Permission to Evaluate s1

Case Study- Student Name: Harley D Preparer Name: Mary Jones

INDIVIDUALIZED EDUCATION PROGRAM (IEP) (Adapted for I-13 Training)

Student’s Name: Harley D. IEP Team Meeting Date (mm/dd/yy): September 5, 2008 IEP Implementation Date (Projected Date when Services and Programs Will Begin): Sept. 15, 2008 Anticipated Duration of Services and Programs: Sept. 14, 2009 Date of Birth: 3-15-1995 Age: 13.5

8th Grade: Anticipated Year of Graduation: 2016 Local Education Agency (LEA): Sample- not needed County of Residence: NA Other Information:

IEP TEAM/SIGNATURES

The Individualized Education Program team makes the decisions about the student’s program and placement. The student’s parent(s), the student’s special education teacher, and a representative from the Local Education Agency are required members of this team. Signature on this IEP documents attendance, not agreement.

Role Printed Name Signature Parent/Guardian/Surrogate Mr. D Mr. D Parent/Guardian/Surrogate Mrs. D Mrs. D Student* Harley Harley Regular Education Teacher** J buck J buck Special Education Teacher L long L long Local Ed Agency Rep R Thomson R Thomson Career/Tech Ed Rep*** Community Agency Rep Teacher of the Gifted**** Speech and Language Clinician H. Davidson H. Jones

1 NOTE: This is NOT an official IEP form! The July 2008 IEP Form has been shortened, and Sections IV, VII, VIII removed, for Indicator 13 Training only! Case Study- Student Name: Harley D Preparer Name: Mary Jones

Occupational Therapist J Richards J Richards Guidance Counselor P. Barnum P. Barnum

* The IEP team must invite the student if transition services are being planned or if the parents choose to have the student participate. ** If the student is, or may be, participating in the regular education environment *** As determined by the LEA as needed for transition services and other community services **** A teacher of the gifted is required when writing an IEP for a student with a disability who also is gifted. One individual listed above must be able to interpret the instructional implications of any evaluation results.

Transfer of Rights at Age of Majority

For purposes of education, the age of majority is reached in Pennsylvania when the individual reaches 21 years of age. Likewise, for purposes of the Individuals with Disabilities Education Act, the age of majority is reached for students with disabilities when they reach 21 years of age.

I. SPECIAL CONSIDERATIONS THE IEP TEAM MUST CONSIDER BEFORE DEVELOPING THE IEP. ANY FACTORS CHECKED AS “YES” MUST BE ADDRESSED IN THE IEP.

Is the student blind or visually impaired? Yes The IEP must include a description of the instruction in Braille and the use of Braille unless the IEP team determines, after an evaluation of the student’s reading and writing skills, needs, and appropriate reading and writing media (including an evaluation of the student’s future needs for instruction in Braille or the use of Braille), that instruction in Braille or the use of Braille is not appropriate for the student. x No

Is the student deaf or hard of hearing? Yes The IEP must include a communication plan to address the following: language and communication needs; opportunities for direct communications with peers and professional personnel in the student’s language and communication mode; academic level; full range of needs, including opportunities for direct instruction in the student’s language and communication mode; and assistive technology devices and services. Indicate in which section of the IEP these considerations are addressed. The Communication Plan must be completed and is available at www.pattan.net x No

Does the student have communication needs? 2 NOTE: This is NOT an official IEP form! The July 2008 IEP Form has been shortened, and Sections IV, VII, VIII removed, for Indicator 13 Training only! Case Study- Student Name: Harley D Preparer Name: Mary Jones

x Yes Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction (SDI), annual goals, etc.) No

Does the student need assistive technology devices and/or services? x Yes Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction, annual goals, etc.) No

Does the student have limited English proficiency? Yes The IEP team must address the student’s language needs and how those needs relate to the IEP. x No

Does the student exhibit behaviors that impede his/her learning or that of others? Yes The IEP team must develop a Positive Behavior Support Plan that is based on a functional assessment of behavior and that utilizes positive behavior techniques. Results of the functional assessment of behavior may be listed in the Present Levels section of the IEP with a clear measurable plan to address the behavior in the Goals and Specially Designed Instruction sections of the IEP or in the Positive Behavior Support Plan if this is a separate document that is attached to the IEP. A Positive Behavior Support Plan and a Functional Behavioral Assessment form are available at www.pattan.net x No

Other (specify):

II. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Include the following information related to the student:  Present levels of academic achievement (e.g., most recent evaluation of the student, results of formative assessments, curriculum-based assessments, transition assessments, progress toward current goals)  Present levels of functional performance (e.g., results from a functional behavioral assessment, results of ecological assessments, progress toward current goals)  Present levels related to current postsecondary transition goals if the student’s age is 14 or younger if determined appropriate by the IEP team (e.g., results of formative assessments, curriculum-based assessments, progress toward current goals)  Parental concerns for enhancing the education of the student  How the student’s disability affects involvement and progress in the general education curriculum  Strengths  Academic, developmental, and functional needs related to student’s disability

Harley is a 13.5 year old young man with mild cerebral palsy and moderate cognitive disability. Harley is enrolled in the district Life Skills Support program in his home school. He attends homeroom, art, music, and lunch with non-disabled peers, with assistance available from a paraeducator in those contexts. His current program focuses on developing functional academic, daily living, and social skills to enable him to participate in school, home, and community activities with increasing independence. Harley is ambulatory, with an unusual gait which becomes unsteady when he walks on uneven surfaces or in crowded locations. He is able to handle and carry some materials, but experiences difficulty with small items such as scissors or other small tools, and with manipulating pieces of paper or turning pages. He uses a backpack or long handled bag to carry his books, lunch, and other school items. He requires the assistance of a paraeducator to manipulate some materials, and for help with lunch and some personal care routines in school. Harley is persistent in his desire to be independent; he tries most tasks himself and uses accommodations whenever he can. He resists the assistance of the paraeducator in many instances.

Previous testing has established Harley’s decoding skill at a 1.5 level. He is able to correctly read 44 words per minute from first grade passages, and based on his progress, will be moving to second grade passages. In the context of classroom activities, he is able to read about 45 sight words with 100% accuracy. Given environmental cues, he demonstrates 85% accuracy with these words around the building and on in community based instruction (at the local grocery store, mall, and bowling center). When presented with unfamiliar words, he often guesses. When prompted to “sound it out”, Harley begins to decode by making the initial sound or sounds, which usually results in a correct guess in context. Harley needs to work on utilizing his reading skills in this manner.

Harley signs his name with a pen (his preference is a felt tip pen) with foam grip, although laboriously. In this manner, he produces a consistent, legible signature. He utilizes a self-inked name stamp (of his own signature) to mark his papers, but requires prompting to use it in 50% of presented opportunities. He is working on recognizing cues in situations in which “quick” is more functional for signing his name. Harley is able to type his name, and copy words or short (3-7 word) sentences from a page to a talking word processor program with 90% accuracy. He uses a 4 NOTE: This is NOT an official IEP form! The July 2008 IEP Form has been shortened, and Sections IV, VII, VIII removed, for Indicator 13 Training only! Case Study- Student Name: Harley D Preparer Name: Mary Jones joystick (positioned at midline on a non-slip surface), but has difficulty using a standard mouse, Using a graphics based word processor (Clicker), Harley can click (using joystick) on words and sentences to generate a journal entry or daily schedule. He independently puts on headphones when using the computer in the classroom and in the computer lab. When a touchscreen is available, he is able to activate a target ( ≤ ¾”) with his right index finger. He enjoys using the computer for these tasks as well as for games, alone and with peers.

Results of the Centered Career Education, Competency Rating Scale-Modified indicate that Harley is able to count items up to 100 with 95% accuracy; his errors in counting are caused by his lack of dexterity rather than by his counting ability. He can count by fives, tens, and by 25. Harley can make change using quarters and dollar bills for amounts up to ten dollars. He needs to experience managing amounts using larger bills as well as smaller change. Harley’s parents have helped him open a bank account with an ATM card. On community shopping trips, he can swipe the card independently, and withdraw ten or twenty dollars. He does not currently keep a record of his balance or withdrawals. Harley has reportedly earned small sums at home for doing chores (such as taking care of pets and emptying trash). His use of the ATM, however, has not yet been connected to these tasks.

Due to his physical disability, Harley’s speech is somewhat slow, but intelligible to familiar and many unfamiliar listeners. His articulation is correct. Harley is extremely sociable. He introduces himself to visitors at school, and is able to initiate appropriate interactions in the community. Due to his enthusiasm and outgoing nature, Harley often interrupts others. This often results in his missing task instructions or failing to answer questions. The speech/language clinician has implemented a number of visual strategies to provide Harley with cues to listen and respond, which have been effective in routine context such as homeroom. In addition, visual cues have been helpful to remind Harley to monitor his volume during assemblies and in certain community situations (e.g. movies, museum). He needs to continue to increase his awareness in these areas. Harley is well liked by other students. He has many acquaintances at school, and many students who greet him in the halls. However, there is only one non-disabled boy who would qualify as a friend. Thomas lives nearby and has known Harley since Kindergarten. Harley sits with Thomas and his other friends at lunch, and Thomas occasionally invites Harley to a movie or to to play video games at his home.

Harley is competent in self-feeding skills for finger foods. He scoops with a spoon with minimal spilling (depending on texture), and spears with a fork, although he is slow and often messy. He needs reminders to chew with his mouth closed. He also needs to work on monitoring his appearance for spills and dropped food particles while eating, and to request assistance when needed.

Harley has become more independent in self care routines. He appropriately requests to use the restroom in school and in familiar community destinations. He requires assistance with some door handles and at times with his clothing. Because he dislikes unsolicited “help”, he has been taught to request and decline assistance appropriately, by saying “Mr. N, I need help. Will you open this, please.”, or “Mr. I can do this, thank you.” He has used these prompt to engage others to help in 55% of presented opportunities during a week of data collection. In 45% of opportunities, staff used verbal prompts to remind Harley how to interact appropriately for maximum independence. In initial trials, Harley required prompts in 85% of opportunities. Harley is independent in tooth brushing, and needs to be introduced to the steps in using an electric shaver safely.

Harley is able to participate in simple meal preparation (scheduled twice weekly) in class. Harley is able to measure ingredients using whole-, half- and quarter- cups, tablespoons, and teaspoons accurately. The OT has provided built-up handles to make the stirring and measuring implements

5 NOTE: This is NOT an official IEP form! The July 2008 IEP Form has been shortened, and Sections IV, VII, VIII removed, for Indicator 13 Training only! Case Study- Student Name: Harley D Preparer Name: Mary Jones easier for Harley to handle.; smaller tools are more difficult for him, He is able to turn on a blender using the standard buttons with prompting, and can operate a microwave in typical fashion, also with verbal prompts, Harley requires some physical assistance with an electric can opener.

Harley’s class performs a variety of office support duties for the school. Harley uses an electric stapler and has utilized a single switch (with Power Link) to operate electric scissors and other small appliances (e.g. small shredder), when the on/off switch is difficult for him. He requires consistent verbal prompting in the use of these tools.

Harley’s parents have indicated that they want their son to continue to increase his independence in functional tasks. They intend to increase his chore responsibilities at home and institute an allowance. They have asked for assistance in determining what kinds of jobs would be appropriate for Harley in the future, given his lack of manual dexterity and balance. In addition, they would like to see Harley gain independent mobility skills in the community. He currently rides a small van to school; his parents transport him to other activities and supervise him closely.

Results of the Reading Free Interest Inventory indicate that Harley’s highest occupational interest levels were in the areas of animal care and clerical/ personal care. Via guidance counselor interview, Harley confirmed his interest in caring for animals. Harley has several pets at home that he helps care for. Harley also expressed that he likes using computers.

Utilizing the Life Centered Career Education, Competency Rating Scale-Modified, Harley scored either “not competent” or “partially competent” on the first 7 items relating to exploring job opportunities. It should be noted that this is baseline date and is reflective of Harley’s initial exposure to transition planning. In addition,

In interviews with his teacher and guidance counselor, Harley has expressed interest in animal care and in computers. Howerver, when asked about future jobs, he does not yet express specific plans. His older sister is in college, but when asked about college, Harley says he does not know or that he can’t drive yet. Harley needs to begin to explore awareness possibilities and job experiences.

Harley has a case manager from his local MH/MR Base Service Unit (Office of Developmental Programs). His parents report that they have met with the supports coordinator at the base service unit and have initiated conversations about future independent living needs.

Harley’s disability limits his ability to engage in the general curriculum

Strengths: Social skills in context of familiar school and community routines School and community sight word reading Addition, subtraction skills by fives, tens up to 100 Self care skills Use of adaptations in school tasks (e.g. built-up pens, adapted kitchen tools, computer joystick or touch screen, signature stamp) Persistence with unfamiliar or difficult tasks

Needs:  Strengthen and utilize decoding skills when presented with new words in functional contexts  Improve money management skills  Listen and respond appropriately without interruption  Monitor voice volume relative to environment (school/community)  Appropriately request assistance for self care when needed.  Develop “work-related” skills (e.g. taking direction, completing tasks in a timely manner with reduction of prompts) in school-based work experience activities.  Refine use of assistive technology and the computer.  Explore job/career interests  Continue occupational therapy to address self help and eating skills.  Continue speech therapy in small group or at least on a consult basis to address interpersonal communication skills.  Begin to explore travel training for the future.

III. TRANSITION SERVICES – This is required for students age 14 or younger if determined appropriate by the IEP team. If the student does not attend the IEP meeting, the school must take other steps to ensure that the student’s preferences and interests are considered. Transition services are a coordinated set of activities for a student with a disability that is designed to be within a results oriented process, that is focused on improving the academic and functional achievement of the student with a disability to facilitate the student’s movement from school to post school activities, including postsecondary education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation that is based on the individual student’s needs taking into account the student’s strengths, preferences, and interests.

POST SCHOOL GOALS – Based on age appropriate assessment, define and project the appropriate measurable postsecondary goals that address education and training, employment, and as needed, independent living. Under each area, list the services/activities and courses of study that support that goal. Include for each service/activity the location, frequency, projected beginning date, anticipated duration, and person/agency responsible.

For students in Career and Technology Centers, CIP Code:

Postsecondary Education and Training Goal: Working Skills Training during Supported Employment Measurable Annual Goal Yes/No (Document in Section V)

Courses of Study: Reading instruction at grade level, emphasis on decoding skills Functional reading instruction based on worksite identifying work-related terms Functional math instruction focusing on counting large quantities of items as well as money management Projected Courses of Study: ( Must List)

Projected Anticipated Person(s)/Agency Service/Activity Location Frequency Beginning Date Duration Responsible Special Education Special Education Self-advocacy Training Daily 9-15-08 6-15-09 Classroom Teacher Minimum of Special Education Special Education Create Transition Portfolio once a week 10-1-08 6-15-09 Classroom Teacher until completed Employment Goal: Supported employment that allows Harley to work to his maximum stamina and incorporates the use of assistive technology Measurable Annual Goal Yes/No (Document in Section V)

Courses of Study: Functional Academics and communication, Career awareness/exploration Computer I Class (keyboarding skills) Career Class Projected Courses of Study: ( Must List) Projected Anticipated Person(s)/Agency Service/Activity Location Frequency Beginning Date Duration Responsible Career exploration in the areas of General Education 3x per 6 day General Education animal care and computer 9-15-08 6-15-09 Classroom cycle Teacher opportunities Participate in tour and explore Special Career & Technical opportunities at Career & Technical 1x Spring semester 5-29-08 Education/Guidance Institute Institute Counselor

Independent Living Goal, if appropriate: Agency Support – Will access community resources and programs with Measurable Annual Goal family and agency support Yes/No

(Document in Section V)

Courses of Study: Family & Consumer Science Class with an emphasis on Food Preparation Functional Academic Curriculum focusing on self-help, feeding & daily living skills Career Class Projected Courses of Study: ( Must List)

Projected Anticipated Person(s)/Agency Service/Activity Location Frequency Beginning Date Duration Responsible Participate in experiences such as Special Education food preparation, laundry & Special Education Class Weekly 9-15-2008 9-14-2009 Teacher cleaning Special Education Participate in CBI trips Community Bi-monthly 9-15-2008 9-14-2009 Teacher

V. GOALS AND OBJECTIVES – Include, as appropriate, academic and functional goals. Use as many copies of this page as needed to plan appropriately. Specially designed instruction may be listed with each goal/objective or listed in Section VI.

Short term learning outcomes are required for students who are gifted. The short term learning outcomes related to the student’s gifted program may be listed under Goals or Short Term Objectives.

MEASURABLE ANNUAL GOAL Describe HOW the Describe WHEN periodic Include: Condition, Name, Behavior, and Criteria student’s progress toward reports on progress will be Report of Progress (Refer to Annotated IEP for description of these meeting this goal will be provided to parents components) measured

Given weekly role playing situations and a script Documentation & review Quarterly Mailed home to parents in the life skills support class, Harley will of chart describe his disability and ask for accommodations 5/5 times over 5 consecutive weeks. Standards Addressed: 1.1.8.D Assess reading strategies that were most effective 1.4.8.D Maintain a record of activities 1.6.8.A, B, C, D, E speaking and asking questions

Given banking documents (deposit slips, balance Teacher-made rubric for Quarterly Mailed home to parents sheet, withdraw slips), Harley will keep record of grading check book, transactions by calculating through addition and deposit/withdraw slips subtraction with 100% accuracy, 5 out of 5 trials and balance sheets for three consecutive weeks. Reference to Alternate Standards: 2.2. Computation and Estimation G. Count, compare and make change using a collection of coins and onedollar bills. (up to 99) H. Apply estimation strategies to a variety of problems including time and money.

While utilizing the internet, Harley will identify, Review of teacher-made Quarterly Mailed home to parents research and present information (education rubric and/or training required, salary, job market) on animal care and computer opportunities weekly throughout the school year until report/presentation is completed. Reference to Career Education and Work Standards: 13.1Career Awareness and Preparation: Abilities and Aptitudes, Personal Interests, Non-Traditional Workplace Roles, Local Career Preparation Opportunities, Career Selection Influences, Preparation for Careers, Career Plan Component, Relationship between Education and Career

Following a demonstration (food preparation, Review of teacher-made Quarterly Mailed home to parents laundry or cleaning), Harley will accurately rubric perform the task with 100% accuracy on 4 out of 5 occasions on three consecutive bi-monthly trials as measured by a teacher-developed rubric. 13.3.8 A: Evaluate personal attitudes and work habits that support career retention and advancement 13.3.8 E: Evaluate time management strategies and their application to both personal and work situations

SHORT TERM OBJECTIVES – Required for students with disabilities who take alternate assessments aligned to alternate achievement standards (PASA).

Short term objectives / Benchmarks

VI. SPECIAL EDUCATION / RELATED SERVICES / SUPPLEMENTARY AIDS AND SERVICES / PROGRAM MODIFICATIONS – Include, as appropriate, for nonacademic and extracurricular services and activities.

A. PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION (SDI)  SDI may be listed with each goal or as part of the table below.  Include supplementary aids and services as appropriate.  For a student who has a disability and is gifted, SDI also should include adaptations, accommodations, or modifications to the general education curriculum, as appropriate for a student with a disability.

Modifications and SDI Location Frequency Projected Beginning Date Anticipated Duration Foam Grip (felt tip pen) All academic settings Daily 9/15/08 9/14/09 Self-inked name stamp of All academic settings Daily 9/15/08 9/14/09 own signature Talking word processor All academic settings Daily 9/15/08 9/14/09 program Joystick (positioned at midline on non-slip surface) All academic settings Daily 9/15/08 9/14/09 or touch screen Graphics based word All academic settings Daily 9/15/08 9/14/09 processor (clicker) Visual cues for listening & All academic settings Daily 9/15/08 9/14/09 responding Family Consumer Science At least 3 days in a 6 day Adapted kitchen tools Class & Special Education 9/15/08 9/14/09 cycle Class Single switch (Power Link) Special Education to operate electric scissors 2x per week 9/15/08 9/14/09 Classroom & other small appliances Verbal reminders to request All academic settings Daily 9/15/08 9/14/09 & decline assistance

B. RELATED SERVICES – List the services that the student needs in order to benefit from his/her special education program.

Service Location Frequency Projected Beginning Date Anticipated Duration Occupational Therapy M.S. At least 1 hr./1x month 9/15/08 9/14/09 Speech/Language Therapy M.S. At least 1 hr./ 1x week 9/15/08 9/14/09 Orientation & Mobility All classrooms, school At least 1 hr./2x a month 9/15/08 9/14/09 13 NOTE: This is NOT an official IEP form! The July 2008 IEP Form has been shortened, and Sections IV, VII, VIII removed, for Indicator 13 Training only! Case Study- Student Name: Harley D Preparer Name: Mary Jones

hallway, cafeteria, on Therapy school grounds & community Adaptive Physical Education Gymnasium 1x per week 9/15/08 9/14/09

C. SUPPORTS FOR SCHOOL PERSONNEL – List the staff to receive the supports and the supports needed to implement the student’s IEP.

School Personnel to Projected Beginning Support Location Frequency Anticipated Duration Receive Support Date Review contents of Special Education IEP & demonstrate Teacher, staff and School 1 hour meeting September 11, 2008 September 11, 2008 visual strategies & general educators assistive technology

14 NOTE: This is NOT an official IEP form! The July 2008 IEP Form has been shortened, and Sections IV, VII, VIII removed, for Indicator 13 Training only!