• N/A for Preschool

• Form will be sent with the referral. Complete the form after the IEP meeting and attach to the bottom of the file organizer. Preschool Transition Plan is not on Goalview

• Preschool Referrals are not on Goalview. Concerns are documented from the Early Intervention Program and parent

• Check all areas on Consent for Evaluation

• Record medical reports contained in the file (if the team is in agreement), and assessment data. Record vision and hearing results

• Note how questions are answered according to evaluation data and disability

• Make sure that at least two considerations are checked

• PLAAFPs need to describe how the disability affects a child's participation in the appropriate activities

• Do when child is changing from a class to a speech only group or visa versa

• Indicate evaluation review, eligibility, IEP development and placement

• Use Goalview Progress Reports--keep copies with the IEP and give a copy to the parent

Emily Elementary

Elementary School Student, 5th Grade, Emotional Disturbance

• Note: Effect on General Education at end of each PLAAFP
• Primary disability is behavioral but has academic delays as well

• Standard procedures

• Note: new referral with multiple concerns

• All areas, except transition, are checked because of the multiple areas of concern listed on the referral

• Behavior: at least two rating scales across two environments (home and school)

• Checked boxes indicate that documented behavior problems impact documented educational performance

• Note: both behavioral and curriculum changes are needed

• Note PLAAFP: Functional statements are included at the end of each PLAAFP. There is a PLAAFP for each skill area that needs addressing.
  Note Goals : There is at least one goal addressing each skill area identified in the PLAAFPs. Academic goals are related to back to core curriculum.
• Note Assessment Grid: The only accommodations checked are those that will be used with Emily on a daily basis

• Not necessary at this point in time

• Standard Procedures

• Will be completed at the end of the year/reporting period

Erica Elementary

Elementary School Student, 5th Grade, Emotional Disturbance

• Exactly the same as Emily with the exception of the PLAAFPs
• Note: Effect on General Education at the end after all PLAAFPs

• Note PLAAFP: same PLAAFPs as Emily however the functional statement is included at the end of ALL the PLAAFPs rather than at the end of each PLAAFP statement

Marcus MiddleSchool

Middle School Student, 7th Grade, Autism

• Note: Initial Referral, Evaluation, Eligibility, IEP, Placement
• Note: Change of Meeting Date
• Note: Denial of FAPE

• Note dates and interventions (General Education form-may use school's form instead)

• Parent Referral: Areas of concern are listed

• (Explanation of how and why to fill out form with tests selected)

• Note: Subtest data input
• Note: Areas of evaluation for Autism

• Note how questions are answered according to evaluation data and disability

• Note: This student's placement is: "Regular class with part-time special education services"

• Note: PLAAFPs for Functional Skills and Social/Emotional Skills
• Note:Goal--4.2 SE/LCCE Work Habits, Annual Goal 2--Denial of FAPE

• N/A at this time

First Notice of Meeting

Second Notice of Meeting

• Note: Original meeting was scheduled for 4/30/07; meeting was cancelled at parent request and rescheduled for 5/16/07. Two "Notice of Meeting" forms document these changes.
• Note: Purposes of the meeting are to (a) review evaluation and consider eligibility for special education; (b) discuss/develop and IEP; (c) discuss educational placement

• Note: A report of progress has been recorded with data and dates showing current IEP year goal progress. Progress for Goal 4.2, Annual Goal 2 is marked, "Not Addressed" as per parent request (denial of FAPE).

Henry HighSchool

High School Student, 11th Grade, Specific Learning Disability

• Note: Transition PLAAFP
• Note: Transition Plan
• Note: Age of Majority

• Note dates and interventions (General Education form—may use school’s form instead)

• Note:  Teacher referral; text box for parent referral does not need to be filled in. 

• (Explanation of how and why to fill out form with tests selected)

• Note:   Transition Assessment

• Note how questions are answered according to evaluation data and disability

• This student is placed in “Regular class with part-time special education services”

• Note Writing PLAAFP:  Statements describe that Henry does well when allowed to use a word processor with spell check.  PLAAFP indicates that Henry will not receive services for writing
• Note Transition PLAAFP:  Statement of Henry’s strengths, interests and preferences
• Note Transition Plan:  Section 8 of IEPNote Age of Majority form:  Section 8 of IEP

• N/A at this time

• Note: Transition will be addressed in meeting

• Note:  Progress Report for first grading period

Ursala Uaa

Elementary School Student, 4th Grade, Intellectual Disabilities

• Utah Alternate Assessement

• Standard IEP Process

• Standard IEP Process

• Standard IEP Process

• Standard IEP Process

• Standard IEP Process

• Standard IEP Process

• PLAAFPs: Note that the general education/functional statement for reading, writing, and math is included under functional skills, The statement has been included within the text for communication, motor, and cocial/emotional.
• Goal/Comment: Note that a keyborarding goal was added approximately two months after the IEP was developed.
• UAA items were selected to match IEP goals: Language Arts-Task Description, Assessment Record; Math-Task Description, Assessment Record; Science-Task Description, Assessment Record
• Participation in State & District Assessment: Note that a reason was stated for using the UAA (see website for instruction manual. See pages 157 &158 for Language Arts- reads 10 sight words; pages 207 & 208 for Math-counts up to 10 objects; pages 329 & 330 for Science-uses 5 food names) http://www.schools.utah.gov/sars/servicesinfo/pdfs/uaamanual.pdf

• Standard IEP Process

• Standard IEP Process

• Note that comments were included for reading goals.

Spencer Speech

High School Student, 11th Grade, Communication Disorder

• Note:

• Note previous services and interventions attempted

• New Referral by Classroom Teacher

• Hearing, Vision, and Communication Areas need to be checked

• Multisource Assessment includes formal/informal results

• Questions answered accordingly for a student with a speech-language impairment

• Receiving speech-language services

• Note Communication and Transition PLAAFPs; PLAAFPs are measureable, descriptive, and age-appropriate; Transition Plan included for students 16 and older; Age of Majority letter ; SLP serves as the requires Special Educator at the IEP Meeting and NON, APPLICABLE is inserted as the Special Education Teacher

• Not needed at this time

• Note: transition will be addressed in meeting

• Progress reports include data and dates detailing current goals