Monroe County Community School Corporation

Case Conference Summary/IEP/ITP

Date March 3, 2008

Student Name Derek Miller DOB 8-21-1996 Sex Males Re-eval Date 3-3-2011

Home School/Attending School Brookside Elementary / Brookside Elementary Grade 5th ID# 64137005

Student Resides with: Phone Caseworker/Agency Representative Phone

Rose and Brian Miller Home 317-251-0882 N/A Home

Parent/Guardian Name Name

2641 Millbrook Dr. Work 317-337-1918 Work

Street Address Street Address

Indianapolis 58442 Emergency 317-640-3219 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)

Catherine Smith Aliza Nusbaum Sara Evans

Chairperson Special Education Teacher

Derek Miller Paul Jones

Student General Education Teacher

Rose Miller Brian Miller

Parent
Student Performance Derek Miller

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: Student has average IQ, No impact on general education

Achievement: Evaluation Data: Woodcock Johnson III, TWS-3, TOWL, Broad Reading 77, Letter/Word ID 72, Spelling 52

Reading: Strengths Decoding skills, Word attack

Weaknesses Letter/Word ID, Spelling

Impact on involvement in general education curriculum: May need help in resource setting

Math: Strengths Calculation

Weaknesses Some difficulty with applied problems

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

Social Emotional: Strengths N/A

Weaknesses N/A

Impact on involvement in general education curriculum: N/A

Communication: Strengths Age appropriate communication

Weaknesses No known deficits

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

Adaptive Behavior: Strengths Good at managing personal care

Weaknesses No known deficits

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

Behavior: Strengths Good attendance

Weaknesses Innatentive in class, difficulty staying engaged in work

Impact on involvement in general education curriculum: May need preferential seating, more structure with less distractions

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 Miller

Student input (strengths, interests, concerns): He reports that he likes school, especially the friends he made this year. His favorite subject is math.

Parent input (strengths, interests, concerns): Derek is pretty good about managing personal care (getting up, dressing, etc.) His mother is concerned that he is not focused and is hyperactive.

She is also concerned that his academic difficulties will intensify if he does not receive help.

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 
✔ Ear difficulties
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

___ 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 Miller 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 Miller
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 Miller Identified Need: Letter/Word ID

Annual Goal Given a random selection of 40 out of a pool of 100 words at a third grade level, Derek will orally name at least 80% accurately over three consecutive weeks.

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

Including Objective Criteria to be reviewed annually (By Title) Evaluation
Given a random selection of 40 out of a pool of 100 words at a third grade Spec. Ed. A, B, D
level, Derek will orally name at least 65% accurately over three consecutive Gen. Ed.
weeks.
Given a random selection of 40 out of a pool of 100 words at a third grade Spec. Ed. A, B, D
level, Derek will orally name at least 70% accurately over three consecutive Gen. Ed.
weeks.
Given a random selection of 40 out of a pool of 100 words at a third grade Spec. Ed. A, B, D
level, Derek will orally name at least 75% accurately over three consecutive Gen. Ed.
weeks.

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 Miller Identified Need: Reading Comprehension

Annual Goal Having been read a fourth grade level story, Derek will retell the story correctly remembering 8 out of 10 key points for three consecutive weekly assignments.

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

Including Objective Criteria to be reviewed annually (By Title) Evaluation
Having been read a fourth grade level story, Derek will retell the story Spec. Ed. A, B, D
correctly remembering 5 out of 10 key points for three consecutive weekly Gen. Ed.
assignments.
Having been read a fourth grade level story, Derek will retell the story Spec. Ed. A, B, D
correctly remembering 6 out of 10 key points for three consecutive weekly Gen. Ed.
assignments.
Having been read a fourth grade level story, Derek will retell the story Spec. Ed. A, B, D
correctly remembering 7 out of 10 key points for three consecutive weekly Gen. Ed.
assignments.

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 Miller Identified Need: Writing

Annual Goal Given a spelling test with a random selection of 15 words from a pool of 20 words at the end of a first grade level, Derek will write 80% of the words correctly on three consecutive wee

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

Including Objective Criteria to be reviewed annually (By Title) Evaluation
Given a spelling test with a random selection of 15 words from a pool of 20 Spec. Ed. A, B, D
words at the beginning of a kindergarten grade level, Derek will write 80% of Gen. Ed.
the words correctly on three consecutive weekly tests.
Given a spelling test with a random selection of 15 words from a pool of 20 Spec. Ed. A, B, D
words at the end of a kindergarten grade level, Derek will write 80% of the Gen. Ed.
words correctly on three consecutive weekly tests.
Given a spelling test with a random selection of 15 words from a pool of 20 Spec. Ed. A, B, D
words at the beginning of a first grade level, Derek will write 80% of the Gen. Ed.
words correctly on three consecutive weekly tests.

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 Miller 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 Miller 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 Miller 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 Miller 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 Miller

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 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 five days a week for one 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:

N/A

3-10-08 3-9-09
Date for Initiation of Services (on or about): , ending date (on or about) following regular school calendar.

Teacher of Record: Aliza Nusbaum

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 Miller

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):
50% extra time, test read orally except comprehension section

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

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 Miller

School: Brookside 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 Miller
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:

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