Monroe County Community School Corporation Case Conference Summary/IEP/ITP

Date

March 4, 2008

Student Name Home School/Attending School

Derek Smith
/

DOB

February 12, 1996
Grade

Sex

Male 5

Re-eval Date ID#

March 4, 2011

Wildrose Elementary

Student Resides with:

Phone Home

Caseworker/Agency Representative Home Name

Phone

Joan and Joan Smith Parent/Guardian Name 1570 Adams Ave. Street Address Bloomington 47406
City/Zip

812-555-1234

Work

812-666-1234
Street Address

Work

Emergency

812-777-1234
City/Zip

Emergency

Legal Guardian:

Natural Parents Natural Mother Natural Father

Adoptive Parents Adoptive Mother Adoptive Father

DFC Court Other __________________________________________

Purpose of Case Conference:

Initial Conference Declassification/Reclassification

Annual Case Review Causal Relationship IEP Review

Transition Move in

Case Conference Committee Members (Indicate role)

Howard Kaplan
Chairperson

Jaclyn Bober
Special Education Teacher

Derek Smith
Student

Stephanie Gordon
General Education Teacher

John and Joan Smith
Parent

Greg Goza (Psychologist)

Student Performance

Derek Smith

Evaluation procedures, assessments, records or reports utilized to help determine eligibility for special education services. Cognitive: WISC-III scores: Verbal IQ -95, Performance IQ- 110, Full-Scale IQ- 96 Impact on involvement in general education curriculum: Achievement: Evaluation Data:

Derek has an average IQ which does not impact cognitive ability.

The achievement test administered was the Woodcock-Johnson III. Broad Reading score - 77, Letter-Word ID- 72, Spelling- 52. He qualifies for LD in these areas.

Reading: Strengths Weaknesses

Derek's strengths in reading are his decoding skills or word attack.

Derek has weaknesses in reading comprehension, broad reading and fluency. His biggest weakness is in written spelling. Derek may benefit from being placed in a resource room for reading.

Impact on involvement in general education curriculum: Math: Strengths Weaknesses

Derek's strength in mathematics is calculation.

Derek's weakness in mathematics is applied problems. Derek is able to participate in a mathematics general education curriculum.

Impact on involvement in general education curriculum: Social Emotional: Strengths Weaknesses

Derek seems to have friends and able to be social with others.

Derek becomes argumentative with others at times. Arguing with others may push other students away, Derek may need self-regulation skills.

Impact on involvement in general education curriculum: Communication: Strengths Weaknesses

Derek is able to form his own opinion and has age-appropriate skills.

Derek has no known deficits in communication. Communication does not have an impact on Derek's education.

Impact on involvement in general education curriculum: Adaptive Behavior: Strengths Weaknesses

Derek is able to manage personal skills.

There are no known deficits in adaptive behavior. There is no apparent impact on Derek's education.

Impact on involvement in general education curriculum: Behavior: Strengths Weaknesses

Derek has good school attendance.

Derek is unfocused and possibly hyperactive. Derek may need preferential seating.

Impact on involvement in general education curriculum: Other: Strengths Weaknesses

NA

NA NA
Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 - FAX=(812)330-7811 Case Conference Summary Page

Impact on involvement in general education curriculum:

2

Derek Smith
Student input (strengths, interests, concerns):

Derek does well in mathematics but has a hard time in language arts. He does not like being at school and does not want to repeat a grade for the

second time. Derek has a hard time paying attention during school.
Parent input (strengths, interests, concerns):

Parents are worried that his academic issues will only get worse and that his repetition of grade 3 did not serve him well. The mother is concerned that

he has a lack of focus and hyperactivity issues. She helps him with his homework, but it is a frustrating process.

The following health data was discussed

✔ no known problems
on medication (specify) seizure activity health plan Special Factors 1. 2. 3. 4. 5. 6. 7. Does behavior impede student learning or the learning of others? Does the student have limited English proficiency? Is the student blind or visually impaired? Is the student deaf or hard of hearing? Does the student require assistive technology devices or services? Should the student be considered for an assistive technology evaluation? “Other”

frequent absences/tardies: days present _____ days absent _____ physical concern (specify) wears glasses/contacts/hearing aid/prosthesis (circle) other ___________________

Yes Yes Yes Yes Yes Yes

✔ ✔
✔ ✔ ✔

No No No No No No

If YES, team must develop and attach intervention plan If YES, team must consider language needs If YES, team must consider appropriate reading and writing media. If YES, team must consider communication needs. If YES, see accommodations and/or related services If YES, appropriate referral forms must be completed

Based on the case conference committee’s discussion of the data noted above:

✔ The student is eligible for special education services as defined in Indiana Code
The student is not eligible for special education services as defined in Indiana Code

___ Autism ___ Hearing Impairment ___ Orthopedic Impairment

___ Communication Disorder 1 ___ Learning Disability ___ Other Health Impairment

Disability Category(ies) 1 = primary disability 2 = secondary disability ___ Dual Sensory Impairment ___ Developmentally Delayed ___ Mild Mental Handicap ___ Moderate Mental Handicap ___ Traumatic Brain Injury ___ Visual Impairment

___ Emotional Handicap ___ Severe Mental Handicap

Does the student require an alternative curriculum?

Yes

No

If YES, explain non-participation in general education curriculum

Can student participate in non-academic and extra curricular activities?

Yes

No

If NO, explain

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 - FAX=(812)330-7811 Case Conference Summary Page

3

Individualized Transition Plan

Name: School Initial Plan Date

Derek Smith

Social Security Number Anticipated final year of school

Review Date

Review Date

Review Date

Review Date

Review Date

1. Projected Post-School Outcomes: Post-Secondary Education Vocational Training Community Living Continuing/Adult Ed. Integrated/Supported Employment Community Participation

2. Statement of student’s interests and preferences:

3. This student is working toward:

Credit - diploma

Non-credit - certificate of completion

GED

4. Ongoing Adult Services:

NO

YES - what information was given?

Date given:

5. I have been informed that at the age of eighteen all rights accorded parents under special education legislation are transferred to the student and are concurrent with the parents’. (Must be completed if student is 17 at the time of conference.)

Student Signature/Date

Parent Signature/Date

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 -- FAX (812)349-7811 Transition Plan Page

1

Derek Smith
6. Statement of Needed Transition Services: (A “ statement of needed transition services” describes services the student needs to gain the skills and connections necessary to achieve his or her desired goals):

Transition Services Needed? YES - See goal/objectives NO - Explain YES NO

IEP must contain goals/ objectives related to all areas marked YES

Coordinated Sequential Set of Activities/objectives

Person Responsible/Agency Linkages

Instruction

Related Services

YES NO

Community Experience

YES NO

Employment/Functional Vocational Evaluation

YES

NO

Daily Living

YES NO

Residential

YES NO

Other (eg: medical, financial)

YES NO

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 -- FAX (812)349-7811 Transition Plan Page

2

Goals and Objectives
Student’s Name Annual Goal

Derek Smith Student will improve reading comprehension skills at the 2nd grade level.

Identified Need: Reading Comprehension

Measurable, Short-term Instructional Objectives Including Objective Criteria to be reviewed annually

Person(s) Responsible (By Title)

Procedures of Evaluation

Progress

Comments

(2.2.4) Ask and respond to questions to aid in comprehension about important elements of informational texts with fewer than 3 errors out of 12 questions given weekly. (2.2.5) Restate facts and details or summarize the main idea in the text to clarify and organize ideas with fewer than 5 errors out of 20 questions given weekly.

Gen. Ed. Spec. Ed. Gen. Ed. Spec. Ed.

A,B,D

A,B,D

Person(s) Responsible General Education Teacher Special Education Teacher Parent Occupational Therapist Physical Therapist Speech/Language Pathologist Hearing Impairment Specialist Vision Impairment Specialist Gen. Ed Spec. Ed. Parent OT PT SLP HI VI A. Observation

Procedures for Evaluation i. Objective Met

Progress

B. Written/Oral Response C. Performance D. Criterion Referenced Test E. Student Self Assessment F. Other (specify):

ii. Progress made, but objective not yet met iii. Little or no progress iv. Met, but not maintained v. Other (specify)

Progress will be reported on the goals form Other (Specify) Progress toward annual goals will be provided at time of report cards; or Other (Specify)

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 -- FAX (812)330-7811 IEP Page

1

Goals and Objectives
Student’s Name Annual Goal

Derek Smith The student will improve writing skills at a pre-primer level.

Identified Need: Writing

Measurable, Short-term Instructional Objectives Including Objective Criteria to be reviewed annually

Person(s) Responsible (By Title)

Procedures of Evaluation

Progress

Comments

(K.6.2) Spell independently using an understanding of the sounds of the alphabet and knowledge of letter words with fewer than 6 errors out of 24 words total. (K.4.4) Write phonetically spelled words and consonant-vowel-consonant words with fewer than 10 errors out of 40 possible given weekly.

Gen. Ed. Spec. Ed. Gen. Ed. Spec. Ed.

A,B,D

A,B,D

Person(s) Responsible General Education Teacher Special Education Teacher Parent Occupational Therapist Physical Therapist Speech/Language Pathologist Hearing Impairment Specialist Vision Impairment Specialist Gen. Ed Spec. Ed. Parent OT PT SLP HI VI A. Observation

Procedures for Evaluation i. Objective Met

Progress

B. Written/Oral Response C. Performance D. Criterion Referenced Test E. Student Self Assessment F. Other (specify):

ii. Progress made, but objective not yet met iii. Little or no progress iv. Met, but not maintained v. Other (specify)

Progress will be reported on the goals form Other (Specify) Progress toward annual goals will be provided at time of report cards; or Other (Specify)

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 -- FAX (812)330-7811 IEP Page

1

Goals and Objectives
Student’s Name Annual Goal

Derek Smith

Identified Need:

Measurable, Short-term Instructional Objectives Including Objective Criteria to be reviewed annually

Person(s) Responsible (By Title)

Procedures of Evaluation

Progress

Comments

Person(s) Responsible General Education Teacher Special Education Teacher Parent Occupational Therapist Physical Therapist Speech/Language Pathologist Hearing Impairment Specialist Vision Impairment Specialist Gen. Ed Spec. Ed. Parent OT PT SLP HI VI A. Observation

Procedures for Evaluation i. Objective Met

Progress

B. Written/Oral Response C. Performance D. Criterion Referenced Test E. Student Self Assessment F. Other (specify):

ii. Progress made, but objective not yet met iii. Little or no progress iv. Met, but not maintained v. Other (specify)

Progress will be reported on the goals form Other (Specify) Progress toward annual goals will be provided at time of report cards; or Other (Specify)

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 -- FAX (812)330-7811 IEP Page

1

Goals and Objectives
Student’s Name Annual Goal

Derek Smith

Identified Need:

Measurable, Short-term Instructional Objectives Including Objective Criteria to be reviewed annually

Person(s) Responsible (By Title)

Procedures of Evaluation

Progress

Comments

Person(s) Responsible General Education Teacher Special Education Teacher Parent Occupational Therapist Physical Therapist Speech/Language Pathologist Hearing Impairment Specialist Vision Impairment Specialist Gen. Ed Spec. Ed. Parent OT PT SLP HI VI A. Observation

Procedures for Evaluation i. Objective Met

Progress

B. Written/Oral Response C. Performance D. Criterion Referenced Test E. Student Self Assessment F. Other (specify):

ii. Progress made, but objective not yet met iii. Little or no progress iv. Met, but not maintained v. Other (specify)

Progress will be reported on the goals form Other (Specify) Progress toward annual goals will be provided at time of report cards; or Other (Specify)
Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 -- FAX (812)330-7811 IEP Page

1

Goals and Objectives
Student’s Name Annual Goal

Derek Smith

Identified Need:

Measurable, Short-term Instructional Objectives Including Objective Criteria to be reviewed annually

Person(s) Responsible (By Title)

Procedures of Evaluation

Progress

Comments

Person(s) Responsible General Education Teacher Special Education Teacher Parent Occupational Therapist Physical Therapist Speech/Language Pathologist Hearing Impairment Specialist Vision Impairment Specialist Gen. Ed Spec. Ed. Parent OT PT SLP HI VI A. Observation

Procedures for Evaluation i. Objective Met

Progress

B. Written/Oral Response C. Performance D. Criterion Referenced Test E. Student Self Assessment F. Other (specify):

ii. Progress made, but objective not yet met iii. Little or no progress iv. Met, but not maintained v. Other (specify)

Progress will be reported on the goals form Other (Specify) Progress toward annual goals will be provided at time of report cards; or Other (Specify)

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 -- FAX (812)330-7811 IEP Page

1

Goals and Objectives
Student’s Name Annual Goal

Derek Smith

Identified Need:

Measurable, Short-term Instructional Objectives Including Objective Criteria to be reviewed annually

Person(s) Responsible (By Title)

Procedures of Evaluation

Progress

Comments

Person(s) Responsible General Education Teacher Special Education Teacher Parent Occupational Therapist Physical Therapist Speech/Language Pathologist Hearing Impairment Specialist Vision Impairment Specialist Gen. Ed Spec. Ed. Parent OT PT SLP HI VI A. Observation

Procedures for Evaluation i. Objective Met

Progress

B. Written/Oral Response C. Performance D. Criterion Referenced Test E. Student Self Assessment F. Other (specify):

ii. Progress made, but objective not yet met iii. Little or no progress iv. Met, but not maintained v. Other (specify)

Progress will be reported on the goals form Other (Specify) Progress toward annual goals will be provided at time of report cards; or Other (Specify)

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 -- FAX (812)330-7811 IEP Page

1

Goals and Objectives
Student’s Name Annual Goal

Derek Smith

Identified Need:

Measurable, Short-term Instructional Objectives Including Objective Criteria to be reviewed annually

Person(s) Responsible (By Title)

Procedures of Evaluation

Progress

Comments

Person(s) Responsible General Education Teacher Special Education Teacher Parent Occupational Therapist Physical Therapist Speech/Language Pathologist Hearing Impairment Specialist Vision Impairment Specialist Gen. Ed Spec. Ed. Parent OT PT SLP HI VI A. Observation

Procedures for Evaluation i. Objective Met

Progress

B. Written/Oral Response C. Performance D. Criterion Referenced Test E. Student Self Assessment F. Other (specify):

ii. Progress made, but objective not yet met iii. Little or no progress iv. Met, but not maintained v. Other (specify)

Progress will be reported on the goals form Other (Specify) Progress toward annual goals will be provided at time of report cards; or Other (Specify)

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 -- FAX (812)330-7811 IEP Page

1

Derek Smith
Special Education Services/Least Restrictive Environment Any potentially harmful effects of the recommendations must be considered. Services considered and rejected (indicate reasons)

The IEP team has considered both full-time and part-time services, but full-time services would be too restrictive of an environment.

Services recommended (indicate reasons; location, frequency and length)

The IEP team recommends part-time services in a resource setting. These would be held 5 days a week for 1 hour per day.

Related Services

(Note intensity, frequency and location of services) week month _____ direct, integrated in classroom & community _____consultation _____ other (specify)________________ _____ direct, integrated in classroom & community _____consultation _____ other (specify)________________ Transportation: Attach Transportation Form.

_____Occupational therapy for a minimum of _____ minutes each

_____Physical therapy for a minimum of _____ minutes each Social Worker Other

week

month

Supplementary aids and services/and/or other factors relevant to proposed services:

NA

Date for Initiation of Services (on or about):

March 4, 2008

,

ending date (on or about)

March 3, 2009

following regular school calendar.

Teacher of Record:

Jaclyn Bober

Other Teachers of Record for Secondary Disabilities

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 -- FAX (812)330-7811 Case Conference Summary Page

4

Derek Smith 08/09 Recommended Participation in Statewide or District standardized testing for the _______________ school year.
Indiana MCCSC This student is not in a standardized testing mandated grade level. This student will fully participate in the standardized testing program without accommodations. This student will not participate in the standardized testing program (Specify reasons below). This student will fully participate in the standardized testing program with accommodations (Specify below). This student will participate in the standardized testing program for diagnostic purposes. This student will be subject to remediation. This student will be subject to retesting. This student will need the following testing accommodations (Specify):

The student will receive 50% extra time, orally read tests (except in reading comprehension) and a calculator.
This student’s essential skills will be tested using an alternate assessment (Specify, including why the statewide or district assessment is not appropriate and how the student will be assessed):

Is extended school year recommended?

YES

NO

If yes, committee must document the degree of regression; amount of time for recoupment; and the extraordinary, irretrievable educational, emotional or vocational reversals.

If yes, describe the nature of the interventions, include interventions parents can provide to meet student’s needs.

Name(s) of person(s) who will submit a written opinion. NA X

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 -- FAX (812)330-7811 Case Conference Summary

5

Student Name: School:

Derek Smith Wildrose Elementary

Parent Permission for Special Education Services

You have the right to request a case conference and/or revoke your written permission for services at any time. If you are prepared to decide at this time, please sign on one of the lines below.

I/we agree with the services recommended and give permission for the plan to be implemented:

Parent Signature

Date

Student Signature (If 18)

Date

I/we do not agree with the services recommended.

Parent Signature

Date

Student Signature (If 18)

Date

Parental Rights have been explained and provided: Parent Initials

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 -- FAX (812)330-7811 Case Conference Summary

6

Modifications/Accommodations/Supports to Meet Educational Needs
Derek Smith
Pacing ✔ Allow more time Vary activity often Allow breaks Avoid timed/pressure situations Other: Environment Preferential seating Planned seating: Bus Classroom Lunchroom Auditorium Alter physical room arrangement Define areas concretely ✔ Reduce/minimize distractions: Visual Auditory ✔ Spatial Movement Provide opportunity for separate seating Teach positive rules for use of space Other: Presentation of Subject Matter Teach to student’s learning style Visual Auditory Model Tactile Multi Experiential Learning Review prior to presenting new materials Individual/small group instruction Utilize alternate specialized curriculum Tape lectures/discussions for replay Utilize manipulatives Emphasize critical information Pre-teach vocabulary Make/use vocabulary files Oral reading on voluntary basis only ✔ Provide study guides/outlines Encourage feedback from student to check for learning Other: Materials Arrangement of material on page Taped tests and/or other class materials Highlighted tests/study guides Notetaking assistance: carbonless or xerox copy of notes of regular students, copy of notes from board provided Large print/graph paper/lined paper ✔ Special Equipment: Word processor Calculator ✔ Computer Math facts sheet Assignments Give directions in small, distinct steps (written/picture/verbal) Use written backup for oral directions Read or tape record directions to student ✔ Adjust difficulty level Shorten assignment/fewer items on page Reduce paper and pencil tasks ✔ Give extra cues or prompts Allow student to record/type or dictate assignment Avoid penalizing for spelling errors/ sloppy papers/penmanship Student should use cursive/printing Other: Self Management/Follow Through Visual daily schedule Calendars ✔ Daily/Weekly assignment sheets Check often for understanding/review Request parent reinforcement ✔ Have student repeat directions Encourage use of notebook with dividers, or file folders, for organization Use student sheets to organize material Design/write/use long term assignment timelines Plan for generalization Develop organized routine ✔ Schedule regular communication/ reports between home and school Other: Student Assessment Oral/taped responses Short answer Taped responses Multiple choice Modify time frame ✔ Read test to student Shorten length Extend time frame ✔ Consider individual progress over time Consider effort Alternative assessment Test administered by: calculator ✔ Other: Social Interaction Supports Peer/cross age tutoring Structure activities to create opportunities of social interaction Focus on social process rather than activity/end product Partial participation Cooperative learning groups Other: Motivation and Reinforcement Verbal Non-verbal Positive reinforcement ✔ Concrete reinforcement Planned motivating sequences of activities Reinforce initiation Offer choices ✔ Use strengths/interests often ✔ Reinforce approximation Response cost Other:

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401 (812)349-4756 or (812)349-4757 -- FAX (812)330-7811 Case Conference Summary

7

Master your semester with Scribd & The New York Times

Special offer for students: Only $4.99/month.

Master your semester with Scribd & The New York Times

Cancel anytime.