IEP Page Student Plan Date 3/29/2017 Extended School Year Yee No More Data Needed Are extended school year services required for this student? Ix yes, services must be described within this IEP or in attached documentation. See attached determination documentation. ‘Student Name Dos. Schoo! John Adams Middle School Date of Determination: Reviewer Name: Eligible: YES _X /A multidisciplinary team shall consider the following three areas to determine the child's need for Extended School Year services: Regression and Recoupment, Self Sufficiency, and the Pupils Unique Need. To qualify, the child must meet the criteria in A, B or C AND the criteria in D. (For complete information regarding these disablity requirements, refer to MN Rule 3525.0755, Effective: 11/26/2001, CFL Revised: 9/2/2002.) YES __NO_ A. REGRESSION AND RECOUPMENT: Dis this child experience a significant regression of a skill or acquired knowledge specified in the IEP goal(s) that required more than the length ofthe break to recoup? To qualify, answer Yes to Al or A2. YES __NO 1, Forachild who is new to the district or with an inital IEP, use observations of his/her tendency to regress over extended breaks of instruction during the school year--specify fll, winter, spring break YES __NO 2, Fora child with a continuing IEP, use prior observation of his/her regression and recoupment over the summer. Refer to progress reports, test scores, and end of first grading period. YES __NO_ B, SELF-SUFFICIENCY: Willa break in special educational programming prevent the child from achieving/maintaining a reasonable degree of independence in the following functional skills identified ‘on the TEP? To qualify, check at least one functional area in BI and answer Yes to either B2 or B3, YES __NO 1. Check all functional skill areas that apply to self sufficiency (check one or more). “yes __No a Basie self-help, toileting, eating, feeding and dressing “yes __No , Muscular contro! — yes __No ©. Physical mobility “Yes _xo. 4. Impulse control “yes __No ©. Personal hygiene “yes __No f Development of stable relations with peers and adults “_YEs __No Basic communication ‘YES __NO hh, Functional academic competency: basic reading, writing, concepts, time and money, numerical or temporal relationships YES __NO 2. Identify the goals and objectives that are critical to the overall disability. specific needs ofthe child because of the nature ofthe skill addressed and the child's age and level of development YES __NO 3, Explain why the skill would not be Iearmed without the continuation of service due to the timefiness for teaching the skill. Explain why future years will not be sufficient to lear the skill, (OC. CHILD'S UNIQUE NEED: ‘This form is available in other formats, Contact he IEP Manager for an alternate format,IEP Page 3 Student: Plan Dae 3/29/2017 YES __NO 1. Given the child's unique need, the IEP team has determined that continued services are necessary to ensure thatthe child receives a Free Appropriate Public Education, Explain why. ___YES __NO_ D. In making the determination of needs in areas A, B and C, the IEP/ILP team did consider and document, where relevant, the following factors which are: (Cheek one or more) YES __NO 1. Child's progress and maintenance of skills uring regular school year YES __NO 2. Child's degree of impairment “YES __NO 3. Child's rate of progress YES __NO 4. Child's behavioral or physical problems YES __NO 5. Availability of altemative resources YES __NO 6, Child's ability and need to interact with non-disabled peers YES __NO 7. Areas of child's curiculum which need continuous attention YES __NO 8, Chilk's vocational needs [ : ; ‘Program. The Present Levels of Academic Achievement and Functional Performance (PLAAFP) isan integrated summary of data from all sources including parents, + For preschool children , describe how the disability affects the child's participation in appropriate activities. + For K-12 students , describe how the disability affects the child's involvement and progress inthe general curriculum, + In addition, for student ages 14-21, address the present level of performance in each of the transition areas. sam 8th grade student at John Adams Middle School. He currently receives special education support in an academic still class one period per day where he works on reading, writing, math, and social skis. He is in @co-taught language arts ‘and math class with a general education teacher and special education teacher. has received special education support since he was in preschool. He is currently being served under the Other Health Disabilities categorical label with diagnosis of ADED and a Mood Disorder. grades as of March 7, 2017: [Cases [se Quarter fad Quarter rd Quarier uneation As B B Spanish F sical Education kk iw [fart Scenes Ep b & ial Studies: F oglsh 8 = inear Algebra ie 7 Hea E Di to Robots jArt B "Grade may change by the end of the quarer is currently missing 7 assignments In academic skills class, works hard when is motivated and wants to accomplish the task on hand, When presented ‘This form is avaliable in ther formats. Contact the IEP Manager fr an alternate format,IEP pace 4 srodent: Pian Due 3/29/2017 ‘with an obstacle, sometimes he does not complete it and/or with refusal, He is a good kid who is developing different aspect jn writing, reading, and math. He continues to struggle with writing in an appropriate way, smaller letters and not shading sso much. He is a passionate individual who enjoys the class when he can share his opinions. He gets along with many of the students, but sometimes has issues when conflict arises. Occasionally, he will try to irvtate other students In science class, _works hard and tres to accomplish the task at hand. He works quietly by himself and many times struggles without additional assistance. The teacher continues to provide support through re-teaching, redirecting, and follow-up communication, ‘as trouble believing in himself, following along with the pace ofthe classroom, and ‘writing legibly. He really struggles to understand most material, even with multiple re-teachings. The following ‘modifications have been tried in order to help in science: he receives guided notes, modified tests with reduced choices and comprehension checks after material has been presented and work time is given. is im a.co-taught math class, This seems to help withthe additional support from the other teacher. However, his ‘math teacher is concerned with reluctance to write anything down and reports that he is struggling in the elass with the different topics they are covering, even when he isin a small group setting, He usually struggles to complete the tasks ‘presented to him independently. He needs the additional support from the teacher to assist in his ability to solve math problems. The teacher continues to check on him throughout the class to ensure that he is working and staying on task, He is reminded of instructions and process throughout the class period. In Social Studies class, _ teacher has seen a lot of progress since the start of the year. There are days where he does not want to work on the activities, but usually with some coaxing he is willing to work on assignments if he has the ight support around him, ‘The following charts summarize _ Minnesota Comprehensive Assessment (MCA) and Northwest Evaluation Association (NWEA)/Measures of Academic Progress (MAP), scores indicate that he does not meet the state standard for the MCA assessment measured from 2013-2015 in reading, mathematis, and science, MAP Mathematics Scores [vine 2016-2017 35 = 2016 35 ow a a7 ow [Wier 20152016 oo bow Faas ss bee fnter 2014-2015 los ex 1204 ise pow pag 2014 96 ow inter 2OTSOTE 38 ow Faron 87 ew MAP Reading Scores [viewer 2016.2017 01 ia Faz0ie 03 Few Pring 2016 200 ow ater 2015-2016 33 Pow ll2015 (a few Borne 2015 los cow [Winer 2014-2015 [0 | ‘This forms avaible other formats, Contact the IEP Manager for en altete format.IEP Page Shader Plas Dae 3/29/2017 fae ii [ow ng 20 oT ow inter 20137014 96 Fao 00 i MCA Mathematis Sores 0152016 mB To mee expectations ora a [Does normeet expectations MCA Reading Scores 01572016 7D Poss notmeet expecations T4015 Be [oes not meet expectations ora 20, [oes not meet expectations ora ROT ar oes not mest expecaions Teansition: -Home and Daily Living: ‘Vacuuming eleaning, taking out garbage, cleaning the house, making own bed. He would cook bacon and eges. He really enjoys video games, He would call 911 in case of an emergency. And he plans on living in Rochester afte high school ‘Community Participation: He has never used a bus before. He did say that he had a savings account that money is put into it. He said that his favorite place to go to is the Mall of America Leisure favorite hobbies are YouTube and playing video games. He said that he likes to bow. He does not belong to any clubs or organizations and does not read the newspaper. The last vacation vas on was in South Dakota. He went to ‘Wall Drug with his uncle. He indicated that he would go to Los Angeles or Arizona for fun sometime. ‘Jobs and Job Training: said that ie has never had a job or applied for a job. He also said that he has never filled out an application for a job. He di say that he wanted help with this process inthe future, His job strengths are smartnice and his job weakness are ‘nervous/scared. He thinks that working at Pepsi, slong the lines of a delivery truck driver, would be a good job after high school. He also said that being a YouTuber would be a good job. He thought that $40,000 would be enough to live off of. He also indicated that he gets upset would affect his jab. ost-Secondary Training His favorite classes in school are gym, an, history, and reading. His least favorite classes in school are math, communication ars, 21st century technology, and science sometimes, He did indicate that he would like help finding a career in the future. [He wants to work for Pepsi or YouTube in five to ten years from now. He would also like more help with personal finanee, ‘Academic needs: needs to improve his reading comprehension skills, ‘needs to improve his math comprehension skills needs to improve his written expression skills. needs to continue learning coping strategies for anxiety, frustration, and anger. needs to work on completing tasks more independently, ‘This form is avalable nother formats, Contact the JEP Manager for an allerte format,Plan Date 3/29/2017 TEP Poses Student ‘Annual Instructional Goals Goal #1 ‘Area: Academic Performance Goal: will demonstrate his understanding of a text at his independent reading level, by drawing inferences and successfully identifying the main idea by correctly citing text evidence, from 40% of the time to 60% of the time as measured by teacher checklists, radebook, and student work by general and special education staff ‘Short Term Objectives or Benchmarks ‘Objective #1: When given texts at his independent reading level, _will identify the correct inference about what he is reading for 4 out of S trials as measured by class work and teacher checklists by general and special education staf. Objective #2: When given texts at his independent reading level, _will correctly identify the main idea of what he is reading for 4 out of S trials as measured by class work and teecher checklists by general and special education staff. Objective #3: When given texts at his independent reading level, will cite text evidence to support his analysis of ‘what he has read in 4 out ofS trials as measured by class work and teacher checklists by general and special education staff Performance will increase his paragraph writing skills from writing atopic sentence 60% of the time, writing 2-3 simple sentences (on the topic 80% of the time, and writing a concluding sentence 40% of the time to writing a paragraph with atopic sentence, and 3-5 sentences with detailed facts, and a concluding sentence as measured by student work samples by the special education teacher. Short Term Objectives or Benchmarks ‘Objective #1: After selecting a topic, _will write atopic sentence for a paragraph that incorporates the main idea on 4 out of 5 trials as measured by student work samples Objective #2: will write a paragraph on a given topic with 3-5 detailed sentences on 4 out of 5 trials as measured by student work samples. will write a paragraph with a concluding sentence on 4 out of 5 trials as measured by student work ‘This formis avaiable in ther formats, Contact he IEP Manager for an atlerate format.Plan Date 3/29/2017 TEP Page 7 sient Annual Instructional Goals (continued) Goal #3 ‘Area: Academic Performance Gos ‘ll improve his ability to solve real-world mathematical problems using addition, subtraction, multiplication and 4ivision correctly from 50% of the time to 75% ofthe time using knowledge of basic calculation skis to using math reasoning to solve multistep word problems accurately as measured by teacher checklists, gradebook and student work by ‘general and special education staff. ‘Short Term Objectives or Benchmarks ‘Objective #1: will add, subtract, multiply, and divide real world, multi-step word problems correctly 75% of the time ‘as measured by class work and teacher checklists by general and special educetion staff. Objective #2: When given a teal world multi-step word problem, ill identify key information and solve problems with 75% accuracy as measured by class work and teacher checklists by general and special education sta ss SSS This form is avaiable in ther formats, Contact the IEP Manager fer an atemate format.TEP Page s Seadent Plan Date 3/29/2017 ‘Measurable Post-Secondary Goals “Measurable Post-Secondary Goals, Courses of Study and Transition Service Needs are components of the IEP for Students in grades 9 - graduation (to be updated annually) ‘Transition information isto be periodically updated such that these sections will continue to be a current part of the student's TEP, Post Secondary Education and Training 1 will work atthe Pepsi company. I do not want to goto college. Employment | want o join the Pepsi company and wrk with forklifts and trucks Independent Living (where appropriate: recreation and leisure, community participation, home living) | want to live in Minnesota or lowa. I want to live ina house. ‘Coursés of Study School] Grade ‘Courses tobe taken each year Year| Levet 2016-2017 | 08 [Academic Skills ICo-Taught Mathematics {co-Taught English Science Social Studies Elective(Arv Technology/Physical Education) 2017-2018] 09 [Academic Skilis |Co-Taught Mathematics }Co-Taught English Science Social Studies Elective(ArtTechnology/Physical Education) Anticipated month and year of graduation: June 2021 ‘Tis form ie avaiable nother formats. Contact he IEP Manager for an alternate format.IEP Page 9 Seen Piss Date 3/29/2017 ES Statement of Transition Service Needs [anything else in the community, ‘Transition Services ‘Needs & Activities “Agencies Responsible instruction (e, specialized or regular requires direct specialize instruction due tohis |Special Education instruction, career and technical education) need to improve his on task behavior, reading, writing, [Staff land mathematics skills 535 District Related Services [Currently goes tothe school social worker once a [535 District Jweck. He does this to communicate end talk about different ideas and concepts. [Community Participation plays bowling, but otherwise does not participate [rfome in any organized sports. does not believe he does |Bowlocity The development of employment and other |post-school adult living objectives hhas indicated that he would like help in job training skills in the Future. He will receive those in high schoo! through different classes and real-world setings [ohn Marshall High School if appropriate, acquisition of daily living skills & provision ofa functional vocation evaluation ‘vacuums, takes out the garbage, cleans his room, Jcleans up the back yard, and sometimes mows. tome ‘This forms avaiable h other formats, Contact the IEP Manager foraTEP Page 10 Suudent: Pas Da 3/29/2017 Special Edueation Services Tasco or Toca ‘vated MinsSess Service Ee Service Provided Frogeney “oa Tom | Spm | mapa] ¥* enerat Sper Werk 10 [a6 | s29n017 | onv2017 Math Co-Taught support a [Other Healt Disabitites (OND) General Sper Week 10 [a6 | sasnor7 | oniaor7 english Language Arts Co-Taught | Ea support [Other Health Disabiides (OHD) Special ‘Sper Week 30 [46 | szno7 | sao Reading writing, math, and soca skills [Ed instruction [Other Heath Disabtes (OD) Special per Week 5 [30 | 329207 | saszo1s Soctal Worker Ea ‘Supplemental Aids and Services Due to difficulties with processing speed and attention, Studies and Science to help with note taking and keeping focused. transportation due to difficulties in the area of anxiety, frustration, and coping skills. will have paraprofessional also requi speci Evacuation Plan 0 ve Hi vo Is Emergency Evacuation Plan required? Program Modifications Describe needed program modifications or supports for school personnel to meet the neods of the student. Due to his difficulties with attention and processing, ‘accommodatior 1) Comprehension check when independent work time is given. 2) Preferential se 3) Writing assignments modified in length and comple: special education teachers. 4) Option to type all written work, 5) Note hand outs provided. fe peer role models. 6) Additional time to complete tests and assignments. 7) Non-reading tests and assignments read aloud. 8) May use a number line and/or manipulatives to solve math problems and math assessments. 9) Access to classroom technology for notes ing. ‘ill need the following modifications and based upon the individual assignment by the general and Assistive Technology Describe needed assistive technology. «ill have access (o a standard mouse when working on a laptop, especially during testing sessions, due to his mood disorder to ease his frustration level. ‘may also use any text-to-speech technology available to him. ‘This form is avalabe in other formats. Contact the IEP Manager for an ekemate formatIEP Page 11 Student Plan Date 3/29/2017 Special Considerations Special Considerations: The IEP team must consider the following factors during the IEP process, The present level of performance must specifically address all the factors that apply to the student, Is the student visually impaired or legally blind? (Plan must document consideration of instruction and use of Braille) - No Does the student have limited English proficiency? (Plan must document language consideration), + No Is the student Deaf or Hard of Hearing? (Plan must document consideration of language/communication needs, opportunities ‘with peers, and direct instruction in language/communication mode.) - No Does behavior impede learning of self or others? (Plan must document consideration of strategies including positive behavioral interventions and supports to address that behavior.) - No Does the students behavior require a Behavior Intervention Plan? = No Is special transportation required to benefit from his/her education? (Please note- parents who apply for a boundary exception and choose to send their child to a schoo! other than their home school are responsible for transporting their child outside their home attendance area) = Yes ‘Least Restrictive Environment (URE) Explanation Explanation of why and to what extent full participation with non-disabled students in the regular classroom and other activities is not possible: requires specialized instruction due to: {Due to his documented needs in the areas of reading comprehension, math calculation, math reasoning, written expression, and coping skills, will receive English and math support in a co-taught class. He will receive reading, writing, math, and social skills instruction in an academic skills resource in a Special Education setting. ‘While receiving special education services, will not participate in the following general education classes/ativities An elective will participate with his peers in all other classes. This fom is avaiable in other formats. Contac! the IEP Manager for an tema format,TEP Page 2 Student Phin Date 3/29/2017 State Assessments for Accountability Minnesota Comprehensive Assessment (MCA) ‘The MCA testis administered for Reading, Mathematics and Seience. Reading is administered in grades 3,4 , 5, 6,7, 8 and 10 Math is administered in grades 3, 4, $, 6,7, 8and I Science is administered in grades S, 8 and in high school(after completion of Biology) Please note- accommodations can only be used if allowed by the state. Not every accommodation listed is available for every test [Assessment Condit Reading | Math [Science [Not applicable at this time or not vested in this grade level ol/olo Wit participate without accommodations oO fol]o Witt parcipae with accommodations Hisied Timing/Scheduling: Extended testing time of sections/segments over multiple testing & |] w | & Minnesota Test of Academic Skills (MTAS) ‘The MTAS is an Alternate Assessment version of the Minnesota Comprehensive Assessments and is administerd for Reading, Mathematies and Science. MTAS Reading is available in grades 3, 4,5, 6, 7, 8 and 10 TAS Mathis evailable in grades 3, 4,5, 7,8 and 1] TAS Science is available in grades 5, 8 and in high school (after completion of Biology) ‘There is not a need to mark specific accommodations for the MTAS since the proctoring instructions involving the MTAS. allow for accommodations to be decided upon and made during the administration ofthe assessment. [assessment Conditions Reading] Math [Science [Not applicable at this time or not tested inthis grade level ww ie] ie [Wil participate withont accommodations a oO oO District-Wide Assessments District Assessments District Assessments ‘This form is avatable in other formats. Contact the IEP Manager for an alternate formaTEP Pape 13, sent: Pan Dawe 3/29/2017 [Assessment Conditions Reading | Math [Wating [Not applicable at his tine or aot tested inthis rade level oO fvolo Will participate without accommodations ofol Will participate with accommodations listed Read mathematics and science (not Reading or Language Usage) text portions aloud (for Special Education students only) Mathematics and Science o ‘Test an individual stadent in a separate setting Test with a small group of students in a separate setting but familiar locaton, a ‘Extend testing time Offer frequent breaks Will participate with modifications listed O| & @ ‘This forms avaiable in cther formats, Contac he IEP Manager for an aternate format.