- DRAFT - Maine Department of Education sds spo rhage PUD ne SAU or CDS Placement: 08 22-Weto Due Bast wm Pave INDIVIDUALIZED EDUCATION PROGRAM (IEP) 1. CHILD INFORMATION Child's Name: = Date of Mesting: o3i192015 Date of Birth: 112012003 Age: 12 Effective Date of IEP: 3/20/2015 - 3/19/2016 School/Program: \WJH Grade: 06 Date of Annual IEP 3120/2016 Review: Parent Information: "ac 21-a Date of Re-evaluation: 3720/2016 emeamerod en Date(s) of Amended IEP: NIA == Case Manager: Maryann Nyman State Agency Giient: Yes [] no E] 2. DISABILITY (MUSER) Vil2 Lasse LX reatstincness Lreatness [11 ceveionmentat Delay (ages 35) [Doevetopmentat Detay (cindergerten) Demo [Hearing impairment ivrevar impairment incusing tinsness) [J otner Heath impairment [=] onhopedic impairment Ei seecchitanguage impairment LE speeite Learning Disabity [i treumate sain niry i] Matte ois list concomitant disabilities) Page | of 113, CONSIDERATIONS - INCLUDING SPECIAL FACTORS "A. Concerns of parents for enhancing the education of their child. (MUSER X3.G.(1 RAEN SEER 9121 Nother WOuld lke to have the schoo! help the use of public restrooms. 'B. Does the child exhibit behavior that impedes the chi's learning or . Does the child have limited English proficiency? (MUSER IX.2.C (2)()) others? (MUSER K3.C. Oe Bw Bs [wo Does the child need positve behavioral interventions and supports and other | Does the child have language needs which need to be addressed inthe IEP? strategies to address the behavior? BvD mo Dv Bw If yes, where is this addressed in the IEP? dressed in goals and objectives Iyes, where is this addressed in the IEP? D. Ifthe chit is bind or visually impaired, does the child require instruction in|. Does the child have communication needs? (MUSER IX3.C,(2) Braile andthe use of Braille? (MUSER IK.3.C (2\c)) Lives no O ves & 10 |s the child deaf or hard of hearing? Does the child have a print disability that requires accessibi [ves i] no ‘materials (AIM) to access the curiculum? (MUSER IX.3.C. TESTS Sica cadre wn SEP? ves [i] xo It yes, what ype of accessible instructional materials (AIM) does the student require? Ityes, where is this addressed in the IEP? F.0 need assistive technology devices and services? (MUSER |G. Does the child have academic needs? Eves Ovo mac. Ityes, where is this addressed in the IEP? Ow ‘Adressed inthe goals and objectives section ofthe IEP tyes, where is this addressed in the IEP? Does the child have functional needs? ves O wo If yes, where is this addressed in the IEP? Adressed in the goals and objectives Does the child have developmental needs? O ves & x0 Iyes, where is this addressed in the IEP? CDS ONLY: Developmental must be YES. (MUSER IX3.C Page 2 of 11U1g0 ¢28ea ‘onTewoye Ue Rey UeD oY EUR OS wit JO} BuDHOM r0U s) ido Bu 29) 01 wiy peBeunoous seu Y pue sown e syse) Sse; ‘51 Pue 20M ota Op 01 UM 40} Sei6Bnas ob “Ais © pul {,upinoM | Burdou sem 2H “suey UO sem auo pul ado sor g fo} seysouyy puooes ays 20} Ge PLE ZaISOWN IS1y +B © PaLueD aH ‘Aaowoo6 pue ‘ounow 014 hje}oedso ‘uewaunseoWL ‘(s\eW09p ‘suo! 0 sed zuaeyip yam suogesado ul Ayeqnarued ‘sanaMoy ‘s6pa|MoUy LReU! Sy Ul Sde6 a)qelOU awos ave atau, "sse001d BuLNOS-Walgoud un JO frou os se0p a uonoaup stun 30) Sunjem pue pouisse Yooq axel few exp Yiowad fue Buna: (00: fw Ui Yen Uoun| Keg 96UeI0 Se spuads pu aro 'S8eu0 ape. Wig ot J FoqwOU eS mm Joey Sy Buso; Ka Sse 44 OSU Ape! Oy AUN SEU pono oq SNL-eMMMIOU UEUR Layo sion {ueeUIG SA) ayo pue aie) U0 (uo spuew)eet 2.9 Buey2 295 0) Unb am (S0u07 eDxeM) s0u905 >HoOMSSE: Suissed Kuaysisuoo s! 3}1~"paseaicap Aeai6 sey 3.0m Sty SpseMo LOYs Siy“LONIppe Ll 30M Buldno.6 Aue inoge qui anxs 5326 286u0) ou 9} shui puE Si80d siy ym JedWO] HOUS e LMOYS LONE sey PUE Pale}GE su!SeS 9} 'sauISep pue opr. ‘neu | Klenuga.s jo BuluuiBaq uy 2ourg “AyBeuB uy Kua | puE zowny jo asus inyZepuom e yuan hog parleeypUN "6X1 Y3SNI) ‘IUD 947 0 UONEnjend 1uE091 ISOU 0 VORENIERS en uauuosnUe jooLgs au UI Gunjos wogoid jeonewou.ew pue ‘Burjeads ‘Suusrsi ‘Gunua ‘Guypess ur sys exeudoidde ejensuowep ove syse} (sieed apesjabe eles 01 aiqeredusoo) sierdoidde abe wojied 0} Age s,pu0 € 0) sieje1 soueWHO}iad oIwepeoy reouBuojed o1WepeoY “y “swowssosse ojeuseie sioidiu0o oWM Ussp} 105 poLInbed Aluo o4e SONTDAIAO ‘SION. ‘sqe9y\ KyeIued = d ‘PSUS ION = N'SI@9/I = WW 'spae0%"g = 3 "leayV ION S20q = G {(s]Ie06 jenuue 104 sepoo ssaiBaud yo mojaq uonduasep atn poy (pouuerep fie20)) ‘sepo0 Guynojo, oun Bulsn ‘eek apece sad sewn ¢ pauodss eq lim sie08 Uo ssaiGo1g KL) ex! YaSNW) (SN¥OS TWANNY S1evEnsvaN "y ‘431 eu) jo 19pUIEWDs oWp Busjaydusod eso}09 Polaidwod oq pINOUS BuOTBES "SOKH o-oo 2901010 91 PINE ath SI “dl ou Jo Jopurewies ox Buriordwioo e10j0q porotduiod oq pinous g uoN2aS ‘Sok 1 fon sa CJ conogeo opei6 ns 01g ut piyo axa s| :NOILISNYLL AUWANODAS|Homework:Science: At redo for a beter grade. (peu submits homework assignments one class after their due dete, but usualy he completes and submits his homework in good time imetBaams has an Fin Scence... Hes missing two homework asignments and recived 2 67 on another assignment, which he can 'Social Studies: ‘ework is usually in on time and done wel. His homework grades are solid. He has had one homework assignment this trimester, however, and it know the answers, he shuts down, stops right there at that question, and won't do any more - ting him to do it over isthe right way to go as it might be sending the wrong message regarding taking responsibility to study. However, refusing to take the test does not give us an assessment of his achievement, discussions, his work thoroughly, and is @ popular partner in group ikeable boy His creativity is unique and can ad tod: 1ge of dificult math problems. He works carefully, d [SS. temamp-has good ability! He makes valuable contributions to class discussions! He is a pleasure to have in cass. [Englteading - NB is interesting to tak to! He has a unique perspective on the world and enjoys sharing what he's noticed \Areas of Difficuty/Need:Science: mm needs to work on organization and taking responsibilty or his materials as well as getting work done on time. |temae began the year with a fairly significant achievernent delay in mathematics. Although he is closing that achievement gap, he continues to achieve below grade level {meas can shut down completely when faced with some challenges, [Engireading - mmmme needs to acvocate more for himself, ask questions when confused, and develop independence in task completion, [Present Levels of Academic Performane (MUSER IXSA,(1V aX) {iam is off task in Englsh/Reading, and is not completing all of his class assignments in science. He is currently earning a B+ in Social Studies, Fin Science. is a D+ and in Math, he is frequently not prepared and has gaps in his math knowledge. 4473 Math Samm is presently performing atthe late 3rd grade to early fourth grade level across the Common Core mathematics curriculum. has a kind heart and is a likeable boy. His creativity is unique and can adi !Math: SMB is curious and enjoys the challenge of dificult math problems. He works caref. daily discussions. , does his work thoroughly, and is @ popular partner in group Page 4 of 11‘SS. MB has good ability! He makes valuable contributions to ciass discussions! He is a pleasure to have in cass. resting to talk to! He has a unique perspective on the world and enjoys sharing what he’s noticed. for his materials as well as getting work done on time. ‘mathematics. Although he is closing that achievement gap, he continues to achieve below Math: mm began the year witn a fairly significant achievement ‘can shut down completely when faced with some challenges. [Englteading - tg needs to advocate more for himself, ask questions when confused, and develop independence in task completion. Sumas is sometimes off task and sometimes needs redirection. Goal (MUSER IX3.A(1)(0)&(6)) GoallD: 24473 Area of Focus: Wath (child) will as measured by, signed instruction in mathematics, gage will meet Common Core State ‘Standards for mathematics atthe early to mic-Sth grade level as determined by Curriculum Based Measurement (Objective(s) required? Page Sof 11BB. Functional Performance: Functional performance refers to how the child is managing daily activities in cognitive, communicative, motor, adaptive, socialemotional and sensory areas. (MUSER KSC, this goal 85% of the time. mE. needs supporto complete assignments and write assignmer jows directions from staff 85% of the time without arguing or complai needs to complete his work, independently, and take responsibilty for writing assignments in his planner. (Measurable Goal (MUSER X3.A(1(0)&(c)) GoallD: 24471 Area of Focus: Behavioral Progress: iy (date) (given) as measured by. eri872015 [By March 19, 2016, tgamm will espect peers and staff 95% ofthe time as measured by his goal chart and teacher] yo/4a/2015 peeevern: 2ra2016 re? Eves Ono eriaro15. Progress ertarz015: soner2015 2nrez0%6 [Objective(s) requires? (ves [] x0 Page 6 of 11Il as measured by. ymplete assignments Independently and will write his assignments in his pianner 80% 1e by October 2015, 95% ofthe time by January 2016, mastering his goal erarors 018 282016 servation, |Objective(s) requires? [ves [] no By (date) (given), (child) will as measured by. [By June, 2015, tame will folow directions from staff $0% of the time without arguing or complaining, 95% of the time by Octover, 2015, mastering his goal Progress: eria2015 1812015 2182016 er8/2015 1812015 2na2016 Page 7 of 115. SUPPLEMENTARY AIDS, SERVICES, IFICATIONS ANDIOR SUPPORTS (Mi In addition to ongoing classroom supports and services, supplemental aids, and modifica individual appropriete eovommodetons that are necessary to measure the academic achievement and functional performance ofthe chi on State and cisictwide and classroom assessments. (MUSER IX3.A,(1) co) Daraion Supplementary sds, services, modifications andor supports for SAU personnel Location Froquamey Boginningfnding Date Tocniques/Actviies - Soc Personal case Gain Spa & Reged per Day 3202015 to aB2016 Development Spectl Eeveaton and as needed Classroom Assessment | Regular Education Settings. Helo student select aterative wave to respond o rictwide Assessment situstione Provide a clear routine and pre-teach when state assessment Schedule changes. Behaviors Season Ferien See a Rega oa Day THORS to TOE Special and Regular Daly ssroom Assessment | egucaton Stings Distictwide Assessment Estate assessment Secon heron SpEa RegEa per Day TRIAS VWI ‘Special and Regular ‘As needed Classroom Assessment | Eaucaton Stings Ci oistrict wide Assessment state assessment PhysicalEnvronmerial Nedicatons cata rion Sposaea war Day SOUS te TOIT Learning Support Center aly Environmental breaks (motor breaks, calming (Classroom Assessment i bictrice wide Assessment [state assessment IB. Alternate Assessments hile cannot participate in the regular assessment and why the particul the IEP Team determines that the child shall take an alternate assessment on a particular State or disitict-wide assessment of child achievement, a statemer Itemate assessment selected Is appropriate for the child. (MUSER IX. Page 9 of 11i 6. SPECIAL EDUCATION AND RELATED SERVICES MUSER IX3.A.(1}@) & 1X3. ‘Special Education Services: Position Responsible | Location ‘uration [Speech and Language Services: Frequency BeginninglEnding Date pecially Designed Instruction Ceied Specal Education | Special ed. | Stimes per Day for 8Ominutes | 820/201 to 3/19/2016 “The Learning Center Support Teacher [Consultation [Speech and Language Services [Tutorial instruction [Exended School Year Services Duration Related Services Position Responsible_| Location Fre nning/Ending Dato [Occupational Therapy [Physical Therapy [Social Work Services [Transporation lomner 7. LEAST RESTRICTIVE ENVIRONMENT What percentage of time with non-disabled children? For children ages 3-5 only (CDS) General Education ‘Special Education appar oF evan Tonos i than 10 hours Seno Tesinal nou thous inven cater sotng wih ypical | eauoatonel sting win ypcal| /Aiitonal hours in noneductonal peers. peers. oe Fork ofthe extent, any, to which the child will not parcpate with non-disabled children in the regular class and in only and other nonacademic ative. Tam arring Suppo center every ay freight mints. Page 10 of 11