District: / Ponderosa School District / School: / Jackson Elementary School / Phone: (208) 888-2222
Parent/Guardian Name: Angela andJuanOrtizPrimary Phone Number: (208)666-3333
Mailing Address: 1234WhitepineRdSecondary PhoneNumber:
NativeLanguage:EnglishEmail Address:
Parent/GuardianName:Primary PhoneNumber:
MailingAddress:Secondary PhoneNumber:
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REVIEWOFREFERRAL34 CFR300.111(a)(1)(i)
Describe the reason for referral:
Ben has not made adequate grade-level progress in his basic reading skills. He has participated in evidence-based reading interventions in addition to core reading instruction since September but continues to fall behind his same-grade peers despite this additional help.
Who brought the concern forward?
Ben's third grade teacher, Julie Smith
How is the concern impacting the student's education?
Ben's low reading skills have impacted his ability to participate in completion of activities in all academic areas that require reading to access the content. He is not able to independently complete activities that require reading at home and school. He is not making the Performance Benchmark on district and state-wide assessments.
What are theparent/guardian'sconcerns?34 CFR300.501(b)(1)
Ben's mom and dad report that he shows very little interest in books at home. He used to love to look at books and listen to stories read to him. They noticed a change in first grade when his reading struggles first became observable. Throughout the last 2 years he has grown increasingly disconnected from books at home.
Describe appropriate instruction in reading and math, and the student's response (or attach Intervention Plan and graph or visualrepresentation): 34 CFR300.306(b)(1)(i)-(ii)
Ben receives reading instruction with his same-grade peers each day for 60 minutes with Treasures by McMillian Mcgraw curricular
materials. On his last three reading fluency probes he read 68, 67, and 65 CWPM.
Ben receives math instruction with his same-grade peers each day for 60 minutes based on third grade-level Idaho Content Standards. On his last three math assessments he scored 85%, 83%, and 90%.
Describe scientific research-based intervention implemented and results (attach Intervention Plan and graph or visual representation): 34 CFR300.309(a)(2)(i)
Ben has worked within the Waterford Reading Program (Level 2) which covers: Letter-sound introduction, letter-sound instruction,
power-word instruction, power-word spelling, automatic word recognition, word reading strategies, comprehension and vocabulary assessments, read-along books, and traditional texts. Ben uses this intervention tool 30 minutes daily. He has been working within this program since September 2016.
In December 2016, Ben's Problem-Solving Team added an intervention to his daily schedule. In addition to 30 minutes daily on Waterford, Ben also attended intervention from the Reading Specialist using the Read Well Reading Program. This program covers phonemic awareness, phonics, vocabulary, fluency, and comprehension strategies. The instructional focus moves from internalizing phonics sequences to applying and generalizing that knowledge toward becoming a reader.
DOES THE LEARNER HAVE LIMITED PROFICIENCYINENGLISH? YesNo
34 CFR 300.306(b)(1)(iii)
Native Lang: / English / Ethnicity: / HispanicBirthdate:12/13/08 / Age: 8District: / Ponderosa School District / School: / Jackson Elementary School / Phone: (208) 888-2222
DATAREVIEWED(Check all that apply and attach documentation,ifapplicable)34 CFR300.304
Informationfromparent/guardiansObservationsMedical/outside providerrecords
ProgressmonitoringFine/GrossmotorAssistive technologydata
AchievementdataSocial/emotional/behavioraldataDisciplinerecords Psychologicalevaluation(s) Adaptivebehavior BehaviorinterventionplanSpeech-languagedata Classroom progress, grade reports, &worksamples Hearing/Visionscreeningdata Instructional methodology, interventions &curriculumprovidedAttendancerecords Otherdata:
REVIEW OF AGEAPPROPRIATESKILLS34 CFR300.304(c)(4)
Review each of the following areas and determine if the student is performing at age expectations:
Areas / Student demonstrates age-appropriate skills / Need More Information / Current Level of PerformanceIntellectual/Cognitive Functioning / Yes / No / Yes / No / Ben's ability to read grade-level text is significantly lower than that of his peers. He requires one on one support to complete tasks that require reading.
Academic Performance
(including grades) / Yes / No / Yes / No / Ben's basic reading skills are below grade- level.
Communication
(Speech/Language) / Yes / No / Yes / No
Motor Development
(Fine/Gross) / Yes / No / Yes / No
Hearing/Vision / Yes / No / Yes / No
Developmental/Medical History / Yes / No / Yes / No / More information is needed to understand Ben's development/medical history
Results from Statewide or Districtwide Assessments / Yes / No / Yes / No
Emotional/Social/Behavioral/ Development / Yes / No / Yes / No
Transition/Vocational/ Occupational / Yes / No / Yes / No
Adaptive Skills / Yes / No / Yes / No
OTHERCONSIDERATIONS34 CFR300.504(a)(1)
The Procedural Safeguards Notice has been sent to the parent/adult student: 1/19/17
Native Lang: / English / Ethnicity: / HispanicBirthdate:12/13/08 / Age: 8District: / Ponderosa School District / School: / Jackson Elementary School / Phone: (208) 888-2222
PROBLEM SOLVING TEAM INFORMATION
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