/ / ST. BERNARD PARISH DEPARTMENT OF EXCEPTIONAL CHILDREN
Date Received Checked by: / IEP Compliance Checklist
Cover page required with Original IEP to Central Office within 5 days of meeting date
School: / Meeting Date:
Student: / SID#: / DOB:
Old IEP Goals Closed / Old IEP Objectives Closed (Rev., Cont., Disc., Date Ach.) / Only Last 4 Digits of State ID Printed
Interim IEP / Initial IEP / Annual Review IEP
IEP PAGES
The ODR/Administrator will answer the Y/N questions.
Transition Services Page
Method & Date of Invitation – What method did you use & what type of
documentation was used? (If phone contact: Date and person who you spoke to must be indicated on Prior Notice)
Measurable Post-Secondary Goals
Transition Assessment(s) – 1 Formal & 1 Informal Assessment; List Results
Action Steps
School – Current Info Only
Student – 1st person only and related to School Action Steps
Family – Seek input from parent early; don’t volunteer their actions
Agency – Consent must be in folder to document parent decision
Agency Linkage Documentation – Include copy of flyer in IEP
Type of Exit Document – Years to graduate; projected exit date
General Student Information Page
Participants’ Signatures
General Information (interests, age, attendance, length of sped service, etc.)
Strengths – From the evaluation, data-driven, etc.
Parent Concerns – Do not type until the meeting unless you have
spoken with parent
Evaluation Results
Current Exceptionality Qualifying Conditions
Current Universal Screening/CBM Scores
Academic, Developmental, Functional Needs
Areas of Difficulty Important Areas to Master
Statewide Assessment Results (Most Current)
Progress/Lack of Progress in General Education Curriculum
Affect of Disability on Progress # of Goals/Obj. Achieved
Current Grades Specific interventions/duration/frequency
Strategies being used that are successful
If student failing strategies listed for success
General Student Information Page (Continued)
Behavior
Specific Behavior Concerns Positive Behavior Strategies
Documented need for counseling w/provider & minutes per week
BIP Statement
If student has 4/7/10 days suspended, strategies are listed to support behavior
Limited English Proficiency
Communication Needs
Instruction in and use of Braille
Assistive Technology – Review and complete AT Consideration Checklist
Health Needs – Complete Health Screening Form
Individual Health Plan Crisis Plan Emergency Transportation Plan
Transition Courses of Study
Educational Needs
Instructional Plan Page(s)
Educational Need Area
Content Area
Reading Math Written Expression Behavior Social Comm Motor
Present Level of Academic Achievement (PLAAFP)
Type of Assessment/Scores/Functioning Level
Y N – Does the PLAAFP include formative baseline data?
Strengths & Support Needs – 3 Strengths and 3 Supports
Y N Does the PLAAFP describe the student’s strengths and areas of need in observable/measureable terms?
Progress Monitoring Schedule
Performance for an Average Student at Grade Level
Y N Does the PLAAFP include an average student’s performance on a formative assessment or extended standards? / Instructional Page(s) (Continued) – Annual Goal
Measurable Academic/Functional Goal
Does the goal match the PLAAFP (are the same skills targeted in the
PLAAFP also targeted in the annual goal)?
Goal – #1: Y N #2: Y N #3: Y N #4: Y N
Measurable
Does the annual goal describe the targeted skills in observable/measureable terms?
Goal – #1: Y N #2: Y N #3: Y N #4: Y N
Method of Measurement
Does the annual goal include formative data?
Goal – #1: Y N #2: Y N #3: Y N #4: Y N
Standards-Based
Is the same type of progress monitoring tool used in both the PLAAFP and the annual goal?
Goal – #1: Y N #2: Y N #3: Y N #4: Y N
Terminal Point
Is there a terminal point of review?
Goal – #1: Y N #2: Y N #3: Y N #4: Y N
Other
Is the annual goal based on the Louisiana State Standards (LEAP) or extended standards (LAA1)?
Goal – #1: Y N #2: Y N #3: Y N #4: Y N
Are the teaching strategies/contingencies included?
Goal – #1: Y N #2: Y N #3: Y N #4: Y N
Objective (Short Term Objectives)
Measurable
Y N – Do the short-term objectives match the PLAAFP & the
annual goal (i.e., are the same skills or sub-skills targeted in the PLAAFP
and annual goal also targeted in the short-term objectives)?
Y N – Do the short-term objectives describe the targeted skills in
measurable terms?
Method of Measurement
Y N – Do the short-term objectives include formative data?
Proficiency Level
Y N – Is the same type of progress monitoring tool used in both
the PLAAFP, annual goal, and short-term objectives?
Terminal Point
Y N – Is there a terminal point of review?
Personnel Responsible
Accommodations Page
Accommodations marked for Classroom and or Testing
Program/Services Page
Correct assessment program checked (LEAP, EOC, GEE, LAA1, LAA2)
Justifications completed (if alternate assessment only)
ACT 833 Eligibility checked
Regular classes checked [if NONE-explain]
Extra-Curricular activities [checked if student included]
ESY criteria chosen
Supports include accommodations/BIP/Crisis Management Plan statement/additional supervision
Student: / SID#: / DOB:
IEP PAGES – Continued
Services/Placement Page
Time frames complete
Instructional day/minutes match school day
Services are documented correctly and completely
Placement with educational benefit is completed and includes specific
classroom supports and how different from other classes
Comments including health services as needed, 100% supervision; child-specific (MUST Be approved by central office); additional
support paraprofessional as necessary/needed / Placement Page
Special transportation checked and described
Bus Attendant Curb to Curb Lift Bus Nearest Corner
Supervision Car Seat/Safety Vest REASON
Attending a School other than Home School for Programming/Services
Site Determination (if not attending Home-District school)
Progress Reports and Age of Majority completed
Alternate Assessment Implications checked (if appropriate)
Parent decision checked
Supporting documentation checked (as relevant)
BOTH Parent/ODR have signed and dated
ADDITIONAL REQUIRED PAGES (Please Arrange Pages in Order Listed Below)
ELEMENTARY / MIDDLE/HIGH
1. Site Determination Page
2. Behavior Intervention Plan (if applicable)
FBA Forms
Baseline Data Collection Form
Progress Monitoring Form
Daily / Weekly Behavior Checklist
Positively stated replacement behaviors
Rewards state by whom and frequency
3. Assistive Technology Consideration Checklist
4. Health Services Screening(if applicable)
5. Health Plan / Emergency & Transportation Plan(if applicable)
Release of Information Form(s)/Crisis Plan
6. LEAP Alternate Assessment Participation Criteria Form(if applicable)
LAA-1
7. Parental (Student) Notification Forms
1st 2nd 3rd
8. Full & Effective Waiver Notice (if applicable)
9. Parental Consent for Agencies to Attend Letter(if applicable)
10. Medicaid Form
11. ESY IEP (if applicable)
12. MDR Paperwork (IEP dates corresponds with MDR dates)
13. Medicaid Reimbursement Consent / 1. Site Determination Page
2. Behavior Intervention Plan
FBA Forms
Baseline Data Collection Form
Progress Monitoring Form
Daily / Weekly Behavior Checklist
Positively stated replacement behaviors
Rewards state by whom and frequency
3. Assistive Technology Consideration Checklist
4. Health Services Screening
5. Health Plan / Emergency & Transportation Plan
Release of Information Form(s)/Crisis Plan
6. LEAP Alternate Assessment Participation Criteria Form
LAA-1 LAA-2 (if applicable)
7. 5-Year Plan
Individual Graduation Plan
LAA 1 Educational / Career Plan
8. Transition Assessment(s)
9.
10. Age of Majority Letter
11. Parental (Student) Notification Forms
1st 2nd 3rd
12. Full & Effective Waiver Notice (if applicable)
13. Parental Consent for Agencies to Attend Letter
14. Completed Agency Notification Letter
15. Contact Form
18. Medicaid Form
21. Progress Monitoring Results (Academic/Behavior) – Charts and Graphs
22. ESY IEP
23. MDR Paperwork (IEP dates corresponds with MDR dates)
Teacher Signature
My signature indicates this IEP is in compliance according to parish and state guidelines. / Date
ODR/Administrator Signature
My signature indicates that I have received and checked this IEP to ensure that it is compliant. / Date
Instructions:
- This form is initially completed by the teacher when writing the IEP. Teachers should ensure they are completing the Y/N questions accurately on the IEP, but will NOT mark the Y/N boxes on this checklist.
- The ODR/Administrator will answer the Y/N questions.
- The ODR/Administratorwill initially hi-light all questions which the teacher did not complete within guidelines.
- After reviewing, if correct, the ODR/Administrator will indicate the Y for “yes.” If incorrect, the ODR/Administrator will circle the N for “no,” then make the corrections or have the teacher make the necessary corrections if the timelines permit.