STUDENT NAME: John Doeform SE #815

STUDENT NAME: John DoeForm SE #815

Revised 7/20/00

FUSD NO. ONE
3285 E. Sparrow.Ave.
Flagstaff, AZ 86004
(520) 527-6182
FAX (520) 527-6181 / FLAGSTAFF UNIFIED SCHOOL DISTRICT NO. ONE
SPECIAL EDUCATION CONFERENCE REPORT / Form SE #815
Revised 7/20/00
Page 1 of 6

STUDENT DATA

Date: 4/3/01

Census: 9530

PURPOSE OF CONFERENCE

/ {x} Individual Education Plan
Student Name: John Doe / {} Determine eligibility for special education / From: 01/01/01 / To: 01/01/02
Date of Birth: / M {x} F {} / Grade: 9
Address: 123 East Main St. / {x} Develop/Revise IEP / {} Initial {x} Review
Zip Code: / Date of last eligibility
determination:
{x} Parent: Jack and jill Doe / {} Addendum Date:
{} Guardian: / The multi-disciplinary team has determined the student is eligible for special education: {x} Yes {} No Eligibility is based on a review of current data.
{} Surrogate Parent:
Home Phone: 555-1234 / Work Phone: 555-4567 / Disability Category: Specific Learning Disability
School: Anyschool / Pertinent Medical Information (allergies, medications, seizures, etc.)
None
Primary Language of Home: English / Primary Language of Student: English
Limited English Proficient (LEP)? {} Yes {x} No / Ethnicity {} A {} B {} H {} I {} W
Vision Screening Date: / Hearing Screening Date:
Recommendations: The Team recommends that the attached IEP be implemented immediately. John continues to be eligible for special education services and will receive special education services an average of 50% of his school week this semester and next year. In addition, John will receive case management servi9ces, as needed, to help him meet the goals and objectives of the IEP.
Position / Date / Agree / Disagree / The basis for providing Special Education services for my student has been explained to me, including the results of tests given classroom performance, staff observations, and recommendations for my student's educational needs.
I approve of the above placement recommendation and program
I do not approve of the above placement recommendation and program.
Home school placement, or as close as possible, to the student's home: {x} Yes {} No
If no, explain:
______
*Signature of Parent or Legal Guardian
I have received a copy of my procedural safeguards/parents' rights.
Signature of Student
*Gen. Ed. Teacher:
*Sp. Ed. Teacher:
*Dist. Rep.:
Interpreter:
Speech Path.:
Psychologist:
Therapist:

SUMMARY OF PERFORMANCE

PRESENT LEVEL OF EDUCATIONAL PERFORMANCE Describe those areas below that enhance or interfere with the student’s performance. Check “NA” if not a strength or a weakness, or if area is not pertinent to student. Include notation of any assistive technology/device used in any areas.

NA / PERTINENT INFORMATION / STRENGTHS / NEEDS
READING (State Standards)
Level:
High Essentials (6-8) / John has met the state standards at the low essentials level with respect to reading and analyzing manuals and directions. / John is approaching the state standards at the high essentials level with respect to interpreting documents and analyzing literature.
LANGUAGE/
WRITTEN EXPRESSION (State Standards)
Level:: High Essentials (6-8) / John has met the state standards at the high essentials level with respect to writing a personal narrative and writing a summary. / John is approaching the high essentials level with respect to writing expository essays, responses to literature and formal communications.
MATH (State Standards)
Level: High Essentials (6-8) / John has met the state standards at the essentials level with respect to number theory and geometric functions. / John is approaching the state standards at the high essentials level with respect to algebraic functions and probability.
COGNITIVE PROCESSING
Auditory, visual / John demonstrates relative strengths in the areas of auditory discrimination and auditory memory. / John demonstrates relative needs in the areas of visual-motor skills and visual and auditory sequencing skills.
X / SENSORY/MOTOR
Balance, coordination, fine/gross motor, hypersensitivities, etc. / Not applicable / Not applicable
X / SPEECH/LANGUAGE
Articulation, voice, fluency, etc. / Not applicable / Not applicable
SOCIAL/BEHAVIORAL/EMOTIONAL
Appropriate/inappropriate behaviors, etc. / John has met the state standards at the foundations level with respect to teamwork skills and accepting leadership roles. / John is approaching the essentials level with respect to building action plans to negotiate a conflict and ataking leadership roles.
X / OTHER / Not applicable / Not applicable
ESY DETERMINATION
The team has determined the student is eligible
for Extended School Year: {} Yes {x} No / The ESY determination was based upon: Determination based on a review of current data.

Previous year IEP summary:Number written: 1 Number met: 1

Progress toward current year Goals is discussed prior to recommendation of new goals.

STATEMENT OF TRANSITION SERVICES

STUDENT PREFERENCES AND INTERESTS: ` John has expressed an interest in pursuing technical school (e.g., Devry) upon graduation. He indicated that he is interested in a career in the computer field. / VOCATION/TRANSITION STRENGTHS AND NEEDS: John has a clear idea of his post-high school goals at this time. This allows him to plan and work toward these goals in the time that he is in high school. John should work on job acquisition skills, as well as vocational training.
TRANSITION SERVICE NEEDS RELATED TO COURSE OF STUDY, BEGINNING AT AGE 14 (OR YOUNGER, IF DETERMINED BY THE IEP TEAM)
Course of study options (e.g. work experience, vocational education, college preparation, related career development programs) recommended for the student are: John will continue a path toward high school graduation, which will include a mixture of general academic classes and vocational training classes. For his 10th grade year, John will take General English 10, General World History, Applied Math Science, Tech Applications, Basic Electronics, Weight Training and Basketball/Football. For the following two years, John will continue to take classes to help prepare him for a career in computer technology.

NEEDED TRANSITION SERVICES, BEGINNING AT AGE 16 (OR YOUNGER, IF DETERMINED BY THE IEP TEAM)

TRANSITION AREAS

/ TRANSITION SERVICES / PERSON RESPONSIBLE
VOCATIONAL INSTRUCTION
{x} Career exploration
{x} Vocational training
{} Post [secondary training
{} Other: / John will participate in career exploration and vocational training in his computer related classes. In addition, he will learn job acquisition skills in his General English 10 class. / Sp. Ed. Teacher: Lanterman/Latham
Gen. Ed. Teacher: Horn/Wannie
Parent:
Student:
Agency:
Other:
EMPLOYMENT
{x} Competitive employment
{} Supported employment
{} Military
{} Other: / John will learn and develop competitive employment skills through skill development and training in the classes listed above. / Sp. Ed. Teacher: Lanterman/Latham
Gen. Ed. Teacher:
Parent:
Student:
Agency:
Other:

PERSONAL MANAGEMENT

{} Daily living skills
{} Social/interpersonal
{} Financial/planning
{} Living arrangements
{} Other: / The Team has determined that this area does not need to be addressed at this time. / Sp. Ed. Teacher: N/A
Gen. Ed. Teacher:
Parent:
Student:
Agency:
Other:

COMMUNITY PARTICIPATION

{} Medical resources
{} Leisure resources
{} Community resources
{} Transportation
{} Other: / The Team has determined that this area does not need to be addressed at this time. / Sp. Ed. Teacher: N/A
Gen. Ed. Teacher:
Parent:
Student:
Agency:
Other:

PLEASE NOTE: IF STUDENT IS 17 YEARS OLD, PLEASE READ: At age 18, students become of legal age in the State of Arizona, and educational rights and procedural safeguards transfer from the parent to the student. Parent, please initial that you have been informed: ______

MEASURABLE ANNUAL GOALS/SHORT TERM OBJECTIVES

Goals and benchmarks must be related to meeting the student's needs that result from the student's disability and should enable the student to be involved in and progress in the general curriculum. Parents will receive reports of progress toward annual goals at the same time student report cards are provided for general education classes.

MEASUREMENT OF PROGRESS: {x} observation {x} checklist {x} daily performance/work samples {x} school personnel interviews {} testing {} state standards assessment {} other ______/ STATEMENT OF RESPONSIBILITY / Suggested materials, strategies, and techniques
GOAL: 1) John will write formal communications, such as personal or business letter, messages, memos, directions or applications, for a specific audience and purpose (W-E6), as evidenced by the successful completion of at least two of the following objectives at the high essentials level: / Special Education Teacher {x}
General Education Teacher {x}
Content Area: Written expression/Transition
Related Service Provider {} OT {} PT
{} Speech {} Counselor: / Direct instruction and guided practice
Modeling
Peer editing
Real-life(contextual) applications
Spell-checking device
SHORT TERM objectives / 'X' for ESY
a) When writing a personal or business letter, John will use the correct format, as assigned by the classroom teacher, at least 8 out of 10 times, as assessed by the classroom teacher.
b) When completing a letter or application, John will spell at least 90^ of the words correctly, as assessed by the classroom teacher.
c) When completing a job application, John will leave no questions unanswered and no blanks, which may impede understanding, as assessed by the classroom teacher.
MEASUREMENT OF PROGRESS: {x} observation {x} checklist {} daily performance/work samples {x} school personnel interviews {} testing {} state standards assessment {} other ______/ STATEMENT OF RESPONSIBILITY / Suggested materials, strategies, and techniques
GOAL: 2) John will work individually and collaboratively within a team setting (WP-4), as evidenced by the successful completion of at least two of the following objectives at the essentials level: / Special Education Teacher {x}
General Education Teacher {x}
Content Area: Transition
Related Service Provider {} OT {} PT
{} Speech {} Counselor: / Direct instruction and guided practice
Modeling
Positive reinforcement for leadership
SHORT TERM objectives / 'X' for ESY
a) Given a hypothetical situation, John will develop at least two alternative solutions in which the conflict will be solved so that all parties are satisfied (a compromise), as assessed by the classroom teacher.
b) In a group setting, John will participate positively and at least as much of the time as he represents a percentage of the group members, as assessed by the classroom teacher.
c) John will voluntarily assume the leadership role in group activities at least 50% of the time when the opportunity arises, as assessed by the classroom teacher.

Goals/benchmarks must specify any assistive devices and technology needed by student as appropriate.

ADAPTATIONS (See menu)

ADAPTATIONS are changes made to the environment, curriculum, instruction, and/or assessment practices in order for a student to be a successful learner. Adaptations include accommodations and modifications. Adaptations are based on an individual student's strengths and needs.

ACCOMMODATIONS are provisions made in how a student accesses and demonstrates learning. These do not substantially change the instructional level, the content or the performance criteria. The changes are made in order to provide a student equal access to learning and equal opportunity to demonstrate what is known. / MODIFICATIONS are substantial changes in what a student is expected to learn and to demonstrate. Changes may be made in the instructional level, the content or the performance criteria. Such changes are made to provide a student with meaningful and productive learning experiences, environments, and assessment based on individual needs and abilities.

Describe accommodations/modifications to be made in the school environment.

(Please include the following areas: reading, written expression, math, content areas, LEP, behavior, student responsibility as appropriate.)

{} Check if none are needed.
Indicate (*) those that will be used for State/District assessments. / Initiation
Date /

Duration

(length of Time) /

Frequency

(how often) /

Location

Opportunity to negotiate for a mutually acceptable alternative to writing assignments longer than 3 pages based on identified strengths. / 4/01 / 1 year / 100% / All classes
*Use of a spell-checking device for writing assignments using the writing process, published or graded for spelling. / 4/01 / 1 year / 100% / All classes; DAP; Stanford testing; AIMS testing
*Use of a calculator. / 4/01 / 1 year / 100% / All classes; Stanford testing; AIMS testing
*Up to 150% of time allowed for paper-pencil tests. / 4/01 / 1 year / 100% / All classes; DAP; Stanford testing; AIMS testing
Positive reinforcement for appropriate behavior / 4/01 / 1 year / 100% / All classes
Use of Learning Resource Center for additional assistance with paper-pencil tests (in-class) / 4/01 / 1 year / 100% / All classes
Modified grades are required in: / {} Reading / {} Math / Content
Area (list):
{x} None / {} Written Expression
Statement of needed support for school personnel (indicate person responsible).
{} Check if none are needed. /

Initiation

Date / Duration
(length of timee) / Frequency
(how often) /

Location

Consultation and collaboration, as needed, with special education teacher

STATEMENT OF SPECIAL EDUCATION SERVICES

{} 1st semester {x} 2nd semester

PARTICIPATION IN GENERAL EDUCATION CLASSES NOT REQUIRING SPECIAL EDUCATION SERVICES (please list)

Power Mechanics/Auto Care / Health/PE

PARTICIPATION IN NON-ACADEMIC/EXTRA CURRICULAR ACTIVITIES

Student has equal access and opportunity to participate with age-appropriate, non-disabled peers. Check the appropriate areas:

{X} ASSEMBLIES / {X} CLUBS / {X} FIELD TRIPS / {X} PASSING PERIODS / {X} SPECIAL EVENTS / {X} ALL ACTIVITIES
{X} ATHLETICS / {X} COMMUNITY EVENTS / {X} LUNCH / {N/A} RECESS / {} OTHER: None
LIST CHANGES NECESSARY TO PERMIT ACCESS TO ABOVE ACTIVITIES: Not applicable
STUDENT WILL RECEIVE SPECIAL EDUCATION SERVICES IN THE FOLLOWING SUBJECT AREAS: / special education services in the following setting(s): / program description
(in detail) / dates of service
GENERAL ED. Min. per week / special ed. min. per week / total min. per week / initiation / DURATION
General Science / 425 / 425 / Direct instruction in a resource setting / 4/01 / 6/01
General Math / 425 / 425 / Direct instruction in a resource setting / 4/01 / 6/01

statement of educationally relevant related service to be proVided

Related service means such developmental, corrective and other supportive services required to assist a student with a disability to benefit from special education. The following list is not exhaustive, and other services may be required to assist a student with a disability to benefit from special education: physical therapy, occupational therapy, orientation and mobility services, speech-language pathology and audiology services, counseling services and transportation.

SPECIAL ED RELATED SERVICES: / special education RELATED services in the following setting(s): / program description
(in detail) / dates of service
GENERAL ED. Min. per week / special ed. min. per week / total min. per week / iNitiation / DURATION
NONE
*Total minutes of special education services
(*Includes general education with support, pull-out, and related services)* / 850 / (Divide total number of special ed minutes per week by total Total percent of Johne
number of school minutes per week.) / 50%

STATEMENT OF SPECIAL EDUCATION SERVICES

{x} 1st semester {x} 2nd semester

PARTICIPATION IN GENERAL EDUCATION CLASSES NOT REQUIRING SPECIAL EDUCATION SERVICES (please list)

Computer Tech Appl. / Basic Electronics / Weight Training / Basketball/Football

PARTICIPATION IN NON-ACADEMIC/EXTRA CURRICULAR ACTIVITIES

Student has equal access and opportunity to participate with age-appropriate, non-disabled peers. Check the appropriate areas:

{X} ASSEMBLIES / {X} CLUBS / {X} FIELD TRIPS / {X} PASSING PERIODS / {X} SPECIAL EVENTS / {X} ALL ACTIVITIES
{X} ATHLETICS / {X} COMMUNITY EVENTS / {X} LUNCH / {n/a} RECESS / {} OTHER: None
LIST CHANGES NECESSARY TO PERMIT ACCESS TO ABOVE ACTIVITIES: Not applicable
STUDENT WILL RECEIVE SPECIAL EDUCATION SERVICES IN THE FOLLOWING SUBJECT AREAS: / special education services in the following setting(s): / program description
(in detail) / dates of service
GENERAL ED. Min. per week / special ed. min. per week / total min. per week / initiation / DURATION
General English 10 / 425 / 425 / Direct instruction in a resource setting / 8/01 / 1 sem.
General World History / 425 / 425 / Direct instruction in a resource setting / 8/01 / 1 sem.
Applied Math/Science (1st sem.) / 425 / 425 / Direct instruction in an inclusive setting / 8/01 / 1 sem.
Applied Math/Science (2nd sem.) / 425 / 425 / Direct instruction in an inclusive setting / ½ / 1 sem.

statement of educationally relevant related service to be proVided

SPECIAL ED RELATED SERVICES: / special education RELATED services in the following setting(s): / program description
(in detail) / dates of service
GENERAL ED. Min. per week / special ed. min. per week / total min. per week / iNitiation / DURATION
NONE
*Total minutes of special education services
(*Includes general education with support, pull-out, and related services)* / 850* / (Divide total number of special ed minutes per week by total Total percent of Johne
number of school minutes per week.) / 50%*

*Minutes and percentage of John being served are averaged over the course of the academic year.

STATEMENT OF LEAST RESTRICTIVE ENVIRONMENT

JUSTIFICATION Explain why site and setting is appropriate and least restrictive: John will participate in the general curriculum an average of 50% of his school week for this semester and for next year, while receiving additional assistance in his areas of need the remainder of the school week. He will demonstrate success among his non-disabled peers. / List any potential harmful effects of site and setting:
John may experience discomfort from his association with the special education program.
The need for assistive technology devices and services has been considered. / {} Not needed
{x} Needed; See Page 2A of IEP
The communication needs of the student have been considered. / {x} Not needed
{} Needed; See Page 2A of IEP
Transition service (school to adult life) needs of the student have been considered. / {} Not needed
{x} Needed; See Page 2A of IEP
For a student whose behavior impedes his/her learning or that of others, positive behavioral interventions, strategies and supports have been considered. / {x} Not needed
{} Needed; See Page 2A of IEP
For a student who is Limited English Proficient, The effect(s) of his/her language needs on the content of the IEP have been considered. / {x} Student is not LEP
{} Not needed
{} Needed; See Page 2A of IEP
For a student who is blind or visually impaired, an evaluation, the need for instruction, and the use of Braille have been considered. / {x} Student is not VI
{} Not needed
{} Needed; See Page 2A of IEP
For a student who is deaf or hard of hearing, his/her need for communicating with peers and professional personnel in his/her mode of communication has been considered. / {x} Student is not HI
{} Not needed
{} Needed; See Page 2A of IEP
DISTRICT ASSESSMENT / AIMS / STATE STANDARDIZED ASSESSMENT
Indicate appropriate level, based on present level of performance. / Indicate appropriate level, based on present level of performance. / Indicate appropriate level, based on present level of performance.
Reading: High Essentials (6-8) / Reading: High Essentials (6-8) / Reading: HS

Language/