A

Referrals: PLAP: SDI Services: Additional Services:

2/3/2017 (second ELA: ELA:

grade) -conventions of 400 minutes biweekly
English
Team notice student -context clues
had a hard time with -constructing Math:
remembering paragraphs 400 minutes biweekly
content, took several -comprehension
tries before it clicked, Executive
and processing Math: functioning:
speed 400 minutes biweekly
-solve multi-step
Was at a end of word problems
kindergarten -decimals
standard for math -fractions with unlike
denominators
Had psychological
testing for learning Executive
development, functioning:
academic testing, -on task behaviors
and classroom -prioritizing
observation* -self advocacy

*did not qualify for an

SLD in 2nd grade,
team moved forward
with a 504

Classroom Accom.: Testing Accom.: IEP Goals: Eval.:

- allowed to talk - multiplication chart Executive 9/24/2020 (fifth

through math - extended time functioning: grade)
problems - distraction reducing - will recognize
- multiplication chart - small group setting when they Does qualify under
- small group setting - text-to-speech or needs adult SLD
when possible using a human help on their
- preferential seating reader (NOT allowed academics Has a hard time
- frequent check-ins for reading and will retaining information,
- opportunities to passages) advocate for one day they
revise and resubmit their remember it, the next
work academic they don’t
- extra organization needs by
time independently Scored low average
- visuals, graphic asking an when WISC-V was
organizers adult for help completed
- break down at least 70%
multi-step directions of the time, 12/2020
- extra time for given 3 Typical verbal
processing consecutive comprehension index
- visual directions opportunities,
- repeat directions teacher Below average for
- visual schedule collected data visual spatial index:
- sentence starters and student visual discrimination,
- word work samples poor visual attention,
banks/equation math - will visuomotor,
banks independently integration deficits, or
- check lists create a plan low reasoning ability,
- extended time by 1 that outlines and geometric
to 2 class periods which designs of a model
- repetition assignments
- shortened on their list Strong fluid
assignments should be reasoning index
- give answers orally completed
with adult scribing first, second, *mental control and
- modified and so on visual scanning
assessments based on
assigned due Assessments given:
dates with at Developmental
least 70% Numeracy
accuracy, Assessment
over 3
consecutive Developmental
opportunities, reading assessment
teacher
collected data WRAML-2nd ed
and student
work samples CTOPP- 2nd ed
- will increase
their on-task KTEA-3
behaviors (ex.
using a *very inconsistent,
checklist, varies day by day
looking at
teacher during Latest IEP:
directions, 1/19/2022
actively
responding to Next re-eval:
the teacher, 1/12/2024
and complete
tasks/activity
independently
with minimal
adult/peer
assistance) to
complete and
turn in
assignments
 on time with
at least 70%
accuracy,
given 3
consecutive
opportunities,
teacher
collected data
and student
work samples

Math:
- will be able to
add and
subtract
fractions with
unlike
denominators
(including
mixed
numbers) by
replacing
given
fractions with
equivalent
fractions in
such a way as
to produce an
equivalent
sum or
difference of
fractions with
like
denominators
with at least
80%,
accuracy
given 3
consecutive
tasks, formal
and informal
assessments,
teacher
collected data
and student
work samples
(CCSS.MATH
.CONTENT.5.
NF.A.1)
- will multiply
and divide
decimals to
hundredths,
using
concrete
models or
drawings and
strategies
based on
place value,
properties of
operations,
and explain
the reasoning
used with at
least 85%
accuracy,
given 3
consecutive
opportunities,
informal and
formal
assessments,
teacher
collected
data, student
work samples
(CCSS 5.
NBT.7.)
- will solve
multi-step
word
problems
using the four
operations
with at least
80%
accuracy,
given 3
consecutive
opportunities,
informal and
formal
assessments,
teacher
collected
data, and
student work
samples
 (CCSS.MATH
.CONTENT.5.
NBT.B.7)

ELA:
- will
determinate
the meaning
of an
unknown
word using
context clues
with 80%
accuracy,
given 3
consecutive
opportunities,
teacher
collected
data, formal
and informal
assessments
and student
work samples
(CCSS.ELALI
TERACY.L.6.
4.A)
- will
independently
produce
coherent
writing with a
clear
introduction,
at least three
details, and a
clear
conclusion
with 70%
accuracy,
given 3
consecutive
opportunities,
teacher
collected
data, formal
and informal
assessments
and student
 work samples
(CCSS.ELA-L
ITERACY.W.6
.3.A)
- will
independently
demonstrate
the command
of the
conventions
of standard
English for
punctuation,
capitalization,
grammar and
mechanics
when using
written
language with
at least 70
accuracy, give
3 consecutive
opportunities,
teacher
collected
data, informal
and formal
assessments,
and student
writing
samples
(CCSS.ELA-L
ITERACY.L.5.
2)
- will
independently
answer
comprehensio
n questions
when reading
a text using
context clues
from the text
with at least
70%
accuracy,
given 3
consecutive
opportunities,
teacher
 collected
data, formal
and informal
assessments
and student
work samples
(CCSS.ELALI
TERACY.RL.6
.10)

Other Important Strengths: Needs: Interests:

things:

LRE: 69% ● Age ● Remembering ● Wrestling

appropriate concepts from ● Football
interactions one day to the ● Video games
● Fractions next ● Movies
● Gaining more ● Penmanship
leadership ● Blurting/interr
skills (from upting the
participating teacher
in sports)

Referrals: PLAP: SDI Services:

504 on 6/9/21 Executive functioning: Specially designed instruction

Has been receiving title 1 -Work Completion in executive functioning,
math support since kinder, -Prioritization bi-weekly for 400 minutes
some title 1 reading services -Self Advocacy - Work completion
(kinder) - Prioritization
Social Work: - Self-advocacy
IEP referral on 5/27/22 (6th) -Impulse control
and 9/12/22 (continuation -Accountability Social Work for 120 minutes
from last year) monthly
- Impulse control
- Accountability
Exceptionality: OHI (ADHD)

Classroom Testing Accommodations: Related services

Accommodations:
 ● preferential seating ● Speech to text Social work
● limit amount of work ● Text to speech
to be completed on ● Individual or small
assignments/assessm group instruction
ents/projects ● Extended time
● graphic ● Using administrator
organizers/visual verification of student
checklists for verification of student
assignments/assessm understanding
ents/projects following the reading
● help visually break of test directions
down long ● Turn off universal
assignments/projects directions
into small chunks
● checklists breaking
down work into small
chunks
● extended time to
completed
assignments given 1
to 2 classes
● given copies of
teachers' notes and
study guides
● small group for
assessments
● movement
breaks/area to stand
as much as possible
in the classroom
setting
● positive behavior
support plan that will
include CI-CO plan
● text to speech/speech
to text

IEP Goals Eval. Other important

information

Executive Function Goals: WJIV Cluster/Tests NWEA:

will recognize when they
needs adult help on their
academics and will advocate
for their academic needs by
independently asking an adult
for help at least 60% of the
time, given 3 consecutive
opportunities,
(Cognitive)
Math:
Low average: oral
vocabulary, verbal attention,
visualization, oral vocabulary, Reading:
general information, verbal
attention, cognitive
processing, comprehension
knowledge, cognitive Language Usage:
will use a checklist
independently 50% of the
time given 3 consecutive
opportunities to complete and
turn in assignments on time,
will independently create a
plan that outlines which
assignments on their missing
work and/or on time
assignment checklist should
be completed first, second,
and so on based on assigned
due dates with at least 60%
accuracy, over 3 consecutive
opportunities,
Social Work Goals:
will use learned "stop and
think" strategies to help them
better manage their
impulsivity 6 out of 10 times
with no more than two staff
prompts
will use strategies to
understand the perspectives
of their peers before acting,
on 6 out of 10 occasions with
no more than two staff
prompts,
processing speed, pair
cancellation, non-word
repetition Lexile range: 320-470L
Low: short term working
memory, auditory processing, 6th grade scores:
cognitive efficiency Fall 21/Spring 22:
Very low: general intellectual Reading: 169, 189, below
ability (GIA), phonological grade average (210/215)
processing
Math: 186, 191 (214/222)
At-risk: number series,
phonological processing, Moby max (subtraction,
numbers reverse, multiplication, division,
number-pattern matching decimals):
Fall- 2.6 Gr. Level
Processing speed, Spring- 2.9 gr. level
comprehension-knowledge,
short-term working
memory, and auditory S44: Lexile score 230,
processing benchmark 600
—------------------------------------
LRE: 90%
BASC-3
Significant scores in:
attention problems,
hyperactivity, and other
externalized problems
(aggression and conduct
problems), internalizing
problems, and externalizing
behavior
Self-report:
Significant: attitude to
teachers, attitude to school,
atypically, anxiety, attention
problems, hyperactivity,
inattention hyperactivity
At-risk: social stress,
relationship with parents,
interpersonal relationships,
self-esteem, self-resilience,
personal adjustment
Parent:
 Significant:, depression,
adaptability, social skills,
leadership, functional
communication, activities of
daily living, adaptive skills
At-risk: anxiety, internalizing
problems, atypically,
withdrawal, somatization

Teacher:

Significant: attention
problems, behavioral systems
index, school problems

At-risk: anxiety, depression,

learning problems, atypically,
withdrawal, adaptability,
social skills, leadership, study
skills, functional
communication, internalizing
problems, adaptive skills
—------------------------------------

WJIV- Achievement

Low average: broad reading,

academic applications

Low: broad mathematics,

academic skills

IEP Meetings Important things: ISS/OSS

Manifest determination on Absenteeism has been an 9/27/22

1/27/2023 issue since kindergarten 10/26/22
11/21/22
Behavioral day treatment Transferred from Jay 12/09/22*
referral on 4/27/2023 elementary to Cushing 12/20/22*
Elementary 1/25/23*
1/30/23*
Retained for kindergarten 2/01/23*
3/22/23*

*Under an IEP

Strengths: Needs: Student Interests

 ● Socializing with peers ● Completing academic ● Dirt bikes
● When focused, tasks on their own ● Drawing
student can complete consistently ● Music
work on time and ● Impulsivity ● Cars
productively ● Emotional regulation ● snowmobiles/four
● Active ● Appropriate peer wheelers
● Funny conversations ● Weight room

Referrals: PLAP: SDI Services: Additional Services:

Initial referral: English Language SDI in the area of

6/1/18 Arts skill deficits: ELA bi-weekly for
-Conventions of 200 minutes.
Was receiving tiered writing - Conventions
intervention support -Written expression of writing
in math in the second - Written
grade, but that was Math deficits: expression
not working -Measurement
-Fractions with unlike SDI in math bi-weekly
Re-eval: 11/8/21 denominators for 400 minutes.
-Division - Measurement
- Fractions
Exceptionality: SLD (unlike
Executive function: denominators)
-Prioritizing - Division
-Self advocacy
SDI in executive
functioning for 200
minutes bi-weekly
- Prioritizing
- Self-advocacy

Classroom Accom.: Testing Accom.: IEP Goals: Eval.:

● Preferential ● Frequent ELA: Last eval was in 6th

seating breaks - By November grade, was supposed
● Use ● Small group 2023, given to be in 5th grade w/
highlighter for ● Human reader specially reeval meeting
key details (not for designed
● Reduce reading instruction, Dates of eval:
distractions passages) will develop 9/28/21, 11/3/21
● Checklists for ● Read aloud and
multi step ● Text to strengthen Reeval meeting on
assignments speech/speec their writing 11/8/2021
● Sentence h to text skills as
starters needed by Next eval 11/8/24
● I do, you do, planning,
we do revising,
● Extended time editing,
● Shortened editing
assignments conversations
● Chunking of English,
assignments rewriting, or
● Check ins for trying a new
understanding approach with
● Notes and at least 80%
study guides accuracy
given 3
consecutive
opportunities.
- will be able to
introduce a
topic or text
clearly, state
an opinion,
and create an
organizational
paragraphs
structure in
which ideas
are logically
grouped to
support the
writer's
purpose with
80%
accuracy,
given three
consecutive
opportunities,
informal and
formal
assessments,
teacher
collected
data, student
work samples
(CCSS.ELA-L
ITERACY.W.5
.1.A)
Executive
functioning:
- will
independently
create a plan
that outlines
which
assignments
on their list
should be
completed
first, second,
and so on
based on
assigned due
dates with at
least 80%
accuracy,
over 3
consecutive
opportunities,
teacher
collected data
and student
work samples
- will recognize
when they
needs adult
help on their
academics
and will
advocate for
their
academic
needs by
independently
asking an
adult for help
at least 80%
of the time,
given 3
consecutive
opportunities,
teacher
collected data
and student
work samples

Math:
- will be able to
add and
subtract
fractions with
unlike
denominators
(including
mixed
numbers) by
replacing
given
fractions with
equivalent
fractions in
such a way as
to produce an
equivalent
sum or
difference of
fractions with
like
denominators.
Esamae will
show at least
80% accuracy
over 3
consecutive
tasks, teacher
observations,
student work
samples, and
formal and
informal
assessments
(CCSS.MATH
.CONTENT.5.
NF.A.1)
- will be able to
find
whole-number
quotients of
whole
numbers with
up to four-digit
dividends and
two-digit
divisors, using
strategies
based on
place value,
 the properties
of operations,
and/or the
relationship
between
multiplication
and division.
Illustrate and
explain the
calculation by
using
equations,
rectangular
arrays, and/or
area models.
will show at
least 80%
accuracy,
over 3
consecutive
opportunities,
teacher
observation,
student work
samples, and
formal and
informal
measurement
s
(CCSS.MATH
.CONTENT.5.
NBT.B.6)
- will be able to
know relative
sizes of
measurement
units within
one system of
units including
km, m, cm;
kg, g; lb, oz.;
l, ml; hr, min,
sec. Within a
single system
of
measurement,
express
measurement
s in a larger
unit in terms
 of a smaller
unit. Record
measurement
equivalents in
a two-column
table. will
show
accuracy of at
least 80%
over 3
consecutive
tasks, teacher
observation,
student work
samples,
teacher formal
and informal
assessments
(CCSS.MATH
.CONTENT.4.
MD.A.1)

Other Important Strengths: Needs: Interests:

things:

Attended EYS ● Advocating for ● Shyness (can ● Tik tok

Summer 2022 her needs impact their ● Loves their
● Academics in advocating brothers
LRE 79% math (math occasionally) ● Spending time
fact fluency, with their
add/sub, friends
multiply and ● Journaling
dividing) about their
● Doing day
homework
outside of
school

BD
Referrals: PLAP: SDI Services: Additional Services:

2nd grade -Inferencing and ● Consultation

5/16/2018 drawing conclusions of reading and
-Writing mechanics writing 30
Was receiving tiered (commas and minutes per
intervention but it was quotation usage) week
not working. -Word problems ● 90 minutes of
consultation
Exceptionality: SLD of
mathematics
per week
● 200 minutes
of SDI
executive
functioning bi
weekly

Classroom Accom.: Testing Accom.: IEP Goals: Eval.:

● Have ● Small group Executive Last evaluation

directions testing functioning: 7/26/2021*
read to them ● Text to - is
● Have students speech independently
repeat ● Read aloud asking for *Evaluation was in
directions to ● Extended time help in 0% of 2021, but reeval
check for opportunities. meeting was not held
understanding will accept until middle of 6th
● Allow extra help when grade, or 2022, with
time for work offered in the 2021 psych eval
completion 80% of
and work opportunities. Psych eval was
completion at - will recognize written on 8/20/2021
home when she
● Reduce needs help
number of and will
problems independently
● Access to a ask for help
number chart (verbally or
● Preferential through email)
seating to the in 8 out of 10
front of the opportunities
room
● Allow to Math:
process - will accurately
information in identify the
order to give a necessary
response steps and
● Word banks operations to
● Study guides solve a two
 completed by and three step
the student word problem
but checked in 7 out of 10
by teacher for opportunities
accuracy on three
consecutive
tasks

Other Important Strengths: Needs: Interests:

things:

LRE 85% ● Independently ● Advocating for ● Drawing

working on needs (other ● The walking
their own than asking dead, ginny
● Coming into directly) and georgia
class and ● Has a hard ● Music
completing time speaking
any missing out in a larger
work or group
assignments
that need to
get done
● Communicatin
g with adults
in a 1 to 1
setting about
their
questions or
needs
● Knowing what
assignments
need to be
completed

Referrals: PLAP: SDI Services: Additional Services:

Initial Referral: In Mathematics, has 400 minutes of SDI in

8/31/2017 the following skill math bi weekly
Second grade deficits:
-Multi-step word 400 minutes of
Exceptionality: SLD problems executive functioning
-Fractions with unlike SDI bi weekly
denominators
 -Measurement
-Integers

Executive functioning
skill deficits:
-Prioritizing
-Self Advocacy

Classroom Accom.: Testing Accom.: IEP Goals: Eval.:

● Break ● Text to Executive Initial Eval: 4/13/2017

instruction speech/ functioning:
into smaller speech to text - will Reeval: 2/13/2023
pieces ● Small group independently
● Checks for setting create a plan
understanding that outlines
of which
instructions, assignments
activities on their list
● Extended time should be
(1 to 2 class completed
periods) first, second,
● Provide and so on
reminders and based on
prompts assigned due
● Allow verbal dates with at
responses least 85%
● Frequent accuracy,
check ins over 3
● Preferential consecutive
seating opportunities,
teacher
collected data
and student
work samples
- will recognize
when they
needs adult
help on their
academics
and will
advocate for
their
academic
needs by
independently
asking an
adult for help
at least 85%
 of the time,
given 3
consecutive
opportunities,
teacher
collected data
and student
work samples

Mathematics:
- will solve
multi-step
word
problems
using the four
operations
independently
with 85%
accuracy,
given 3
consecutive
opportunities,
student work
samples and
teacher
observation,
formal and
informal
assessments
(CCSS.MATH
.CONTENT.4.
OA.A.3)
- will find and
position
integers and
other rational
numbers on a
horizontal or
vertical
number line
diagram
coordinate
plane with at
least 85%
accuracy, on
3 consecutive
opportunities,
student work
samples and
teacher
 observation,
formal and
informal
assessments
- will be able to
know relative
sizes of
measurement
units within
one system of
units including
km, m, cm;
kg, g; lb, oz.;
l, ml; hr, min,
sec. Within a
single system
of
measurement,
express
measurement
s in a larger
unit in terms
of a smaller
unit. Record
measurement
equivalents in
a two-column
table with at
least 80%,
over 3
consecutive
tasks, teacher
observation,
student work
samples,
formal and
informal
assessments
(CCSS.MATH
.CONTENT.4.
MD.A.1)
- will be able to
add and
subtract
fractions with
unlike
denominators
(including
mixed
numbers) by
 replacing
given
fractions with
equivalent
fractions in
such a way as
to produce an
equivalent
sum or
difference of
fractions with
like
denominators
with at least
80%
accuracy,
over 3
consecutive
opportunities,
teacher
observations,
student work
samples, and
formal and
informal
assessments
(CCSS.MATH
.CONTENT.5.
NF.A.1)

Other Important Strengths: Needs: Interests:

things:

LRE: 80% of the time ● Socially ● Emotional ● Spending time

appropriate regulation with friends
conversations (sometimes) and family
● Determines ● Occasional ● Tik tok or
● Focusing academic other forms of
● Independence support social media
● Advocating for ● Baking
needs ● Rice
● Italian chicken

Referrals: PLAP: SDI Services: Additional Services:

Referred in 1st grade, Math: 400 minutes biweekly
was not meeting the -Multi-step word in the area of SDI in
benchmark in math or problems mathematics
reading -Division
-Fractions with unlike 60 minutes biweekly
Exceptionality: SLD denominators in consultation on
-Measurement writing
-Integers

Executive
functioning:
-Prioritizing
-Self Advocacy

Classroom Accom.: Testing Accom.: IEP Goals: Eval.:

● Provide ● Small group Executive Last eval was on

repetition of setting functioning: 11/4/2021 in 6th
directions and ● Read aloud - will grade
information ● Text to independently
● Read word speech create a plan
math ● Calculator that outlines
problems ● Extended time which
● Prompts and ● Multiplication assignments
reread and table on their list
double check should be
work completed
● Distraction first, second,
reducing and so on
● Speech to text based on
/ text to assigned due
speech dates with at
● Graphic least 85%
organizers accuracy,
● Shortened over 3
assignments consecutive
● Extended time opportunities,
teacher
collected data
and student
work samples
- will recognize
when they
needs adult
help on their
academics
and will
advocate for
their
 academic
needs by
independently
asking an
adult for help
at least 85%
of the time,
given 3
consecutive
opportunities,
teacher
collected data
and student
work samples

Math:
- will be able to
add and
subtract
fractions with
unlike
denominators
(including
mixed
numbers) by
replacing
given
fractions with
equivalent
fractions in
such a way as
to produce an
equivalent
sum or
difference of
fractions with
like
denominators
with at least
80%
accuracy,
over 3
consecutive
opportunities,
teacher
observations,
student work
samples, and
formal and
informal
 assessments
(CCSS.MATH
.CONTENT.5.
NF.A.1)
- will be able to
find
whole-number
quotients of
whole
numbers with
up to four-digit
dividends and
two-digit
divisors, using
strategies
based on
place value,
the properties
of operations,
and/or the
relationship
between
multiplication
and division
with at least
85%
accuracy,
over 3
consecutive
opportunities,t
eacher
observation,
student work
samples, and
formal and
informal
measurement
s
(CCSS.MATH
.CONTENT.5.
NBT.B.6)
- will be able to
know relative
sizes of
measurement
units within
one system of
units including
km, m, cm;
kg, g; lb, oz.;
 l, ml; hr, min,
sec. Within a
single system
of
measurement,
express
measurement
s in a larger
unit in terms
of a smaller
unit. Record
measurement
equivalents in
a two-column
table with at
least 85%,
over 3
consecutive
tasks, teacher
observation,
student work
samples,
teacher formal
and informal
assessments
(CCSS.MATH
.CONTENT.4.
MD.A.1)
- will find and
position
integers and
other rational
numbers on a
horizontal or
vertical
number line
diagram
coordinate
plane with at
least 85%
accuracy, on
3 consecutive
opportunities,
formal and
informal
assessments,
teacher
collected
data, and
student work
 samples
(CCSS.MATH
.CONTENT.6.
NS.6.C)
- will solve
multi-step
word
problems
using the four
operations
independently
with 85%
accuracy,
given 3
consecutive
opportunities,
student work
samples and
teacher
observation
(CCSS.MATH
.CONTENT.4.
OA.A.3)

Other Important Strengths: Needs: Interests:

things:

LRE 89% of the time ● Social skills ● How to talk to ● Showing cows
● Mathematical peers (in a not ● Gardening
calculation mean way) ● Reading
● Organization ● Penmanship ● Loves all their
(always very (only when animals
organized) they are ● Wants to work
● Completing rushing) on a farm for
work on time their first job
● ● Wants to be a
vet in the
future

Referrals: PLAP: SDI Services: Additional Services:

Initial referral in Next re-eval 1/6/2025 400 minutes biweekly Receives social work
kindergarten in ELA instruction and behavioral health
3/8/2016, originally work outside of
identified under SLD ● does not use 400 minutes biweekly school, and OT
context, in math instruction
Wasn’t changed to previous
ED until 1/13/22 knowledge of 400 minutes in
unfamiliar executive functioning
Exceptionality: ED words or what biweekly
they know
about suffixes
and prefixes
to support
their
understanding
of unfamiliar
words. When
faced with an
unknown
word they will
often make
random
unrelated
guesses.
● is able to
answer text
specific
questions with
50-60%
accuracy as
measured on
text specific
questions and
40% accuracy
on implicitly
stated
questions.
● Reading
fluency is at a
lowered level,
so it is
impacting
their
comprehensio
n of texts,
where it is at
50-60%
accuracy and
40% on
implicitly
 stated
questions
from a text.
● Reading
multisyllabic
words with
40-50%
accuracy
using a 4th
grade level
text and
50-60%
accuracy on a
3rd grade
text.
● Needs
teacher
editing to
ensure her
written work is
on topic,
sequenced,
and
grammatically
correct
● Writing the
amounts of
money using
correct
symbols with
70%
accuracy.
They count
money using
dollars and
cents up to $5
with 50%
accuracy.
They require
an adult
prompting to
know when to
add or
subtract the
amounts of
numbers
given and to
place the
decimal point
appropriately.
● Reading 5
digit numbers
with 80%
accuracy, 6
digit numbers
with 50%
accuracy, 7
digit numbers
with 50%
accuracy. Not
fluent in
verbalizing
the meaning
of and her
understanding
of the place
value system.
● Can multiply
by 0, 1, 2, 5,
and 10 with
70-80%. She
can multiply a
three digit by
one digit with
50%
accuracy.
● Is telling time
to the half and
the quarter
with 70%
accuracy. Is
able to tell
time to the
minute with
60-70% with
accuracy.
● They are able
to use
self-regulation
techniques
when
frustrated in 5
out of 10
opportunities.
● They are
unfamiliar with
computer use
and require
adult
assistance to
 navigate 50%
of the time.
● Is unable to
plan or start
tasks
requiring
multiple steps
without adult
assistance

Classroom Accom.: Testing Accom.: IEP Goals: Eval.:

● Provide ● Small group ● Given Kindergarten 5/04

assistance or setting specially and 5/10/16
small group ● Speech to designed
instruction as text, text to instruction, Psych eval: 7/25/18
needed speech will be able to
● Frequent ● Scribe determine the
check ins ● Distraction meaning of 3rd grade 1/29,
● Allow extra reduction words and 2/4/19
weight time ● Extended time phrases as
for responses ● Breaks they are used Adaptive eval
● When student ● Read aloud in a text, 6/8/2020
is upset, distinguishing
acknowledge literal from Psych eval on
it, take care of nonliteral 8/18/21
it, and move language.
on ● will be able to 6th grade
● Allow extra refer to details
time to and examples
complete in text when
written explaining
assignments what the text
or a writing says explicitly
prompts and when
● Allow partner drawing
work inferences
whenever from the text 7
possible out of the 10
● Oral response opportunities
over written on 3
response consecutive
● Breaks as tasks.
needed ● Will be able to
● Graphic read with
organizers sufficient
● Visual accuracy and
supports as fluency to
needed support
● Speech to text comprehensio
● Chunking n. They will
assignments demonstrate
● Reduced an increased
assignment fluency of 20
length points over 3
● Word banks successive
● Short answer reading tasks
responses with a
● Preferential comprehensio
seating near n level of 90%
teacher accuracy on 3
● Verify out of 4
understanding opportunities.
of all verbal ● Apply grade
responses level phonics
● Wait time for and word
oral analysis in
responses decoding
● Provide notes skills. Show
and study accuracy on 8
guides out of 10
opportunities
over 3
consecutive
tasks.
● Demonstrate
the
commands of
writing of
standard
English
capitalization,
punctuation,
and spelling
when writing,
with 80%
accuracy on 3
consecutive
writing
samples.
● Introduce a
topic clearly
producing a 3
paragraph
writing piece
which
includes
descriptive
vocabulary,
details and
 shows a clear
beginning and
conclusion at
80% accuracy
on 3 out of 4
tasks.
● Recognize
that a multi
digit whole
number, a
digit in one
place
represents a
certain place
value, out of 8
of 10 on 3 out
of 4
consecutive
tasks.
● Multiply a
whole number
up to four
digits by a
one digit
number and
multiply a two
digit operation
using
strategies
based on
place value
and the
properties of
operations, in
out of 8 of 10
on 3 out of 4
consecutive
tasks.
● Will be able to
tell and write
time to the
nearest
minute and
measure time
intervals in
minutes,
solving word
problems
involving
addition and
 subtraction of
time with 80%
accuracy on 4
out of 5
consecutive
tasks.
● Use
previously
learned
regulation
techniques
when
frustrated out
of 7 of 10
opportunities
as measured
by teacher
collected
data.
● Increase
independent
computer use
to complete
tasks from
50% to 80%
on 3 out of 4
consecutive
opportunities.
● Utilize
previously
learned and
practiced
organizational
skills that
enable her to
independently
manage a
multi step task
within a
specified
amount of
time requiring
2 or fewer
prompts with
80% success
given 4 out of
5
opportunities.

Other Important Strengths: Needs: Interests:

things:

Student has a safety ● Advocating for ● Positive peer ● Dancing

plan their needs interactions ● Being flexible
● Completing ● Understandin ● Coloring
work on time g of social ● Puzzles
● Sweet, kind interactions ● Legos
hearted ● Ignoring peers ● Playing
● Hard working or not taking games on
● Finding work what they say tablet
when other to heart ● Just dance
work is (interpreting
completed what is aimed
(MAP/ S44) towards them
● Organization or not)

M
Referrals: PLAP: SDI Services: Additional Services:

Initial referral was in ● Inferencing 400 minutes bi SLP services 120

1/7/15 skills with weekly in minutes per month
65-70% mathematics
accuracy on
text specific 400 minutes biweekly
questions in ELA
using 4th
grade level 400 minutes biweekly
text. in executive
● Is able to functioning
introduce a
topic or text
clearly, state
an opinion
with the
organizational
structure to
summarize
the writer’s
purpose with
60-65%
accuracy
● Independently
 reads and
comprehends
with great
reading and
fluency using
informational
text at high
4th low 5th
grade level
showing his
ability to
answer
comprehensio
n questions
with 65-70%
accuracy
● Independently
use correct
conventions
of English
using
grammar,
spelling,
punctuation,
and
capitalization
in his written
work with
55-60% of
written tasks
● Independently
produces a
paragraph to
a specific
topic,
grammatically
correct, and
shows the use
of grade
appropriate
vocabulary
and syntax
when
constructing a
paragraph
55-60% of the
time
● Is able to
independently
recognize cm,
 mm, inches,
feet, and
yards with
80% success.
Can convert
from inches to
yards with
70% success
● Recognizes
fractional
parts and can
add and
subtract
fractions with
like
denominators
with 70-75%
accuracy
● Is dividing
single digit
divisors and
single digit
with double
digit dividends
with 65-70%
accuracy
● Compound
sentences
including
compound
words and
descriptive
terms with an
average 71%
accuracy
● Able to
identify and
use context
clues to
determine the
meaning of
vocabulary
and language
concepts with
an average of
72% accuracy
● Identifies the
order in which
assignments
need to be
 completed
based on
assignment
due date with
50-55%
accuracy
● Recognizes
when he
needs help
and
advocates for
his needs by
asking for
help 60% of
the time
● Independently
accessing the
laptop
65-70% of the
time when
finding
organizing his
academic
tasks through
powerschool,
google
classroom,
and gmail.

Classroom Accom.: Testing Accom.: IEP Goals: Eval.:

● Preferential ● Extended time ● Will be able to Kindergarten

seating near (days beyond refer to details
the front of the MEA test and examples Psych eval 3/8/2016
the class administration of text when
● Verify window explaining 2nd grade
understanding ● Multiple or what the text
of all verbal frequent says explicitly 6th grade- psych eval
directions breaks and when
● Provide ● Small group drawing
repetitio/repea ● Using a inferences
t directions human reader from the text
and (NOT allowed with at least
information in the reading 80% accuracy
frequently passages) on 3
● Wait time for ● Using consecutive
oral administrator tasks
responses verification of ● Will be able to
● Preview new student introduce a
vocabulary understanding text clearly,
● Multi step following the state an
tasks reading of test opinion, and
presented one directions create an
step at a time ● Text to organizational
visual speech/speec structure in
presentation h to text which ideas
of concepts to ● Scribe are logically
be used as a ● Read aloud grouped to
memory aid support the
● Content area writer's
material read purpose with
aloud as 80% accuracy
needed with three
● shortened/mo opportunities
dified lengths ● Read and
of comprehend
assignments informational
● Encourage texts,
students to including
ask for help history/social
when unsure studies,
● Provide science, and
graphic technical
organizers texts, at the
● Provide notes, high end
and/or study grade 4 to 5
guides for all text
in class complexity
assessments band
independently
and
proficiently
with 80%
accuracy in 3
consecutive
attempts
● Demonstrate
the command
of the
conventions
of standard
English
capitalization,
punctuation,
and spelling
when writing
by using
correct
capitalization,
commas, and
 quotation
marks to mark
direct speech
and
quotations
from a text
with 80%
accuracy on
three
consecutive
tasks.
● Independently
introduce a
topic clearly,
group related
information
into
paragraphs
and sections;
including
formatting,
illustrations,
and
multimedia
when useful
to aiding
comprehensio
n with 80%
accuracy on
three
consecutive
tasks.
● Know relative
sizes of
measurement
tools within
one system of
units including
kn, m, cm,
mm, kg, g, lb,
oz, l, ml, hr,
min, sec.
Within a
single system
of
measurement,
express
measurement
s in larger unit
terms of a
 smaller unit .
record
measurement
systems in a
two column
table with
80% accuracy
on three
consecutive
tasks.
● Will be able to
add and
subtract
fractions with
unlike
denominators
including
mixed
numbers, by
replacing
given
numbers with
equivalent
fractions to
produce an
equivalent
sum or
difference of
fractions with
like
denominators
with 80%
accuracy on
three
consecutive
tasks.
● Find whole
number
quotients and
remainders
with up to four
digits
dividends and
one digit
divisors, using
strategies
based on
place value,
the properties
of operations,
 and or the
relationship
between
multiplication
and division
with 80%
accuracy on
three
consecutive
tasks.
● Generate
complex
grammatical
sentences
using
conjunctions
with 80%
accuracy on
three
consecutive
tasks.
● Will produce
compound
sentences
using
conjunctions
with 80%
accuracy on
three
consecutive
tasks.
● Will produce
compound
sentences
using
prepositions
with 80%
accuracy on
three
consecutive
tasks
● Use
comprehensio
n strategies to
understand
the meaning
of language in
age
appropriate
material in 8
 out of 10
opportunities
● Identify
contextual
clues and
prior
knowledge
that he can
use to
determine the
meaning of
novel
vocabulary
term language
concepts 8
out of 10
opportunities
● identify
contextual
clues and
prior
knowledge to
make a
reasonable
guess of the
vocabulary
word or
language
concepts 8
out of 10
opportunities
● Use a planner
to identify the
order in which
assignments
need to be
completed
based on
assignment
due date with
80% accuracy
given 8 out of
10
opportunities
● Will identify
what he
needs help
with 8 out of
10
opportunities
 ● Will increase
his
independent
work on the
computer to
complete
tasks 8 out of
10
opportunities

Other Important Strengths: Needs: Interests:

things:

LRE: 68% ● Communicatin ● Organization ● Dirt biking,

g needs (most ● Self initiation snowmobiling,
of the time) ● Prioritizing four wheeling
● Working ● Video games-
independently call of duty,
, when fortnite,
separated ● Loves coffee
from peers ● Farmington
Fridays

G
Referrals: PLAP: SDI Services: Additional Services:

Initial eval: 9/17/2015 Math: SDI in math for 200 OT

- Place value, minutes per week
subtraction, PT
Reeval: 3rd for basic SDI executive
12/11/18 multiplication, functioning for 75
basic division, minutes per week
Next eval 3/1/2025 adding and
subtracting OT services for 60
decimals, minutes per month
adding and
subtracting
fractions with
common
denominators

Executive
functioning:
- Task initiation,
task
prioritization,
 and
self-advocacy

OT:
- Strength and
grip in her
right hand and
her left
- Fatigue

Classroom Accom.: Testing Accom.: IEP Goals: Eval.:

● Nursing ● Frequent ● Independently First eval in kinder,

services breaks round for academic,
● Adult support ● Distraction numbers to intellectual, and
for reduction the nearest observation
safety/medical ● External tens,
● Adult calculator hundreds, and Eval: 1st for
proximity in ● Small group thousands, speech/language,
academic setting with 50% observation (speech
classes to ● Scribe accuracy as therapy in 2016-2018
implement an ● Speech to measured by
independence text/text to 4 out of 5 Eval: 3rd grade, OT
plan in the speech trials
instances ● Read aloud ● Compute
listed decimal
● Modify the numbers to
activity in the
physical hundredths
education so using the
Grace can standard
access the algorithm for
activity all addition
● Provide and
specific praise subtraction
● Non-verbal with 70%
and verbal accuracy
cues to focus ● Interpret
● Provide whole number
immediate quotients of
feedback whole
when possible numbers, and
● One-step partitioned
directions evenly with
● Graphic 60% accuracy
organizers ● Independently
● Visual compute
schedules multiplication
● Preview facts 0-12,
vocabulary with 80%
● Shortened accuracy
assignments ● Independently
● Extended time add and
● Small group subtract
setting when fractions with
possible like
● Assessments denominators
given in small with 80%
group setting accuracy
● Assist with ● Independently
prewriting subtract
process multi-digit
● Have grace whole
repeat the numbers with
directions and without
● Extended regrouping
thinking time with 80%
● Provide accuracy
repetition/repe ● Participate in
at directions literacy
activities:
writing, typing,
and speech to
text, by
working
independently
on a written
assignment
without hand
fatigue for 5
minutes on 4
out of 5
opportunities
● Given 5 trials,
grace will get
an
assignment
and identify
the first step
of the task
and work
independently
for five
minutes
before asking
for help on 4
out of 5
opportunities
● Given a list of
missing
 assignments
and SDI grace
will be looking
at tasks and
prioritize the
tasks with the
most
important first
(by looking at
the due date
or by looking
at the
assignment
which is worth
more) on 8
out of 10
opportunities.
● Given five
consecutive
trials, grace
will
independently
ask for help
by identifying
what she
needs help
with and
relaying this
information to
her teacher of
9 out of 10
opportunities.

Other Important Strengths: Needs: Interests:

things:

Has a health plan ● Kind ● Retrieving ● Animals

● Talk and academic ● Hunting
Spina bifida remembers information ● Fishing
everything ● Macrame
LRE 85% about an ● Nails
individual ● Fashion
● Utilizing visual ● Sabrina the
reminders teenage witch
W
Referrals: PLAP: SDI Services: Additional Services:

Initial referral in 4th In English Language ELA:

grade Arts: 400 minutes biweekly
-editing written work
12/18/19 -self-correct word Math:
recognition 400 minutes biweekly
-introduce topic or
Exceptionality: OHI text clearly Executive
-produce 3 paragraph functioning:
writing piece 400 minutes biweekly
-drawing inferences

In Mathematics:
-integers
-multiply and divide
decimals
-add and subtract
fractions with unlike
denominators
-measurement
-solve multi-step
word problems

Executive functioning
skill deficits:
-Organization/Prioritiz
ing
-Self Advocacy

Classroom Accom.: Testing Accom.: IEP Goals: Eval.:

- Preferential seating - Extended time Executive Next eval. 1/5/2023

at front of classroom - Multiple and functioning:
- Frequent check-ins frequent breaks
for understanding - Test administered in - By November
- Verbal directions a small group setting 2023, given
specially
supported by visual - Test and test
designed
presentation of directions read aloud instruction , will
concepts as (not for reading tests) independently
reminders - Administrator create a
- Directions given one verification of plan that
outlines which
step at a time directions assignments are
- Repeat, rephrase - Text to speech priority on their
directions to ensure list should be
understanding
- Encourage students
to ask clarifying
questions
- Graphic organizers
for writing tasks
- Shortened or
modified written
assignments
- Instruction in
general education
setting in a small
group to the extent
possible - By November
- Provide notes,
and/or study guides
for all in class
assessments
completed first,
second, and
third based on
assigned due
dates with 80%
accuracy, given 3
consecutive
opportunities, as
measured by
student work
samples, teacher
collected data,
grades on
progress reports
& report cards.
2023, given
specially
designed
instruction , will
identify when a
task is difficult
and initiate a
request for help
on difficult tasks
with at least 80%
accuracy using in
8 out of 10
opportunities, as
measured by
student work
samples, teacher
collected data,
grades on
progress reports
& report cards.

ELA:
- will develop and
strengthen
writing as
needed by
planning,
revising, editing,
rewriting, or
trying a new
approach with at
least 80%
accuracy, on 3
consecutive
opportunities,
student work
samples, teacher
collected data,
and
informal/formal
 assessments
(CCSS.ELA-LITE
RACY.W.5.5)
- will be able to
use context to
confirm or
self-correct word
recognition and
understanding,
rereading as
necessary. will
show an
accuracy level of
80% on 3
consecutive
tasks,informal
and formal
assessments,
teacher collected
data, student
work samples
(CCSS.ELA-LITE
RACY.RF.5.4.C)
- will be able to
introduce a topic
or text clearly,
state an opinion,
and create an
organizational
structure in which
ideas are
logically grouped
to support the
writer's purpose
with 80%
accuracy, given
three
consecutive
opportunities,
informal and
formal
assessments,
teacher collected
data, student
work samples
(CCSS.ELA-LITE
RACY.W.5.1.A)
- will be able to
introduce a topic
clearly producing
a 3 paragraph
writing piece
which includes,
descriptive
vocabulary,
details and
shows a clear
beginning and
conclusion
showing an
accuracy level of
 80% given 3
consecutive
opportunities,info
rmal and formal
assessments,
teacher collected
data, and student
work samples
(CCSS.ELA-LITE
RACY.W.4.2.A)
- will be able to
quote accurately
from a text when
explaining what
the text says
explicitly and
when drawing
inferences from
the text. will
show an
accuracy level of
80% on 3
consecutive
tasks, teacher
collected data,
student work
samples,
informal and
formal
assessments
(CCSS.ELA-LITE
RACY.RL.5.1)

Math:
- will find and
position integers
and other rational
numbers on a
horizontal or
vertical number
line diagram
coordinate plane
with at least 80%
accuracy, on
three
consecutive
opportunities,
formal and
informal
assessments,
teacher collected
data, and student
work samples
(CCSS.MATH.C
ONTENT.6.NS.6.
C)
- will multiply and
 divide decimals
to hundredths,
using concrete
models or
drawings and
strategies based
on place value,
properties of
operations, and
explain the
reasoning used
with at least 80%
accuracy, given 3
consecutive
opportunities,
informal and
formal
assessments,
teacher collected
data, student
work samples
(CCSS 5.
NBT.7.)
- will be able to
add and subtract
fractions with
unlike
denominators
(including mixed
numbers) by
replacing given
fractions with
equivalent
fractions in such
a way as to
produce an
equivalent sum
or difference of
fractions with like
denominators
with at least 80%
accuracy given 3
consecutive
tasks, formal and
informal
assessments,
teacher collected
data and student
work samples
(CCSS.MATH.C
ONTENT.5.NF.A.
1)
- will be able to
know relative
sizes of
measurement
units within one
system of units
including km, m,
cm; kg, g; lb, oz.;
l, ml; hr, min, sec.
 Within a single
system of
measurement,
express
measurements in
a larger unit in
terms of a
smaller unit. will
show an
accuracy level of
at least 80%, on
three
consecutive
tasks, formal and
informal
assessments,
teacher collected
data, and student
work samples
(CCSS.MATH.C
ONTENT.4.MD.A
.1)
- will solve
multi-step word
problems using
the four
operations with
at least 85%
accuracy given 3
consecutive
opportunities,info
rmal and formal
assessments,
teacher collected
data, and student
work
samples(CCSS.
MATH.CONTEN
T.5.NBT.B.7)

Other Important Strengths: Needs: Interests:

things:

LRE 69%* ● Multiplication ● Peer ● Video games

facts appropriate ● Movies
● Quick wit conversations ● Music
*since has changed ● Staying on top ● Understandin ● Spending time
they are now in the of g when with family
inclusion ELA class assignments something is ● Their pets
a joke, and (especially
when it is not their dog)