goodman-armstrong creek school district · [if you need this invitation in a different language or...

Nicole Secrist Education 614

INVITATION TO A MEETING OF THE INDIVIDUALIZED EDUCATION PROGRAM (IEP) TEAM Form I-1 (Rev. 10/06)

GOODMAN-ARMSTRONG CREEK SCHOOL DISTRICT [If you need this invitation in a different language or communicated in a different way, or have

questions about this invitation, please contact__Kate Millan___ at ______906-396-3239___.]

Dear ______Dipak and Bela Shetty__________ Date __12-14-15_____

You are a participant on the IEP Team which will meet to address the educational needs of your child,

__Rashmi Shetty__________. IEP team meetings must be held at a mutually agreeable time and place. An

IEP team meeting has tentatively been scheduled for the following date, __1-16-16_____, at ___2:45pm___

at the Goodman Elementary School Conference Room #201_________. If these meeting arrangements are

not agreeable to you, please call __Kate Millan__ at __906-396-3239_____. You may bring other people

who you believe have knowledge or special expertise about your child to the meeting with you. If your child

is transferring from a Birth to 3 Early Intervention Program we will, at your request, send to the Birth to 3

coordinator or other representative an invitation to the IEP meeting.

The purpose of this IEP team meeting is (check all that apply):

EVALUATION AND REEVALUATION

□ Determine initial eligibility for special education

X Determine continuing eligibility for special education

INDIVIDUALIZED EDUCATION PROGRAM (IEP) (if student is eligible)

□ Develop an initial IEP

X Develop an annual IEP

□ Review/revise IEP

□ Transition – the consideration of postsecondary goals and transition services (required for students beginning at age 14)

PLACEMENT (if student is eligible)

□ Determine initial placement

X Determine continuing placement

OTHER

□ Review existing information to determine need for additional assessments or other evaluation

materials (meeting optional)

□ Conduct a manifestation determination (check appropriate boxes under IEP and placement if

changes in either are contemplated)

□ Determine setting for services during disciplinary change in placement (must also check

appropriate boxes under IEP & placement)

□ Specify: _______________________________________________________________

______________________________________________________________________________________ If transition is checked as one of the purposes of this meeting, your child will be invited to attend. Because

you provided your consent we are also inviting representatives from the following agencies who may assist in

the transition planning for your child: X None

________________________________________________________________________

Agency Name (if known), and Title/Position

________________________________________________________________________

Agency Name (if known), and Title/Position

If at any point during this meeting you or other IEP team participants believe that additional time is needed to

permit your meaningful involvement, additional time will be provided. Decisions related to the purpose(s)

checked above may be made in one meeting or may require more than one meeting, depending on individual

circumstances. In addition and upon request you may receive a copy of the IEP team’s most recent evaluation

report.

The following individuals have been appointed as IEP team participants and will attend the meeting.

_____Nicole Secrist-Reg. Ed. Te __________ ______Josh Baker-Sp. Ed. Teacher ____

_____Kate Millan-LEA Rep. ______________ __________________________________________

____Lisa Fuse-Speech Teacher____________ _ __Melissa Lewis-OT__________________ ___

___Sarah McCord-Sp. Ed. Aide____________ ________________________________________

_____________________________________ ________________________________________

You and your child have protection under the procedural safeguards (rights) of special education law. The

school district must provide you with a copy of your procedural safeguards once a year.

X You received a copy of your procedural safeguard rights in a brochure about parent and child rights

earlier this year. If you would like another copy of this brochure, please contact the district at the

telephone number above.

□ A copy of the parent and child rights brochure is enclosed with this invitation.

In addition to district staff, you may also contact _____Bert Meyers_______ at ____715-923-0237____if you

have questions about your rights.

Sincerely,

Kate Millan-Director of Special Education Name and Title of District Contact Person

EVALUATION REPORT AND IEP COVER SHEET Form I-3 (Rev. 10/06)

Name of Student

Rashmi Shetty

DOB

10-25-06

Sex

F

Grade

3rd

Parent or Legal Guardian

Dipak and Bela Shetty

Telephone (area/number)

(906) 396-5397

District of Residence

Goodman-Armstrong Creek

Current District of Placement

Goodman-Armstrong Creek

Race/Ethnic (if parent chooses to

identify) Indian

Address

205 Partridge Lane

Goodman, WI 54159

For students transferring between public agencies:

IEP reviewed and adopted by ________________________________________________

On _____________________________________________

For students transferring between public agencies:

Evaluation report reviewed and adopted by _____________________________________

On _____________________________________________

PURPOSE OF MEETING (Check all that apply):

□ Evaluation including determination of eligibility X Initial or annual IEP development

□ IEP review/revision □ Develop a statement of transition goals and

services (required for students age 14 and older,

or younger if appropriate)

□ Placement □ Manifestation determination

□ Alternate assessment □ Determine setting for services during

disciplinary change in placement

□ Other: _____________________________ □ Other: _____________________________

If a purpose of this meeting is IEP development, review, and/or revision related to the academic,

developmental and functional needs of the child, the IEP team considered the results of:

Initial or most recent evaluation □ Yes □ Not applicable

Statewide assessments □ Yes □ Not applicable

District-wide assessments X Yes □ Not applicable

Date of Meeting: _____1/16/16___________ (month/day/year)

IEP Team Participants Attending or Participating by Alternate Means in the Meeting:

Parent/Guardian

Dipak and Bela Shetty

Regular education teacher/title:

Nicole Secrist-3rd

Grade Reg. Ed.

Teacher

Regular education teacher/title:

Student (if appropriate):

Special education teacher/title:

Josh Baker-Spec. Ed. Teacher

Special education teacher/title:

LEA Representative/Title:

Kate Millan-Director of Special Ed.

Other: Other: Melissa Lewis-OT

Other: Sarah McCord-Spec. Ed. Aid

Other: Lisa Fuse- Speech Teacher Other:

If the parent did not attend or participate in the meeting by other means and did not agree to the time and place of the IEP

team meeting, document 3 efforts to involve the parents:

INDIVIDUALIZED EDUCATION PROGRAM: PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE Form I-4 (Rev. 9/13)

Name of Student Rashmi Shetty Describe the student’s strengths and the concerns of the parents about the student’s education.

Rashmi is a great addition to any classroom. She enjoys working in peer groups and gets along with other

students well. She has a friendly and happy demeanor. Rashmi also really enjoys her physical education class,

especially when there are jumping games and challenges involved.

Parent Concerns: Rashmi’s parents are concerned about Rashmi completing age and grade appropriate work.

They are concerned that she will fall behind and become retained. They are also concerned about Rashmi’s

self-injurious behavior during class time.

Describe the student’s present level of academic achievement and functional performance including

how the student’s disability affects his or her involvement and progress in the general education

curriculum. For preschool children, describe how the disability affects involvement in age-appropriate

activities. (Note: Present level of performance must include information that corresponds with each annual goal)

Rashmi has significant delays in the areas of cognition, pre-academic skills, adaptive skills, and

communication which impede her ability to understand basic concepts, consistently and effectively

communicate her wants and needs, and keep pace academically and socially with her same aged peers.

Attending Skills: Rashmi can follow a structured routine and classroom rules with moderate verbal and visual

redirections. She is able to leave her instruction area and get supplies for herself with little redirection. She

requires teacher proximity with all academic instruction in order to complete tasks. Activities that allow her to

use manipulatives such as play doh to create letters are more favorable. Using visual and sensory stimulation

helps keep Rashmi’s attention to her task with less reminders. She has been observed working on task for 2

minutes when she is able to use manipulation to learn her academics. Her off task behavior includes, yelling,

hitting her head and ears, biting herself on the hands, crying, and screaming. This behavior has been curbed by

rewards such as pretzels and crackers.

Review of Goals and Self-Contained Classroom Information: Rashmi continues to work hard in her self-

contained special education classroom. With regards to her goals, she is beginning to write legible letters with

prompting, however she requires maximum assistance when printing due to her inability to correctly identify

all letters. Rashmi continues to reverse multiple letters and numbers including B, D, S, L, F, 9, 7, 6, 5, 4, 2.

Reversal errors are due to incorrect stroke sequences that result in left/right confusion and firmly established

motor memory patterns. With regard to her goal concerning numbers, she can print numbers 1-3 correctly.

She can count up to 5 with no prompting. Concerning her goal for reading the Dolch sight words, she was able

to read 10 of the pre-primer words. She is is not successful when the words are embedded in sentences or

when she has to write the words out. On the Pals screener, Rashmi identified 3 lower case letters, 4 upper case

letters, and 6 sounds. Instructional oral reading is at a pre-primer level. Rashmi cannot answer a picture about

a text that is read to her without her picture board.

Speech Therapy: Rashmi continues to have significant difficulties with speech intelligibility and expressive

language skills. These two areas of communication support the need for speech/language intervention. Her

current skills are directly impacting both her ability to be understood and convey the information needed in

both inside and outside the classroom effectively.

Speech Intelligibility: Rashmi has made small gains with speech productions this past IEP year. She

continues to identify all of her vowel sounds, however she only correctly identifies 10 phonemes including h,

p, s, d w, m, n f, r, th. The goals of her treatment last year, recognizing at least 5 phonemes, have been met

successfully. Phoneme blends are slowly emerging nicely.

Expressive Language Skills: Given the significant degree of her speech difficulties, it is not surprising that

Rashmi has a difficult time with the understanding of oral language. She understands and identifies simple

words such as yes, no, mom, bathroom, outside, and school as identified by teachers. She is unable to identify

her own name, point or gesture to different words that label objects such as colors and shapes, and cannot

participate in different curriculum based activities such as songs. Being unable to speak or identify by using

age-appropriate words impacts her ability to effectively participate in the classroom, both in the areas of

written and oral communication, as well as sounding like age-appropriate peers.

Occupational Therapy: Rashmi continues to make both slow and steady progress with her printing skills,

refining her size and overall control. Rashmi is often in a hurry to finish her work, and she can be careless

when printing, but given prompting, she is able to slow down and complete neat and satisfactory work.

Rashmi has not yet established adequate sound/letter matches and requires a great deal of help when writing

letters. She continues to make numerous reversals, but is beginning to recognize when she is doing so. Rashmi

has a dominant right hand, however she often tries writing with her left. She is redirected to write using her

right hand. Rashmi is enthusiastic about coming to OT and really tries her best at all activities. She is easily

distracted, but is also very easily redirected.

Will the student be involved full-time in the general education curriculum or, for preschoolers, in age-

appropriate activities? □ Yes X No

(If no, describe the extent to which the student will not be involved full-time in the general curriculum or,

for preschoolers, in age-appropriate activities)

Rashmi has significant delays in communication, social/emotional, math, reading, and written language that

can’t be addressed in the regular education curriculum. She requires a specialized setting to learn and retain

skills. This is best met in an alternative functional curriculum in a self-contained, CD unit.

SPECIAL FACTORS After consideration for special factors (behavior, limited English proficiency, Braille

needs, communication needs including deaf/hard of hearing, and assistive technology), is there a need in any

of the areas?

X Yes □ No (If yes or student has a visual impairment, attach I-5, “Special Factors” page)

INDIVIDUALIZED EDUCATION PROGRAM SPECIAL FACTORS Form I-5 (Rev. 7/06)

Note: For any need(s) identified below, there must be a statement of the service(s) to meet that need

(including amount/frequency, location, and duration) on the “Program Summary” page (I-9).

Name of Student__Rashmi Shetty_______________

A. Does the student’s behavior impede his/her learning or that of others? X Yes □ No

(If yes, include the positive behavioral interventions, strategies, and supports to address that behavior)

Yes, Rashmi struggles to functionally communicate her wants and needs. When she does not know something,

or does not want to participate in an activity, she will often scream, cry, bite her hands, and hit her head and

ears. Not only is this behavior self-injurious, it is also a large distraction to other students. Rashmi is

sometimes difficult to redirect after an episode. A 5 point behavior scale has been used to show Rashmi what

she feels like and what strategies she can use to calm herself and continue learning.

B. Is the student an English Language Learner? □ Yes X No

(If yes, include the language needs that relate to this IEP)

C. If visually impaired, does the student need instruction in Braille or the use of Braille?

□ Yes X No □ Cannot be determined at this time

(If yes, include Braille needs; if no or cannot be determined, attach ER-3, “Determining Braille

Needs” from the latest evaluation/reevaluation)

D. Does the student have communication needs that could impede his/her learning? X

Yes □ No

(If yes, include communication needs)

{If yes and the student is deaf or hard of hearing, identify the communication needs including (a) the student’s

language; (b) opportunities for direct communication with peers and professional personnel in the student’s

language and communication mode; and, (c) academic level and full range of needs including opportunities for

direct instruction in the student’s language and communicative mode}:

Rashmi is unable to effectively communicate her wants and needs. She is unable to express oral or written

language which makes it difficult for her to participate in academic programming.

E. Does the student need assistive technology services or devices? X Yes □ No

{If yes, specify particular device(s) and service(s)}

Picture board, iPod touch with Picture Board app.

INDIVIDUALIZED EDUCATION PROGRAM ANNUAL GOAL Form I-6 (Rev. 10/06)

Name of Student _____Rashmi Shetty______________

Measurable annual academic or functional goal to enable the student to be involved in and progress in

the general education curriculum, and to meet other educational needs that result from the student’s

disability. (Note: present levels of academic achievement and functional performance must include

information that corresponds with each annual goal)

Upon review: □ Goal met □ Goal not met

Rashmi will be able to read the pre-primer Dolch sight word list with 70% accuracy for three consecutive

weeks.

Procedures for measuring the student’s progress toward meeting the annual goal.

Weekly monitoring of sight words and charting of progress.

Will the student participate in an alternate assessment aligned with alternate achievement standards for

students with disabilities in any subject area? X Yes □ No

(If yes, include benchmarks or short-term objectives for the student)

Rashmi will:

Use strategies to sound out unknown words given assistance, 50% of the time. (Present Level: Not

using strategies.)

State either verbally or with use of picture board when she needs assistance sounding out a word, 50%

of the time. (Present Level: Not asking for assistance.)

When will reports about the student’s progress toward meeting the annual goal be provided to parents?

Quarterly with report cards and annual IEP review.








Rashmi will attend to a task for a minimum of five minutes during independent work time and whole group

lessons. We will know when she can do this when she stays on attention for five minutes with one activity

(either independent work or whole group lessons) for five consecutive days.


Charting

Observation




Rashmi will:

Successfully use strategies to reinforce stamina in independent work 50% of the time as charted in

observational data. (Present Level: Attends to a task for maximum of 2 minutes.)


Quarterly with report cards and annual IEP review








Rashmi will properly express when she does not want not to do an activity or needs or wants something

without participating in self-injurious behaviors 50% of the time.


Charting




Rashmi will:

Successfully use strategies to reinforce stamina in independent work 50% of the time as charted in

observational data. (Present Level: Attends to a task for maximum of 2 minutes.)










Rashmi will be able to write and identify numbers 1-10 with 90% on weekly assessments for three

consecutive weeks.


Charting

Weekly assessment sheets




Rashmi will:

Successfully use strategies to identify and write numbers 50% of the time as charted and shown on

weekly assessment sheets. (Present Level: Identifies and write numbers correctly 1-5.)

State either verbally or with use of picture board when she needs assistance identifying or writing a

number, 50% of the time. (Present Level: Not asking for assistance.)










Rashmi willimprove her overall functional language skills by meeting at least half of the following targeted

short term obectives with 75% accuracy.


SLP/Parent/Teacher Observations

Therapy Data Collection/Checklists

Language Samples




Rashmi will:

Expressive Language

o Improve her ability to participate in songs, stories, nursery rhymes, finger plays, and other

classroom/curriculum based activities.

o Improve her ability to point/gesture/label body parts, colors, shapes

o Tell/Show others her name.

o Improve her vocabulary to at least 10 functional words.

o Can answer simple wh-questions using visuals/pictures.










Rashmi will improve her overall speech production by meeting at least half of the following targeted short

term objectives with 75% accuracy.


SLP/Parent/Teacher Observations

Therapy Data Collection/Checklists




Rashmi will:

Speech Production

o Improve her ability to imitate oral motor movements for purpose of speech production.

o Improve production of easy CV, VC work combinations.

o Improve productions of simple CVC target word structures, if stimuable.



INDIVIDUALIZED EDUCATION PROGRAM: To be completed for students participating

in

PARTICIPATION IN STATEWIDE ASSESSMENTS district-wide assessments Form I-7 District-wide Assessment (Rev. 9/15)

Name of Student__Rashmi Shetty __________

The student will be in (circle) K, or 1st, or 2

nd, or3rd, or 4th, or 5th, or 6th, or 7th, or 8th, or 9

th, or 10

th, or 11

th,

or 12th grade when the district-wide assessment is given.

PARTICIPATION IN DISTRICT-WIDE ASSESSMENTS

District-wide assessments given X District-wide assessments not given

Student will not be in the grade when a district-wide assessment is given

List district-wide assessment(s) student will take:

Describe appropriate testing accommodations, if any:

Alternate Assessment* – If the student does not take the regular district-wide assessment, describe why the

student cannot participate in the regular assessment and an alternate district-wide assessment is appropriate.

Rashmi is unable to participate in the district wide assessments given at her grade level, MAPS and Star

Assessments due to her disability and lack of understanding of written and oral communication. Instead

Rashmi will participate in a series of authentic assessments created by the special education team.

INDIVIDUALIZED EDUCATION PROGRAM: SUMMARY Form I-9 (Rev. 10/06)

Name of Student __Rashmi Shetty______________

Projected beginning and ending date(s) of IEP services & modifications ____1-16-16______ to _

_1-16-17____ (month/day/year) (month/day/year)

Physical education: X Regular □ Specially designed

Vocational education: □ Regular X Specially designed

Include a statement for each of I, II, III and IV below to allow the student (1) to advance appropriately toward

attaining the annual goals; (2) to be involved and progress in the general education curriculum; (3) to be

educated and participate with other students with and without disabilities to the extent appropriate, and (4) to

participate in extracurricular and other nonacademic activities. Include frequency, location, & duration (if

different from IEP beginning and ending dates).

I. Special education

-Reading

-Math

-Behavior Intervention

Frequency/

Amount

-5X120mins/week

-5X80mins/week

-5x30mins/week

Location

Special Ed. Room

Special Ed. Room

Special Ed. Room

Duration

Duration of

IEP

II. Related services needed to benefit from special education including frequency, location, and

duration (if different from IEP beginning and ending dates).

□ None needed to benefit from special education

Freq / Amt Location Duration

X Assistive Technology All day Any school

location

Duration of

IEP

□ Audiology

□ Counseling

□ Educational Interpreting

□ Medical Services for Diagnosis and Evaluation

X Occupational Therapy 3x30mins OT Room Duration of IEP

□ Orientation and Mobility (VI only)

□ Physical Therapy

□ Psychological Services

□ Recreation

□ Rehabilitation Counseling Services

□ School Health Services

□ School Nurse Services

□ School Social Work Services

X Speech / Language 3X30mins Speech Therapy

Room

Duration of IEP

□ Transportation

□ Other: specify

Form I-9 Page ____ of ____

I-9 (2) Revised 7/1/06

III. Supplementary aids and services: aids,

services, and other supports provided to or

on behalf of the student in regular education

or other educational settings.

X Yes □ No (If yes, describe)

-When Rashmi is harmful to herself of others

and all other strategies have been exhausted-CPI

team control position will be used

-Visuals

-Support Aid

Freq / Amt

When Rashmi

is harmful to

herself of

others and all

other strategies

have been

exhausted.

When needed

to support

instruction,

routines,

behavior

regulation, and

other

activities.

5x400min/wee

k

Location

In the setting

where the

incident

occurred

Classroom

where

support is

needed.

All

educational

settings

Duration

Duration of

IEP

Duration of

IEP

Duration of

IEP

IV. Program modifications or supports for

school personnel that will be provided.

X Yes □ No (If yes, describe)

CPI Control training

1 time per

IEP duration

TBD by

CESA

Duration of

IEP

Nicole Secrist Education 614

V. Participation in Regular Education Classes

□ The student will participate full-time with non-disabled peers in regular education

classes, or for preschoolers, in age-appropriate settings.

X The student will not participate full-time with non-disabled peers in regular

education classes, or for preschoolers, in age-appropriate settings. (If you have

indicated a location other than regular education classes or age-appropriate settings in the

case of a preschooler in I, II, or III above, you must check this box and explain why full-time

participation with non-disabled peers is not appropriate.)

Full time education with non-disabled peers is not ideal for Rashmi. She has significant delays in

the areas of cognition, pre-academic skills, adaptive skills, and communication which impede her

ability to understand basic concepts, consistently and effectively communicate her wants and

needs, and keep pace academically and socially with same aged peers. Rashmi also participates

in behaviors that are self-injurious and occasionally dangerous to others.

VI. Participation in Extracurricular and Nonacademic Activities

Will the student be able to participate in extracurricular and nonacademic activities with

nondisabled students? X Yes □ No (If yes, include under I., II., III., and IV. any special education, related services, supplementary

aids and services, and program modifications or supports necessary to assist the student. If no,

describe the extent to which the student will not be involved in extracurricular and nonacademic

activities with nondisabled students)

I-9 (2) Revised 7/1/06

DETERMINATION AND NOTICE OF PLACEMENT Form P-2 (Rev. 7/06)

GOODMAN-ARMSTRONG CREEK SCHOOL DISTRICT [If you need this notice in a different language or communicated in a different way, or have

questions about this notice, please contact Kate Millan at 906-396-3239.]

Date of the placement determination: ___January 16, 2016_______

Date parent provided with notice of placement ___January 16, 2016______

Name of student: ___Rashmi Shetty___________________________

Dear __Dipak and Bela Shetty______________________

The IEP developed on __January 16, 2016___ will be implemented at _Goodman-Armstrong Creek

Elementary School____ in the ______Goodman-Armstrong Creek__________ School District/City, with

a projected date of implementation on ___January 17, 2016________.

Will the child attend the school he/she would attend if nondisabled?

X Yes □ No (If no, explain)

List other options considered, if any, related to the placement site (school building or school district),

frequency, location, and duration of the special education and related services, supplementary aids and

services, program modifications and supports, and the place of those services. List the reason(s) rejected,

and description of any other factors relevant to the proposed action:

X None

□ You previously received a copy of your child’s evaluation report and a copy of his/her IEP is

enclosed.

X A copy of your child’s evaluation report and IEP are enclosed.

You and your child have protection under the procedural safeguards (rights) of special education law.

The school district must provide you with a copy of your procedural safeguards once a year. Enclosed is

a copy or earlier this year you received a copy of your procedural safeguard rights in a brochure about

parent and child rights. If you would like another copy of this brochure, please contact the district at the

telephone number above. In addition to district staff, you may also contact ____Bert Meyers________ at

___715-923-0237_______ if you have questions about your rights.

Sincerely,

Kate Millan-Director of Special Education Name and Title of District Contact Person

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