INDIVIDUALIZED EDUCATION PROGRAM (IEP) Students Name: INDIVIDUALIZED EDUCATION PROGRAM (IEP) Students Name: IEP Team Meeting

Date (mm/dd/yy): *nti$i ated Du"ation o+ Se"'i$es and P"og"ams: Date o+ )i"t&: *ge: /"ade: . 2nd 2023 (est 1&este" *"ea S$&oo! Dist"i$t 1&este" 1ounty P&one (3ome): P&one ((o"9): (410) 5426--17 04/1./200Peyton Manning 01/30/2014 1/31/2014 1 ,ea" (1/30/201-) School Age

IEP Im !ementation Date (P"o#e$ted Date %&en Se"'i$es and P"og"ams (i!! )egin):

*nti$i ated ,ea" o+ /"aduation: 0o$a! Edu$ation *gen$y (0E*): 1ounty o+ 2esiden$e: Ms8 Mi!!y Manning 123 Main St"eet: ;nit (est 1&este" P*8 1.370 <t&e" In+o"mation: None

Name and *dd"ess o+ Pa"ent//ua"dian/Su""ogate:

T&e 0E* and a"ent &a'e ag"eed to ma9e t&e +o!!o%ing $&anges to t&e IEP %it&out $on'ening an IEP meeting: as do$umented =y:

Date of Revi io!( )

Pa"tici#a!t $Role

IEP Sectio!( ) A%e!&e&

Page 1 of 23

December 2013

IEP TEAM$SIGNATURES T&e Indi'idua!i>ed Edu$ation P"og"am team ma9es t&e de$isions a=out t&e students "og"am and !a$ement8 T&e students a"ent(s): t&e students s e$ia! edu$ation tea$&e": and a "e "esentati'e +"om t&e 0o$a! Edu$ation *gen$y a"e "e?ui"ed mem=e"s o+ t&is team8 Signatu"e on t&is IEP do$uments attendan$e: not ag"eement8 Role Mot&e" Student 2egu!a" Edu$ation Tea$&e"@@ S e$ia! Edu$ation Tea$&e" 0o$a! Ed *gen$y 2e S ee$& T&e"a ist <$$u ationa! T&e"a ist Bision Su o"t *da ti'e P&ysi$a! Edu$ation P"i!te& Na%e Mi!!y Manning Peyton Manning *!i$ia Smit& Aen Doug&e"ty Dennis )!ue Sa"a Pin T"i$ia <Nei!! Cate Mo""is Aames * Sig!at'"e

Milly Manning
Peyton Manning

Alicia Smith
Jen Dougherty
Dennis Blue

Sara Pin
Tricia ONeill
Kate Morris
James A

@ T&e IEP team must in'ite t&e student i+ t"ansition se"'i$es a"e =eing !anned o" i+ t&e a"ents $&oose to &a'e t&e student a"ti$i ate8 @@ I+ t&e student is: o" may =e: a"ti$i ating in t&e "egu!a" edu$ation en'i"onment @@@ *s dete"mined =y t&e 0E* as needed +o" t"ansition se"'i$es and ot&e" $ommunity se"'i$es @@@@ * tea$&e" o+ t&e gi+ted is "e?ui"ed %&en %"iting an IEP +o" a student %it& a disa=i!ity %&o a!so is gi+ted8 <ne indi'idua! !isted a=o'e must =e a=!e to inte" "et t&e inst"u$tiona! im !i$ations o+ any e'a!uation "esu!ts8 ("itten in ut "e$ei'ed +"om t&e +o!!o%ing mem=e"s:

T"a! fe" of Right at Age of Ma(o"it) Do" u" oses o+ edu$ation: t&e age o+ ma#o"ity is "ea$&ed in Pennsy!'ania %&en t&e indi'idua! "ea$&es 21 yea"s o+ age8 0i9e%ise: +o" u" oses o+ t&e Indi'idua!s %it& Disa=i!ities Edu$ation *$t: t&e age o+ ma#o"ity is "ea$&ed +o" students %it& disa=i!ities %&en t&ey "ea$& 21 yea"s o+ age8

PROCEDURAL SA*EGUARDS NOTICE

I &a'e "e$ei'ed a $o y o+ t&e Procedural Safeguards Notice du"ing t&is s$&oo! yea"8 T&e Procedural Safeguards Notice "o'ides in+o"mation a=out my "ig&ts: in$!uding t&e "o$ess +o" disag"eeing %it& t&e IEP8 T&e s$&oo! &as in+o"med me %&om I may $onta$t i+ I need mo"e in+o"mation8 Signatu"e o+ Pa"ent//ua"dian/Su""ogate:

Milly Manning

MEDICAL ASSISTANCE PROGRAM +ILLING NOTICE (A##lica,le o!l) to #a"e!t -ho have co! e!te& to the "elea e of ,illi!g i!fo"%atio! to Me&ical A i ta!ce #"og"a% ) I unde"stand t&at t&e s$&oo! may $&a"ge t&e S$&oo!6)ased *$$ess P"og"am (ES)*PF)Go" any "og"am t&at "e !a$es o" su !ements t&e S)*PGt&e $ost o+ $e"tain s e$ia! edu$ation and "e!ated se"'i$es des$"i=ed in my $&i!ds IEP8 To ma9e t&ese $&a"ges to t&e S)*P: t&e s$&oo! %i!! "e!ease to t&e administ"ato" o+ t&at "og"am t&e name: age: and add"ess o+ my $&i!d: 'e"i+i$ation o+ Medi$aid e!igi=i!ity +o" my $&i!d: a $o y o+ my $&i!ds IEP: a des$"i tion o+ t&e se"'i$es "o'ided and t&e times and dates du"ing %&i$& su$& se"'i$es %e"e "o'ided to my $&i!d: and t&e identity o+ t&e "o'ide" o+ su$& se"'i$es8 I understand that such information will not be disclosed, and such charges will not be made, unless I consent to the disclosure. I a$9no%!edge t&at I &a'e "o'ided %"itten $onsent to dis$!ose su$& in+o"mation8 I unde"stand t&at my $onsent is ongoing +"om yea"6to6yea" un!ess and unti! I %it&d"a% it8 I $an %it&d"a% my $onsent in %"iting: o" o"a!!y i+ I am una=!e to %"ite: at any time8 My "e+usa! to $onsent o" my %it&d"a%a! o+ $onsent %i!! not "e!ie'e t&e s$&oo! o+ t&e o=!igation to "o'ide: at no $ost to me o" my +ami!y: any se"'i$e o" "og"am to %&i$& my $&i!d is entit!ed unde" t&e Indi'idua!s %it& Disa=i!ities Edu$ation *$t (EIDE*F) o" t&at is ne$essa"y to ena=!e my $&i!d to "e$ei'e a +"ee a "o "iate u=!i$ edu$ation as des$"i=ed in my $&i!ds IEP8 I unde"stand t&at t&e s$&oo! $annotG 2e?ui"e me o" my +ami!y to sign u +o" o" en"o!! in any u=!i$ =ene+its o" insu"an$e "og"am: su$& as Medi$aid: as a $ondition o+ "e$ei'ing a +"ee a u=!i$ edu$ation +o" my $&i!dH 2e?ui"e me o" my +ami!y to in$u" any eI ense +o" t&e "o'ision o+ a +"ee a un!ess it ag"ees to ay su$& eI enses on my o" my +ami!ys =e&a!+H 1ause a de$"ease in a'ai!a=!e !i+etime $o'e"age o" any ot&e" insu"ed =ene+itH 1ause me o" my +ami!y to ay +o" se"'i$es t&at %ou!d ot&e"%ise =e $o'e"ed =y a u=!i$ =ene+its o" insu"an$e "og"am and t&at a"e "e?ui"ed +o" my $&i!d outside t&e time t&at &e o" s&e is in s$&oo!H 2is9 t&e !oss o+ e!igi=i!ity +o" &ome and $ommunity6=ased %ai'e"s: =ased on agg"egate &ea!t&6"e!ated eI enditu"es8 "o "iate

"o "iate u=!i$ edu$ation to my $&i!d: in$!uding $o6 ayments and dedu$ti=!es:

I. SPECIAL CONSIDERATIONS T/E IEP TEAM MUST CONSIDER +E*ORE DEVELOPING T/E IEP. AN0 *ACTORS C/EC1ED AS 20ES3 MUST +E ADDRESSED IN T/E IEP. I the t'&e!t ,li!& o" vi 'all) i%#ai"e&4 ,es T&e IEP must in$!ude a des$"i tion o+ t&e inst"u$tion in )"ai!!e and t&e use o+ )"ai!!e un!ess t&e IEP team dete"mines: a+te" an e'a!uation o+ t&e students "eading and %"iting s9i!!s: needs: and a "o "iate "eading and %"iting media (in$!uding an e'a!uation o+ t&e students +utu"e needs +o" inst"u$tion in )"ai!!e o" t&e use o+ )"ai!!e): t&at inst"u$tion in )"ai!!e o" t&e use o+ )"ai!!e is not a "o "iate +o" t&e student8 No I the t'&e!t &eaf o" ha"& of hea"i!g4 ,es T&e IEP must in$!ude a $ommuni$ation !an to add"ess t&e +o!!o%ing: !anguage and $ommuni$ation needsH o o"tunities +o" di"e$t $ommuni$ations %it& ee"s and "o+essiona! e"sonne! in t&e students !anguage and $ommuni$ation modeH a$ademi$ !e'e!H +u!! "ange o+ needs: in$!uding o o"tunities +o" di"e$t inst"u$tion in t&e students !anguage and $ommuni$ation modeH and assisti'e te$&no!ogy de'i$es and se"'i$es8 Indi$ate in %&i$& se$tion o+ t&e IEP t&ese $onside"ations a"e add"essed8 T&e 1ommuni$ation P!an must =e $om !eted and is a'ai!a=!e at %%%8 attan8net No Doe the t'&e!t have co%%'!icatio! !ee& 4 ,es Student needs must =e add"essed in t&e IEP (i8e8: "esent !e'e!s: s e$ia!!y designed inst"u$tion (SDI): annua! goa!s: et$8) No Doe the t'&e!t !ee& a i tive tech!olog) &evice a!&$o" e"vice 4 ,es Student needs must =e add"essed in t&e IEP (i8e8: "esent !e'e!s: s e$ia!!y designed inst"u$tion: annua! goa!s: et$8) No Doe the t'&e!t have li%ite& E!gli h #"oficie!c)4 ,es T&e IEP team must add"ess t&e students !anguage needs and &o% t&ose needs "e!ate to t&e IEP8 No

Doe the t'&e!t e5hi,it ,ehavio" that i%#e&e hi $he" lea"!i!g o" that of othe" 4 ,es T&e IEP team must de'e!o a Positi'e )e&a'io" Su o"t P!an t&at is =ased on a +un$tiona! assessment o+ =e&a'io" and t&at uti!i>es ositi'e =e&a'io" te$&ni?ues8 2esu!ts o+ t&e +un$tiona! assessment o+ =e&a'io" may =e !isted in t&e P"esent 0e'e!s se$tion o+ t&e IEP %it& a $!ea" measu"a=!e !an to add"ess t&e =e&a'io" in t&e /oa!s and S e$ia!!y Designed Inst"u$tion se$tions o+ t&e IEP o" in t&e Positi'e )e&a'io" Su o"t P!an i+ t&is is a se a"ate do$ument t&at is atta$&ed to t&e IEP8 * Positi'e )e&a'io" Su o"t P!an and a Dun$tiona! )e&a'io"a! *ssessment +o"m a"e a'ai!a=!e at %%%8 attan8net No Othe" (s e$i+y): Peyton Manning &as a 'isua! diagnosis o+ Esot"o ia (in%a"d tu"n o+ t&e eye) and Nystagmus (in'o!unta"y eye mo'ement)8 *n eye "e o"t indi$ates t&at &e &ad St"a=ismus su"ge"y in 20058 II. PRESENT LEVELS O* ACADEMIC AC/IEVEMENT AND *UNCTIONAL PER*ORMANCE I!cl'&e the follo-i!g i!fo"%atio! "elate& to the t'&e!t6 P"esent !e'e!s o+ a$ademi$ a$&ie'ement (e8g8: most "e$ent e'a!uation o+ t&e student: "esu!ts o+ +o"mati'e assessments: $u""i$u!um6=ased assessments: t"ansition assessments: "og"ess to%a"d $u""ent goa!s) P"esent !e'e!s o+ +un$tiona! e"+o"man$e (e8g8: "esu!ts +"om a +un$tiona! =e&a'io"a! assessment: "esu!ts o+ e$o!ogi$a! assessments: "og"ess to%a"d $u""ent goa!s) P"esent !e'e!s "e!ated to $u""ent ostse$onda"y t"ansition goa!s i+ t&e students age is 14 o" younge" i+ dete"mined a "o "iate =y t&e IEP team (e8g8: "esu!ts o+ +o"mati'e assessments: $u""i$u!um6=ased assessments: "og"ess to%a"d $u""ent goa!s) Pa"enta! $on$e"ns +o" en&an$ing t&e edu$ation o+ t&e student 3o% t&e students disa=i!ity a++e$ts in'o!'ement and "og"ess in t&e gene"a! edu$ation $u""i$u!um St"engt&s *$ademi$: de'e!o menta!: and +un$tiona! needs "e!ated to students disa=i!ity

7 Level of aca&e%ic achieve%e!t6

C'""e!t G"a&e 6 Peyton is $u""ent!y on ta"get +o" meeting =en$&ma"9 t&is yea"8 I!#'t f"o% #ecial e&'catio! teache" (8e! Do'ghe"t))6 9"iti!g : Peyton $omes u %it& good %"iting to i$s8 2e$ent!y: &e $&ose to %"ite to &is +"iend )o==y +o" a +"iend!y !ette" o" $&ose to %"ite a=out 1&"istmas +o" an in+o"mationa! ie$e8 (it& t&e guidan$e o+ a g"a &i$ o"gani>e": &e is a=!e to get good ideas do%n on a e" and t"ans!ate t&em into a %"iting ie$e8 Do" %"iting: Peyton is a!!o%ed to $&oose &is o%n to i$s t&at &e is inte"ested in %&i$& "esu!ts in good %"iting8 Peyton st"ugg!es %&en it $omes to %o"ds t&at &e does not 9no% &o% to s e!!8 3e a!so &as

di++i$u!ty s a$ing &is %o"ds and %"iting on one !ine8 3is senten$e %i!! o+ten go do%n t%o o" t&"ee !ines8 3e a!so tends to +iIate on t&ings !i9e 'o$a=u!a"y %o"ds in &is "egu!a" edu$ation $!ass"oom o" t&e date: %&i$& a!!o%s &im to !ose +o$us8 *not&e" st"ugg!e o+ Peytons is t&at &is &and%"iting is !egi=!e =ut s&ou!d =e neate" =y no%8 Rea&i!g : Peyton is $u""ent!y "e$ei'ing su o"t +o" sma!! g"ou "eading at a !e'e! A8 Peytons "eading s9i!!s "ega"ding unde"standing is &ig&8 3e is a=!e to ans%e" E(3F $om "e&ension ?uestions: du"ing and a+te" "eading8 Peytons "eading +!uen$y is on t&e s!o% side: &o%e'e" &is a$$u"a$y du"ing "og"ess monito"ing is &ig& (.4J: .2J)8 Peyton uses &is magni+ying =a" to "ead =ette"8 3e a!so does %e!! %&en it $omes to un9no%n %o"ds: &e %i!! t"y to sound it out o" as9 me to de$ode t&e %o"d +o" &im on a %&ite =oa"d8 It is di++i$u!t +o" Peyton %&en &e $omes a$"oss %o"ds t&at &e is un+ami!ia" %it&: &o%e'e" i+ %e ma9e it one o+ ou" 'o$a=u!a"y %o"ds: &e memo"i>es it8 Social S;ill : Du"ing so$ia! s9i!!s: %&en Peyton de$ides to a"ti$i ate: &e is $a a=!e o+ ans%e"ing ?uestions and getting in'o!'ed in t&e g"ou 8 3o%e'e": t&e +a$t o+ =eing a"ound &is $!assmates tends to ="ing out t&e negati'e =e&a'io" in &im8 Peyton %i!! sometimes !aug& at $!assmates: mimi$ t&em: o" not ay attention at a!!8 (&en Peyton =e&a'es !i9e t&is: $onse?uen$es a"e ta9en =e$ause it usua!!y ends u t&at &e is dis"u ting &is $!assmates as %e!! as my so$ia! s9i!!s !esson8 I!#'t f"o% "eg'la" e&'catio! teache" (Alicia S%ith)6 La!g'age A"t : Peyton a"ti$i ates in t&e "egu!a" edu$ation $!ass"oom +o" a"ts o+ !anguage a"ts (%o"d study and guided "eading)8 (it& assistan$e: Peyton is a=!e to identi+y and so"t +o" t&e di++e"ent $atego"ies o+ %o"ds in %o"d study ea$& %ee98 3is test s$o"es in %o"d study "ange +"om 716 .5 +o" units 22624 in P"o#e$t 2ead8 In guided "eading: Peyton $an "ead inde endent!y at !e'e! AH &o%e'e": +!uen$y is di++i$u!t +o" &im: e'en %it& t&e =a" magni+ie"8 KK %i!! o+ten sto mid senten$e to te!! a=out a %o"d atte"n o" somet&ing e!se &e noti$ed %&i!e "eading: %&i$& a!so in&i=its "eading +!uen$y8 (&en gi'en a set o+ $om "e&ension ?uestions: Peyton ans%e"s $o""e$t!y most o+ t&e time8 Du"ing =oo9 dis$ussions %it& a sma!! g"ou : &e %i!! a"ti$i ate i+ "om ted8 3e $an ans%e" some !ite"a! ?uestions i+ di"e$ted to t&e teIt: as %e!! as in+e"entia! t&in9ing and ?uestions t&at "e?ui"e &im to synt&esi>e in+o"mation +"om di++e"ent !a$es in t&e teIt8 Math 7 Peyton a"ti$i ates in t&e "egu!a" edu$ation $!ass"oom +o" mat&8 (it& su o"t: &e is a=!e to add and su=t"a$t one and t%o digit num=e"s %it& and %it&out "eg"ou ing a$$u"ate!y using st"ategies taug&t in $!ass8 Peyton sti!! needs some su o"t %it& ot&e" $on$e ts and mat& te"mino!ogy8 Do" eIam !e: de$om osing 3D s&a es in geomet"y o" unde"standing te"mino!ogy su$& as range and mode in data $o!!e$tion8 Do" t&e 2nd ma"9ing e"iod: Peytons addition =en$&ma"9 s$o"e %as 20/-0 $o""e$t in 28minutesH in su=t"a$tion: &is s$o"e %as 21/-0 in 28- minutes8 T&e end6o+6yea" =en$&ma"9 is 4.6-0 %"itten $o""e$t!y in 28- minutes8 Peyton is sti!! %o"9ing on $ounting $oins to L1800 and te!!ing time to +i'e6 minute inte"'a!s8 <'e"a!!: Peyton &as ad#usted %e!! to t&e dai!y "outines o+ se$ond g"ade and is a &a y $&i!d8 *t times: &e %i!! de'e!o =e&a'io"s $ounte"6 "odu$ti'e to !ea"ning o" "o e" so$ia! inte"a$tion8 T&ese =e&a'io"s seem to in$"ease +o" a s&o"t time and t&en de$"ease %it& t&e use o+ adu!t "edi"e$tion: =e&a'io" $&a"ts: M "e%a"ds and $onse?uen$es8

Aca&e%ic a e %e!t 6 P"o#e$t 2ead N .-J a'e"age (o"d Study N 100J Di==!es N 77J 2eading *$$u"a$y N 7-J S#eech the"a#)6 !erbal In"ut from Sara Pin Peyton &as a s ee$& and !anguage im ai"ment8 3e s&o%s de!ays in &is a=i!ity to 'e"=a!!y use $o""e$t !anguage8 Digu"ati'e s ee$& is 'e"y di++i$u!t +o" Peyton to unde"stand: as %e!! as indi"e$t "e?uests and sa"$asm8 3e a!so does not &a'e t&e a=i!ity to "odu$e t&e a "o "iate s ee$& sounds: Es&:F E$&:F Es:F and E>F %&i$& e++e$ts t&e a=i!ity to $ommuni$ate in t&e edu$ationa! setting8 Peyton a!so +"e?uent!y d"o s &is E"sF %&i!e s ea9ing: t&e"e+o"e a!so inte"+e"ing %it& &is o%n !ea"ning as %e!! as &is ee"s8 Occ'#atio!al the"a#)6 !erbal In"ut #ricia $%Neill Peyton &as =een ma9ing "og"ess %it& +ine moto" and 'isua! moto" s9i!!s8 *!t&oug&: &e &as made "og"ess &e sti!! needs su o"t t&"oug& <T se"'i$es to ="ing t&ese s9i!!s to a t&i"d g"ade !e'e!8 A&a#tive #h) ical the"a#)6 @!erbal In"ut from &r. ' Due to t&e signi+i$ant =i"t& and medi$a! &isto"y and de'e!o menta! de!ays: Peyton &as made "og"ess is g"oss moto" s9i!!s and +!eIi=i!ity8 3e a!so is im "o'ing &is inde enden$e on t&e !ay g"ound8 3o%e'e": &e demonst"ates de+i$its in &is g"oss moto" $oo"dination and s9i!!s in $om a"ison to &is ee"s8 *'!ctio!al #e"fo"%a!ce6 Peyton is easi!y dist"a$ted and o+ten o++ tas9: ta!9ing a=out un"e!ated to i$s: un!ess "edi"e$ted se'e"a! times =y an adu!t/tea$&e"/P1*8 3e &as a P1* t&at is %it& &im t&"oug&out t&e s$&oo! days %&o a!so $o!!e$ts data =ased on &is =e&a'io"8 Peytons negati'e =e&a'io" is de+iant to%a"d aut&o"ity +igu"es as %e!! as $!assmates8 Do" eIam !e: Peyton %i!! mimi$ &is +"iends du"ing "e$ess8 3is ee"s +"e?uent!y te!! t&em t&at t&ey dont !i9e it and Peyton does not sto 8 Peyton is a!so de+iant to%a"d tea$&e"s8 Du"ing "eading and ot&e" a$ademi$ a"eas: Peyton %i!! use an Ea$$entF on u" ose: to get attention8 3e 9no%s %&at &e is doing is not a!oud8 It ta9es se'e"a! $o""e$ting and $onse?uen$ing to get Peyton to "ead $o""e$t!y: at !east +o" t&at e"iod o+ time8 *not&e" +o"m o+ de+ian$e +"om Peyton is a noise t&at &e ma9es using &is t&"oat: a!so 9no%n as E=eat =oIing8F T&is is anot&e" +"e?uent diso=edient =e&a'io" t&at Peyton %i!! do %&ene'e" &e +ee!s: as %e!! as t&e a$$ent8 3e %i!! E=eat =oIF at any time and it is eIt"eme!y dist"a$ting to &is $!assmates: %&i$& signi+i$ant!y inte"+e"es %it& !ea"ning8 T&ese =e&a'io"s a"e not a$$e ta=!e at s$&oo! and sometimes $onse?uen$es a"e not enoug& +o" Peyton8 Peytons a$tions a"e =eing done so!ey +o" t&e u" ose to annoy t&ose a"ound &im as %e!! as get attention8 Peyton a!so tends to igno"e aut&o"ity +igu"es %&i!e =eing "edi"e$ted o" as9ed to sto using an a$$ent o" E=eat =oIing8F Pa"e!tal Co!ce"! : Ms8 Manning %ou!d !i9e to see &e" son on a 2nd g"ade !e'e! and =e "e a"ed +o" t&e 3"d g"ade as mu$& as ossi=!e8 Social hi to") 7 Peyton !i'es %it& &is mot&e" and un$!e in (est 1&este": P*8 Eng!is& is t&e "ima"y !anguage s o9en at &ome8 3is =io!ogi$a! mot&e" assed a%ay %&en &e %as t%oH s&e %as in #ai! and on a met&adone mainten$e "og"am %&en Peyton %as =o"n8 3is mot&e" ado ted &im8 Peyton &as a !a"ge

eItended +ami!y o+ aunts: un$!es: g"and a"ents: and $ousins8 Me&ical hi to") 7 Peyton %as =o"n "ematu"e: %eig&ing one ound: due to d"ug eI osu"e %&i!e in t&e %om=8 3e s ent t&e +i"st t&"ee mont&s in t&e &os ita! due to !o% =i"t& %eig&t and "ematu"ity $om !i$ations8 (&en Peyton %as one: &e %as &os ita!i>ed again =e$ause &is !ungs $o!!a sed8 3e a!so %ent unde" su"ge"y to $o""e$t &is eye mus$!e osition and %ea9ness8 Peyton &as +"e?uent ea" in+e$tions8 3e is $u""ent!y not ta9ing any medi$ations on a "egu!a" =asis8 Develo#%e!tal6 Peyton %as +i"st assessed +o" ea"!y inte"'ention at siI mont&s o+ age8 De'e!o menta! &isto"y is signi+i$ant +o" de!ayed !anguage and de'e!o ment: g"oss and +ine moto" $on$e"ns: so$ia!: and emotiona! $on$e"ns: and so$ia! s9i!!s de!ays8 Peyton %as diagnosed %it& *utism in 2007: as %e!! as de'e!o menta! de!ays8 /o- &oe the &i a,ilit) affect Pe)to!< #"og"e i! the ge!e"al e&'catio! c'""ic'l'% : Peytons disa=i!ity a++e$ts &is "og"ess in t&e gene"a! edu$ation $u""i$u!um =e$ause o+ &is 'isua! disa=i!ity: =e&a'io" issues: and autism8 St"e!gth : Peyton $an =e a g"eat student %&en &is =e&a'io" issues do not inte"+e"e8 (&en &e is doing %e!!: Peyton is a E"o$9 sta"F and &e !o'es t&e attention8 3e $an =e 'e"y o!ite and a &a"d %o"9e"8 Peyton is a good t&in9e" and ans%e"s ?uestions $"iti$a!!y8 Peyton is an a%esome student to &a'e in t&e $!ass"oom: %&en a$ting a "o "iate!y8 Peyton a!so eI$e!s at "etaining in+o"mation and "o'iding ti s %&en &e $omes into t&e $!ass"oom8 3e a!so eI$e!s in s e$i+i$ to i$s t&at &e is inte"ested in8 Aca&e%ic !ee& ("elate& to &i a,ilit)) : Due to Peytons disa=i!ity: &e $omes to t&e *utisti$ Su o"t $!ass"oom t&"ee times a day +o" sma!! g"ou "eading: %"iting: and so$ia! s9i!!s8 T&is inst"u$tion is mo"e one6on6one =ased to meet &is a"ea o+ needs8 Du"ing inst"u$tion: &e needs to unde"stand to as9 +o" a ="ea9 =e+o"e getting +"ust"ated due to not unde"standing8 Develo#%e!tal !ee& ("elate& to &i a,ilit)) : Peyton does not a!!o% anyone to sing o" dan$e a"ound &im8 3o%e'e": &e does !i9e musi$ $!ass8 Peyton needs to gi'e mo"e "es e$t to aut&o"ity +igu"es and de'e!o +"iends&i s =ot& in and out o+ s$&oo!8 Peyton does not unde"stand t&e $on$e t o+ +igu"ati'e !anguage and some #o9es &e $annot $om "e&end8 Do!!o%ing =asi$ di"e$tions is a!so in need +o" im "o'ement as %e!! as !istening to ot&e"s8 *$ademi$a!!y: "eading +!uen$y needs im "o'ing8 *'!ctio!al !ee& ("elate& to &i a,ilit)) : Peyton &as di++i$u!ty in "agmati$s and s ee$& as %e!! as +igu"ati'e !anguage8 3e %i!! a!so $ontinue to attend so$ia! s9i!!s g"ou to de'e!o $on'e"sationa! s9i!!s and de'e!o +"iends&i s8 Peyton a!so &as di++i$u!ty +o!!o%ing di"e$tions and !istening to adu!ts (%&en &e $&ooses not to)8 3e a!so needs to unde"stand t&e $on$e t t&at a tea$&e" is an aut&o"ity +igu"e and must =e "es e$ted8

III. TRANSITION SERVICES : Thi i "e='i"e& fo" t'&e!t age >? o" )o'!ge" if &ete"%i!e& a##"o#"iate ,) the IEP tea%. I+ t&e student does not attend t&e IEP meeting: t&e s$&oo! must ta9e ot&e" ste s to ensu"e t&at t&e students "e+e"en$es and inte"ests a"e $onside"ed8 T"ansition se"'i$es a"e a $oo"dinated

set o+ a$ti'ities +o" a student %it& a disa=i!ity t&at is designed to =e %it&in a "esu!ts o"iented "o$ess: t&at is +o$used on im "o'ing t&e a$ademi$ and +un$tiona! a$&ie'ement o+ t&e student %it& a disa=i!ity to +a$i!itate t&e students mo'ement +"om s$&oo! to ost s$&oo! a$ti'ities: in$!uding ostse$onda"y edu$ation: 'o$ationa! edu$ation: integ"ated em !oyment (in$!uding su o"ted em !oyment): $ontinuing and adu!t edu$ation: adu!t se"'i$es: inde endent !i'ing: o" $ommunity a"ti$i ation t&at is =ased on t&e indi'idua! students needs ta9ing into a$$ount t&e students st"engt&s: "e+e"en$es: and inte"ests8 POST SC/OOL GOALS N )ased on age a "o "iate assessment: de+ine and "o#e$t t&e a "o "iate measu"a=!e ostse$onda"y goa!s t&at add"ess edu$ation and t"aining: em !oyment: and as needed: inde endent !i'ing8 ;nde" ea$& a"ea: !ist t&e se"'i$es/a$ti'ities and $ou"ses o+ study t&at su o"t t&at goa!8 In$!ude +o" ea$& se"'i$e/a$ti'ity t&e !o$ation: +"e?uen$y: "o#e$ted =eginning date: anti$i ated du"ation: and e"son/agen$y "es onsi=!e8 *o" t'&e!t i! Ca"ee" a!& Tech!olog) Ce!te" @ CIP Co&e6

Po t eco!&a") E&'catio! a!& T"ai!i!g Goal6 Not o!d enoug&

Measu"a=!e *nnua! /oa! ,es/No (Do$ument in Se$tion B)

1ou"ses o+ Study:

Se"'i$e/*$ti'ity

0o$ation

D"e?uen$y

P"o#e$ted )eginning Date

*nti$i ated Du"ation

Pe"son(s)/*gen$y 2es onsi=!e

E%#lo)%e!t Goal6 Not o!d enoug&

Measu"a=!e *nnua! /oa! ,es/No (Do$ument in Se$tion B)

1ou"ses o+ Study:

Se"'i$e/*$ti'ity

0o$ation

D"e?uen$y

P"o#e$ted )eginning Date

*nti$i ated Du"ation

Pe"son(s)/*gen$y 2es onsi=!e

I!&e#e!&e!t Livi!g Goal@ if a##"o#"iate6 Not o!d enoug&

Measu"a=!e *nnua! /oa! ,es/No (Do$ument in Se$tion B)

1ou"ses o+ Study:

Se"'i$e/*$ti'ity

0o$ation

D"e?uen$y

P"o#e$ted )eginning Date

*nti$i ated Du"ation

Pe"son(s)/*gen$y 2es onsi=!e

IV. PARTICIPATION IN STATE AND LOCAL ASSESSMENTS I! t"'ctio! fo" IEP Tea% 6 P!ease se!e$t t&e a "o "iate assessment o tion8 In+o"mation on a'ai!a=!e testing a$$ommodations may =e +ound in t&e *$$ommodations /uide!ines a'ai!a=!e on %%%8edu$ation8state8 a8us8 State A e %e!t Not A e e& No state%ide assessment is administe"ed at t&is students g"ade !e'e!8 No Eng!is& "o+i$ien$y assessment administe"ed =e$ause t&e student is not an Eng!is& 0anguage 0ea"ne"8 PSSA (Mat& a'ai!a=!e in g"ades 367H S$ien$e a'ai!a=!e in g"ades 4 and 7H 2eading a'ai!a=!e in g"ades 367H ("iting a'ai!a=!e in g"ades - and 7H and E0*@) (it&out (it& Tested Su=#e$t *$$ommodations *$$ommodations *$$ommodations to =e P"o'ided Mat& S$ien$e 2eading ("iting E0*@ @E0* %i!! "e !a$e t&e 2eading and ("iting PSS*s in 201461- +o" g"ades 3678

1e) to!e E5a% (*'ai!a=!e %&en student &as $om !eted t&e $ou"se/su=#e$tH and "e !a$es t&e PSS* in &ig& s$&oo!) (it&out (it& Tested Su=#e$t *$$ommodations *$$ommodations *$$ommodations to =e P"o'ided *!ge="a 1 0ite"atu"e )io!ogy 1e) to!e P"o(ect +a e& A e %e!t (*'ai!a=!e %&en student is una=!e to demonst"ate "o+i$ien$y on a Ceystone EIam o" Ceystone EIam modu!e8) (it&out (it& Tested Su=#e$t *$$ommodations *$$ommodations *$$ommodations to =e P"o'ided *!ge="a 1 0ite"atu"e )io!ogy Vali&ate& Local A e %e!t (*'ai!a=!e %&en se!e$ted as o tion =y 0E*) (it&out (it& Tested Su=#e$t *$$ommodations *$$ommodations

*$$ommodations to =e P"o'ided

V. GOALS AND O+8ECTIVES N In$!ude: as a "o "iate: a$ademi$ and +un$tiona! goa!s8 ;se as many $o ies o+ t&is age as needed to !an a S e$ia!!y designed inst"u$tion may =e !isted %it& ea$& goa!/o=#e$ti'e o" !isted in Se$tion BI8

"o "iate!y8

S&o"t te"m !ea"ning out$omes a"e "e?ui"ed +o" students %&o a"e gi+ted8 T&e s&o"t te"m !ea"ning out$omes "e!ated to t&e students gi+ted "og"am may =e !isted unde" /oa!s o" S&o"t Te"m <=#e$ti'es8 ME*S;2*)0E *NN;*0 /<*0 In$!ude: 1ondition: Name: )e&a'io": and 1"ite"ia (2e+e" to *nnotated IEP +o" des$"i tion o+ t&ese $om onents) Aca&e%ic (Rea&i!g) : To en&an$e "eading +!uen$y: Peyton %i!! $om !ete an a$$u"a$y "ead 1I e" %ee9: "eading a !e'e! A teIt: &is goa! =eing a !e'e! M8 +a eli!e N Peyton is $u""ent!y "eading on a !e'e! A8 Des$"i=e 3<( t&e students "og"ess to%a"d meeting t&is goa! %i!! =e measu"ed Data Collectio!6 <n$e e" %ee9: t&e s e$ia! edu$ation tea$&e" %i!! $om !ete an a$$u"a$y "o=e %it& Peyton =eginning %it& a !e'e! A assage8 Peyton %i!! "ead a!oud as t&e tea$&e" monito"s &is +!uen$y8 9o"; Sa%#le6 Du"ing %"iting: %&en Peyton &as $om !eted &is "oug& d"a+t: &e %i!! se!+6monito" and edit it using a $&e$9 !ist ($a ita! !ette"s: un$tuation: s e!!ing: s a$ing88) Data Collectio! A Teache" O, e"vatio!6 Peytons P1*: s e$ia! edu$ation: and "egu!a" edu$ation tea$&e"s %i!! "e$o"d a ta!!y ma"9 i+ &e $ontinues ma9ing so$ia! noises du"ing $!ass8 Dou" ta!!ys means no sta"8 I+ &e does not E=eat =oIF t&e %&o!e e"iod: &e %i!! "e$ei'e a sta": %&i$&

Des$"i=e (3EN e"iodi$ "e o"ts on "og"ess %i!! =e "o'ided to a"ents Oua"te"!y

2e o"t o+ P"og"ess

*t t&e end o+ t&e ma"9ing e"iod: a "og"ess "e o"t %i!! =e sent &ome to a"ents8

Aca&e%ic (9"iti!g) : (&en $om !eting a %"iting assignment: Peyton %i!! use a $&e$9!ist +o" ea$& %"iting assignment: 2I e" mont&: =e+o"e mo'ing on to &is +ina! ie$e8 +a eli!e 7 1u""ent!y: Peyton is at 0J +o" using a $&e$9!ist du"ing %"iting8 +ehavio"al : Peyton %i!! "e+"ain +"om u" ose!y using ina "o "iate so$ia! noises du"ing inst"u$tiona! time: de$"easing +"om 2- minutes o+ t&e &a!+ &ou" session to on!y - minutes8 T&is %i!! =e measu"ed 1I e" %ee9 in s$&oo!8 +a eli!e6 Peyton is $u""ent!y E=eat =oIingF +o" a 2- minutes out o+ 30 minutes8

Oua"te"!y

*t t&e end o+ t&e ma"9ing e"iod: a "og"ess "e o"t %i!! =e sent &ome to a"ents8

Oua"te"!y

*t t&e end o+ t&e ma"9ing e"iod: a "og"ess "e o"t %i!! =e sent &ome to a"ents8

!eads to a "e%a"d at t&e end o+ t&e day8

*'!ctio!al$Social : Peyton %i!! inde endent!y as9 to ta9e a ="ea9 du"ing $!ass: i+ needed: =e+o"e getting +"ust"ated o" u set in 5/10 o o"tunities e" %ee98 +a eli!e6 1u""ent!y: Peyton is getting o'e"%&e!med and not as9ing to ta9e a ="ea9 %&en it is needed8 *'!ctio!al$Social 7 Peyton "e+"ain +"om !aug&ing at $!assmates du"ing a 206minute e"iod at ina "o "iate times8 +a eli!e6 1u""ent!y: Peyton is !aug&ing 10/20 times du"ing e"iod8 3is goa! is to !imit &is !aug&ing to -/20 times8

Teache" O, e"vatio! A Data Collectio!6 T&e tea$&e"s $an "e$o"d using a $&e$9!ist %&en Peyton inde endent!y as9s +o" a ="ea98

Oua"te"!y

*t t&e end o+ t&e ma"9ing e"iod: a "og"ess "e o"t %i!! =e sent &ome to a"ents8

Data Collectio! A Teache" O, e"vatio!

Oua"te"!y

*t t&e end o+ t&e ma"9ing e"iod: a "og"ess "e o"t %i!! =e sent &ome to a"ents8

S/ORT TERM O+8ECTIVES : 2e?ui"ed +o" students %it& disa=i!ities %&o ta9e a!te"nate assessments a!igned to a!te"nate a$&ie'ement standa"ds (P*S*)8 S&o"t te"m o=#e$ti'es / )en$&ma"9s N None at t&is time8

VI. SPECIAL EDUCATION $ RELATED SERVICES $ SUPPLEMENTAR0 AIDS AND SERVICES $ PROGRAM MODI*ICATIONS : In$!ude: as a and eIt"a$u""i$u!a" se"'i$es and a$ti'ities8

"o "iate: +o" nona$ademi$

A. PROGRAM MODI*ICATIONS AND SPECIALL0 DESIGNED INSTRUCTION (SDI) SDI may =e !isted %it& ea$& goa! o" as a"t o+ t&e ta=!e =e!o%8 In$!ude su !ementa"y aids and se"'i$es as a "o "iate8 Do" a student %&o &as a disa=i!ity and is gi+ted: SDI a!so s&ou!d in$!ude ada tations: a$$ommodations: o" modi+i$ations to t&e gene"a! edu$ation $u""i$u!um: as a "o "iate +o" a student %it& a disa=i!ity8 &odifications and SDI ;se o+ magni+ie" =a" +o" "eading (Pe"mission +o" a$$ommodation) *ssignments in !a"ge "int Be"=a! o" 'isua! "eminde"s %&en student u" ose!y s ea9s in$o""e$t!y (not "onoun$ing 2s)8 Initiating !ay +o" inte"a$tion %it& ee"s du"ing in indoo"/outdoo" "e$ess8 *du!t to de="ie+ %it& Peyton +o!!o%ing =e&a'io"a! situation to "e$ogni>e "es onsi=i!ity +o" a$tions and a$$e ting $onse?uen$es8 < o"tunities to &a'e +"ee time ="ea9s %it& "e+e""ed a$ti'ity $&oi$es =et%een (ocation 2egu!a" edu$ation $!ass"oom: *utisti$ Su o"t $!ass"oom: s ee$& and !anguage $!ass"oom: 'ision *!! $!ass"ooms )re*uenc+ *!! assignments t&at in$!ude "eading Pro,ected -eginning Date 1/31/2014 'ntici"ated Duration 1/31/201-

*!! assignments

1/31/2014

1/31/201-

2eading

Dai!y

1/31/2014

1/31/201-

2e$ess

Dai!y

1/31/2014

1/31/201-

2egu!a" and S e$ia! Edu$ation 1!ass"ooms

Dai!y

1/31/2014

1/31/201-

S e$ia! Edu$ation 1!ass"oom

Dai!y

1/31/2014

1/31/201-

inst"u$tion8 +. RELATED SERVICES : 0ist t&e se"'i$es t&at t&e student needs in o"de" to =ene+it +"om &is/&e" s e$ia! edu$ation "og"am8 Ser.ice S ee$& t&e"a y <$$u ationa! t&e"a y *da ti'e &ysi$a! edu$ation T"ans o"tation Bision (ocation S ee$& M 0anguage $!ass"oom S$&oo! /ym To/D"om S$&oo! S$&oo! )re*uenc+ 2I e" %ee9 1I e" %ee9 1I e" %ee9 E'e"y day o+ t&e s$&oo! yea" 1I e" %ee9 Pro,ected -eginning Date 1/31/2014 1/31/2014 1/31/2014 1/31/2014 1/31/2014 'ntici"ated Duration 1/31/2011/31/2011/31/2011/31/2011/31/201-

C. SUPPORTS *OR SC/OOL PERSONNEL : 0ist t&e sta++ to "e$ei'e t&e su School Personnel to /ecei.e Su""ort S ee$& T&e"a ist P&ysi$a! T&e"a ist <$$u ationa! T&e"a ist Bision Su""ort 1onso!ation 1onso!ation 1onsu!tation 1onso!ation S$&oo! S$&oo! S$&oo! S$&oo! (ocation

o"ts and t&e su )re*uenc+ *s needed *s needed *s needed *s needed

o"ts needed to im !ement t&e students IEP8 Pro,ected -eginning Date 1/31/2014 1/31/2014 1/31/2014 1/31/2014 'ntici"ated Duration 1/31/2011/31/2011/31/2011/31/201-

D. GI*TED SUPPORT SERVICES *OR A STUDENT IDENTI*IED AS GI*TED 9/O ALSO IS IDENTI*IED AS A STUDENT 9IT/ A DISA+ILIT0 : Su o"t se"'i$es a"e "e?ui"ed to assist a gi+ted student to =ene+it +"om gi+ted edu$ation (e8g8: sy$&o!ogi$a! se"'i$es: a"ent $ounse!ing and edu$ation: $ounse!ing se"'i$es: t"ans o"tation to and +"om gi+ted "og"ams to $!ass"ooms in =ui!dings o e"ated =y t&e s$&oo! dist"i$t)8

Su""ort Ser.ice

None at t&is time8

E. EBTENDED SC/OOL 0EAR (ES0) : The IEP tea% ha co! i&e"e& a!& &i c' e& ES0 e"vice @ a!& &ete"%i!e& that6

Student IS e!igi=!e +o" ES, =ased on t&e +o!!o%ing in+o"mation o" data "e'ie%ed =y t&e IEP team: Peyton Mainning is e!igi=!e +o" (est 1&este" *"ea S$&oo! Dist"i$t ES, "og"ams and se"'i$es in t&e a"eas o+ so$ia! s9i!!s: =e&a'io" s9i!!s: "eading: %"iting: s ee$& t&e"a y: o$$u ationa! t&e"a y: ada ted &ysi$a! edu$ation: and &ysi$a! t&e"a y +o" t&e summe" o+ 20148 <2 *s o+ t&e date o+ t&is IEP: student is N<T e!igi=!e +o" ES, =ased on t&e +o!!o%ing in+o"mation o" data "e'ie%ed =y t&e IEP team:

T&e *nnua! /oa!s and: %&en a "o "iate: S&o"t Te"m <=#e$ti'es +"om t&is IEP t&at a"e to =e add"essed in t&e students ES, P"og"am a"e: *'!ctio!al$Social : Peyton %i!! inde endent!y as9 to ta9e a ="ea9 du"ing $!ass: i+ needed: =e+o"e getting +"ust"ated o" u set in 5/10 o o"tunities e" %ee98 1u""ent!y: Peyton is getting o'e"%&e!med and not as9ing to ta9e a ="ea9 %&en it is needed8 9"iti!g : (&en $om !eting a %"iting assignment: Peyton %i!! use a $&e$9!ist (1a ita! !ette"s: un$tuation: s a$ing: s e!!ing: %"iting st"aig&t ton t&e !ine88) +o" ea$& %"iting assignment: 2I e" mont&: =e+o"e mo'ing on to &is +ina! ie$e8 1u""ent!y: Peyton is not using a $&e$9!ist du"ing %"iting8 I+ t&e IEP team &as dete"mined ES, is a ES0 Ser.ice to be Pro.ided S ee$& T&e"a y *da ti'e P&ysi$a! Edu$ation (ocation S$&oo! )ui!ding S$&oo! )ui!ding 1I e" %ee9: 30 Minutes "o "iate: $om !ete t&e +o!!o%ing: )re*uenc+ 1I e" %ee9: 30 Minutes 5/01/2014 ./01/2014 Pro,ected -eginning Date 5/01/2014 'ntici"ated Duration ./01/2014

<$$u ationa! T&e"a y So$ia! S9i!!s *$ademi$s (2eading: ("iting) T"ans o"tation

S$&oo! )ui!ding 1I e" %ee9: 30 Minutes S$&oo! )ui!ding 2I e" %ee9: 30 Minutes S$&oo! )ui!ding Dai!y a$$o"ding to ES, $a!enda" To/+"om s$&oo! ES,

5/01/2014 5/01/2014 5/01/2014

./01/2014 ./01/2014 ./01/2014

5/01/2014

./01/2014

VII. EDUCATIONAL PLACEMENT A. CUESTIONS *OR IEP TEAM : T&e +o!!o%ing ?uestions must =e "e'ie%ed and dis$ussed =y t&e IEP team "io" to "o'iding t&e eI !anations "ega"ding a"ti$i ation %it& students %it&out disa=i!ities8 It is t&e "es onsi=i!ity o+ ea$& u=!i$ agen$y to ensu"e t&at: to t&e maIimum eItent a "o "iate: students %it& disa=i!ities: in$!uding t&ose in u=!i$ o" "i'ate institutions o" ot&e" $a"e +a$i!ities: a"e edu$ated %it& students %&o a"e not disa=!ed8 S e$ia! $!asses: se a"ate s$&oo!ing o" ot&e" "emo'a! o+ students %it& disa=i!ities +"om t&e gene"a! edu$ationa! en'i"onment o$$u"s on!y %&en t&e natu"e o" se'e"ity o+ t&e disa=i!ity is su$& t&at edu$ation in gene"a! edu$ation $!asses: EBEN (IT3 t&e use o+ su !ementa"y aids and se"'i$es: $annot =e a$&ie'ed satis+a$to"i!y8 (&at su !ementa"y aids and se"'i$es %e"e $onside"edK (&at su !ementa"y aids and se"'i$es %e"e "e#e$tedK EI !ain %&y t&e su !ementa"y aids and se"'i$es %i!! o" %i!! not ena=!e t&e student to ma9e "og"ess on t&e goa!s and o=#e$ti'es (i+ a !i$a=!e) in t&is IEP in t&e gene"a! edu$ation $!ass8 (&at =ene+its a"e "o'ided in t&e gene"a! edu$ation $!ass %it& su edu$ation $!assK !ementa"y aids and se"'i$es 'e"sus t&e =ene+its "o'ided in t&e s e$ia!

(&at otentia!!y =ene+i$ia! e++e$ts and/o" &a"m+u! e++e$ts mig&t =e eI e$ted on t&e student %it& disa=i!ities o" t&e ot&e" students in t&e $!ass: e'en %it& su !ementa"y aids and se"'i$esK To %&at eItent: i+ any: %i!! t&e student a"ti$i ate %it& nondisa=!ed ee"s in eIt"a$u""i$u!a" a$ti'ities o" ot&e" nona$ademi$ a$ti'itiesK

EI !anation o+ t&e eItent: i+ any: to %&i$& t&e student %i!! not a"ti$i ate %it& students %it&out disa=i!ities in t&e "egu!a" edu$ation $!ass: Peyton %i!! =e %o"9ing %it& students %it&out disa=i!ities in &is "egu!a" edu$ation $!ass"oom +o" mat&: so$ia! studies: s$ien$e: musi$: a"t: and PE8 EI !anation o+ t&e eItent: i+ any: to %&i$& t&e student %i!! not a"ti$i ate %it& students %it&out disa=i!ities in t&e gene"a! edu$ation $u""i$u!um:

INDIVIDUALIZED EDUCATION PROGRAM (IEP) Students Name: +. T)#e of S'##o"t >. A%o'!t of #ecial e&'catio! '##o"t Itine"ant: S e$ia! edu$ation su o"ts and se"'i$es "o'ided =y s e$ia! edu$ation e"sonne! +o" 20J o" !ess o+ t&e s$&oo! day o"ts and se"'i$es "o'ided =y s e$ia! edu$ation e"sonne! +o" mo"e t&an 20J o+ t&e day =ut !ess t&an

Su !ementa!: S e$ia! edu$ation su 70J o+ t&e s$&oo! day Du!!6Time: S e$ia! edu$ation su D. T)#e of #ecial e&'catio! '##o"t *utisti$ Su o"t o"t o"t

o"ts and se"'i$es "o'ided =y s e$ia! edu$ation e"sonne! +o" 70J o" mo"e o+ t&e s$&oo! day

)!ind6Bisua!!y Im ai"ed Su Dea+ and 3a"d o+ 3ea"ing Su Emotiona! Su 0ea"ning Su 0i+e S9i!!s Su o"t o"t o"t o"t

Mu!ti !e Disa=i!ities Su P&ysi$a! Su o"t

S ee$& and 0anguage Su

o"t

Page 20 of 23

December 2013

INDIVIDUALIZED EDUCATION PROGRAM (IEP) Students Name: C. Locatio! of t'&e!t< #"og"a% Name o+ S$&oo! Dist"i$t %&e"e t&e IEP %i!! =e im !emented: Name o+ S$&oo! )ui!ding %&e"e t&e IEP %i!! =e im !emented: (est 1&este" *"ea S$&oo! Dist"i$t East /os&en E!ementa"y S$&oo!

Is t&is s$&oo! t&e students neig&=o"&ood s$&oo! (i8e8: t&e s$&oo! t&e student %ou!d attend i+ &e/s&e did not &a'e an IEP)K ,es No8 I+ t&e ans%e" is Eno:F se!e$t t&e "eason %&y not8 S e$ia! edu$ation su o"ts and se"'i$es "e?ui"ed in t&e students IEP $annot =e "o'ided in t&e neig&=o"&ood s$&oo! <t&e"8 P!ease eI !ain:

Page 21 of 23

December 2013

INDIVIDUALIZED EDUCATION PROGRAM (IEP) Students Name: VIII. PENNDATA REPORTING6 Edu$ationa! En'i"onment (Co%#lete eithe" Sectio! A o" +E Select o!l) o!e E&'catio!al E!vi"o!%e!t)
To $a!$u!ate t&e e"$entage o+ time inside t&e "egu!a" $!ass"oom: di'ide t&e num=e" o+ &ou"s t&e student s ends inside t&e "egu!a" $!ass"oom =y t&e tota! num=e" o+ &ou"s in t&e s$&oo! day (in$!uding !un$&: "e$ess: study e"iods)8 T&e "esu!t is t&en mu!ti !ied =y 1008

SECTION A6 *o" St'&e!t E&'cate& i! Reg'la" School +'il&i!g -ith No! Di a,le& Pee" : I!&icate the Pe"ce!tage of ti%e INSIDE the "eg'la" cla "oo% fo" thi

t'&e!t6

Time s ent outside t&e "egu!a" $!ass"oom "e$ei'ing se"'i$es un"e!ated to t&e students disa=i!ity (e8g8: time "e$ei'ing ES0 se"'i$es) s&ou!d =e $onside"ed time inside t&e "egu!a" $!ass"oom8 Edu$ationa! time s ent in age6a "o "iate $ommunity6=ased settings t&at in$!ude indi'idua!s %it& and %it&out disa=i!ities: su$& as $o!!ege $am uses o" 'o$ationa! sites: s&ou!d =e $ounted as time s ent inside t&e "egu!a" $!ass"oom8 Calc'latio! fo" thi St'&e!t6

1o!umn 1
Tota! &ou"s t&e student s ends in t&e "egu!a" $!ass"oom e" day -8-0 3ou"s

1o!umn 2
Tota! &ou"s in a ty i$a! s$&oo! day (in$!uding !un$&: "e$ess M study e"iods) 5 3ou"s

1a!$u!ation
(3ou"s inside "egu!a" $!ass"oom P &ou"s in s$&oo! day) I 100 Q J (1o!umn 1 P 1o!umn 2) I 100 Q J ( - 3ou"s -0 Minutes P 5 3ou"s) Q 578-0 I 100 Q 578-0J

Indi$ate Pe"$entage
Se$tion *: T&e e"$entage o+ time student s ends inside t&e "egu!a" $!ass"oom: 578-0J

Pe"$entage 1atego"y
;sing t&e $a!$u!ation "esu!t N se!e$t t&e a "o "iate e"$entage $atego"y

-8-0 3ou"s

5 3ou"s

578-0 J o+ the &a)

INSIDE the Reg'la" Cla "oo% FGH o" Mo"e of the Da) INSIDE the Reg'la" Cla "oo% IJ7?GH of the Da) INSIDE the Reg'la" Cla "oo% Le Tha! ?GH of the Da)

SECTION +6 Thi ectio! "e='i"e& o!l) fo" St'&e!t E&'cate& OUTSIDE Reg'la" School +'il&i!g fo" %o"e tha! KGH of the &a) : elect a!& i!&icate the Na%e of School o" *acilit) o! the li!e co""e #o!&i!g -ith the a##"o#"iate electio!6 (I+ a student s ends !ess t&an -0J o+ t&e day in one o+ t&ese !o$ations: t&e IEP team must do t&e $a!$u!ation in Se$tion *)
* "o'ed P"i'ate S$&oo! (Non 2esidentia!) * "o'ed P"i'ate S$&oo! (2esidentia!) <t&e" P"i'ate Da$i!ity (Non 2esidentia!) <t&e" P"i'ate Da$i!ity (2esidentia!) <t&e" Pu=!i$ Da$i!ity (2esidentia!) RRRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRR RRRRRRRRRRRRRRRRRRRRRRRR <t&e" Pu=!i$ Da$i!ity (Non 2esidentia!) RRRRRRRRRRRRRRRRRRRRRRRRR 3os ita!/3ome=ound RRRRRRRRRRRRRRRRRRRRRRRRR 1o""e$tiona! Da$i!ity RRRRRRRRRRRRRRRRRRRRRRRRR <ut o+ State Da$i!ity RRRRRRRRRRRRRRRRRRRRRRRRR Inst"u$tion 1ondu$ted in t&e 3ome RRRRRRRRRRRRRRRRRRRRRRRRR

EBAMPLES fo" Sectio! A6 /o- to Calc'late Pe!!Data:E&'catio!al E!vi"o!%e!t Pe"ce!tage

Page 22 of 23

December 2013

INDIVIDUALIZED EDUCATION PROGRAM (IEP) Students Name:

1o!umn 1 Tota! &ou"s t&e student s ends in t&e "egu!a" $!ass"oom e" day 1o!umn 2 Tota! &ou"s in a ty i$a! s$&oo! day (in$!uding !un$&: "e$ess M study e"iods) 481a!$u!ation (3ou"s inside "egu!a" $!ass"oom P &ou"s in s$&oo! day) I 100 Q J (1o!umn 1 P 1o!umn 2) I 100 Q J (-8- 48-) I 100 Q 7-J Indi$ate Pe"$entage Se$tion *: T&e e"$entage o+ time student s ends inside t&e "egu!a" $!ass"oom:

7-J o+ t&e day (Inside 70J o" Mo"e o+ Day) EIam !e 2 3 40J o+ t&e day (3 -) I 100 Q 40J (Inside 5.640J o+ Day) EIam !e 3 1 20J o+ t&e day (1 -) I 100 Q 20J (Inside !ess t&an 40J o+ Day) Do" &e! in unde"standing t&is +o"m: an annotated IEP is a'ai!a=!e on t&e PaTT*N %e=site at %%%8 attan8net Ty e E*nnotated Do"msF in t&e Sea"$& +eatu"e on t&e %e=site8 I+ you do not &a'e a$$ess to t&e Inte"net: you $an "e?uest t&e annotated +o"m =y $a!!ing PaTT*N at 70064416321-8

EIam !e 1

-8-

Page 23 of 23

December 2013