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INDIVIDUALIZEDEDUCATIONPROGRAM(IEP)

DISABILITYCLASSIFICATION:Autism

STUDENTNAME:JuliaBieganski
DATEOFBIRTH:12/26/2006LOCALID#:221249675
PROJECTEDDATEIEPISTOBEIMPLEMENTED:02/26/2016

PROJECTEDDATEOFANNUALREVIEW:02/23/2017

STUDENTNAME:JuliaBieganski

NYCID:221249675
PRESENTLEVELSOFPERFORMANCEANDINDIVIDUALNEEDS

DOCUMENTATIONOFSTUDENT'SCURRENTPERFORMANCEANDACADEMIC,DEVELOPMENTALANDFUNCTIONALNEEDS
EVALUATIONRESULTS(INCLUDINGFORSCHOOLAGESTUDENTS,PERFORMANCEONSTATEANDDISTRICTWIDE
ASSESSMENTS)
SANDI20152016OverallFallScore:1029
SANDISubtests:Reading:149/436,Writing:92/276,Math:44/396,CommunicationDevelopment:149/324,FineMotor:114/160,GrossMotor:
150/236,SocialEmotional/Behavioral(SE):148/352,VocationalTransition:Education/Employment(VE):38/144,VocationalTransition:
Community(VC):10/124,Adaptive/DailyLivingSkills(AD):87/164,Science:48/316.
BehavioralAssessments(MAS):10/2015
SocialSkillsChecklist:Level1
Accordingtothegoals/objectiveresultsfromlastyear'sIndividualEducationPlan,StudentAnnualNeedsDeterminationInventory(SANDI),
SocialSkillsChecklist(October2015),MotivationAssessmentScale(MAS)(October2015)&informalassessment,Julia'sresultsarereflected
below:
ACADEMICACHIEVEMENT,FUNCTIONALPERFORMANCEANDLEARNINGCHARACTERISTICS
LEVELSOFKNOWLEDGEANDDEVELOPMENTINSUBJECTANDSKILLAREASINCLUDINGACTIVITIESOFDAILYLIVING,LEVELOF
INTELLECTUALFUNCTIONING,ADAPTIVEBEHAVIOR,EXPECTEDRATEOFPROGRESSINACQUIRINGSKILLSANDINFORMATION,
ANDLEARNINGSTYLE:
Juliaisa9yearoldgirlwithAutism,presentlyfollowingahighlyspecializededucationalprogrambasedontheinstructionalprogrambasedon
theCommonCoreLearningStandards.Parent/Guardian,AldonaBieganski(mother),wasinvitedandattended.Juliamastered1objective
frompreviousIndividualEducationPlan.Shewillcontinuetoworkoncountingoutobjectsfromagroup,identifyingcoinsbynameandvalue&
receptivelyandexpressivelyidentify20nounsbyblendinglettersounds.Juliauses34wordutterancestocommunicateherwantsandneeds.
AccordingtoSANDI,Juliacanidentifyhernameandsomesightwords.However,shehasdifficultyblendinglettersoundstoreadCVCand
CVCewords.Juliaisabletowritesomeuppercaseletters.However,shecannotwriteherfirst&lastname.Juliacanidentifynumerals110.
However,shehasdifficultycountingoutobjectsfromagroup.Sheneedsmuchprompting.Inaddition,shecannotidentifycoinsbynameor
value.Juliacanidentifybasicemotionsandactionsusingpicturesofrealpeople.However,shehasdifficultyansweringsocialquestionsupon
request.Juliaisindependentwithtoiletingandhandwashing.Juliaisabletofollowonestepdirections&canfeedherselfduringmealtimes.
AccordingtoParent,Juliacandressherselfwithassistanceandpullovershirtswithassistance.Juliarequirestheuseofaschedule(with
transitioncue)toaidintransitionsthroughouttheday.Currently,Juliaisavisual&auditorylearner.Therefore,benefitsfrompairinginstruction
withvisualsand/ormusic.

Speech&Language:
Juliaisverbalandcommunicatesprimarilyaboutthehereandnowusing34wordutterancesforvariouscommunicativefunctionsincluding
respondingtogreetings,requesting,makingchoices,rejecting/protesting,gainingattention,respondingtovariouswhquestions,and
commenting.Shebenefitsgreatlyfromvisualsupportssuchassentenceboards,schedules,andtokenboards.Receptively,shecanfollow
onestepdirections,identifyemotionsandverbsinpictures,identifyobjects,andrespondtosimplewhquestions.Expressively,shecanlabel
objects,bodyparts,andplaces,verballyrequest,andusesimplesentences(suchasItsaorIhave).Socially,Juliaiscanrespondto
greetings,establisheyecontact,orienttowardandmaintainappropriateproximitytohercommunicativepartner.Juliaenjoysengagingwithher
peersandcontinuestorequiresignificantpromptingtoappropriatelyinitiatewithbothpeersandadults.Thisskillshouldcontinuetobe
targetedintherapy.Itwouldbenefithertoincreasethenumberofopportunitiesforhertoengagewithherpeerswithproviderassistance,
thereforeitisrecommendedthathermandatebemodifiedtoincludeone30minutesessionperweekindividuallyandtwo30minutesessions
perweekinagroupoftwo.ThismodificationwasdiscussedwithandagreedtobyJuliasmotheratthetimeofthemeeting.
STUDENTSTRENGTHS,PREFERENCES,INTERESTS:
Juliarespondswelltovocalpraise.She,successfully,utilizesachoiceandtokenboardtocompleteacademictasksthroughouttheday.In
addition,sheisabletograsptheconceptofthefirst/thenboard.Forexample,shewillcompleteataskin1:1instructionwhensheknowsshe
willearnapreferreditem.Sheisanactivegirlwhoenjoysgrossmotoractivitiesandactiveengagement,especiallyduringphysicaleducation
activities.Sheenjoysdancing,whenmusicisplayed,duringactivities.Juliaismotivatedbymusicandtechnology.Shedoeswellwhen
technologyisweavedintoheractivitiesandwork.
ACADEMIC,DEVELOPMENTALANDFUNCTIONALNEEDSOFTHESTUDENT,INCLUDINGCONSIDERATIONOFSTUDENTNEEDS
THATAREOFCONCERNTOTHEPARENT:
Needsto:
beabletoreceptively&expressivelyidentify20nounsbyblendinglettersounds
beabletocountoutobjectsfromalargergroup
beabletowriteherfirstandlastname
beabletoanswer10socialquestions
beabletoidentify5coinsand5billsbynameandvalue
NoconcernswereindicatedbyparentconcernswereaddressedwithinIEP.
SOCIALDEVELOPMENT
THEDEGREE(EXTENT)ANDQUALITYOFTHESTUDENTSRELATIONSHIPSWITHPEERSANDADULTSFEELINGSABOUTSELF
ANDSOCIALADJUSTMENTTOSCHOOLANDCOMMUNITYENVIRONMENTS:
Attimes,Julianeedsdirectivestoberepeatedduringgroupactivities,asshegetseasilydistracted.Sheisabletotaketurnsappropriatelyina
socialsetting.Juliahasmasteredreciprocatinggreetingswithadultsandpeersbywavingandsaying"hi+name".Accordingtothe
MotivationalAssessmentScale(MAS),Juliademonstrateddifficultyintheareasofescape.Thesebehaviorsareescapemotivatedinresponse
tostressandskilldeficits.
STUDENTSTRENGTHS:
Juliarespondswelltovocalpraiseandtangiblereinforcement.Shereceivessocialreinforcement(highfivesorverbalpraise)whensheis
attendingtotaskandshowingappropriatebehavior.Sheparticipatesingroupactivitiesandwillremainseatedfor3035minutes,with
redirection(asneeded).SheisabletotaketurnsappropriatelywiththeiPad.
SOCIALDEVELOPMENTNEEDSOFTHESTUDENT,INCLUDINGCONSIDERATIONOFSTUDENTNEEDSTHATAREOFCONCERNTO
THEPARENT:
Juliahasdifficultycompletingataskorfollowingasimpledirectiveinordertoreceiveattentionand/orherreinforcer.Juliaisusuallyredirected

whenthisoccursandshownthefirst/thenboardand/ortheactualitemssheisworkingfor.Noconcernswereindicatedbyparentconcerns
wereaddressedwithinIEP.
PHYSICALDEVELOPMENT
THEDEGREE(EXTENT)ANDQUALITYOFTHESTUDENTSMOTORANDSENSORYDEVELOPMENT,HEALTH,VITALITYAND
PHYSICALSKILLSORLIMITATIONSWHICHPERTAINTOTHELEARNINGPROCESS:
APE.JuliaisactivelyinvolvedinAPEactivities.Shehasgainedsomeproficiencyinthelocomotorskills.Shemustalternatelywalk/runnonstop
foruptooneminute.
OT:Juliahasbeenworkingonimprovingherwritingskillsandherproblemsolvingskillswhencompletingpuzzles,managingclothing
fasteners,andwithmultistepschoolrelated/therapeutictasks.Shehasshownprogresswithherabilitytomanageavarietyofschoolsupplies
suchasgluesticks,folders,foodpackaging,andbuttons,buthasnotmasteredmanagingzippersandtyingshoelaces.Shepresentsdifficulty
withcompletinga24puzzle,however,whengiven23interlockingpiecesatatime,Juliaisabletoinconsistentlyproblemsolvehowto
interlockthepieceswithminimalassistance.Juliahasbeenusingherlefthandtocompletewritingtasks.Shehasmadeprogresswith
handwritingskillsbuthasnotachievedhergoaltocopyhernameandtraceuppercaseletterswithcorrectletterformation,letterplacement,
anddirectionalityconsistently.Sheisabletocopy/writeherfirstnameon3linedelementarypaperbutwithinconsistentletterplacementand
letterformation.Shebenefitsfromverbalpromptsinordertorecallthecorrectsequentialstepstoformuppercaseletters.Juliadoesrequire
redirectionwhenshegetsdistractedbyotherauditoryandvisualstimuli.ItisrecommendedthatJuliacontinuetoreceiveOccupational
Therapyatthecurrentmandateof3xaweekfor30minutes,individually.
PT:Juliaisa9yearoldverbalstudentwithadisabilityclassificationofAutism.Sheiscurrentlyreceivingphysicaltherapyservicefor2X30X1.
TheGMFCS(GrossMotorFunctionClassificationSystem)andSFA(SchoolFunctionAssessment)wereusedtoassessherperformancein
schoolenvironment.TheGMFCSlevelforJuliaisassigned1indicatingthatshehasnolimitationwithherambulationbutspeed,balanceand
coordinationarelimited.OnSFA,Juliahasascoreof5/6ininthespecialeducationclassroomwhereJuliaperformmosttasksandactivities
independentlybutneedcueseverynowandthen,Scored4/6intransitionJuliaambulatesindependentlybutduringtransitioningfromclass
toclasssheusuallyislaggingfrompeersandalwaysrequirephysicalandverbalcuestonotbumpedintootherstudentsinthehallway.Julia
scored4/6withPlayground/
recesssheisabletouseequipmentplaygroundindependentlyandrequiresminimalassistwhenneeded.Whenperforminggrossmotor
activityJuliaperformsslowerthanpeerslikerunning.Shehasdifficultywithcoordinationskillslikegalloping,skipping.Sheenjoysplayingball
activitiesandisgoodatit.Scored6/6bathroomasJuliaisabletoidentifythelocationoftherestroominherclassroom,enter/exit
independentlyandparticipatefullyinthisdomain.JuliacanparticipatefullywithTransportationdomain.shecanexit/accessschoolbuilding,
Sheisabletonegotiatethestepstogeton/offthebuswithoutdifficultyJuliareceived6/6/asshecanparticipatefully.Scored6/6in
mealtime/snacktimeasJuliaisabletogetitemsfromfooddistributionareaandplaceontrayindependentlyandcouldcarryhertraywithout
spillage,sheisabletocleanup/canplaceitemsingarbagebinsindependently.JuliatotalSFAscoreis31/36withcriterionscoreof74/100.
STUDENTSTRENGTHS:
APE.Juliahasattainedsomeproficiencyinthelocomotorskillofleaping
Juliaisabletofollowsimple2stepdirectionsandwillingtotrynewactivities.
PT:Julialovesplayingballactivities.Sheworkswellwithfirstandthen.Shecanfollowsimpledirection.
PHYSICALDEVELOPMENTNEEDSOFTHESTUDENT,INCLUDINGCONSIDERATIONOFSTUDENTNEEDSTHATAREOFCONCERN
TOTHEPARENT:
OT:Juliahasmadeprogresswithhandwritingskills,buthasnotmasteredherabilitytoconsistentlywriteletterswithcorrectformation,correct
lineplacement,andconsistentlettersizing.Shehasnotmasteredhergoaltosuccessfullymanipulatezippersandshoelacetying.Therefore,
Julianeedstoworkonimprovingherhandwritingskillsandhervisualmotor/perceptualskillswhichareneededfortaskssuchasshoelace
tying,zippers,puzzles,andscissorcuttinginorderforhertobeasindependentaspossiblewithschoolrelatedtasks.

PT:Julianeedstoimprovehisbalance/coordination,grossmotorplanningskillsandspatialawarenesstobeabletotravelinschooltransition
efficientlyandeffectively.Itisrecommendedtocontinuephysicaltherapyservicesfor2X30X1.
MANAGEMENTNEEDS
THENATURE(TYPE)ANDDEGREE(EXTENT)TOWHICHENVIRONMENTALANDHUMANORMATERIALRESOURCESARENEEDED
TOADDRESSNEEDSIDENTIFIEDABOVE:
Smallgroupinstruction
1:1instruction
Assistanceofaclassroomparaprofessional
APE(3timesperweek)
OccupationalTherapy3x30
Speech&LanguageServices1x30:1/2x30:2
PhysicalTherapy2x30
Ontaskfocusingpromptsscheduledfrequentbreaks&restperiodlowstimulationenvironmenttolearnnewskillsadaptationsininstruction
delivery(visualaids&handsonactivities)adaptationsinwritingtasksopportunitiesforgeneralizingskillsadjustingclassworkalternate
formatsofassessmentsthatrequirelessfinemotorskillactivitybehaviormanagementplantokeneconomyandfirst/then&choiceboards.
OtherresourcesavailableincludeParentCounseling&Training&DoortoDoorMiniBus.
EFFECTOFSTUDENTNEEDSONINVOLVEMENTANDPROGRESSINTHEGENERALEDUCATIONCURRICULUMOR,FORA
PRESCHOOLSTUDENT,EFFECTOFSTUDENTNEEDSONPARTICIPATIONINAPPROPRIATEACTIVITES
WeareindividualizingJulia'seducationprogrambecauseoftheiruniqueneedsendogenoustotheirdisabilityintheareasofreading,writing,
organization,attention,behaviormanagementand/ormotorskills,suchasdifficultyinorganizingmaterials&informationwhichaffectsabilityto
completeassignmentsindependently,whichaffectstheirabilitytoprocessandretaininformationcomparabletothatoftheirpeerswithinthe
generaleducationsetting.
STUDENTNAME:JuliaBieganski

NYCID:221249675

STUDENTNEEDSRELATINGTOSPECIALFACTORS
BASEDONTHEIDENTIFICATIONOFTHESTUDENT'SNEEDS,THECOMMITTEEMUSTCONSIDERWHETHERTHESTUDENT
NEEDSAPARTICULARDEVICEORSERVICETOADDRESSTHESPECIALFACTORSASINDICATEDBELOW,ANDIFSO,THE
APPROPRIATESECTIONOFTHEIEPMUSTIDENTIFYTHEPARTICULARDEVICEORSERVICE(S)NEEDED:
Doesthestudentneedstrategies,includingpositivebehavioralinterventions,supportsandotherstrategiestoaddressbehaviorsthatimpede
thestudent'slearningorthatofothers? Yes No
Doesthestudentneedabehavioralinterventionplan? No Yes
ForastudentwithlimitedEnglishproficiency,doessheneedaspecialeducationservicetoaddressherlanguageneedsastheyrelatetothe
IEP? Yes No NotApplicable
Forastudentwhoisblindorvisuallyimpaired,doessheneedinstructioninBrailleandtheuseofBraille? Yes No NotApplicable
Doesthestudentneedaparticulardeviceorservicetoaddresshercommunicationneeds? Yes No

Inthecaseofastudentwhoisdeaforhardofhearing,doesthestudentneedaparticulardeviceorserviceinconsiderationofthestudent's
languageandcommunicationneeds,opportunitiesfordirectcommunicationswithpeersandprofessionalpersonnelinthestudent'slanguage
andcommunicationmode,academiclevel,andfullrangeofneeds,includingopportunitiesfordirectinstructioninthestudent'slanguageand
communicationmode?
Yes No NotApplicable
Doesthestudentneedanassistivetechnologydeviceand/orservice? Yes No
Ifyes,doestheCommitteerecommendthatthedevice(s)beusedinthestudent'shome?

Yes

No

STUDENTNAME:JuliaBieganski

NYCID:221249675

BEGINNINGNOTLATERTHANTHEFIRSTIEPTOBEINEFFECTWHENTHESTUDENTISAGE15(ANDATAYOUNGERAGEIF
DETERMINEDAPPROPRIATE)
MEASURABLEPOSTSECONDARYGOALS
LONGTERMGOALSFORLIVING,WORKINGANDLEARNINGASANADULT
EDUCATION/TRAINING:NA
EMPLOYMENT:NA
INDEPENDENTLIVINGSKILLS(WHENAPPROPRIATE):NA
TRANSITIONNEEDS
Inconsiderationofpresentlevelsofperformance,transitionserviceneedsofthestudentthatfocusonthestudent'scoursesofstudy,taking
intoaccountthestudentsstrengths,preferencesandinterestsastheyrelatetotransitionfromschooltopostschoolactivities:
NA
STUDENTNAME:JuliaBieganski

NYCID:221249675

ALTERNATESECTIONFORSTUDENTSWHOSEIEPSWILLINCLUDESHORTTERMINSTRUCTIONALOBJECTIVESAND/OR
BENCHMARKS
(REQUIREDFORPRESCHOOLSTUDENTSAND/ORSCHOOLAGESTUDENTSWHOMEETELIGIBILITYCRITERIATOTAKETHE
NEWYORKSTATEALTERNATEASSESSMENT)
MEASURABLEANNUALGOALS
THEFOLLOWINGGOALSARERECOMMENDEDTOENABLETHESTUDENTTOBEINVOLVEDINANDPROGRESSINTHEGENERAL
EDUCATIONCURRICULUMOR,FORAPRESCHOOLCHILD,INAPPROPRIATEACTIVITIES,ADDRESSOTHEREDUCATIONALNEEDS
THATRESULTFROMTHESTUDENTDISABILITY,AND,FORASCHOOLAGESTUDENT,PREPARETHESTUDENTTOMEETHIS/HER
POSTSECONDARYGOALS.
ANNUALGOALS
WHATTHESTUDENTWILLBEEXPECTEDTO

CRITERIA
MEASURETO

METHOD

SCHEDULE

ACHIEVEBYTHEENDOFTHEYEARINWHICH
THEIEPISINEFFECT

DETERMINEIFGOAL
HASBEENACHIEVED

HOWPROGRESSWILL
BEMEASURED

WHENPROGRESSWILL
BEMEASURED

ReadingJuliawillreceptivelyandexpressivelyidentify 80%accuracyover3
3timesperweek
datacollectionsheets
20nounsbyblendinglettersounds.
consecutivesessions
SHORTTERMINSTRUCTIONALOBJECTIVESAND/ORBENCHMARKS(INTERMEDIATESTEPSBETWEENTHESTUDENT'SPRESENT
LEVELOFPERFORMANCEANDTHEMEASURABLEANNUALGOAL):
Juliawillreceptivelyandexpressivelyidentify5nounsbyblendinglettersounds.
Juliawillreceptivelyandexpressivelyidentify10nounsbyblendinglettersounds.
ANNUALGOALS
WHATTHESTUDENTWILLBEEXPECTEDTO
ACHIEVEBYTHEENDOFTHEYEARINWHICH
THEIEPISINEFFECT

CRITERIA
MEASURETO
DETERMINEIFGOAL
HASBEENACHIEVED

METHOD
HOWPROGRESSWILL
BEMEASURED

SCHEDULE
WHENPROGRESSWILL
BEMEASURED

APEInoneyearJuliawillimprovehercardiovascular 80%accuracyfor3consec. DataCollection


1timeperweek
endurancebyalternatelywalking/runningnonstop.
sess.
SHORTTERMINSTRUCTIONALOBJECTIVESAND/ORBENCHMARKS(INTERMEDIATESTEPSBETWEENTHESTUDENT'SPRESENT
LEVELOFPERFORMANCEANDTHEMEASURABLEANNUALGOAL):
Juliawillalternatelywalk/runnonstopfor30seconds
Juliawlllalternatelywalk/runnonstopfor45seconds.
ANNUALGOALS
WHATTHESTUDENTWILLBEEXPECTEDTO
ACHIEVEBYTHEENDOFTHEYEARINWHICH
THEIEPISINEFFECT

CRITERIA
MEASURETO
DETERMINEIFGOAL
HASBEENACHIEVED

METHOD
HOWPROGRESSWILL
BEMEASURED

SCHEDULE
WHENPROGRESSWILL
BEMEASURED

ClassActivities
1timeperquarter
Teacher/Provider
OT:Juliawillcompletehandwritingtaskwithcorrect
Observations
letterformation,letterplacement,lettersize,andcorrect 75%Accuracy
PerformanceAssessment
directionalityusingvisualandverbalpromptsasneeded.
Task
HandwritingWithoutTears
SHORTTERMINSTRUCTIONALOBJECTIVESAND/ORBENCHMARKS(INTERMEDIATESTEPSBETWEENTHESTUDENT'SPRESENT
LEVELOFPERFORMANCEANDTHEMEASURABLEANNUALGOAL):
Julialwilltraceuppercaseletterswithcorrectletterformation,letterplacement,andlettersizeon3linedelementarypaperindependentlywith
visualandverbalpromptsasneeded3outof4times.
Juliawillcorrectlyspellandwritethreefamiliarwordsfromherdailyscheduleboardwithcorrectletterformation,letterplacement,andletter
size3outof4timeswithvisualandverbalprompts.

ANNUALGOALS
WHATTHESTUDENTWILLBEEXPECTEDTO
ACHIEVEBYTHEENDOFTHEYEARINWHICH
THEIEPISINEFFECT

CRITERIA
MEASURETO
DETERMINEIFGOAL
HASBEENACHIEVED

METHOD
HOWPROGRESSWILL
BEMEASURED

SCHEDULE
WHENPROGRESSWILL
BEMEASURED

WritingJuliawillwriteherfirstandlastname,using
80%accuracyover3
3timesperweek
datacollectionsheets
correctletterformation.
consecutivesessions
SHORTTERMINSTRUCTIONALOBJECTIVESAND/ORBENCHMARKS(INTERMEDIATESTEPSBETWEENTHESTUDENT'SPRESENT
LEVELOFPERFORMANCEANDTHEMEASURABLEANNUALGOAL):
Juliawillwriteherfirstname,usingcorrectletterformation.
Juliawillwritethefirstfourlettersofherlastname,usingcorrectletterformation.
ANNUALGOALS
WHATTHESTUDENTWILLBEEXPECTEDTO
ACHIEVEBYTHEENDOFTHEYEARINWHICH
THEIEPISINEFFECT

CRITERIA
MEASURETO
DETERMINEIFGOAL
HASBEENACHIEVED

METHOD
HOWPROGRESSWILL
BEMEASURED

SCHEDULE
WHENPROGRESSWILL
BEMEASURED

MathJuliawillcountout115objects,outofalarger
80%accuracyover3
3timesperweek
datacollectionsheets
group,byusingtheverbalprompt"giveme".
consecutivesessions
SHORTTERMINSTRUCTIONALOBJECTIVESAND/ORBENCHMARKS(INTERMEDIATESTEPSBETWEENTHESTUDENT'SPRESENT
LEVELOFPERFORMANCEANDTHEMEASURABLEANNUALGOAL):
Juliawillcountout15objects,outofalargergroup,byusingtheverbalprompt"giveme".
Juliawillcountout610objects,outofalargergroup,byusingtheverbalprompt"giveme".
ANNUALGOALS
WHATTHESTUDENTWILLBEEXPECTEDTO
ACHIEVEBYTHEENDOFTHEYEARINWHICH
THEIEPISINEFFECT

CRITERIA
MEASURETO
DETERMINEIFGOAL
HASBEENACHIEVED

METHOD
HOWPROGRESSWILL
BEMEASURED

SCHEDULE
WHENPROGRESSWILL
BEMEASURED

Social/EmotionalJuliawillanswer10socialquestions 80%accuracyover3
3timesperweek
datacollectionsheets
uponrequest.
consecutivesessions
SHORTTERMINSTRUCTIONALOBJECTIVESAND/ORBENCHMARKS(INTERMEDIATESTEPSBETWEENTHESTUDENT'SPRESENT
LEVELOFPERFORMANCEANDTHEMEASURABLEANNUALGOAL):
Juliawillanswer3socialquestionsuponrequest.
Juliawillanswer6socialquestionsuponrequest.
ANNUALGOALS
WHATTHESTUDENTWILLBEEXPECTEDTO
ACHIEVEBYTHEENDOFTHEYEARINWHICH

CRITERIA
MEASURETO
DETERMINEIFGOAL

METHOD
HOWPROGRESSWILL

SCHEDULE
WHENPROGRESSWILL

THEIEPISINEFFECT

HASBEENACHIEVED

BEMEASURED

BEMEASURED

ADLJuliawillidentify5coins(penny,nickel,dime,
80%accuracyover3
3timesperweek
datacollectionsheets
quarter&halfdollar)and5billsbynameandvalue.
consecutivesessions
SHORTTERMINSTRUCTIONALOBJECTIVESAND/ORBENCHMARKS(INTERMEDIATESTEPSBETWEENTHESTUDENT'SPRESENT
LEVELOFPERFORMANCEANDTHEMEASURABLEANNUALGOAL):
Juliawillidentify5coins(penny,nickel,dime,quarter&halfdollar)bynameandvalue.
Juliawillidentify5billsbynameandvalue.
ANNUALGOALS
WHATTHESTUDENTWILLBEEXPECTEDTO
ACHIEVEBYTHEENDOFTHEYEARINWHICH
THEIEPISINEFFECT

CRITERIA
MEASURETO
DETERMINEIFGOAL
HASBEENACHIEVED

METHOD
HOWPROGRESSWILL
BEMEASURED

SCHEDULE
WHENPROGRESSWILL
BEMEASURED

PT:In12monthsJuliawillimprovebalanceandspatial
Teacher/Provider
1timeperquarter
awarenesstocompletetransitionsincrowdedhallways, for4/5transitionsfor3
Observations
notbumpingintoanotherstudentandkeepingpace
consecutivetreatment
togetherwithpeersduringtransitioningfor4/5transitions sessions.
asmeasuredmonthlybyPTorteacher.
SHORTTERMINSTRUCTIONALOBJECTIVESAND/ORBENCHMARKS(INTERMEDIATESTEPSBETWEENTHESTUDENT'SPRESENT
LEVELOFPERFORMANCEANDTHEMEASURABLEANNUALGOAL):
Juliawilltransitionincrowdedhallwaysnotbumpingintoanotherstudentgivenaverbalcueasneededduringtransitioningfor4/5transitions
for3consecutivetreatmentsessionsmeasuredbyPTorteacher.
Juliawillwalkinlineduringtransitioningkeepingpacewithherpeersbylagging3secstothepeerinfrontofherfor4/5transitionsfor3
consecutivetreatmentsessionsmeasuredbyPTorteacher.
ANNUALGOALS
WHATTHESTUDENTWILLBEEXPECTEDTO
ACHIEVEBYTHEENDOFTHEYEARINWHICH
THEIEPISINEFFECT

CRITERIA
MEASURETO
DETERMINEIFGOAL
HASBEENACHIEVED

METHOD
HOWPROGRESSWILL
BEMEASURED

SCHEDULE
WHENPROGRESSWILL
BEMEASURED

ClassActivities
1timepermonth
Teacher/Provider
3outof4timeswith75%
Observations
accuracy
PerformanceAssessment
Task
SHORTTERMINSTRUCTIONALOBJECTIVESAND/ORBENCHMARKS(INTERMEDIATESTEPSBETWEENTHESTUDENT'SPRESENT
LEVELOFPERFORMANCEANDTHEMEASURABLEANNUALGOAL):
Juliawillmanipulatefasteners(zippers,smallsizebuttonsshoelaces)withminimalverbal/visualcues,3outof4timeswith75%accuracywith
everyattempt.
OT:Juliawillproblemsolvethroughvisual
perceptual/visualmotortaskswithminimalverbal
promptstocompletetask.

Juliawillcompletea16piecepuzzlewithminimalassistance3outof4times.
ANNUALGOALS
WHATTHESTUDENTWILLBEEXPECTEDTO
ACHIEVEBYTHEENDOFTHEYEARINWHICH
THEIEPISINEFFECT

CRITERIA
MEASURETO
DETERMINEIFGOAL
HASBEENACHIEVED

METHOD
HOWPROGRESSWILL
BEMEASURED

SCHEDULE
WHENPROGRESSWILL
BEMEASURED

SPEECH&LANGUAGE1/2:Juliawillretellstepsina
foratleast4stepsofa
asmeasuredbyspeech
2timespermonth
routine/eventsfromastoryinalogicalmannerby
routine/eventsfromastory teacherobservationsand
sequencingpicturesanddescribingthemusingtemporal over3consecutive
datacollection
markers(first/next/then/last)
sessions.
SHORTTERMINSTRUCTIONALOBJECTIVESAND/ORBENCHMARKS(INTERMEDIATESTEPSBETWEENTHESTUDENT'SPRESENT
LEVELOFPERFORMANCEANDTHEMEASURABLEANNUALGOAL):
1.1Juliawillretellstepsinaroutine/eventsfromastoryinalogicalmannerbysequencingpicturesanddescribingthemusingtemporal
markers(first/last)givenvisualsupportandverbalpromptsforatleast2stepsofaroutine/eventsfromastoryover3consecutivesessions.as
measuredbyspeechteacherobservationsanddatacollection.
1.2Juliawillretellstepsinaroutine/eventsfromastoryinalogicalmannerbysequencingpicturesanddescribingthemusingtemporal
markers(first/next/last)givenvisualsupportandverbalpromptsforatleast3stepsofaroutine/eventsfromastoryover3consecutive
sessions.asmeasuredbyspeechteacherobservationsanddatacollection.
ANNUALGOALS
WHATTHESTUDENTWILLBEEXPECTEDTO
ACHIEVEBYTHEENDOFTHEYEARINWHICH
THEIEPISINEFFECT

CRITERIA
MEASURETO
DETERMINEIFGOAL
HASBEENACHIEVED

METHOD
HOWPROGRESSWILL
BEMEASURED

SCHEDULE
WHENPROGRESSWILL
BEMEASURED

SPEECH&LANGUAGE2/2:Juliawillappropriately
asmeasuredbyspeech
2timespermonth
interactwithpeersandadultsbyinitiatingrequests
4/5xover3consecutive
teacherobservationsand
verbally(e.g."CanIhave...?","Canyouhelpme?",etc.) sessions
datacollection
usingatleast4wordutterancesduringvariousactivities
SHORTTERMINSTRUCTIONALOBJECTIVESAND/ORBENCHMARKS(INTERMEDIATESTEPSBETWEENTHESTUDENT'SPRESENT
LEVELOFPERFORMANCEANDTHEMEASURABLEANNUALGOAL):
2.1Juliawillappropriatelyinteractwithpeersandadultsbyinitiatingrequestsforpermissionverbally(e.g."CanIhave...?")usingatleast4
wordutterancesduringvariousactivities4/5xover3consecutivesessionsasmeasuredbyspeechteacherobservationsanddatacollection.
2.2Juliawillappropriatelyinteractwithpeersandadultsbyinitiatingrequestsforhelpverbally(e.g."Canyouhelpme?")usingatleast4word
utterancesduringvariousactivities4/5xover3consecutivesessionsasmeasuredbyspeechteacherobservationsanddatacollection.

STUDENTNAME:JuliaBieganski

NYCID:221249675

REPORTINGPROGRESSTOPARENTS
Identifywhenperiodicreportsonthestudent'sprogresstowardmeetingtheannualgoalswillbeprovidedtothestudentsparents:
4timesperyear:3timesattimeofReportCards&1timewhenIEPisupforReview.
STUDENTNAME:JuliaBieganski

NYCID:221249675

RECOMMENDEDSPECIALEDUCATIONPROGRAMSANDSERVICES

SPECIALEDUCATION
PROGRAM/SERVICES

FREQUENCY
SERVICEDELIVERY HOWOFTEN
RECOMMENDATIONS* PROVIDED

DURATION
LENGTHOF
SESSION

LOCATION
WHERESERVICE
PROJECTED
WILLBE
BEGINNING/
PROVIDED
SERVICEDATE(S)

SPECIALEDUCATIONPROGRAM:
AdaptedPhysicalEducation

SpecialClass
D75program

6:1+1
LanguageofService:
English

3time(s)per Period
week
37time(s)
Period
perweek

OtherFacilityAPE
Room
SpecialEducation
Classroom

02/26/2016

02/26/2016

3time(s)per 30minutes
week

SeparateLocation
TherapyRoom
/Classroom

02/26/2016

School

02/26/2016

2time(s)per 30minutes
week

SeparateLocation
Totalschool
environment

02/26/2016

1time(s)per 30minutes
week

SeparateLocation
specialeducation
classroomorschool
building
SeparateLocation
specialeducation
classroomorschool

02/26/2016

RELATEDSERVICES:
OccupationalTherapy

Individualservice
LanguageofService:
English

ParentCounselingandTraining

groupand/orindividual 1timeper
month

PhysicalTherapy

Individualservice
LanguageofService:
English

SpeechLanguageTherapy

Individualservice
LanguageofService:
English

SpeechLanguageTherapy

Groupof2
LanguageofService:

30to60minutes

2time(s)per 30minutes
week

02/26/2016

English

building

SUPPLEMENTARYAIDSAND
SERVICES/PROGRAM
MODIFICATIONS/ACCOMMODATIONS:
ASSISTIVETECHNOLOGYDEVICES
AND/ORSERVICES:
SUPPORTSFORSCHOOL
PERSONNELONBEHALFOFTHE
STUDENT:

*Identify,ifapplicable,classsize(maximumstudenttostaffratio),languageifotherthanEnglish,grouporindividualservices,directand/or
indirectconsultantteacherservicesorotherservicedeliveryrecommendations.
STUDENTNAME:JuliaBieganski

NYCID:221249675

12MONTHSERVICEAND/ORPROGRAMStudentiseligibletoreceivespecialeducationservicesand/orprogramduringJuly/August:
No Yes
Ifyes:

* Studentwillreceivethesamespecialeducationprogram/servicesasrecommendedabove.

OR

Studentwillreceivethefollowingspecialeducationprogram/services:

PROJECTED
BEGINNING/
SPECIALEDUCATION
SERVICEDELIVERY
SERVICE
PROGRAM/SERVICES
RECOMMENDATIONS FREQUENCY
DURATION
LOCATION
DATE(S)

Nameofschool/agencyproviderofservicesduringJulyandAugust:
NYCDOESpecializedSchool
Forapreschoolstudent,reason(s)thechildrequiresservicesduringJulyandAugust:
NA
STUDENTNAME:JuliaBieganski

NYCID:221249675

TESTINGACCOMMODATIONS(TOBECOMPLETEDFORPRESCHOOLCHILDRENONLYIFTHEREISANASSESSMENTPROGRAM
FORNONDISABLEDPRESCHOOLCHILDREN):INDIVIDUALTESTINGACCOMMODATIONS,SPECIFICTOTHESTUDENTS
DISABILITYANDNEEDS,TOBEUSEDCONSISTENTLYBYTHESTUDENTINTHERECOMMENDEDEDUCATIONALPROGRAMAND
INTHEADMINISTRATIONOFDISTRICTWIDEASSESSMENTSOFSTUDENTACHIEVEMENTAND,INACCORDANCEWITH
DEPARTMENTPOLICY,STATEASSESSMENTSOFSTUDENTACHIEVEMENT.
TESTINGACCOMMODATIONS

IMPLEMENTATION
RECOMMENDATIONS**

CONDITIONS*

NONE
OnTaskFocusingPrompts

NewYorkStateAlternateAssessment
(NYSAA)
StudentAnnualNeedsDeterminationInventory
(SANDI)
NewYorkStateAlternateAssessment
(NYSAA)
StudentAnnualNeedsDeterminationInventory
(SANDI)

Breaks

Juliahasadisabilitywhichaffectsherabilityto
maintainattentiononthetest.Juliamayneed
visual,physical,orverbalpromptstostayon
taskandremainfocused.
Juliamaytakebreaksduringthetest
administration,thedurationoftestingpriorto
thebreakmustbestated(afiveminutebreak
forevery20minutetestperiod).

*ConditionsTestCharacteristics:Describethetype,length,purposeofthetestuponwhichtheuseoftestingaccommodationsis
conditioned,ifapplicable.
**ImplementationRecommendations:Identifytheamountofextendedtime,typeofsetting,etc.,specifictothetestingaccommodations,if
applicable.
STUDENTNAME:JuliaBieganski

NYCID:221249675

BEGINNINGNOTLATERTHANTHEFIRSTIEPTOBEINEFFECTWHENTHESTUDENTISAGE15(ANDATAYOUNGERAGE,IF
DETERMINEDAPPROPRIATE).
COORDINATEDSETOFTRANSITIONACTIVITIES
NEEDEDACTIVITIESTOFACILITATETHE
STUDENTSMOVEMENTFROMSCHOOL
TOPOSTSCHOOLACTIVITIES
Instruction
RelatedServices
CommunityExperiences
DevelopmentofEmploymentandOther
PostschoolAdultLivingObjectives
AcquisitionofDailyLivingSkills(if

SERVICE/ACTIVITY

SCHOOLDISTRICT/AGENCY
RESPONSIBLE

applicable)
FunctionalVocationalAssessment(if
applicable)
STUDENTNAME:JuliaBieganski

NYCID:221249675

PARTICIPATEINSTATEANDDISTRICTWIDEASSESSMENTS
(TOBECOMPLETEDFORPRESCHOOLSTUDENTSONLYIFTHEREISANASSESSMENTPROGRAMFORNONDISABLED
PRESCHOOLSTUDENTS)
ThestudentwillparticipateinthesameStateanddistrictwideassessmentsofstudentachievementthatareadministeredtogeneral
educationstudents.

ThestudentwillparticipateinanalternateassessmentonaparticularStateordistrictwideassessmentofstudentachievement.
Identifythealternateassessment:

NewYorkStateAlternateAssessment(NYSAA)

StudentAnnualNeedsInventory(SANDI)
Statementofwhythestudentcannotparticipateintheregularassessmentandwhytheparticularalternateassessmentselectedis
appropriateforthestudent:

Julia'smarkedcognitive,communication/language,&social/emotional&/oradaptivebehaviorchallenges,requiringahighlyspecialized
educationalprogram&educationalsupportsystems,meetstheeligibilitycriteriaforAlternatedassessment.
STUDENTNAME:JuliaBieganski

NYCID:221249675
PARTICIPATIONWITHSTUDENTSWITHOUTDISABILITIES

REMOVALFROMTHEGENERALEDUCATIONENVIRONMENTOCCURSONLYWHENTHENATUREORSEVERITYOFTHEDISABILITY
ISSUCHTHAT,EVENWITHTHEUSEOFSUPPLEMENTARYAIDSANDSERVICES,EDUCATIONCANNOTBESATISFACTORILY
ACHIEVED.
FORTHEPRESCHOOLSTUDENT:
Explaintheextent,ifany,towhichthestudentwillnotparticipateinappropriateactivitieswithageappropriatenondisabledpeers(e.g.,
percentoftheschooldayand/orspecifyparticularactivities):

NA
FORTHESCHOOLAGESTUDENT:

Explaintheextent,ifany,towhichthestudentwillnotparticipateinregularclass,extracurricularandothernonacademicactivities(e.g.,
percentoftheschooldayand/orspecifyparticularactivities):

Juliaisexperiencingmarkedcognitive&behavioralchallengesthereforewillnotparticipateinEnglishorMath100minutesperday.
Ifthestudentisnotparticipatinginaregularphysicaleducationprogram,identifytheextenttowhichthestudentwillparticipatein
speciallydesignedinstructioninphysicaleducation,includingadaptedphysicaleducation:
Julianeedsprecludeparticipationingeneraleducationclasses,thereforeparticipatesinAdaptivePhysicalEducation2/3periodsper
week.
EXEMPTIONFROMLANGUAGEOTHERTHANENGLISHDIPLOMAREQUIREMENT:

No YesTheCommitteehasdeterminedthatthestudent'sdisabilityadverselyaffectshis/herabilitytolearnalanguageand
recommendsthestudentbeexemptfromthelanguageotherthanEnglishrequirement.

STUDENTNAME:JuliaBieganski

NYCID:221249675

SPECIALTRANSPORTATION
TRANSPORTATIONRECOMMENDATIONTOADDRESSNEEDSOFTHESTUDENTRELATINGTOHIS/HERDISABILITY

None.
Studentneedsspecialtransportationaccommodations/servicesasfollows:
Vehicleand/orEquipmentNeedsAirConditioning
OtherAccommodationsLimitedTravelTime:notmorethan60min
Otheraccommodations:doortodoorminibus

Studentneedstransportationtoandfromspecialclassesorprogramsatanothersite:
PLACEMENTRECOMMENDATION

NYCDOESpecializedSchool

SUMMARY
STUDENTINFORMATION
StudentName:JuliaBieganski

NYCID:221249675
DOB:12/26/2006
Gender:Female
ParentsLanguage(s)Spoken/ModeCommunication:
IEPINFORMATION
DateofIEPMeeting:02/25/2016
IEPAmendment:

Yes

No

ReconveneofIEPMeeting:

Yes

No
INSTRUCTIONAL/FUNCTIONALLEVELS

Reading:
Math:
SUMMARYOFRECOMMENDATIONS
ClassificationofDisability:Autism
RecommendedServices:
SpecialEducationPrograms
AdaptedPhysicalEducation
SpecialClass

English
RelatedServices

ParentCounselingandTraining
SpeechLanguageTherapy
SpeechLanguageTherapy
OccupationalTherapy
PhysicalTherapy

English
English
English
English

12MonthServices:
AdaptedPhysicalEducation
SpecialClass

English

ParentCounselingandTraining

SpeechLanguageTherapy
SpeechLanguageTherapy
OccupationalTherapy
PhysicalTherapy

English
English
English
English

ThestudentwillparticipateinanalternateassessmentonaparticularStateordistrictwideassessmentofstudentachievement
Alternateassessment:

NewYorkStateAlternateAssessment(NYSAA)

StudentAnnualNeedsInventory(SANDI)
Julia'smarkedcognitive,communication/language,&social/emotional&/oradaptivebehaviorchallenges,requiringahighlyspecialized
educationalprogram&educationalsupportsystems,meetstheeligibilitycriteriaforAlternatedassessment.
DoesJuliahaveaBehavioralInterventionPlan?No
RecommendedforSpecializedTransportation: None Studentneedsspecializedtransportation
SchoolType:NYCDOESpecializedSchool
MedicalAlert:Thestudenthas medicalconditionsand/or physicallimitationswhichaffecther learning,
participationinschoolactivities.
Thestudentrequires medicaland/or healthcaretreatment(s)orprocedure(s)duringtheschoolday.

behaviorand/or

PROMOTIONCRITERIA
CURRENTYEAR
Standard
Modified
NEXTYEAR
Standard
Modified
ParentConcerns:
OTHEROPTIONSCONSIDERED
SpecialClassinaspecializedschool8:1+1
Reason(s)forRejection:Julianeedsmoreintensiveadult:studentratio.
STUDENTNAME:JuliaBieganski
DATEOFIEP:02/25/2016

NYCID:221249675

ATTENDANCEPAGE
PLEASENOTETHATYOURSIGNATUREREFLECTSYOURPARTICIPATIONATTHECONFERENCEANDDOESNOTNECESSARILY
INDICATEAGREEMENTWITHTHEINDIVIDUALIZEDEDUCATIONPROGRAM.
ROLE(INDICATEIFBILINGUAL)
NAME
SIGNATURE
RelatedServiceProvider/SpecialEducation
LisaCalise
Teacher
Parent/LegalGuardian

AldonaBieganski

DistrictRepresentative

LisaCalise

SpeechLanguagePathologist

CalianneBotsaris

OccupationalTherapist

NeemaPanchal

PhysicalTherapist

RubyUy