Individual Student General Supervision File Review Checklist
2017-2018 Revised 10-11-2017
Reviewed byDistrict / School
Date of Birth / Grade
Category of Eligibility / LEP / Yes / No
Current Eligibility Report Date / Current Annual IEP Date
Secondary Transition Student / Yes / No / Preschool Student / Yes / No
Please refer to the directions for additional guidance on each item.
Item
/ Yes /No
/NA
/Evaluation/Eligibility
/ Written Notice or Parental Consent for Initial Assessment was obtained prior to administrating assessments or evaluation on initial evaluation. (IDEA 300.9 and 300.300 AND 300.503).
Reviewer Comments 1:
2.
/ Documentation of consent for Reevaluation OR reasonable attempts is present for a 3-year re-evaluation. OR Documentation of written notice for a reevaluation consisting only of a review of existing new data (IDEA 300.9 and 300.503).Reviewer Comments 2:
3. / Eligibility was determined by a team (all required participants), including the parent. (Title I B 614 (d)(1)(b))
Reviewer Comments 3:
4. / A comprehensive evaluation was conducted and all areas of concern identified on the Consent for Assessment are reflected in the Eligibility Report. (300.503(b)(3))
Reviewer Comments 4:
5. / Eligibility Category
☐ Autism Spectrum Disorder / ☐ Hearing Impairment / ☐ Specific Learning Disability
☐ Deaf-Blindness / ☐ Intellectual Disability / ☐ Speech/Language Impairment: Language
☐ Deafness / ☐ Multiple Disabilities / ☐ Speech/Language Impairment: Speech
☐ Developmental Delay / ☐ Orthopedic Impairment / ☐ Traumatic Brain Injury
☐ Emotional Disturbance / ☐ Other Health Impairment / ☐ Visual Impairment including blindness
Evaluations and Assessment show that the student meets the State eligibility criteria for disability category identified (IDEA 300.304(c)(4), 300.306(c)(i)-(ii).
☐ Check box for SLD eligibility and complete SLD checklist
Reviewer Comments 5:
6. / Eligibility Report appropriately addresses adverse effect.
Reviewer Comments 6:
7. / Eligibility Report appropriately addresses need for specially designed instruction.
Reviewer Comments 7:
8. / Limited English Proficiency: A language proficiency score was obtained and appropriate assessments were selected based on the student’s level of proficiency.
Reviewer Comments 8:
Individualized Education Program
9. / IEP Team Members in attendance:
☐ Student (if and when appropriate)
(IDEA 300.321(a)(7) and (300.321(b)(1) / ☐ Parent or Guardian
(IDEA 300.321(b)(1) / ☐ School District Administrator or Designee
(IDEA 300.321.(a)(4)(i)-(iii) / ☐ General Education Teacher
(IDEA 300.321(a)(2) / ☐ Special Education Teacher
(IDEA 300.321(a)(3)
Reviewer Comments 9. Comments:
10. / IEP includes appropriate Present Levels of Academic Achievement and Functional Performance (PLAAFP) and Appropriate corresponding Goal(s). Please see criteria checklist below:
Present Level(s) of Academic Achievement and Functional Performance (PLAAFP) and Goal Aligned to that PLAAFP
Each skill area will have a corresponding goal(s). Checked boxes indicate criteria was met:
Skill Area / ☐ Strength and needs of the child (IDEA 3000.324(a)(i). / ☐ Disability affects involvement in general ed. (IDEA 300.320(a)(1)(i)
Annual Goal / ☐ Baseline (IDEA 300.324(a)(iii) / ☐ Condition e.g. When given, or During / ☐ Targeted Skill or behavior / ☐ Criteria or Level of Performance / ☐ Procedure 300.320(a)(3)(i) / ☐ Schedule – daily, weekly, monthly 300.320(a)(3)(i) / ☐ References an acceptable Idaho Standard
Skill Area / ☐ Strength and needs of the child (IDEA 3000.324(a)(i). / ☐ Disability affects involvement in general ed. (IDEA 300.320(a)(1)(i)
Annual Goal / ☐ Baseline (IDEA 300.324(a)(iii) / ☐ Condition e.g. When given, or During / ☐ Targeted Skill or behavior / ☐ Criteria or Level of Performance / ☐ Procedure 300.320(a)(3)(i) / ☐ Schedule – daily, weekly, monthly 300.320(a)(3)(i) / ☐ References an acceptable Idaho Standard
Skill Area / ☐ Strength and needs of the child (IDEA 3000.324(a)(i). / ☐ Disability affects involvement in general ed. (IDEA 300.320(a)(1)(i)
Annual Goal / ☐ Baseline (IDEA 300.324(a)(iii) / ☐ Condition e.g. When given, or During / ☐ Targeted Skill or behavior / ☐ Criteria or Level of Performance / ☐ Procedure 300.320(a)(3)(i) / ☐ Schedule – daily, weekly, monthly 300.320(a)(3)(i) / ☐ References an acceptable Idaho Standard
Reviewer Comments 10. Comments:
11. / IEP includes a statement about Written Progress Reports (IDEA 300.320(a)(3)(i)) .
Reviewer Comments 11:
12. / The IEP includes a description of the special education and related services being provided to the student including: Please see criteria checklist below:
Checked boxes indicate criteria was met:
Service 1 / ☐ Special Education and/or Related Service IDEA 3000.320(a)(4) / ☐ Title of Professional Staff Responsible IDEA 300.320(a)(4) / ☐ Frequency of service 300.320(a)(7) / ☐ Location
300.320(a)(7) / ☐ Start date
300.320(a)(7) / ☐ End date
300.320(a)(7)
Service 2 / ☐ Special Education and/or Related Service IDEA 3000.320(a)(4) / ☐ Title of Professional Staff Responsible IDEA 300.320(a)(4) / ☐ Frequency of service 300.320(a)(7) / ☐ Location
300.320(a)(7) / ☐ Start date
300.320(a)(7) / ☐ End date
300.320(a)(7)
Service 3 / ☐ Special Education and/or Related Service IDEA 3000.320(a)(4) / ☐ Title of Professional Staff Responsible IDEA 300.320(a)(4) / ☐ Frequency of service 300.320(a)(7) / ☐ Location
300.320(a)(7) / ☐ Start date
300.320(a)(7) / ☐ End date
300.320(a)(7)
Service 4 / ☐ Special Education and/or Related Service IDEA 3000.320(a)(4) / ☐ Title of Professional Staff Responsible IDEA 300.320(a)(4) / ☐ Frequency of service 300.320(a)(7) / ☐ Location
300.320(a)(7) / ☐ Start date
300.320(a)(7) / ☐ End date
300.320(a)(7)
Service 5 / ☐ Special Education and/or Related Service IDEA 3000.320(a)(4) / ☐ Title of Professional Staff Responsible IDEA 300.320(a)(4) / ☐ Frequency of service 300.320(a)(7) / ☐ Location
300.320(a)(7) / ☐ Start date
300.320(a)(7) / ☐ End date
300.320(a)(7)
Reviewer Comments 12:
13. / Services show a direct relationship to other components of the IEP.
Reviewer Comments 13:
14. / The IEP team has explained the extent, if any, to which a student will not participate in general education and has provided a rationale for that placement decision (IDEA 300.320(a)(5).
Reviewer Comments 14:
15. / The Least Restrictive Environmental Code is reflective of the time documented on the IEP service grid. 300.320(a)(5)
Reviewer Comments 15:
16. / When applicable, ESY is addressed as a consideration and services are identified in the IEP (IDEA 300.106).
Reviewer Comments 16:
17. / When behavior impedes student’s learning or the learning of others, it is addressed in the IEP. (Positive behavior supports incorporated within the IEP or Behavior Intervention Plan attached) 34 CFR 300.324(a)(2)(i) and 300.530(d)(1)(i)
Reviewer Comments 17:
18. / IEP lists accommodations/adaptations the student requires to be involved and make progress in the general education curriculum to the maximum extent possible. (IDEA 300.320(a)(4)(i)-(ii) & 300.320(a)(6)(i) .
Reviewer Comments 18:
19. / Participation is addressed for each individual statewide assessment. (IDEA 300.320(a)(6)(i)).
Reviewer Comments 19:
20. / Written Notice was provided and included an explanation for all required components related to the contents of the IEP. 34 CFR 300.503(b)(6) 34 CFR 300.503(b)(7) .
Reviewer Comments 20:
Additional Comments:
If you identified this student as a Secondary Transition Student, a Preschool Student, or a student with a Specific Learning Disability please fill out the relevant additional checklist.