Name of Student (Last, First): Young Tyler

Individual Student General Supervision File Review Checklist

2017-2018 Revised 10-11-2017
Reviewed by Kendra Carlson
District Idaho Falls School District #91 School A.H. Bush Elementary School
Date of Birth 5/6/2008 Grade 04
Category of Eligibility Specific Learning Disability LEP Yes No
Current Eligibility Report Date 12/10/2015 Current Annual IEP Date 11/7/2017
Secondary Transition Student Yes No Preschool Student Yes No
Please refer to the directions for additional guidance on each item.

Item Yes No NA

Evaluation/Eligibility
Written Notice or Parental Consent for Initial Assessment was obtained prior to
1. administrating assessments or evaluation on initial evaluation. (IDEA 300.9 and 300.300 AND X
300.503).

Reviewer Comments 1:
Documentation of consent for Reevaluation OR reasonable attempts is present for
2. a 3-year re-evaluation. OR Documentation of written notice for a reevaluation X
consisting only of a review of existing new data (IDEA 300.9 and 300.503).
Reviewer Comments 2:
Eligibility was determined by a team (all required participants), including the
3. X
parent. (Title I B 614 (d)(1)(b))
Reviewer Comments 3:
A comprehensive evaluation was conducted and all areas of concern identified on
4. X
the Consent for Assessment are reflected in the Eligibility Report. (300.503(b)(3))
Reviewer Comments 4:
Eligibility Category
☐ Autism Spectrum Disorder ☐ Hearing Impairment ☒ Specific Learning Disability
☐ Deaf-Blindness ☐ Intellectual Disability ☐ Speech/Language Impairment:
Language
☐ Deafness ☐ Multiple Disabilities ☐ Speech/Language Impairment: Speech
5. ☐ Developmental Delay ☐ Orthopedic Impairment ☐ Traumatic Brain Injury
☐ Emotional Disturbance ☐ Other Health Impairment ☐ Visual Impairment including blindness
Evaluations and Assessment show that the student meets the State eligibility
criteria for disability category identified (IDEA 300.304(c)(4), 300.306(c)(i)-(ii). X
☒ Check box for SLD eligibility and complete SLD checklist
Reviewer Comments 5:

6. Eligibility Report appropriately addresses adverse effect. X

Reviewer Comments 6:
Name of Student (Last, First): Young Tyler

Item Yes No NA
7. Eligibility Report appropriately addresses need for specially designed instruction. X
Reviewer Comments 7:
Limited English Proficiency: A language proficiency score was obtained and
8. X
appropriate assessments were selected based on the student’s level of proficiency.
Reviewer Comments 8:

Individualized Education Program

IEP Team Members in attendance:
☐ Student (if and ☒ Parent or ☒ School District ☒ General ☒ Special
9. when appropriate) Guardian Administrator or Education Education Teacher X
(IDEA 300.321(a)(7) and (IDEA 300.321(b)(1) Designee Teacher (IDEA 300.321(a)(3)
(300.321(b)(1) (IDEA 300.321.(a)(4)(i)-(iii) (IDEA 300.321(a)(2)

Reviewer Comments 9. Comments:

IEP includes appropriate Present Levels of Academic Achievement and Functional
10. Performance (PLAAFP) and Appropriate corresponding Goal(s). Please see criteria X
checklist below:
Present Level(s) of Academic Achievement and Functional Performance (PLAAFP) and Goal Aligned to that PLAAFP
Each skill area will have a corresponding goal(s). Checked boxes indicate criteria was met:
Skill Area ☒ Strength and needs of the child (IDEA 3000.324(a)(i). ☒ Disability affects involvement in general ed. (IDEA 300.320(a)(1)(i)
☒ Baseline ☒ Condition e.g. ☒ Targeted Skill ☒ Criteria or ☒ Procedure ☒ Schedule – ☒ References an
Annual Goal (IDEA When given, or
300.324(a)(iii) During
or behavior Level of 300.320(a)(3)(i) daily, weekly, acceptable Idaho Standard
Performance monthly
300.320(a)(3)(i)

Skill Area ☒ Strength and needs of the child (IDEA 3000.324(a)(i). ☒ Disability affects involvement in general ed. (IDEA 300.320(a)(1)(i)
☒ Baseline ☒ Condition e.g. ☒ Targeted Skill ☒ Criteria or ☒ Procedure ☒ Schedule – ☒ References an
Annual Goal (IDEA When given, or
300.324(a)(iii) During
or behavior Level of 300.320(a)(3)(i) daily, weekly, acceptable Idaho Standard
Performance monthly
300.320(a)(3)(i)

Skill Area ☐ Strength and needs of the child (IDEA 3000.324(a)(i). ☐ Disability affects involvement in general ed. (IDEA 300.320(a)(1)(i)
☐ Baseline ☐ Condition e.g. ☐ Targeted Skill ☐ Criteria or ☐ Procedure ☐ Schedule – ☐ References an
Annual Goal (IDEA When given, or
300.324(a)(iii) During
or behavior Level of 300.320(a)(3)(i) daily, weekly, acceptable Idaho Standard
Performance monthly
300.320(a)(3)(i)

Reviewer Comments 10. Comments:

11. IEP includes a statement about Written Progress Reports (IDEA 300.320(a)(3)(i)) . X
Reviewer Comments 11:

12. The IEP includes a description of the special education and related services being
X
provided to the student including: Please see criteria checklist below:
Checked boxes indicate criteria was met:
Service 1
☒ Special Education and/or ☐ Title of Professional Staff ☒ Frequency of ☒ Location ☒ Start date ☒ End date
Related Service IDEA 3000.320(a)(4) Responsible IDEA 300.320(a)(4) service 300.320(a)(7) 300.320(a)(7) 300.320(a)(7) 300.320(a)(7)
Service 2
☒ Special Education and/or ☐ Title of Professional Staff ☒ Frequency of ☒ Location ☒ Start date ☒ End date
Related Service IDEA 3000.320(a)(4) Responsible IDEA 300.320(a)(4) service 300.320(a)(7) 300.320(a)(7) 300.320(a)(7) 300.320(a)(7)
Service 3
☐ Special Education and/or ☐ Title of Professional Staff ☐ Frequency of ☐ Location ☐ Start date ☐ End date
Related Service IDEA 3000.320(a)(4) Responsible IDEA 300.320(a)(4) service 300.320(a)(7) 300.320(a)(7) 300.320(a)(7) 300.320(a)(7)
Service 4
☐ Special Education and/or ☐ Title of Professional Staff ☐ Frequency of ☐ Location ☐ Start date ☐ End date
Related Service IDEA 3000.320(a)(4) Responsible IDEA 300.320(a)(4) service 300.320(a)(7) 300.320(a)(7) 300.320(a)(7) 300.320(a)(7)
 Name of Student (Last, First): Young Tyler

Item Yes No NA
Service 5
☐ Special Education and/or ☐ Title of Professional Staff ☐ Frequency of ☐ Location ☐ Start date ☐ End date
Related Service IDEA 3000.320(a)(4) Responsible IDEA 300.320(a)(4) service 300.320(a)(7) 300.320(a)(7) 300.320(a)(7) 300.320(a)(7)
Reviewer Comments 12: Missing title of professional staff responsible for providing service.
13. Services show a direct relationship to other components of the IEP. X
Reviewer Comments 13:
The IEP team has explained the extent, if any, to which a student will not
14. participate in general education and has provided a rationale for that placement X
decision (IDEA 300.320(a)(5).
Reviewer Comments 14:
The Least Restrictive Environmental Code is reflective of the time documented on
15. X
the IEP service grid. 300.320(a)(5)
Reviewer Comments 15:
When applicable, ESY is addressed as a consideration and services are identified in
16. X
the IEP (IDEA 300.106).
Reviewer Comments 16:
When behavior impedes student’s learning or the learning of others, it is
17. addressed in the IEP. (Positive behavior supports incorporated within the IEP or X
Behavior Intervention Plan attached) 34 CFR 300.324(a)(2)(i) and 300.530(d)(1)(i)
Reviewer Comments 17:
IEP lists accommodations/adaptations the student requires to be involved and
18. make progress in the general education curriculum to the maximum extent X
possible. (IDEA 300.320(a)(4)(i)-(ii) & 300.320(a)(6)(i) .
Reviewer Comments 18:
Participation is addressed for each individual statewide assessment. (IDEA
19. X
300.320(a)(6)(i)).

Reviewer Comments 19: Not specified for Science

Written Notice was provided and included an explanation for all required
20. x
components related to the contents of the IEP. 34 CFR 300.503(b)(6) 34 CFR 300.503(b)(7) .

Reviewer Comments 20:

Additional Comments:

If you identified this student as a Secondary Transition Student, a Preschool Student, or a student with a
Specific Learning Disability please fill out the relevant additional checklist.