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Monroe County Community School Corporation

Case Conference Summary/IEP/ITP

Date March 4, 2008

Student Name Derek Smith DOB February 12, 1996 Sex Male Re-eval Date March 4, 2011

Home School/Attending School / Wildrose Elementary Grade 5 ID#

Student Resides with: Phone Caseworker/Agency Representative Phone

Joan and Joan Smith Home 812-555-1234 Home


Parent/Guardian Name Name

1570 Adams Ave. Work 812-666-1234 Work


Street Address Street Address

Bloomington 47406 Emergency 812-777-1234 Emergency


City/Zip City/Zip

Legal Guardian: ✔ Natural Parents


  Adoptive Parents  DFC
 Natural Mother  Adoptive Mother  Court
 Natural Father  Adoptive Father  Other __________________________________________

Purpose of Case Conference:



✔ Initial Conference  Annual Case Review  Transition
 Declassification/Reclassification  Causal Relationship  Move in
 IEP Review

Case Conference Committee Members (Indicate role)

Howard Kaplan Jaclyn Bober


Chairperson Special Education Teacher

Derek Smith Stephanie Gordon


Student General Education Teacher

John and Joan Smith Greg Goza (Psychologist)


Parent
Student Performance Derek Smith

Evaluation procedures, assessments, records or reports utilized to help determine eligibility for special education services.

Cognitive:
WISC-III scores: Verbal IQ -95, Performance IQ- 110, Full-Scale IQ- 96

Impact on involvement in general education curriculum: Derek has an average IQ which does not impact cognitive ability.

Achievement: Evaluation Data: The achievement test administered was the Woodcock-Johnson III. Broad Reading score - 77, Letter-Word ID- 72, Spelling- 52. He qualifies for LD in these areas.

Reading: Strengths Derek's strengths in reading are his decoding skills or word attack.

Weaknesses Derek has weaknesses in reading comprehension, broad reading and fluency. His biggest weakness is in written spelling.

Impact on involvement in general education curriculum: Derek may benefit from being placed in a resource room for reading.

Math: Strengths Derek's strength in mathematics is calculation.

Weaknesses Derek's weakness in mathematics is applied problems.

Impact on involvement in general education curriculum: Derek is able to participate in a mathematics general education curriculum.

Social Emotional: Strengths Derek seems to have friends and able to be social with others.

Weaknesses Derek becomes argumentative with others at times.

Impact on involvement in general education curriculum: Arguing with others may push other students away, Derek may need self-regulation skills.

Communication: Strengths Derek is able to form his own opinion and has age-appropriate skills.

Weaknesses Derek has no known deficits in communication.

Impact on involvement in general education curriculum: Communication does not have an impact on Derek's education.

Adaptive Behavior: Strengths Derek is able to manage personal skills.

Weaknesses There are no known deficits in adaptive behavior.

Impact on involvement in general education curriculum: There is no apparent impact on Derek's education.

Behavior: Strengths Derek has good school attendance.

Weaknesses Derek is unfocused and possibly hyperactive.

Impact on involvement in general education curriculum: Derek may need preferential seating.

Other: Strengths NA

Weaknesses NA

Impact on involvement in general education curriculum: NA

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401

(812)349-4756 or (812)349-4757 - FAX=(812)330-7811

Case Conference Summary Page 2


Derek Smith

Student input (strengths, interests, concerns): Derek does well in mathematics but has a hard time in language arts. He does not like being at school and does not want to repeat a grade for the

second time. Derek has a hard time paying attention during school.

Parent input (strengths, interests, concerns): Parents are worried that his academic issues will only get worse and that his repetition of grade 3 did not serve him well. The mother is concerned that

he has a lack of focus and hyperactivity issues. She helps him with his homework, but it is a frustrating process.

The following health data was discussed



✔ no known problems  frequent absences/tardies: days present _____ days absent _____
 on medication (specify)  physical concern (specify)

 seizure activity  wears glasses/contacts/hearing aid/prosthesis (circle)


 health plan  other ___________________

Special Factors

1. Does behavior impede student learning or the learning of others? Yes ✔ No If YES, team must develop and attach intervention plan
2. Does the student have limited English proficiency? Yes ✔ No If YES, team must consider language needs
3. Is the student blind or visually impaired? Yes ✔ No If YES, team must consider appropriate reading and writing media.
4. Is the student deaf or hard of hearing? Yes ✔ No If YES, team must consider communication needs.
5. Does the student require assistive technology devices or services? Yes ✔ No If YES, see accommodations and/or related services
6. Should the student be considered for an assistive technology evaluation? Yes ✔ No If YES, appropriate referral forms must be completed
7. “Other”

Based on the case conference committee’s discussion of the data noted above:


 The student is eligible for special education services as defined in Indiana Code

 The student is not eligible for special education services as defined in Indiana Code

Disability Category(ies)
1 = primary disability 2 = secondary disability
___ Autism ___ Communication Disorder ___ Dual Sensory Impairment ___ Developmentally Delayed ___ Emotional Handicap
___ Hearing Impairment 1 Learning Disability
___ ___ Mild Mental Handicap ___ Moderate Mental Handicap ___ Severe Mental Handicap
___ Orthopedic Impairment ___ Other Health Impairment ___ Traumatic Brain Injury ___ Visual Impairment

Does the student require an alternative curriculum? Yes ✔ No If YES, explain non-participation in general education curriculum

Can student participate in non-academic and extra curricular activities? ✔ Yes No If NO, explain

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401

(812)349-4756 or (812)349-4757 - FAX=(812)330-7811

Case Conference Summary Page 3


Individualized Transition Plan

Name: Derek Smith Social Security Number

School Anticipated final year of school

Initial
Plan Date Review Date Review Date Review Date Review Date Review Date

1. Projected Post-School Outcomes:

Post-Secondary Education

Vocational Training

Community Living

Continuing/Adult Ed.

Integrated/Supported Employment

Community Participation

2. Statement of student’s interests and preferences:

3. This student is working toward:  Credit - diploma  Non-credit - certificate of completion  GED

4. Ongoing Adult Services:  NO  YES - what information was given? Date given:

5. I have been informed that at the age of eighteen all rights accorded parents under special education legislation are transferred to the student and are concurrent with the parents’.
(Must be completed if student is 17 at the time of conference.)

Student Signature/Date Parent Signature/Date

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401
(812)349-4756 or (812)349-4757 -- FAX (812)349-7811

Transition Plan Page 1


Derek Smith
6. Statement of Needed Transition Services: (A “ statement of needed transition services” describes services the student needs to gain the skills and connections necessary to
achieve his or her desired goals):

Transition Services Needed? IEP must contain goals/ Coordinated Sequential Set of Person Responsible/Agency
objectives related to all Activities/objectives Linkages
YES - See goal/objectives areas marked YES
NO - Explain
Instruction  YES

 NO

Related Services  YES

 NO

Community Experience  YES

 NO

Employment/Functional  YES
Vocational Evaluation
 NO

Daily Living  YES

 NO

Residential  YES

 NO

Other (eg: medical, financial)  YES

 NO

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401
(812)349-4756 or (812)349-4757 -- FAX (812)349-7811

Transition Plan Page 2


Goals and Objectives

Student’s Name Derek Smith Identified Need: Reading Comprehension

Annual Goal Student will improve reading comprehension skills at the 2nd grade level.

Measurable, Short-term Instructional Objectives Person(s) Responsible Procedures of Progress Comments


Including Objective Criteria to be reviewed annually (By Title) Evaluation
(2.2.4) Ask and respond to questions to aid in comprehension about Gen. Ed. A,B,D
important elements of informational texts with fewer than 3 errors out of 12 Spec. Ed.
questions given weekly.
(2.2.5) Restate facts and details or summarize the main idea in the text to Gen. Ed. A,B,D
clarify and organize ideas with fewer than 5 errors out of 20 questions given Spec. Ed.
weekly.

Person(s) Responsible Procedures for Evaluation Progress

General Education Teacher Gen. Ed A. Observation i. Objective Met

Special Education Teacher Spec. Ed. B. Written/Oral Response ii. Progress made, but objective not yet met

Parent Parent C. Performance iii. Little or no progress

Occupational Therapist OT D. Criterion Referenced Test iv. Met, but not maintained

Physical Therapist PT E. Student Self Assessment v. Other (specify)

Speech/Language Pathologist SLP F. Other (specify):

Hearing Impairment Specialist HI

Vision Impairment Specialist VI

 Progress will be reported on the goals form  Other (Specify)



✔ Progress toward annual goals will be provided at time of report cards; or
 Other (Specify)

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401
(812)349-4756 or (812)349-4757 -- FAX (812)330-7811
IEP Page 1
Goals and Objectives

Student’s Name Derek Smith Identified Need: Writing

Annual Goal The student will improve writing skills at a pre-primer level.

Measurable, Short-term Instructional Objectives Person(s) Responsible Procedures of Progress Comments


Including Objective Criteria to be reviewed annually (By Title) Evaluation
(K.6.2) Spell independently using an understanding of the sounds of the Gen. Ed. A,B,D
alphabet and knowledge of letter words with fewer than 6 errors out of 24 Spec. Ed.
words total.
(K.4.4) Write phonetically spelled words and consonant-vowel-consonant Gen. Ed. A,B,D
words with fewer than 10 errors out of 40 possible given weekly. Spec. Ed.

Person(s) Responsible Procedures for Evaluation Progress

General Education Teacher Gen. Ed A. Observation i. Objective Met

Special Education Teacher Spec. Ed. B. Written/Oral Response ii. Progress made, but objective not yet met

Parent Parent C. Performance iii. Little or no progress

Occupational Therapist OT D. Criterion Referenced Test iv. Met, but not maintained

Physical Therapist PT E. Student Self Assessment v. Other (specify)

Speech/Language Pathologist SLP F. Other (specify):

Hearing Impairment Specialist HI

Vision Impairment Specialist VI

 Progress will be reported on the goals form  Other (Specify)



✔ Progress toward annual goals will be provided at time of report cards; or
 Other (Specify)

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401
(812)349-4756 or (812)349-4757 -- FAX (812)330-7811
IEP Page 1
Goals and Objectives

Student’s Name Derek Smith Identified Need:

Annual Goal

Measurable, Short-term Instructional Objectives Person(s) Responsible Procedures of Progress Comments


Including Objective Criteria to be reviewed annually (By Title) Evaluation

Person(s) Responsible Procedures for Evaluation Progress

General Education Teacher Gen. Ed A. Observation i. Objective Met

Special Education Teacher Spec. Ed. B. Written/Oral Response ii. Progress made, but objective not yet met

Parent Parent C. Performance iii. Little or no progress

Occupational Therapist OT D. Criterion Referenced Test iv. Met, but not maintained

Physical Therapist PT E. Student Self Assessment v. Other (specify)

Speech/Language Pathologist SLP F. Other (specify):

Hearing Impairment Specialist HI

Vision Impairment Specialist VI

 Progress will be reported on the goals form  Other (Specify)


 Progress toward annual goals will be provided at time of report cards; or
 Other (Specify)

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401
(812)349-4756 or (812)349-4757 -- FAX (812)330-7811
IEP Page 1
Goals and Objectives

Student’s Name Derek Smith Identified Need:

Annual Goal

Measurable, Short-term Instructional Objectives Person(s) Responsible Procedures of Progress Comments


Including Objective Criteria to be reviewed annually (By Title) Evaluation

Person(s) Responsible Procedures for Evaluation Progress

General Education Teacher Gen. Ed A. Observation i. Objective Met

Special Education Teacher Spec. Ed. B. Written/Oral Response ii. Progress made, but objective not yet met

Parent Parent C. Performance iii. Little or no progress

Occupational Therapist OT D. Criterion Referenced Test iv. Met, but not maintained

Physical Therapist PT E. Student Self Assessment v. Other (specify)

Speech/Language Pathologist SLP F. Other (specify):

Hearing Impairment Specialist HI

Vision Impairment Specialist VI

 Progress will be reported on the goals form  Other (Specify)


 Progress toward annual goals will be provided at time of report cards; or
 Other (Specify)

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401
(812)349-4756 or (812)349-4757 -- FAX (812)330-7811
IEP Page 1
Goals and Objectives

Student’s Name Derek Smith Identified Need:

Annual Goal

Measurable, Short-term Instructional Objectives Person(s) Responsible Procedures of Progress Comments


Including Objective Criteria to be reviewed annually (By Title) Evaluation

Person(s) Responsible Procedures for Evaluation Progress

General Education Teacher Gen. Ed A. Observation i. Objective Met

Special Education Teacher Spec. Ed. B. Written/Oral Response ii. Progress made, but objective not yet met

Parent Parent C. Performance iii. Little or no progress

Occupational Therapist OT D. Criterion Referenced Test iv. Met, but not maintained

Physical Therapist PT E. Student Self Assessment v. Other (specify)

Speech/Language Pathologist SLP F. Other (specify):

Hearing Impairment Specialist HI

Vision Impairment Specialist VI

 Progress will be reported on the goals form  Other (Specify)


 Progress toward annual goals will be provided at time of report cards; or
 Other (Specify)

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401
(812)349-4756 or (812)349-4757 -- FAX (812)330-7811
IEP Page 1
Goals and Objectives

Student’s Name Derek Smith Identified Need:

Annual Goal

Measurable, Short-term Instructional Objectives Person(s) Responsible Procedures of Progress Comments


Including Objective Criteria to be reviewed annually (By Title) Evaluation

Person(s) Responsible Procedures for Evaluation Progress

General Education Teacher Gen. Ed A. Observation i. Objective Met

Special Education Teacher Spec. Ed. B. Written/Oral Response ii. Progress made, but objective not yet met

Parent Parent C. Performance iii. Little or no progress

Occupational Therapist OT D. Criterion Referenced Test iv. Met, but not maintained

Physical Therapist PT E. Student Self Assessment v. Other (specify)

Speech/Language Pathologist SLP F. Other (specify):

Hearing Impairment Specialist HI

Vision Impairment Specialist VI

 Progress will be reported on the goals form  Other (Specify)


 Progress toward annual goals will be provided at time of report cards; or
 Other (Specify)

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401
(812)349-4756 or (812)349-4757 -- FAX (812)330-7811
IEP Page 1
Goals and Objectives

Student’s Name Derek Smith Identified Need:

Annual Goal

Measurable, Short-term Instructional Objectives Person(s) Responsible Procedures of Progress Comments


Including Objective Criteria to be reviewed annually (By Title) Evaluation

Person(s) Responsible Procedures for Evaluation Progress

General Education Teacher Gen. Ed A. Observation i. Objective Met

Special Education Teacher Spec. Ed. B. Written/Oral Response ii. Progress made, but objective not yet met

Parent Parent C. Performance iii. Little or no progress

Occupational Therapist OT D. Criterion Referenced Test iv. Met, but not maintained

Physical Therapist PT E. Student Self Assessment v. Other (specify)

Speech/Language Pathologist SLP F. Other (specify):

Hearing Impairment Specialist HI

Vision Impairment Specialist VI

 Progress will be reported on the goals form  Other (Specify)


 Progress toward annual goals will be provided at time of report cards; or
 Other (Specify)

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401
(812)349-4756 or (812)349-4757 -- FAX (812)330-7811
IEP Page 1
Derek Smith

Special Education Services/Least Restrictive Environment Any potentially harmful effects of the recommendations must be considered.

Services considered and rejected (indicate reasons)

The IEP team has considered both full-time and part-time services, but full-time services would be too restrictive of an environment.

Services recommended (indicate reasons; location, frequency and length)


The IEP team recommends part-time services in a resource setting. These would be held 5 days a week for 1 hour per day.

Related Services (Note intensity, frequency and location of services)

_____Occupational therapy for a minimum of _____ minutes each  week  month


_____ direct, integrated in classroom & community
_____consultation _____ other (specify)________________

_____Physical therapy for a minimum of _____ minutes each  week  month


_____ direct, integrated in classroom & community
_____consultation _____ other (specify)________________

Social Worker Transportation: Attach Transportation Form.

Other

Supplementary aids and services/and/or other factors relevant to proposed services:


NA

March 4, 2008 March 3, 2009


Date for Initiation of Services (on or about): , ending date (on or about) following regular school calendar.

Teacher of Record: Jaclyn Bober

Other Teachers of Record for Secondary Disabilities

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401
(812)349-4756 or (812)349-4757 -- FAX (812)330-7811
Case Conference Summary Page 4
Derek Smith
08/09
Recommended Participation in Statewide or District standardized testing for the _______________ school year.

Indiana MCCSC
This student is not in a standardized testing mandated grade level.
This student will fully participate in the standardized testing program without accommodations.
This student will not participate in the standardized testing program (Specify reasons below).
✔ ✔ This student will fully participate in the standardized testing program with accommodations (Specify below).
This student will participate in the standardized testing program for diagnostic purposes.
This student will be subject to remediation.
This student will be subject to retesting.
This student will need the following testing accommodations (Specify):

The student will receive 50% extra time, orally read tests (except in reading comprehension) and a calculator.

This student’s essential skills will be tested using an alternate assessment (Specify, including why the statewide or district assessment is not appropriate and
how the student will be assessed):

Is extended school year recommended? YES ✔ NO

If yes, committee must document the degree of regression; amount of time for recoupment; and the extraordinary, irretrievable educational, emotional or vocational reversals.

If yes, describe the nature of the interventions, include interventions parents can provide to meet student’s needs.

Name(s) of person(s) who will submit a written opinion.

NA X

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401
(812)349-4756 or (812)349-4757 -- FAX (812)330-7811
Case Conference Summary 5
Student Name: Derek Smith

School: Wildrose Elementary

Parent Permission for Special Education Services

You have the right to request a case conference and/or revoke your written permission for services at any time. If you are prepared to decide at this time, please sign on one of
the lines below.

I/we agree with the services recommended and give permission for the plan to be implemented:

Parent Signature Date Student Signature (If 18) Date

I/we do not agree with the services recommended.

Parent Signature Date Student Signature (If 18) Date

Parental Rights have been explained and provided:


Parent Initials

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401
(812)349-4756 or (812)349-4757 -- FAX (812)330-7811
Case Conference Summary 6
Modifications/Accommodations/Supports to Meet Educational Needs
Derek Smith
Pacing Assignments Social Interaction Supports
✔ Allow more time ✔ Give directions in small, distinct Peer/cross age tutoring
Vary activity often steps (written/picture/verbal) Structure activities to create opportunities
Allow breaks Use written backup for oral directions of social interaction
Avoid timed/pressure situations Read or tape record directions to Focus on social process rather than
Other: student activity/end product
✔ Adjust difficulty level Partial participation
Environment Shorten assignment/fewer items on Cooperative learning groups
Preferential seating page Other:
Planned seating: Bus Classroom Reduce paper and pencil tasks
Lunchroom Auditorium ✔ Give extra cues or prompts Motivation and Reinforcement
Alter physical room arrangement Allow student to record/type or Verbal
Define areas concretely dictate assignment Non-verbal
✔ Reduce/minimize distractions: Avoid penalizing for spelling errors/ ✔ Positive reinforcement
✔ Visual Auditory sloppy papers/penmanship Concrete reinforcement
Spatial Movement Student should use cursive/printing Planned motivating sequences of activities
Provide opportunity for separate seating Other: Reinforce initiation
Teach positive rules for use of space ✔ Offer choices
Other: Self Management/Follow Through ✔ Use strengths/interests often
Visual daily schedule Reinforce approximation
Presentation of Subject Matter Calendars Response cost
Teach to student’s learning style ✔ Daily/Weekly assignment sheets Other:
Visual Auditory Model Check often for understanding/review
Tactile Multi Experiential Learning Request parent reinforcement
Review prior to presenting new materials ✔ Have student repeat directions
Individual/small group instruction Encourage use of notebook with
Utilize alternate specialized curriculum dividers, or file folders, for organization
Tape lectures/discussions for replay Use student sheets to organize
Utilize manipulatives material
Emphasize critical information Design/write/use long term
Pre-teach vocabulary assignment timelines
Make/use vocabulary files Plan for generalization
Oral reading on voluntary basis only Develop organized routine
✔ Provide study guides/outlines ✔ Schedule regular communication/
Encourage feedback from student to check for learning reports between home and school
Other: Other:

Materials Student Assessment


Arrangement of material on page Oral/taped responses Short answer
Taped tests and/or other class materials Taped responses Multiple choice
Highlighted tests/study guides ✔ Read test to student Modify time frame
Notetaking assistance: carbonless or xerox copy of notes of Shorten length ✔ Extend time frame
regular students, copy of notes from board provided Consider individual progress over time
Large print/graph paper/lined paper Consider effort
✔ Special Equipment: Alternative assessment
Word processor ✔ Calculator Test administered by:
Computer Math facts sheet ✔ Other: calculator

Monroe County Community School Corporation - 315 North Drive - Bloomington, IN 47401
(812)349-4756 or (812)349-4757 -- FAX (812)330-7811
Case Conference Summary 7

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