Monroe County Community School Corporation

Case Conference Summary/IEP/ITP

Date March 5, 2008

Student Name Derek Slovin DOB March 2, 1996 Sex Male Re-eval Date March 5, 2011

Home School/Attending School / Templeton Elementary Grade 5th ID#

Student Resides with: Phone Caseworker/Agency Representative Phone

Susan and Larry Slovin Home (812) 345- 9768 Home

Parent/Guardian Name Name

5 Heritage Plaza Drive Work (812) 545- 8765 Work

Street Address Street Address

Bloomington 47404 Emergency (812) 855- 1287 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)

Rebecca Smith Merrin Rosenberg

Chairperson Special Education Teacher

Derek Slovin Shari Robin

Student General Education Teacher

Susan and Larry Slovin Psychologist: Jillian Katz

Parent
Student Performance Derek Slovin

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

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

Impact on involvement in general education curriculum: Because of average IQ there is no impact on the general education curriculum

Achievement: Evaluation Data: Woodcock- Johnson III- Broad Reading: 77, Letter-Word ID: 72, Spelling:52

Reading: Strengths Student is strong in Decoding/ Word Attack

Weaknesses Student is struggling with Broad Reading, Letter-Word ID, and Spelling

Impact on involvement in general education curriculum: Student may benefit from time in the resource room

Math: Strengths Student is strong in Math Calculation

Weaknesses Student could use a little extra help in Math Applied Problems

Impact on involvement in general education curriculum: No impact on general education curriculum

Social Emotional: Strengths Derek is extremely social with peers

Weaknesses Derek is hyperactive at time, and can't stay on task for a long period of time.

Impact on involvement in general education curriculum: May need preferential seating

Communication: Strengths Can communicate his feelings whether happy/sad effectively

Weaknesses Has trouble finding appropriate words to complete sentences

Impact on involvement in general education curriculum: May need verbal assistance, allow Derek to communicate by written expression

Adaptive Behavior: Strengths Can get up, and get dressed for school independently: Good at managing personal care

Weaknesses Has trouble staying seated and still on bus to school

Impact on involvement in general education curriculum: No impact

Behavior: Strengths Follows directions when asked

Weaknesses Argumentative at time

Impact on involvement in general education curriculum: No impact

Other: Strengths N/A

Weaknesses N/A

Impact on involvement in general education curriculum: N/A

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 Slovin

Student input (strengths, interests, concerns): "I want to become a better speller and writer." "I am really good in math." "I don't want to be separated from my friends."

Parent input (strengths, interests, concerns): "I am worried that Derek might have a hearing problem because of his ruptured ear drum."

"I am concerned that Derek might be hyperactive, which makes him lose focus." "I think Derek has pretty good self-managing skills."

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” It would benefit Derek to have a Hearing Screen Test

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

___ Autism
___ Hearing Impairment
___ Orthopedic Impairment
Disability Category(ies)
1 = primary disability 2 = secondary disability
___ Communication Disorder ___ Dual Sensory Impairment ___ Developmentally Delayed ___ Emotional Handicap
1 Learning Disability
___ ___ Mild Mental Handicap ___ Moderate Mental Handicap ___ Severe Mental Handicap
___ 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 Slovin 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 Slovin
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 Slovin Identified Need: Reading

Annual Goal Derek will improve in Reading at the Second grade level

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

Including Objective Criteria to be reviewed annually (By Title) Evaluation
2.1.1 Demonstrate an an awareness of the sounds that are made by Gen. Ed. A, B, D
different letters by making less than 5 errors when reading aloud passages Spec. Ed.
of 20 words
2.2.11 Know and use common word families(such as -ale, -est, -ine, -ock, Gen. Ed. A, B, D
-ump) when reading unfamiliar words by making less than 5 errors when Spec. Ed.
reading aloud passages of 20 words

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 Slovin Identified Need: Writing

Annual Goal Derek will improve writing skills at the 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 names by completing weekly 20 word Spec. Ed.
spelling tests with less than 5 errors.
K.4.4 Write phonetically spelled words(words that are written as they Gen. Ed. A, B, D
sounds) and consonant-vowel-consonant words(demonstrating the Spec. Ed.
alphabetic principle)writing passages of 100 words with less than 25 errors

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 Slovin 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 Slovin 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 Slovin 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 Slovin 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 Slovin 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 Slovin

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

Services considered and rejected (indicate reasons)

Full time and part time were considered, but full time would be too restrictive.

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

Committee recommends part time services in a resource room setting. 5 days a week and 1 hour each 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:

N/A

March 5, 2008 March 4, 2009

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

Teacher of Record: Merrin Rosenberg

Other Teachers of Record for Secondary Disabilities N/A

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 Slovin

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):

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. N/A

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 5
Student Name: Derek Slovin

School: Templeton 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 Slovin
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: Only read test to student if requested

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