Request for Paraeducator Services Form

Request for Paraeducator Services

Assistance Justification Form

Iowa CityCommunitySchool District

When applying for paraeducator services, complete the Assistance Justification Form and the Schedule and Modification Form. Both forms and a copy of the IEP are to be sent to Jane Fry. Include the health plan and behavior plan, if applicable.

Student:Date Completed:

Date of Birth:IEP Date:

Grade:

To be completed by the IEP team to help determine if there is a need for additional assistance based upon student need.

1. List those team members who have observed the student and the location of the observations. (The administrator and special education teacher must observe the child).

2.Is there a safety concern for the students or others? Yes No

If yes, describe specific concern.

3.Does a behavior plan exist? Yes No

If so, please attach.

4.Does the student require assistance with basic functional skills?

• Toileting Yes No
• Mobility Yes No
• Feeding Yes No
• Dressing Yes No
• Following Safety Rules Yes No
• Communication Yes No

5.Does a health plan exist? Yes No

If so, please attach.

6.Does the student exhibit behaviors or lack appropriate behaviors that prevent the child from learning independently? Yes No

If yes, describe the concern and the plan to teach necessary skill.

7.Does the student exhibit behaviors or lack appropriate behaviors that would prevent other children from learning? Yes No

If yes, describe the concern and the plan to teach the necessary skill.

8.Do the student’s peers include him/her in classroom activities? Yes No

9.Is the student receptive to peer tutoring and support? Yes No

If yes, please explain why peers are unable to meet the needs of this student. If no, what plan is in place to help to increase the student’s receptiveness?

10.Is the student currently receiving small group or individualized instruction in specific academic areas? Yes No

If yes, describe the student’s academic level and the specialized instruction including accommodations and curriculum modifications.

11.In the chart below, record the results of other interventions that have been tried before considering the use of adult assistance to meet this student’s needs.

Intervention or program change that was tried

• Behavior management plan Yes No
• Grouping Yes No
• Preferential seating Yes No
• Adjusted assignments/expectations Yes No
• Accommodations for learning style Yes No
• Accommodations for sensory sensitivities Yes No
• Use of visuals Yes No
• Adapted materials Yes No
• Adaptive technology Yes No
• Other: Yes No
• Other: Yes No
• Other: Yes No

Describe the results of the interventions that have been tried:

12.Did the previous IEP include the use of a paraprofessional or include an Assistance Justification Sheet? Yes No

If yes, describe how the student has decreased his/her dependence upon adult assistance.

13.At this rate of growth, when would the team anticipate that the additional adult assistance will no longer be needed?

14.Are there any other facts, not already addressed, that would be helpful in making the decision to use adult assistance to meet this student’s need?

Principal’s SignatureDate

Schedule and Modification Form

Student IEP Meeting Date:

Special Education Teacher:

General Education Teacher:

Minutes paraeducator works directly with student: (add time in last column)

(Highlight areas that are in the IEP to increase independence. Include planning time with the paraeducator.

Copies: AEALEAParentTeacherDCSD Director of Special Education

ROLE OF EDUCATIONAL ASSISTANT

Educational assistants are important members of the instructional teams in the schools. The quality of special education instructional programs is enhanced by the many contributions of education assistants. The role varies considerably according to the special education instructional model and type of disability served. Educational assistants come under the Iowa Department of Education’s definition of educational assistants as licensed educational assistants. [281-41.10(256B)]

1.Educational aides are employed persons who, in the presence or absence of professional instructional staff members but under the direction, supervision, and control of the instructional professional staff, perform the following tasks:

• Supervise students on a monitorial or service basis; and

• Work with students in a supportive role under conditions determined by the instructional professional staff responsible for the students, but are not substitutes for or replacements of a teacher as established in 3.4(4), 670 Iowa Administrative Code 3.4(5).

2.Educational assistants should assume the following responsibilities from the Iowa Administrative Code 41.10(1):

• Complete appropriate pre-service and ongoing staff development specific to the functions to be performed. The agency shall make provisions for or require such completion prior to the beginning of service wherever practicable and within a reasonable time of the beginning of service where the pre-entry completion is not practical.
• Work under the supervision of professional personnel who are appropriately authorized to provide direct services in the same area where the educational assistants provides assistive services.
• Not serve as a substitute for appropriately authorized professional personnel.

3.The Department of Education recommends that if educational assistants work with students when the certificated teacher is not present, the following guidelines should be applied:

• A bi-weekly informal review of the educational assistants work is conducted by the responsible certificated teacher;
• The IEP states that the assigned educational assistants can work with students in a supportive role;
• Daily feedback, written or verbal, regarding student progress is provided by the educational assistants to the responsible certificated teacher;
• Guidelines regarding the special education procedures to be used with the students are written by the responsible certificated teacher; and
• Training is provided to the educational assistants by the responsible certificated teacher or agency.

4.The Department of Education further recommends that the educational assistant’s role may involve the following situations:

• Educational assistant may provide periodic student supervision in situations where individualized or small group instruction is being provided in more than one setting (for example, in two community settings or two classroom settings). In these situations, the responsible certificated teacher need not be present. In all cases, however, the educational assistant must follow the instructions of the responsible certificated teacher.
• When the responsible certificated teacher is off-campus, a designated on-campus professional must be identified as the on-campus supervisor. This supervisor may be a special education teacher, general education teacher, principal, or other certificated staff member whom the educational assistant is to contact with concerns or questions. In situations where the educational assistant is off-campus, the responsible certificated teacher or designated on-campus professional must be available by phone, and written instructions must be clear as to what the educational assistant is authorized to do, what the emergency procedures are, under what circumstances the responsible certificated teacher or designated on-campus professional is to be contacted, and when the educational assistant and students must return to school.

The roles of special education assistants in the District should subscribe to the definition and recommendations referenced above from the Iowa Department of Education.