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Sample Career Objectives - Excel

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					                               Individualized Education Program                                                                               For Initial IEP
                                                                                                                                     Date of Referral
                                                                   with   Transition                                            Date Consent Sought
                                    Local School:                                                                             Date Consent Received


                                                                       STUDENT INFORMATION
Date of Meeting             Initial/ReEval IEP Date         Date of Last IEP    Birthdate        Ethnic Group                   Gender                      Grade

Student's Last Name                                         First Name          Middle Initial                Interpreter Needed?                              Sec 52
                                                                                                                        Yes          No                        Sec 53
Student's Home Address                                               City               State    ZIP Code      Student's Home Telephone
                                                                                        MI
Parent/Guardian/Surrogate Last Name                   First Name Parent Native Language Student Native LanguageParent's Home Telephone/Cell

Parent/Guardian/Surrogate Address (if different)                     City                        State        ZIP Code          Parent's Work Telephone
                                                                                                 MI
Resident District (your own district here)                           Operating District                       Attending Building
                                                                             Cass City Schools                                       Transition Center

                                                                     PURPOSE OF IEP MEETING
Purpose(s) of this Individualized Educational Planning (IEP) Meeting (check all that apply) :
      Initial Eligibility       Revise/Review/IEP             Reevaluation      Transition          Additional/Change of Disability           Other     Change of program

                                                                            PARENT CONTACT
School personnel contacted parents to arrange a mutually agreeable time and place for the IEP meeting.

Method of Contact                                      By                                              Date                          Result

If the parent could not be reached to arrange a mutually agreed upon time and place, an additional contact(s) was made:

Method of Contact                                      By                                              Date                          Result

                                                         TEAM MEMBERS ATTENDING IEP MEETING
Signatures of the following individuals indicate attendance at this IEP.

    Check box                 indicating IEP Team member who can explain the instructional implications of evaluation results.

    Check box                 indicating IEP Team member who has observed the student suspected of having a learning disability.


Student, when appropriate                                                       General Education Teacher



Parent(s)                                                                       Special Education Teacher



Parent(s)                                                                       District Representative/Designee (other than child's general ed. teacher)


Adult Service Agency Representative                                             Other



Other                                                                           Other

Participant signatures are required to verify a determination regarding a suspected learning disability under R340.1713. Any member who
disagrees must submit a separate statement presenting his or her conclusion.

                                                         STUDENT DETERMINATION OF ELIGIBILITY
For an initial or redetermination of eligibility the IEP Team determines this student to be:

            Eligible                                                           Ineligible
                                                                                 (proceed to Resident district Commitment, Operating District commitment, and
      If 3-year is due within the next year, please complete one.                Adult Providing IEP Consent).

                                                                   STUDENT ELIGIBILITY CATEGORY
This student is eligible for special education in the category of:

            Primary :                               Eligibility:


        Secondary:                                  Eligibility:




Revised (10/1/08)                                                                                                                                                   Page 1
Student Name:                                                                                                Date of IEP:


                                                         STUDENT TRANSITION PLAN
34 CFR 300.344(b) requires the school to invite students to participate in IEP Team meetings if the meeting will include consideration of transition
needs or services. Addressing Transition is recommended beginning at 7th grade and annually thereafter if determined by the IEP Team.

If the student does not attend, describe the steps that were taken to ensure that the student's preferences and interests were considered.




                                                                     Agency Involvement
Was there a need to invite a community agency representative likely to provide current or future services?
                    Yes          Considered, none needed

If Yes, did the community agency representative attend the IEP?                        Yes              No       Explain:


                                                 Michigan Educational Development Plan
Michigan High School Graduation Requirements states that each pupil in grade 7 is provided with an opportunity to develop an educational
development plan to be completed before beginning high school. The plan is developed by the student under the supervision of the pupil's school
counselor (or qualified designee) and is based on a career pathways (or similar) career exploration program that students use to explore careers
and the educational requirements for achieving a career goal. (Sec 1278(b)(11))


Educational Development Plan (EDP): Please check the EDP areas that this student has completed prior to this IEP.
        1-Personal Information          2-Career Goals           3-Educational/Training Goals      4-Assessment Results     5-Plan of Action
        6-Parent Consultation and Endorsement

Career Pathways: These Career Area(s) are of particular interest to the student: Please prioritize (1, 2, etc) if more than one.
                            Arts & Communication                                                             Health Sciences
                            Business, Management, Marketing and Technology                                   Human Services
                            Engineering, Manufacturing and Industrial Technology                             Natural Resources and Agriscience


                                                                   Post Secondary Vision
The student's post secondary vision is:                            (the vision occurs after the student leaves school)




1) Adult Living: As an adult, where do you want to live?
               Apartment                                 Alone                      Additional Ideas:

               Own Home                                  With Roommate(s)

               With Family

2) Career/Employment: As an adult, what kind of work do you want to do? Choose a career category based on your Career Pathway interest.




3) Community Participation: As an adult, what hobbies and activities do you want to have?




4) Post-Secondary Education/Training: After high school, what additional education and training do you want?
                     College - 4 Year                       Tuscola P.R.E.P. Program                    None

                     Community College                      Military                               Additional Ideas:

                     Vocational Trade School                On the Job Training




Revised (10/1/08)                                                                                                                               Page 2
Student Name:                                                                                             Date of IEP:


                                                             Present Level of Transition Needs
Statement of Needed Transition Services - Include by age 16 (Required)
(Recommended beginning at 8th grade and annually thereafter if determined by the IEP Team.)


    Transition           Current Functional                                                                                         Responsible
                           Performance                              Verifying                         Needed Transition
   Performance                                                                                                                     Agency/School/
                         Assessment Used                         Strength/Need                        Activities/Services
       Area                                                                                                                        Parent/Student
                       (STAT scores, Observation, etc.)

                      STAT Date:
                                                                                              Worksite based learning or TTC   PREP/Student
                                                             Strength; no activity required
Career/ Employment
                                                             Need

                                                                                              College field trips              PREP/Student
  Post Secondary                                             Strength; no activity required MCTI tour
 Education/Training
                                                             Need
                                                                                              Cooking, cleaning, laundry       PREP/Student
                                                             Strength; no activity required
      Adult Life
                                                             Need
                                                                                              Recreational activities          PREP/Student
    Community                                                Strength; no activity required Volunteering
    Participation
                                                             Need

                                                             Strength; no activity required
         Other
                                                             Need



                                                          Parental Rights and Age of Majority
Check all applicable:
   If the student will be age 17 during this IEP, the student was informed of parental rights that will transfer to him/her at age 18.
   If the student has turned age 18 the student and parent were informed of the parental rights that transferred to the student at age 18.
   The student has turned age 18 and there is a guardian established by court order. The guardian is:

                                                                      Course of Study
Course of Study Addressing Post-School Transition Needs for Post-Secondary Adult Activities - Consider the following for any
students who will reach age 14 during this IEP (consider at age 13 or younger if determined appropriate by the IEP Team, and review at each
subsequent IEP). Check one:

                      General and/or special education classes leading to a diploma
                      Course of study leading to a certificate of completion




Revised (10/1/08)                                                                                                                                   Page 3
Student Name:                                                                                                        Date of IEP:

                           Factors to consider in order to provide FAPE (Free Appropriate Public Education)
The IEP Team must consider each of the following (check each box) and comment as appropriate:

      strengths of the student                                                                              progress on the current IEP annual goals and objectives
      parent input and concerns for enhancing the education of the student                                  student's anticipated needs or other matters
      results of an initial evaluation or the most recent
      reevaluation of the student

Comment(s):




The IEP Team must consider each of the following specific need areas (check each box) and provide a statement describing any area
needed by the student:

      communication needs of student                                                                      Braille instruction for students who are blind or visually impaired
      positive behavior interventions, supports, and strategies for                                       communication and language support for students who are
      students whose behavior impedes learning                                                            deaf or hearing impaired
      language support for students with limited English proficiency                                      assistive technology devices or services

Comment(s):




PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
After reviewing the above factors, please include the following information regarding this student's ongoing progress in the general education curriculum and/or
achievement in age-appropriate activities (for preschool).

                                                                              How does the disability affect
                                         Current                              this student's progress in the
    Academic and                                                                                                                          How will this need be
                                     Baseline Data                          general curriculum or involvement
   Functional Areas                                                                                                                      addressed by this IEP?
                             (Obtained within the past 6 weeks)                in age-appropriate activities
                                                                                       (preschool)?

Mathematics                 Score:                                Because the student's skill level in this area is below that of   Special Ed Classroom Goals & Objectives
                                                                  his/her same age peers, he/she will need special education        Ancillary Service Goal & Objectives
                                                                  services/programs/supports for any course involving the
       An area                   Age       Grade Level                                                                              Supplemental Aids & Services
                                                                  following curricular content skills:
       deemed by the                                                                                                                Other:
                                 Standard Score     Other
       IEP Team as
                                                                      Data Probability                    Measurement
       not needing
       attention in this             type of assessment               Number Operations                   Geometry
       IEP                  Describe:                                 Algebra
                                                                      Other:

                                   Put in scores or
                                     grade level



Written Language            Score:                                Because the student's skill level in this area is below that of   Special Ed Classroom Goals & Objectives
                                                                  his/her same age peers, he/she will need special education        Ancillary Service Goal & Objectives
                                                                  services/programs/supports for any course involving the
       An area                   Age       Grade Level                                                                              Supplemental Aids & Services
                                                                  following curricular content skills:
       deemed by the                                                                                                                Other:
                                 Standard Score     Other
       IEP Team as
                                                                      Genre                               Grammar Usage
       not needing
       attention in this             type of assessment               Process                             Spelling
       IEP                  Describe:                                 Personal Style                      Handwriting
                                                                                                          Writing Attitude
                                                                      Other:
                                   Put in scores or
                                     grade level



Revised (10/1/08)                                                                                                                                                         Page 4
Student Name:                                                                                                      Date of IEP:

PLAAFP cont'd
                                                                            How does the disability affect
                                       Current                              this student's progress in the
    Academic and                                                                                                                           How will this need be
                                   Baseline Data                          general curriculum or involvement
   Functional Areas                                                                                                                       addressed by this IEP?
                           (Obtained within the past 6 weeks)                in age-appropriate activities
                                                                                     (preschool)?

Reading                    Score:                               Because the student's skill level in this area is below that of      Special Ed Classroom Goals & Objectives
                                                                his/her same age peers, he/she will need special education           Ancillary Service Goal & Objectives
                                                                services/programs/supports for any course involving the
       An area                 Age       Grade Level                                                                                 Supplemental Aids & Services
                                                                following curricular content skills:
       deemed by the                                                                                                                 Other:
                               Standard Score     Other
       IEP Team as
                                                                    Word Recognition                    Informational Text
       not needing
       attention in this            type of assessment              Word Study                          Comprehension
       IEP                 Describe:                                Fluency                             Metacognition
                                                                    Narrative Text                      Critical Standards
                                                                    Other:
                                 Put in scores or
                                   grade level



Social                     Score:                                      Unusual or inappropriate behaviors or harmful                 Special Ed Classroom Goals & Objectives
Emotional                                                              relationships with teachers, peers & administrators           Ancillary Service Goal & Objectives
Behavioral                                                             Avoidance behaviors causing difficulty with completion of     Supplemental Aids & Services
                               Age       Grade Level
(behaviors that impede                                                 coursework
                               Standard Score     Other                                                                              Other:
learnings)
                                                                       Oppositional/defiant behavior interfering with coursework
complete depending on
student need                        type of assessment
       An area             Describe:                                   Disturbance with mood/affect
       deemed by the                                                   Other:
       IEP Team as
       not needing
       attention in this
       IEP


Communication              Score:                                      Difficulty/inability to be understood by teachers and peers   Special Ed Classroom Goals & Objectives
(Speech & Language)                                                    in the classroom due to articulation, voice or fluency
                                                                       issues                                                        Ancillary Service Goal & Objectives
complete depending on          Age       Grade Level                   Difficulty/inability to appropriately express themselves
student need                                                           verbally or in writing due to language delay                  Supplemental Aids & Services
                               Standard Score     Other
       An area                                                                                                                       Other:
       deemed by the                                                   Difficulty/inability to comprehend language in the learning
       IEP Team as                                                     environment
                                    type of assessment
       not needing
       attention in this   Describe:                                Other:
       IEP




Sensory/                   Score:                                      A significant gross motor impairment that interferes with     Special Ed Classroom Goals & Objectives
Perception/                                                            participation in PE, recess and mobility in school            Ancillary Service Goal & Objectives
Motor/                                                                 A significant impairment in sensory development that          Supplemental Aids & Services
                               Age       Grade Level
Mobility                                                               inhibits normal relations in the school and transitional
                               Standard Score     Other
                                                                       activities                                                    Other:
complete depending on                                                  A significant impairment in perceptual motor
student need                                                           development that inhibits independent functioning in the
                                                                       classroom or any school related activity
       An area                      type of assessment
       deemed by the       Describe:
       IEP Team as
                                                                    Other:
       not needing
       attention in this
       IEP



Revised (10/1/08)                                                                                                                                                          Page 5
Student Name:                                                                                                      Date of IEP:


PLAAFP cont'd

                                                                            How does the disability affect
                                            Current                         this student's progress in the
    Academic and                                                                                                                            How will this need be
                                        Baseline Data                     general curriculum or involvement
   Functional Areas                                                                                                                        addressed by this IEP?
                                (Obtained within the past 6 weeks)           in age-appropriate activities
                                                                                     (preschool)?

Medical:                       Score:                                   Difficulty/Inability to see coursework                        Special Ed Classroom Goals & Objectives
Health/                                                                 Difficulty/Inability to orient and maneuver in the            Ancillary Service Goal & Objectives
Vision/                                                                 school/community                                              Supplemental Aids & Services
                                    Age       Grade Level
Hearing                             Standard Score     Other            Difficulty/Inability to hear classroom instruction or peers   Other:
complete depending on                                                   Impairment of alertness/vitality that interferes with
student need                                                            coursework
       An area                          type of assessment
       deemed by the           Describe:                                A severe health impairment
       IEP Team as
       not needing                                                      Other:
       attention in this
       IEP


Other:                         Score:                                   Student is deficient in one or more of the                    Special Ed Classroom Goals & Objectives
                                                                        areas of transition and needs further                         Ancillary Service Goal & Objectives
                                                                        training to increase probability of living
                                    Age       Grade Level                                                                             Supplemental Aids & Services
                                                                        independently.
                                    Standard Score     Other                                                                          Other:
                                                                                                                                       Attendance at PREP program
                                        type of assessment
                               Describe:
                                            STAT
                                 List scores from four areas




REPORTING PROGRESS
Parents will be regularly informed in writing on goals and objectives of this IEP at the regular reporting periods applicable to general education
students, unless otherwise indicated.
                 Other - Explain:




                                                                     PROGRAM CONSIDERATIONS
LEAST RESTRICTIVE ENVIRONMENT


                           Fully participate with students who are nondisabled in the general education setting except for the time spent in separate
                           education programs/services provided outside the general education classroom as specified in this IEP.
                              Yes            No (explain):


                           Be fully involved in and progress in the general curriculum.
                             Yes             No (explain):                          will participate in the PREP curriculum.


                           Have the same opportunity as general education students to participate in nonacademic and extracurricular activities.
                             Yes          No (explain):


                                                    ANNUAL GOALS AND SHORT-TERM OBJECTIVES
                                                 (All goals must be derived from a need listed in PLAAFP statement)
                             Click on the Goals & Objectives Page at the bottom of this document to see specific PREP goals.




Revised (10/1/08)                                                                                                                                                           Page 6
Student Name:                                                                                   Date of IEP:

SUPPLEMENTARY AIDS AND SERVICES BASED ON STUDENT NEEDS
Please list any regular education accommodations that would be helpful in case student attends TTC or college in the future.
The following supplementary aids/services will be provided to the student:
                    Supplementary Aid/                                Amount of Time/
                     Service/Support                               Frequency/Conditions                                        Location




Other health services, as defined in IDEA, may be provided to help the student benefit from the special education services listed in the IEP.

All supplementary aids/services and supports listed above will begin on the initiation date of the IEP and continue for one calendar year, following
the approved school district calendar. Note below any exceptions to beginning and ending dates and locations given above.
                  Specify the month/day/year:

                                                          PROGRAMS AND SERVICES
PROGRAM
Is there a need for a teacher with a particular endorsement?           Yes             No            specify:

   Classroom Program:           MoCI - 340.1739                               For Resource Room only: Is a Teacher Consultant with
                                                                              endorsement needed:      Yes        No
Amount of Time and Frequency:                                                 Departmentalized Program (340.1749c):                Yes        No
Location:                Transition Center                         5

All programs listed above will begin on the initiation date of the IEP and continue for one calendar year, following the approved school district
calendar. Extended school year (ESY) services must be provided only if the IEP Team determines on an individual basis that ESY services are
necessary for the provision of a free and appropriate public education. Note below any exceptions to beginning and ending dates given above.
    Specify the month/day/year:

ANCILLARY SERVICES
      Service         Amount of Time and Freq            Location               Service                Amount of Time and Freq             Location
OT                                                                      R340.1745 SLI
PT                                                                      R340.1746 H/H
SSW                                                                     R340.1749 TC
Other:                                                                  Work Experience
Other:                                                                  Other:
All services listed above will begin on the initiation date of the IEP and continue for one calendar year, following the approved school district
calendar. Extended school year (ESY) services must be provided only if the IEP Team determines on an individual basis that ESY services are
necessary for the provision of a free and appropriate public education. Note below any exceptions to beginning and ending dates and locations
given above.
    Specify the month/day/year:
                                                                                               If full time and no TTC = 30 hrs
                                                                                               If full-time and TTC = 15 hrs SE + 15 GE
                                                                       HOURS
 Total Hours in School Weekly                       Total Hours in Special Education             Total Hours in General Education         Spec Ed FTE
                  30                                                                                                                         0.00


                                                      PRIMARY EDUCATIONAL SETTING
Student is placed (pulled) outside the general education classroom:
      less than 21% of the school day.                  between 21% and 60% of the school day.                  greater than 60% of the school day.
                                                       check here if attending TTC                              check here if not attending TTC
(Inclusive placements are considered General Education time. )

                                                           OTHER CONSIDERATIONS
TRANSPORTATION
Is specialized transportation required?             No
                                                  Yes, specify:        Yes, specify:

NONPUBLIC SCHOOL PUPILS
Identify special ed programs/services offered by the district but not provided because the parent elected to enroll the child in a nonpublic school:




Revised (10/1/08)                                                                                                                                  Page 8
Student Name:                                                                                             Date of IEP:

                                                 STATE- AND DISTRICT-WIDE ASSESSMENT
The student will participate in the Michigan Educational Assessment System (MEAS), district-wide assessment, and/or the National Assessment of
Educational Progress (NAEP*) assessments as follows:

Directions: Check the one that applies to this IEP
     State Assessments are NOT administered at the grade level covered by this IEP.
     State Assessments ARE administered at the grade level covered by this IEP and the student DOES NOT need any special accommodations.
     State Assessments ARE administered at the grade level covered by this IEP. (If checked, continue below.)
Section 1: Michigan Educational Assessment Program (MEAP)
                                                           If YES, for each content area, indicate if the student needs
                              Is the assessment        any assessment accommodation(s) and what specifically is                    Is the Assessment
    MEAP Content          appropriate for the student? needed.                                                                accommodation(s) standard
    Area Assessed          Check the appropriate box                                                                           as per current guidelines?
                                     below             If NO, state the reason why the specific MEAP assessment is          Check the appropriate box below.
                                                           not appropriate for the student.

                                YES              NO                                                                               YES               NO**
          English
      Language Arts
    (Grades 3-8 and 11)

       Mathematics
    (Grades 3-8 and 11)

        Scienceu
   (Grades 5, 8 and 11)

     Social Studiesu
   (Grades 6, 9 and 11)
* For students indicate what standardized assessment(s) will be administered for each MEAP content area NOT assessed.
** Scores received using a nonstandard assessment accommodation are not eligible for the Michigan Merit Award. Also, for the No Child Left
  Behind (NCLB) the student will not count as assessed for NCLB participation rates.
u For students whose IEP Team determines the MEAP science and/or social studies assessment(s) are not appropriate for the student, the IEP
Team must determine how the student will be assessed in science and/or social studies.

Section 2: MI-Access, Michigan's Alternate Assessment Program

     MI-Access                                             If YES, why is the alterante assessment identified appropriate
                              Is the assessment        for the student? and                                                        Is the Assessment
       Type of
                          appropriate for the student?                                                                         accommodation standard
   Assessment and
                           Check the appropriate box If YES, for each type of MI-Access assessment and/or                      as per current guidelines?
    Content Area                                       content area, indicate if the student needs any assessment
                                     below                                                                                  Check the appropriate box below.
      Assessed                                             accommodation(s) and what specifically is needed.

                                YES              NO                                                                               YES               NO**

       Participation


        Supported
      Independence

       Functional
     Independence:
         English
     Language Arts
       Functional
     Independence:
      Mathematics


                                                               If the MEAP science and/or social studies
     Content Areas
                                                               assessment(s) are NOT appropriate for the
     where the State
                                                               student, indicate how the student will be
    does not currently
                                                               assessed in science and/or social studies
       have state
                                                               until the state has alternate assessments in
      assessments
       developed                                               these content areas available. Also, indicate if
                                                               any assessment accommodations are needed.



          Science



      Social Studies



Revised (10/1/08)                                                                                                                                          Page 9
Student Name:                                                                                     Date of IEP:

Section 3: English Language Proficiency Assessment (ELPA)
Directions: Check the one that applies to this IEP
        The student IS an English Language Learner and has been in ELPA will States
        The student is NOT an English Language Learner, therefore the the UnitedNOT be administered.
for                                                                                                              number of years. Therefore,
           the student will participate in the EPLA.

Requires reading assessments using tests written in English for any student who has attended school in the US (excluding Puerto Rico) for 3 or more
consecutive years, with LEA discretion to use tests in another language for up to 2 additional years. States also must annually assess English proficiency
for all LEP students beginning with the 2002-03 school year.

Section 4: District-wide Assessment
Directions: Check the one that applies to this IEP
     District-wide Assessments are NOT administered at the grade level covered by this IEP.
     District-wide Assessments ARE administered at the grade level covered by this IEP. (If checked, continue below.)


      District-wide
     Assessment:                  Is the                  If YES, for each content area, indiate if the student needs any assessment
List each assessment          assessment                  accommodation(s) and what specifically is needed.
  that is administered appropriate for the student?
district-wide below and Check the appropriate box         If NO, state the reason why the specific district-wide assessment is not appropriate
 answer the questions             below                   for the student and indicate what alternate assessment the student will be administered.
       to the right

                                YES              NO




Section 5: National Assessment of Educational Performance (NAEP)
Directions: Check the one that applies to this IEP
     The NAEP assessments are NOT administered at the grade level covered by this IEP.
      The NAEP Assessments ARE administered at the grade level covered by this IEP and this student was selected as part of the sample.
      (If checked, continue below.)
      The NAEP Assessments ARE administered at the grade level covered by this IEP, but our school was NOT selected in the sample.
      (If checked, nothing else is needed.)



                                                       If YES, for each content area, indiate if the student needs any assessment
                                     Is the
                                                       accommodation(s) and what specifically is needed.
                                 assessment
         NAEP
                          appropriate for the student?
      Assessments                                      If NO, state the reason why the specific NAEP assessment is not appropriate for
                           Check the appropriate box
                                                       the student. If the student is participating in MI-Access for the NAEP content areas
                                     below
                                                       being assessed, an alternate assessment does NOT need to be administered.

                                YES              NO




Revised (10/1/08)                                                                                                                                   Page 10
Student Name:                                                                                            Date of IEP:

                                                          RESIDENT DISTRICT COMMITMENT
Resident District superintendent/designee (check all that apply):
         Agrees with the IEP and its implementation.                                                     Disagrees with this IEP but will allow its implementation
                Authorizes the nonresident operating district                                            Disagrees with this IEP and requests mediation
                to conduct subsequent IEP Team meetings.
            Agrees that the student is not eligible for special education.                               Sending District signs

          Signed:                                                                                               Date:
                                                   Superintendent or Designee                                               month/day/year

                                      OPERATING DISTRICT COMMITMENT (to be used when authorized)
Student is attending program outside of resident district. The operating district superintendent/designee:
         Agrees to provide the IEP program(s) and/or service(s).                              Disagrees with this IEP but will allow its implementation
              Agrees to conduct subsequent IEP Team meetings.                                 Disagrees with this IEP and requests mediation
         Agrees that the student is not eligible for special education.

          Signed:                                                                                               Date:
                                                   Superintendent or Designee                                               month/day/year

                                                           ADULT PROVIDING IEP CONSENT
I have been informed of all procedural safeguards and sources to obtain assistance, and (check all that apply):
         Understand the contents of this IEP.                               Disagree, but will allow implementation of this IEP
         Agree with the IEP and its implementation.                         Disagree with this IEP and request mediation
         I give my consent for the invitation of any
         necessary agencies to future IEP's for my child.
         I/we agree to allow the resident and intermediate school districts to release minimal student information to the state for the
         purpose of billing the state for any Medicaid-related services on this IEP. Consent may be revoked at any time, and billing
         does not affect or limit any family Medicaid benefits.

          Signed:                                                                                               Date:
                                                     Adult Providing Consent                                                month/day/year
          Signed:                                                                                               Date:
                                                           Adult Student                                                    month/day/year

                                                                NOTICE AND ASSURANCES
The superintendent or designee of the operating district assures that:
                        To the maximum extent appropriate, a person who has a disability, including a person who is assigned to a public or private institution
                    a) or other care facility, is educated with persons who do not have disabilities.
                        Placement of a person who has a disability in special classes, separate schools, or the removal of a person who
                    b) has a disability from the general education environment occurs only when the nature or severity of the disability is

                    c) The placement for the student is as close as possible to his or her home.

                    d) Unless the IEP of a student with a disability requires some other arrangement, the student is educated in the school
                        that he or she would attend if nondisabled.

                    e) In selecting the least restrictive environment, consideration shall be given to any potentially harmful effects to the
                        student or the quality of services that the student needs.

                    f) A child with a disability will not be removed from education in age-appropriate regular classrooms solely because of
                        needed accommodations in the general curriculum.


               Location (building) of program(s) and/or service(s):                                            Transition Center

               Person responsible for implementation:                                               PREP Program Teacher

         Beginning Date:                                                                Ending Date:
                                           (month/day/year)                                                        (month/day/year)
 Sending District signs here
             Signed:                                                                             Date:
                                     Superintendent or Designee                                                    Month/Day/Year

DISSENTING REPORT
Any IEP Team member may submit a dissenting report for attachment to this IEP Team Report.

If a parent or public agency disagrees with this IEP, either party has the right to request a due hearing by following the procedures outlined in the
Procedural Safeguards.




Revised (10/1/08)                                                                                                                                         Page 11
Student Name:                                                                                    Date of IEP:
REPORTING PROGRESS
Parents will be regularly informed in writing on goals and objectives of this IEP at the regular reporting periods applicable to general education
students, unless otherwise indicated.
                      Other - Explain:

                                            ANNUAL GOALS AND SHORT-TERM OBJECTIVES
Present Level of Performance Data: All goals must be derived from a need listed in PLEP statement

Measurable              _____________________ will perform self evaluations to determine specific transition goals to focus on in the PREP
Annual Goal:            program.
Short-Term Objectives (at least two per goal)                                                   Evaluation              Criterion               Schedules
1. _________________ will complete a detailed transition assessment measuring
   performance in the areas of community participation, post-school
   education/training, adult living, and career employment by September 30, 20__.

2. _________________ will complete a person-centered planning document
   evaluating present circumstances and future goals by September 30, 20__.

3.


      Reporting              Status          Status               Status
       Period                Obj. 1          Obj. 2               Obj. 3
                                                                                                    Comments/Data on Progress

           1.

           2.

           3.

           4.

           5.

           6.

Present Level of Performance Data: All goals must be derived from a need listed in PLEP statement

Measurable
Annual Goal:
Short-Term Objectives (at least two per goal)                                                   Evaluation              Criterion               Schedules

1.


2.


3.


      Reporting              Status          Status               Status
       Period                Obj. 1          Obj. 2               Obj. 3
                                                                                                    Comments/Data on Progress

           1.

           2.

           3.

           4.

           5.

           6.
          Evaluation                       Criterion                   Schedule                                 Status of Progress on Objectives
S    Student's Daily Work                 % Accuracy              W   Weekly                  1 Achieved/Maintained
D    Documented                   of      Rate                    D   Daily                   2 Progressing at a rate sufficient to meet the annual goal for this
      Observation                         Achievement Level       M   Monthly                 objective
R    Rating Scale                         Other (specify above)   G   Grading Period          3. Progressing below a rate sufficient to meet the annual goal for
T    Standardized Test                                            O   Other (specify above)   this objective (explain above)
O    Other (specify above)                                                                    4 Not applicable during this reporting period
                                                                                              5 Other (specify above)
TISD (rev. 8/03)                                                                                                                                            Page 7

				
DOCUMENT INFO
Description: Sample Career Objectives document sample