$es c$m"#ete science "r$%ects8 and h$me&$r6; In regards t$ her

raising her hand in c#ass8 Jecarra $+ten d$es &hen she thin6s she 6n$&s the ans&er; It is e'ident t$ teachers &hen she is c$n+ident in her ans&er; When Jecarra is n$t +idgeting &ith $9%ects8 she is "aying attenti$n and understands &hat is g$ing $n in c#ass; Present #e'e#s re#ated t$ current "$stsec$ndary transiti$n g$a#s i+ the students age is 1- $r y$unger i+ determined a""r$"riate 9y the IEP team (e;g;8 resu#ts $+ +$rmati'e assessments8 curricu#um?9ased assessments8 "r$gress t$&ard current g$a#s) The student is 1- years $r y$unger8 s$ there are n$ transiti$n g$a#s current#y +$r Jecarra; Parenta# c$ncerns +$r enhancing the educati$n $+ the student Jecarras "arents are c$ncerned a9$ut her &$r6 getting c$m"#eted; They see that she has di++icu#ty +inishing her &$r6 and need t$ 6ee" $n her a9$ut it8 9ut they &ere n$t a&are $+ her #$& academic achie'ement in c$m"aris$n t$ her "eers; They &ant her t$ +ee# c$m+$rta9#e in sch$$#8 9ut &ant t$ see her succeed &ith c$m"#eting her &$r6 t$ the 9est $+ her a9i#ities; Present #e'e#s $+ +uncti$na# "er+$rmance (e;g;8 resu#ts +r$m a +uncti$na# 9eha'i$ra# assessment8 resu#ts $+ ec$#$gica# assessments8 "r$gress t$&ard current g$a#s) Jecarras +uncti$na# #e'e#s are n$rma# &ith her "eers; She has s"eci+ic "eers that she en%$ys "#aying &ith at recess and +ree time; She has di++icu#ty "aying attenti$n and c$m"#eting her &$r6 in a## c#asses; Teachers ha'e $9ser'ed Jecarra +idgeting during c#ass &ith her c#$thes8 "enci#s8 and "a"ers; When she gets +rustrated &ith her &$r68 Jecarra ends u" %ust sitting there and #$$6ing at it; Teachers &i## usua##y gi'e her eDtra time t$ c$m"#ete her &$r6; E'en &hen they as6 her <uesti$ns a9$ut the &$r6 in +r$nt $+ her8 she 6n$&s the ans&ers8 9ut %ust cann$t &rite them d$&n $n "a"er; Teachers ha'e tried "#acing her at di++erent ta9#es t$ is$#ate her in $rder +$r her t$ c$m"#ete her &$r6; S$metimes this strategy &$r6s8 and s$metimes it d$es n$t; Jecarra can 9e distracted easi#y and stares $++ int$ s"ace; *n$ther strategy that teachers try t$ use t$ get her t$ c$m"#ete her &$r6 is t$ sit neDt t$ her and enc$urage her c$ntinu$us#y; This strategy is $n#y a'ai#a9#e i+ the teacher is a9#e t$ sit neDt t$ her; 5$& the students disa9i#ity a++ects in'$#'ement and "r$gress in the genera# educati$n curricu#um 3urrent#y8 Jecarra is accessing the genera# educati$n curricu#um &ith n$ ser'ices $r m$di+icati$ns; *cademic8 de'e#$"menta#8 and +uncti$na# needs re#ated t$ students disa9i#ity She is $n#y 9eing "#aced at a di++erent ta9#e at times; With$ut ser'ices8 she is ha'ing di++icu#ty c$m"#eting her &$r68 and 6ee"ing u" &ith the rest $+ her "eers in academic achie'ement; 7n her assessments8 and $'era## "r$gress8 she &$u#d 9e c$nsidered (e#$& *'erage +$r her grade; Jecarra needs t$ &$r6 $n her +#uency in additi$n and su9tracti$n +acts; She a#s$ is &e## 9e#$& a'erage in c#assi+ying and s$rting $9%ects 9ased $n characteristics; *n$ther &ea6ness that Jecarra is strugg#ing &ith is s$#'ing &$rd "r$9#ems in math; She needs t$ "ractice "u##ing $ut essentia# in+$rmati$n &ithin the "r$9#em in $rder t$ s$#'e it c$rrect#y;

III. TRANSITION SERVICES 7 Thi i "e8'i"e& fo" t'&e!t age 9: o" )o'!ge" if &ete"%i!e& a##"o#"iate ,) the IEP tea%. I+ the student d$es n$t attend the IEP meeting8 the sch$$# must ta6e $ther ste"s t$ ensure that the students "re+erences and interests are c$nsidered; Transiti$n ser'ices are a c$$rdinated set $+ acti'ities +$r a student &ith a disa9i#ity that is designed t$ 9e &ithin a resu#ts $riented "r$cess8 that is +$cused $n im"r$'ing the academic and +uncti$na# achie'ement $+ the student &ith a disa9i#ity t$ +aci#itate the students m$'ement +r$m sch$$# t$ "$st sch$$# acti'ities8 inc#uding "$stsec$ndary educati$n8 '$cati$na# educati$n8 integrated em"#$yment (inc#uding su""$rted em"#$yment)8 c$ntinuing and adu#t educati$n8 adu#t ser'ices8 inde"endent #i'ing8 $r c$mmunity "artici"ati$n that is 9ased $n the indi'idua# students needs ta6ing int$ acc$unt the students strengths8 "re+erences8 and interests; POST SC/OOL GOALS I (ased $n age a""r$"riate assessment8 de+ine and "r$%ect the a""r$"riate measura9#e "$stsec$ndary g$a#s that address educati$n and training8 em"#$yment8 and as needed8 inde"endent #i'ing; Jnder each area8 #ist the ser'ices/acti'ities and c$urses $+ study that su""$rt that g$a#; Inc#ude +$r each ser'ice/acti'ity the #$cati$n8 +re<uency8 "r$%ected 9eginning date8 antici"ated durati$n8 and "ers$n/agency res"$nsi9#e; *o" t'&e!t i! Ca"ee" a!& Tech!olog) Ce!te" ; CIP Co&e6

Po t eco!&a") E&'catio! a!& T"ai!i!g Goal6 N/*

Measura9#e *nnua# /$a# 1es/N$ (D$cument in Secti$n K)

3$urses $+ Study:

Ser'ice/*cti'ity

2$cati$n

>re<uency

Pr$%ected (eginning Date

*ntici"ated Durati$n

Pers$n(s)/*gency 4es"$nsi9#e

E%#lo)%e!t Goal6 N/* 3$urses $+ Study:

Measura9#e *nnua# /$a# 1es/N$ (D$cument in Secti$n K)

Ser'ice/*cti'ity

2$cati$n

>re<uency

Pr$%ected (eginning Date

*ntici"ated Durati$n

Pers$n(s)/*gency 4es"$nsi9#e

I!&e#e!&e!t Livi!g Goal; if a##"o#"iate6 N/* 3$urses $+ Study:

Measura9#e *nnua# /$a# 1es/N$ (D$cument in Secti$n K)

Ser'ice/*cti'ity

2$cati$n

>re<uency

Pr$%ected (eginning Date

*ntici"ated Durati$n

Pers$n(s)/*gency 4es"$nsi9#e

IV. PARTICIPATION IN STATE AND LOCAL ASSESSMENTS I! t"'ctio! fo" IEP Tea% 6 P#ease se#ect the a""r$"riate assessment $"ti$n; In+$rmati$n $n a'ai#a9#e testing acc$mm$dati$ns may 9e +$und in the *cc$mm$dati$ns /uide#ines a'ai#a9#e $n &&&;educati$n;state;"a;us; State A e %e!t Not A e e& E N$ state&ide assessment is administered at this students grade #e'e#; Te""a!ova Te t i a&%i!i te"e& to <!& g"a&e.She -ill !ot "eceive a!) acco%%o&atio! fo" the Te""a!ova. Afte" IEP; it -o'l& ,e 'gge te& that he i #lace& i! a e#a"ate "oo% to a&%i!i te" the te t a -ell a give! e5t"a ti%e. PSSA (Math a'ai#a9#e in grades !?)C Science a'ai#a9#e in grades - and )C 4eading a'ai#a9#e in grades !?)C Writing a'ai#a9#e in grades . and )C and E2*=) With$ut With Tested Su9%ect *cc$mm$dati$ns *cc$mm$dati$ns *cc$mm$dati$ns t$ 9e Pr$'ided Math Science 4eading Writing E2*= =E2* &i## re"#ace the 4eading and Writing PSS*s in 0 1-?1. +$r grades !?); 1e) to!e E5a% (*'ai#a9#e &hen student has c$m"#eted the c$urse/su9%ectC and re"#aces the PSS* in high sch$$#) With$ut With Tested Su9%ect *cc$mm$dati$ns *cc$mm$dati$ns *cc$mm$dati$ns t$ 9e Pr$'ided *#ge9ra 1 2iterature (i$#$gy PASA (*'ai#a9#e in grades !?)8 11 +$r 4eading and MathC /rades -8 )8 11 +$r Science) Student &i## "artici"ate in the P*S*; ED"#ain &hy the student cann$t "artici"ate in the PSS* $r the Feyst$ne EDam +$r 4eading/2iterature8 Math/*#ge9ra 18 Science/(i$#$gy8 and 3$m"$siti$n:

ED"#ain &hy the P*S* is a""r$"riate:

3h$$se h$& the students "er+$rmance $n the P*S* &i## 9e d$cumented; Kide$ta"e ("re+erred meth$d) Written narrati'e n$tes (re<uires "ri$r a""r$'a# in acc$rdance &ith PDE guidance) Local A e %e!t 2$ca# assessment is n$t administered at this students grade #e'e#C 74 Student &i## "artici"ate in #$ca# assessments &ith$ut acc$mm$dati$nsC 74 E Student &i## "artici"ate in #$ca# assessments &ith the +$##$&ing acc$mm$dati$nsC 74 Te""a!ova Te t i a&%i!i te"e& to <!& g"a&e &'"i!g %ath ectio! . It -o'l& ,e 'gge te& that he I #lace& i! a e#a"ate "oo% to a&%i!i te" the te t Give! e5t"a ti%e O,(ect a"e "e%ove& f"o% he" a"ea ,e i&e the te t a!& #e!cil

The student &i## ta6e a #$ca# a#ternate assessment; ED"#ain &hy the student cann$t "artici"ate in the #$ca# regu#ar assessment:

ED"#ain &hy the #$ca# a#ternate assessment is a""r$"riate:

V. GOALS AND O+=ECTIVES I Inc#ude8 as a""r$"riate8 academic and +uncti$na# g$a#s; Jse as many c$"ies $+ this "age as needed t$ "#an a""r$"riate#y; S"ecia##y designed instructi$n may 9e #isted &ith each g$a#/$9%ecti'e $r #isted in Secti$n KI; Sh$rt term #earning $utc$mes are re<uired +$r students &h$ are gi+ted; The sh$rt term #earning $utc$mes re#ated t$ the students gi+ted "r$gram may 9e #isted under /$a#s $r Sh$rt Term 79%ecti'es; ME*SJ4*(2E *NNJ*2 /7*2 Inc#ude: 3$nditi$n8 Name8 (eha'i$r8 and 3riteria (4e+er t$ *nn$tated IEP +$r descri"ti$n $+ these c$m"$nents) When gi'en her math +#uency test each day8 Jecarra &i## increase her c$rrect ans&ers 9y 0 c$rrect "r$9#ems a &ee6 $'er $ne sch$$# year; Descri9e 57W the students "r$gress t$&ard meeting this g$a# &i## 9e measured Teacher &i## rec$rd sc$res +r$m her &ee6#y math +#uency "r$9es8 and chart the a'erage sc$re $nce a &ee6;

Descri9e W5EN "eri$dic re"$rts $n "r$gress &i## 9e "r$'ided t$ "arents Pr$gress m$nit$ring &i## 9e re"$rted e'ery t&$ &ee6s t$ the "arents;

4e"$rt $+ Pr$gress

2.2.2.A: Develop fluency in the use of basic facts for addition and subtraction.
When gi'en $9%ects &ith di++erent characteristics8 Jecarra &i## s$rt the $9%ects int$ the c$rrect categ$ry &ith , L accuracy in three tria#s $'er an IEP year; Teacher &i## $9ser'e Jecarra s$rting the $9%ects8 and c$unt h$& many &ere mis"#aced $nce a &ee6; Pr$gress m$nit$ring &i## 9e re"$rted t$ the "arents e'ery nine &ee6s;

2.6.2.E: Identify patterns and predict trends based on a comparison to data displayed in a graph 2.8.2.C: Recognize, describe, extend, create, and replicate a variety of patterns including attribute, activity, number, and geometric patterns

When gi'en an additi$n $r su9tracti$n &$rd "r$9#em8 Jecarra &i## "u## $ut the essentia# in+$rmati$n and &rite a num9er sentence t$ g$ &ith the "r$9#em &ith ,.L accuracy "u##ing $ut the essentia# in+$rmati$n and &riting a num9er sentence $'er an IEP year;

2.5.2.A: Develop a plan to analyze a problem, identify the information needed to solve the problem, carry out the plan, chec !hether an ans!er ma es sense, and explain ho! the problem !as solved in grade appropriate contexts.

Teacher &i## c$##ect Jecarras &$r6sheet at the end $+ $ne c#ass "eri$d and #$$6 at the &$rd "r$9#em; (7ne &$rd "r$9#em "er &$r6sheet in c#ass); The teacher &i## c$##ect Jecarras &$r6sheet $nce a &ee6;

Pr$gress m$nit$ring &i## 9e sent h$me dai#y &hen teacher c$rrects and sends h$me Jecarras h$me&$r6 and c#ass &$r6;

S/ORT TERM O+=ECTIVES 7 4e<uired +$r students &ith disa9i#ities &h$ ta6e a#ternate assessments a#igned t$ a#ternate achie'ement standards (P*S*); Sh$rt term $9%ecti'es / (enchmar6s When gi'en her math +#uency test8 Jecarra &i## ans&er G?1 math "r$9#ems c$rrect#y in 0 and a ha#+ minutes; When gi'en t&$ s$rting categ$ries8 Jecarra &i## se"arate the $9%ects int$ the c$rrect categ$ry &ith ) L accuracy; When gi'en a mathematics &$rd "r$9#em8 Jecarra &i## identi+y the ty"e $+ "r$9#em it is (su9tracti$n $r additi$n) and &hat num9ers &i## 9e used t$ s$#'e the "r$9#em &ith G L accuracy

VI. SPECIAL EDUCATION $ RELATED SERVICES $ SUPPLEMENTAR0 AIDS AND SERVICES $ PROGRAM MODI*ICATIONS 7 Inc#ude8 as a""r$"riate8 +$r n$nacademic and eDtracurricu#ar ser'ices and acti'ities; A. PROGRAM MODI*ICATIONS AND SPECIALL0 DESIGNED INSTRUCTION (SDI) SDI may 9e #isted &ith each g$a# $r as "art $+ the ta9#e 9e#$&; Inc#ude su""#ementary aids and ser'ices as a""r$"riate; >$r a student &h$ has a disa9i#ity and is gi+ted8 SDI a#s$ sh$u#d inc#ude ada"tati$ns8 acc$mm$dati$ns8 $r m$di+icati$ns t$ the genera# educati$n curricu#um8 as a""r$"riate +$r a student &ith a disa9i#ity; Modifications and S"I EDtra Time $n math and reading assignments Ne& seating arrangement (*#&ays a#$ne at a se"arate ta9#e in +r$nt $+ c#assr$$m); #ocation Math 3#assr$$m Math 3#assr$$m $re%uency E'ery day during math instructi$n E'ery day during math instructi$n Pro&ected 'eginning "ate 1 / )/1! 1 / )/1! (ntici)ated "uration ,/! /1,/! /1-

+. RELATED SERVICES 7 2ist the ser'ices that the student needs in $rder t$ 9ene+it +r$m his/her s"ecia# educati$n "r$gram; Ser*ice #ocation $re%uency Pro&ected 'eginning "ate (ntici)ated "uration

C. SUPPORTS *OR SC/OOL PERSONNEL 7 2ist the sta++ t$ recei'e the su""$rts and the su""$rts needed t$ im"#ement the students IEP; School Personnel to +ecei*e Su))ort 4es$urce 4$$m Teacher Su))ort Wee6#y a""$intment &ith math c$ach and math teacher #ocation 4$9ert >u#t$n $re%uency 7nce a &ee6 Pro&ected 'eginning "ate 1 / )/1! (ntici)ated "uration ,/! /1-

D. GI*TED SUPPORT SERVICES *OR A STUDENT IDENTI*IED AS GI*TED >/O ALSO IS IDENTI*IED AS A STUDENT >IT/ A DISA+ILIT0 7 Su""$rt ser'ices are re<uired t$ assist a gi+ted student t$ 9ene+it +r$m gi+ted educati$n (e;g;8 "sych$#$gica# ser'ices8 "arent c$unse#ing and educati$n8 c$unse#ing ser'ices8 trans"$rtati$n t$ and +r$m gi+ted "r$grams t$ c#assr$$ms in 9ui#dings $"erated 9y the sch$$# district);

Su))ort Ser*ice Su))ort Ser*ice Su))ort Ser*ice E. E?TENDED SC/OOL 0EAR (ES0) 7 The IEP tea% ha co! i&e"e& a!& &i c' e& ES0 e"vice ; a!& &ete"%i!e& that6 Student IS e#igi9#e +$r ES1 9ased $n the +$##$&ing in+$rmati$n $r data re'ie&ed 9y the IEP team:

74 *s $+ the date $+ this IEP8 student is N7T e#igi9#e +$r ES1 9ased $n the +$##$&ing in+$rmati$n $r data re'ie&ed 9y the IEP team:

The *nnua# /$a#s and8 &hen a""r$"riate8 Sh$rt Term 79%ecti'es +r$m this IEP that are t$ 9e addressed in the students ES1 Pr$gram are:

I+ the IEP team has determined ES1 is a""r$"riate8 c$m"#ete the +$##$&ing: ES, Ser*ice to be Pro*ided #ocation $re%uency Pro&ected 'eginning "ate (ntici)ated "uration

VII. EDUCATIONAL PLACEMENT A. @UESTIONS *OR IEP TEAM 7 The +$##$&ing <uesti$ns must 9e re'ie&ed and discussed 9y the IEP team "ri$r t$ "r$'iding the eD"#anati$ns regarding "artici"ati$n &ith students &ith$ut disa9i#ities; It is the res"$nsi9i#ity $+ each "u9#ic agency t$ ensure that8 t$ the maDimum eDtent a""r$"riate8 students &ith disa9i#ities8 inc#uding th$se in "u9#ic $r "ri'ate instituti$ns $r $ther care +aci#ities8 are educated &ith students &h$ are n$t disa9#ed; S"ecia# c#asses8 se"arate sch$$#ing $r $ther rem$'a# $+ students &ith disa9i#ities +r$m the genera# educati$na# en'ir$nment $ccurs $n#y &hen the nature $r se'erity $+ the disa9i#ity is such that educati$n in genera# educati$n c#asses8 EKEN WIT5 the use $+ su""#ementary aids and ser'ices8 cann$t 9e achie'ed satis+act$ri#y; What su""#ementary aids and ser'ices &ere c$nsideredM What su""#ementary aids and ser'ices &ere re%ectedM ED"#ain &hy the su""#ementary aids and ser'ices &i## $r &i## n$t ena9#e the student t$ ma6e "r$gress $n the g$a#s and $9%ecti'es (i+ a""#ica9#e) in this IEP in the genera# educati$n c#ass; The su""#ementary aids that &ere c$nsidered &ere eDtra time8 and a res$urce teacher that "u##s Jecarra $ut $+ c#ass $nce a &ee6 t$ he#" her &ith c$ncentrating and +inishing her &$r6; The student &i## 9e a9#e t$ ma6e "r$gress $n her g$a#s &ith these su""#ementary aids 9ecause it &i## assist her in c$m"#eting her &$r6 9y ha'ing eDtra time; *#s$8 the res$urce teacher &i## 9e a9#e t$ assist Jecarra in c$m"#eting her &$r6 as &e## as he#"ing her +$cus; They &i## &$r6 &ith her $ne $n $ne t$ reach these g$a#s8 and enc$urage her &hen the genera# educati$n teacher cann$t "r$'ide these ser'ices; The ser'ices that &ere re%ected &ere 9eing "#aced in s"ecia# educati$n 9ecause the student &$u#d 9e 'ery u"set &ith this8 and n$t +uncti$n that the #e'e# she has 9een seen t$ +uncti$n; She is ca"a9#e $+ d$ing the &$r68 %ust has di++icu#ty +$cusing; Jecarra %ust needs a #itt#e eDtra su""$rt t$ 9ring her grades and &$r6 #e'e# u"; What 9ene+its are "r$'ided in the genera# educati$n c#ass &ith su""#ementary aids and ser'ices 'ersus the 9ene+its "r$'ided in the s"ecia# educati$n c#assM Student &i## 9e a9#e t$ 9e &ith her n$ndisa9#ed "eers8 and c$m"#ete m$st $+ the &$r6 that she is a9#e t$ d$; *n$ther reas$n Jecarra &as re+erred &as 9ecause she is n$t m$ti'ated and cann$t "ay attenti$n; She en%$ys 9eing &ith her "eers8 and can d$ m$st $+ the &$r6; It may he#" t$ sh$rter her &$r6#$ad in c#ass &hen she is ha'ing m$re di++icu#ty; Jecarra is n$t that +ar 9ehind her regu#ar educati$n c#assmates that she cann$t 9e taught &ithin their en'ir$nment; What "$tentia##y 9ene+icia# e++ects and/$r harm+u# e++ects might 9e eD"ected $n the student &ith disa9i#ities $r the $ther students in the c#ass8 e'en &ith su""#ementary aids and ser'icesM The student may 9e em9arrassed t$ ha'e m$di+icati$ns and acc$mm$dati$ns during their c#ass time; *#s$8 the student may ha'e a hard time eD"#aining t$ her +riends &hy she is 9eing ta6en $ut $+ c#ass $nce a &ee6 t$ g$ &ith an$ther teacher; The eDtra time and "u## $ut $nce a &ee6 &i## he#" the student im"r$'e her &$r6 ethic8 and h$& she hand#es m$re rig$r$us &$r6; It &i## 9e 9ene+icia# 9ecause the student &i## ha'e eDtra enc$uragement and su""$rt t$ +inish the tas6 and c$m"#ete a## $+ her &$r6; T$ &hat eDtent8 i+ any8 &i## the student "artici"ate &ith n$ndisa9#ed "eers in eDtracurricu#ar acti'ities $r $ther n$nacademic acti'itiesM The student &i## "artici"ate &ith her n$ndisa9#ed "eers in a## eDtracurricu#ar acti'ities;

ED"#anati$n $+ the eDtent8 i+ any8 t$ &hich the student &i## n$t "artici"ate &ith students &ith$ut disa9i#ities in the regu#ar educati$n c#ass: The student &i## 'isit the res$urce r$$m +$r thirty minutes a &ee6 during math c#ass8 9ut &i## 9e &ith her regu#ar educati$n c#assmates the rest $+ the &ee6; ED"#anati$n $+ the eDtent8 i+ any8 t$ &hich the student &i## n$t "artici"ate &ith students &ith$ut disa9i#ities in the genera# educati$n curricu#um: The student &i## use the genera# educati$n curricu#um &ith her n$ndisa9#ed "eers;

+. T)#e of S'##o"t 9. A%o'!t of #ecial e&'catio! '##o"t E Itinerant: S"ecia# educati$n su""$rts and ser'ices "r$'ided 9y s"ecia# educati$n "ers$nne# +$r 0 L $r #ess $+ the sch$$# day Su""#ementa#: S"ecia# educati$n su""$rts and ser'ices "r$'ided 9y s"ecia# educati$n "ers$nne# +$r m$re than 0 L $+ the day 9ut #ess than ) L $+ the sch$$# day >u##?Time: S"ecia# educati$n su""$rts and ser'ices "r$'ided 9y s"ecia# educati$n "ers$nne# +$r ) L $r m$re $+ the sch$$# day <. T)#e of #ecial e&'catio! '##o"t *utistic Su""$rt (#ind?Kisua##y Im"aired Su""$rt Dea+ and 5ard $+ 5earing Su""$rt Em$ti$na# Su""$rt E 2earning Su""$rt 2i+e S6i##s Su""$rt Mu#ti"#e Disa9i#ities Su""$rt Physica# Su""$rt S"eech and 2anguage Su""$rt C. Locatio! of t'&e!tA #"og"a% Name $+ Sch$$# District &here the IEP &i## 9e im"#emented: Name $+ Sch$$# (ui#ding &here the IEP &i## 9e im"#emented: Pitts9urgh Pu9#ic Sch$$# District 4$9ert >u#t$n

Is this sch$$# the students neigh9$rh$$d sch$$# (i;e;8 the sch$$# the student &$u#d attend i+ he/she did n$t ha'e an IEP)M 1es E N$; I+ the ans&er is @n$8A se#ect the reas$n &hy n$t; S"ecia# educati$n su""$rts and ser'ices re<uired in the students IEP cann$t 9e "r$'ided in the neigh9$rh$$d sch$$# 7ther; P#ease eD"#ain: Jecarra attends a Magnet sch$$#;

VIII. PENNDATA REPORTING6 E&'catio!al E!vi"o!%e!t (Co%#lete eithe" Sectio! A o" +B Select o!l) o!e E&'catio!al E!vi"o!%e!t)
T$ ca#cu#ate the "ercentage $+ time inside the regu#ar c#assr$$m8 di'ide the num9er $+ h$urs the student s"ends inside the regu#ar c#assr$$m 9y the t$ta# num9er $+ h$urs in the sch$$# day (inc#uding #unch8 recess8 study "eri$ds); The resu#t is then mu#ti"#ied 9y 1 ;

SECTION A6 *o" St'&e!t E&'cate& i! Reg'la" School +'il&i!g -ith No!&i a,le& Pee" 7 I!&icate the #e"ce!tage of ti%e INSIDE the "eg'la" cla "oo% fo" thi

t'&e!t6

Time s"ent $utside the regu#ar c#assr$$m recei'ing ser'ices unre#ated t$ the students disa9i#ity (e;g;8 time recei'ing ES2 ser'ices) sh$u#d 9e c$nsidered time inside the regu#ar c#assr$$m; Educati$na# time s"ent in age?a""r$"riate c$mmunity?9ased settings that inc#ude indi'idua#s &ith and &ith$ut disa9i#ities8 such as c$##ege cam"uses $r '$cati$na# sites8 sh$u#d 9e c$unted as time s"ent inside the regu#ar c#assr$$m;

Calc'latio! fo" thi St'&e!t6 3$#umn 1 T$ta# h$urs the student s"ends in the regu#ar c#assr$$m "er day 3$#umn 0 T$ta# h$urs in a ty"ica# sch$$# day (inc#uding #unch8 recess N study "eri$ds) 3a#cu#ati$n (5$urs inside regu#ar c#assr$$m O h$urs in sch$$# day) D 1 P L (3$#umn 1 O 3$#umn 0) D 1 PL Indicate Percentage Secti$n *: The "ercentage $+ time student s"ends inside the regu#ar c#assr$$m: Percentage 3ateg$ry

Jsing the ca#cu#ati$n resu#t I se#ect the a""r$"riate "ercentage categ$ry

C.D

DDF
DD F of the &a)

E INSIDE the Reg'la" Cla "oo% EGF o" Mo"e of the Da) INSIDE the Reg'la" Cla "oo% CDH:GF of the Da) INSIDE the Reg'la" Cla "oo% Le Tha! :GF of the Da)

SECTION +6 Thi ectio! "e8'i"e& o!l) fo" St'&e!t E&'cate& OUTSIDE Reg'la" School +'il&i!g fo" %o"e tha! IGF of the &a) 7 elect a!& i!&icate the Na%e of School o" *acilit) o! the li!e co""e #o!&i!g -ith the a##"o#"iate electio!6 (I+ a student s"ends #ess than . L $+ the day in $ne $+ these #$cati$ns8 the IEP team must d$ the ca#cu#ati$n in Secti$n *)

*""r$'ed Pri'ate Sch$$# (N$n 4esidentia#) *""r$'ed Pri'ate Sch$$# (4esidentia#) 7ther Pri'ate >aci#ity (N$n 4esidentia#) 7ther Pri'ate >aci#ity (4esidentia#) 7ther Pu9#ic >aci#ity (4esidentia#)

7ther Pu9#ic >aci#ity (N$n 4esidentia#) 5$s"ita#/5$me9$und

1

3$rrecti$na# >aci#ity 7ut $+ State >aci#ity Instructi$n 3$nducted in the 5$me

E?AMPLES fo" Sectio! A6 5$& t$ 3a#cu#ate PennData I Educati$na# En'ir$nment Percentages 3$#umn 1 T$ta# h$urs the student s"ends in the regu#ar c#assr$$m I "er day 3$#umn 0 T$ta# h$urs in a ty"ica# sch$$# day (inc#uding #unch8 recess N study "eri$ds) 3a#cu#ati$n (5$urs inside regu#ar c#assr$$m O h$urs in sch$$# day) D 1 P L (3$#umn 1 O 3$#umn 0) D 1 P L Indicate Percentage Secti$n *: The "ercentage $+ time student s"ends inside the regu#ar c#assr$$m:

EDam"#e 1 EDam"#e 0 EDam"#e !

.;. ! 1

H;. . .

(.;. O H;.) D 1 (! O .) D 1 (1 O .) D 1

P ).L PH L P0 L

).L $+ the day (Inside ) L $r M$re $+ Day) H L $+ the day (Inside G,?- L $+ Day) 0 L $+ the day (Inside #ess than - L $+ Day)

>$r he#" in understanding this +$rm8 an ann$tated IEP is a'ai#a9#e $n the PaTT*N &e9site at &&&;"attan;net Ty"e @*nn$tated >$rmsA in the Search +eature $n the &e9site; I+ y$u d$ n$t ha'e access t$ the Internet8 y$u can re<uest the ann$tated +$rm 9y ca##ing PaTT*N at ) ?--1?!01.;