Student: Marshall Moore STN: 3124987615

DOB: 9/22/02 Age: 11 Grade: _5_____ Gender: Male

Effective IEP File

Dates: Date:

Case Conference Committee Meeting Scheduled:

Date: 2/23 Time: 9:00 am Place: Crestwood Elementary

Guardian Information:

Relation: Dad Relation: Mom

Name: Mike Moore Name: Pam
Business Business
Home Phone: Home Phone:
Mobile Mobile Phone:
Phone:
Home 407 Park Avenue in Linton, Home
Address: Indiana. Address: 407
Park Avenue in
Linton, Indiana.

Purposes of the Case Conference:

x Initial Evaluation x Consider Placement in an Alternative

Reevaluation Review
Annual IEP Review
Revise IEP
Transition IEP
Move-in
First Steps Intake
Exit from Secondary Education
Program
Consider Placement at a State School
Consider Placement in a Private Facility
Consider Service Plan
Consider PA placement with a different PA of
Service
Manifestation Determination
Interim Alternative Educational Placement
Out-of-school placement 60-day Review

Enrollment Date (Move in only):

Page 1 of 27
 Student: STN:
DOB: Age: Grade: Gender:

Existing Data:
Strengths of the student:

Marshall is currently on the middle school basketball team. He has a lot of friends at school. He enjoys going to school.
While he is at school

he works very hard. He works really hard on his homework while at home. He is on the student council. He also loves to
read the lunch menu

aloud for the schools announcements.

Concerns of Parent:

His parents are very concerned about when the work load gets harder for him he will just give up.
They

struggle to get through it now. He has melt downs before he is able to get through it. His parents
do not want
him to give up once the work gets harder.

Response to instructional Strategies and research based interventions:

His response to his instructional strategies hasnt gone well. Even though there has been
accommodations to his
work he still seems to struggle with it. He will need multiple explanations before he is able to grasp
the concept of the homework. He will need a review of previous material before he is able to move on
to the new material. His mom and his teacher also lets him use a calculator for all of his math
problems.

Progress Monitoring Data:

After being tested by the school psychologist the results show that he is learning disables in math. It is recommended
that he is to take

the IMAST test. This is just a modification of the ISTEP+ since he can eventually grasp the concepts of math.
 Student: STN:
DOB: Age: Grade: Gender:
Present Level of Academic Achievement and Functional Performance:

As of right now Marshalls grade in math is a D. His math grade is always low and can never seem to
bring it up. He fails the tests all the time and the only reason he sees a passing grade is because of his
homework. He is testing at 2.4 in Accelerated Math. Marshall did not pass the ISTEP tests in the 3rd
th
and 4 grade, missing the cut off by a considerable margin.
Reevaluation:

The public agency must consider reevaluation for each student receiving special
education and related services at least once every three (3) years unless the parent and
the public agency agree that it is unnecessary. In addition, the public agency must
consider reevaluation if the public agency determines at any time during the three (3)
year cycle that additional information is needed to address the special education or
related services needs of the student, or if the students parent or teacher requests an
evaluation.
Initial Eligibility Date: 2/23/05

Anniversary Reevaluation Date:

The Case Conference committee has reviewed existing data and has determined:

Information is needed to reestablish eligibility for special education and related

services (12 month timeline)
Information is needed to determine that the student is eligible for special
education under a different of additional eligibility category (50 instructional day
timeline)
Information is needed to inform the students case conference committee of
the students special education and related service needs (50 instructional day
timeline)
There is no need for reevaluation information
 Eligibility Decision:
The case conference committee has determined that the student's disability adversely
affects the student's
educational performance: x Yes No

Eligibility Areas: (Please indicate one Primary disability and all Secondary
disabilities)

Autism Spectrum Disorder Language Impairment

Blind or Low Vision Speech Impairment
Cognitive Disability Multiple Disabilities
Deaf or Hard of Hearing Other Health Impaired
Deaf-Blind Orthopedic
Developmental Delay Impairment
xx Specific Learning
Emotional Disability x Disability
Traumatic Brain Injury

Describe the reasons for eligibility determination including the other options considered
and reasons these options were rejected.

He is eligible because he struggles in math and it takes him a long time to grasp the concepts of the lessons. He and his
mom have a very hard time getting through his homework. He always fails his math tests and the only reason for a

passing grade is his homework.

 Special Considerations:

Yes xNo Does the student have needs related to Limited

English Proficiency? If yes, please describe the students needs:

Yes xNo Are there considerations regarding the student's language and
communication needs, opportunities for direct communications with peers and
professional personnel in the student's language and communication mode, academic
level, and full range of needs, including opportunities for direct instruction in the
student's language and communication mode? (Only Deaf or Hard of Hearing or
Deaf-Blind eligibility areas require this response.)

If yes, please describe the students language and communication needs:

Yes xNo Are there considerations regarding the instruction in Braille and the
use of Braille? (Only Blind or Deaf-Blind Eligibility Areas require this response.)

If yes, please describe the considerations regarding Braille:

Behavioral Concerns:

xYes No Does the Behavior of this student impede his or her progress or
that of others? If yes, please complete the following prompts:
Behaviors of Concern: (Please describe the patterns of concerning behaviors.)

The students seems to have a hard time getting directions from his mom on his math homework. His mother has said
that it takes about 2 or 3 emotional breakdowns before he is able to complete his homework.
 Functions of the Behavior: (Please include evidence of factors affecting behavior.)

The evidence f Marshall acting poorly is his work. He has a very hard time grasping the work and that is what causes
him to become very upset and have some meltdowns. He always ends up finishing his homework, but the meltdowns are caused by the
difficulty of work he has to do.

Positive Strategies/Instructional Experiences: (Please articulate the plan to provide

behavioral support/intervention.)

A plan we could have is having him get a tutor that is around his age and have them work together. Maybe it is just his
mom that makes him upset and in turn throws some tantrums. Since he is fine with making friends and gets along with all of them,
maybe he can get one of them to help him with his homework. Maybe the way they explain it will make more sense to him and be able to
grasp it quicker. We could try and get them to stay after school 2 times a week or they could meet at one anothers house and do their
homework together.
 Transition:
List of Transition Assessments:

Discuss the findings of age-appropriate transition assessments that have been

conducted, the indication of need for future transition assessments, and any curricular
connections that support that development of transition skills.

Summarize these discussion points:

Post-Secondary Goals:

Is there evidence that this student has achieved sufficient skills for Independent Living?

xYes No

If yes, cite evidence to support the decision that an Independent Living goal is
applicable:

He seems to be able to make friends and not be shy. He is a good person and just seems to struggle at math. He does
fine in school and never gets in trouble. Some of the problems he has is with his mom , because she is the one who makes him get
through his math homework.

If no, Regarding Independent Living Skills after high school, I will

Regarding Education and Training after high school, I will

I will keep in touch with the student and let him know that I will be willing it help him with anything that he needs.
Regarding Employment after high school, I will
 State Assessments and other Considerations:

Anticipated date of Graduation:

This student will pursue a Certificate of Completion.

Therefore, the student's goals and objectives are generally prerequisites to
grade-level academics or are highly individualized extensions to the standards.

x The student will pursue a High School Diploma.

Therefore, the student's academic goals are the same as non-disabled peers at
grade-level or generally aligned to grade-level curriculum.

Participation in State Testing Programs:

Student does not attend an accredited school and will not participate in statewide
assessments.
Student will not yet be in grade 3.
X Student and will be in grades 3-8 at an accredited school.

High School Diploma is the selected outcome for this student.

Math (grade 3-8) Language Arts (grade Science (grade 4 & Social Studies (grade 5
ISTEP+ 3-8)
ISTEP+ 6)
ISTEP+ & 7)
ISTEP+
without without without without
accommodati
ISTEP+ with accommodati
ISTEP+ with accommodati
ISTEP+ with accommodati
ISTEP+ with
accommodations accommodations accommodations accommodations
Certificate of Completion is the selected outcome of this
student.
Math (Grade 3-8) Language Arts (grade Science (grade 4 & Social Studies (grade 5
Alternate Assessment Alternate Assessment Alternate Assessment Alternate Assessment

Student will be in high school.

Student will not be in 10th grade. Therefore, State Assessment is not required.

High School Diploma is the selected outcome for this student.

Algebra Language Arts (HS) Biology
End of Course Assessment without End of Course Assessment without End of Course Assessment without
accommodations accommodations accommodations
End of Course End of Course End of Course
Assessment with Assessment with Assessment with
accommodations
Student has passed this accommodations
Student has passed this accommodations
Student has passed this
assessment.
Tested course is not yet in assessment.
Tested course is not yet in assessment.
Tested course is not yet in course of
course of study. course of study.
study.
Certificate of Completion is the selected outcome for this
student.
Algebra Language Arts (HS) Biology
(HS)
Alternate Assessment Alternate Assessment (HS)
Alternate Assessment
 State Testing Accommodations:
Please record all accommodations selected for state assessment purposes: (All
accommodations selected for
assessment purposes must be provided on a regular basis.)

Marshall has had accommodations in his math class but still seems to struggle. The one major accommodations he gets
is that he is

allowed to use his calculator for all of his math problems.

Describe the plans for participation in other local, national, and international testing
The plan for him is to be able to get him to stop using his calculator for simple math problems. If we
can get him to just use his calculator on the harder questions that would be helpful. A teacher could go through the
test before h takes it and mark the only problems he will be able to use a calculator on. And slowly start to having
him use the calculator as much as the other studemts.

Page 10 of 27
 IREAD3
Only complete this section if the student is in third grade or participating in
IREAD3 remediation.

Yes No Did the student pass IREAD3?

Complete the following prompts if the student did not pass IREAD3:

Yes No Will the student be retained?

Yes No If the student is to be retained, will he or she receive remediation?

If the student did not pass IREAD3 and is not to be retained explain the rationale for not
retaining the student:

Yes No Did the student pass IREAD3 following remediation?

Student has not yet taken IREAD3 following remediation.

Rationale:

Explain why the chosen assessments are appropriate for the student. If the student
will participate in an alternate assessment, describe why the student cannot
participate in the general assessment. Include information in support of each criterion
for participation in an alternate or modified assessment if relevant:

Page 11 of 27
 Annual Goals
Title:

Needs addressed through this annual goal:

Some of his annual goals are that he should stop having the melt downs at home with his mom and
actually get his work done without them. He should also begin to start getting a passing grade on his tests. Im not
saying he should be receiving As or Bs, but better than an F.

Annual Goal Statement:

If student is of transition age, which post-secondary goal(s) does this annual goal
support?

Employment Education and Training

Independent Living (if required) Method/Instrumentation for
Measuring Progress:

Progress Monitoring Design:

Descriptive Documentation Single Point

Single Rubric Collection of Indicators Standards aligned
to this Annual Goal:
Progress Monitoring Parameters: (Please include Objectives, Benchmarks, Initial Dates
and Values, Metrics, Frequency of Collection, and Rubric information required by the
Progress Monitoring Design selected.)
 Provisions:
Transition Services (Transition IEP only)

Description By Whom To Support Completion Date

Narrative:

Description By Whom To Support Completion Date

Narrative:

Description By Whom To Support Completion Date

Narrative:

Description By Whom To Support Completion Date

Narrative:

Description By Whom To Support Completion Date

Narrative:

(Transition IEP only) Please document the written information presented to the parent
and student regarding available adult services provided through state and local
agencies and other organizations to facilitate student movement from the public agency
to adult life:
Special Education Services

Descriptio Initiation Frequenc Length Duration Location To Support

Narrative:

Descriptio Initiation Frequenc Length Duration Location To Support

Narrative:

Descriptio Initiation Frequenc Length Duration Location To Support

Narrative:

Descriptio Initiation Frequenc Length Duration Location To Support

Narrative:

If the purpose of the IEP is First Steps Intake, please record the Service
Initiation Date:
Related Services

Descriptio Initiation Frequency Length Duration Location To Support

n (date) (time) (date)

Narrative:

Descriptio Initiation Frequency Length Duration Location To Support

Narrative:

Descriptio Initiation Frequency Length Duration Location To Support

n (date) (time) (date)

Narrative:

Descriptio Initiation Frequency Length Duration Location To Support

Narrative:

Accommodations:

Describe any additional accommodations, if appropriate:

Transportation:

If the students transit time or needs are different from that of non-disabled peers,
describe and justify these needs. Record as a related service if additional
provisions are necessary.

If Transportation is indicated as a related service, list and describe any criteria to

needed to determine
health-related need for special education transportation
Accessible Materials:

If this student requires any instructional materials provided in an accessible

format, describe the environments, tasks, tools, and services related to their
provision:

Assistive Technology:

Describe this assistive technology required if any:

Extended School Year:

Record extended school year services required in order to provide a free and
appropriate education for this student: (Record ESY services under special education
and related services if needed.)

Aids/Supports:

Document the types and general intent of supports necessary to provide public agency
personnel with the knowledge and skills necessary to implement the students
individualized education program and the general intent of the supports:
Program Modifications:

Describe any program modifications needed to enable the student to advance

appropriately toward attaining the annual goals, to be involved in and make progress in
the general education curriculum, to participate in extracurricular and other
nonacademic activities or to be educated or participate with other students with
disabilities and non-disabled students.

Progress Reporting:

Describe when periodic reports on the progress the student is making toward meeting the
annual goals will be provided:

Rationale:

Describe the rationale for providing these services and supports as well as describing
reasons for rejecting other options:

Does this student require an Emergency Evacuation Plan?

Yes No
 Least Restrictive Environment and Program:
Course of Study - (For Transition IEPs only) Choose a course of study from the list
(these courses focus on
improving the academic and functional achievement of the student in order to
support the attainment of post-secondary goals):

Certificate of Completion
X General Diploma
Core 40 Diploma
Core 40 with Honors

LRE Placement Category based Federal Program Types:

School Age (6-21) - Student will be Age 6+ as of next December 1st

50 Regular class 80% or more (In a regular classroom for 80% or more of the day)
51 Resource Room (In a regular class for 40% to 79% of the day)
52 Separate Class (In a regular class for less than 40% of the day)
53 Separate day school facility
54 Residential Facility
55 Correctional Facility
56 Parentally placed in private school
57 Homebound/hospital

Preschool Age (3-5) - Student will not be 6+ as of the next December 1st
26 In a regular early childhood program at least 10 hours per week and receiving the majority of
27 Inservices there.
a regular early childhood program at least 10 hours per week and receiving the majority of
services in some other location.
28 In a regular early childhood program less than 10 hours per week and receiving the majority of
29 services
In there.
a regular early childhood program less than 10 hours per week and receiving the majority of
services in some other location.
33 Separate Class
34 Separate School
35 Residential Facility
36 Service Provider Location
37 Home
Additional Descriptors:

Any potentially harmful effects of the services on the student or on the

quality of services needed:
Reasons for placement determination including reasons for rejecting other
options:

Page 20 of 27
 General Considerations:

Consider the student's participation in general education and record any supplementary
aids and services that are determined by the case conference committee to be appropriate
and necessary in order to afford the student equal opportunity for participation with non-
disabled students.

x Yes, Student will be able to participate in all educational programs and

activities available to non- disabled students.

No, state the exceptions and describe the reasoning for these exceptions:

xYes, Student will be able to participate in all non-educational and

extracurricular activities available to non-disabled students.

No, state the exceptions and describe the reasoning for these exceptions:

x Yes, Student will participate in the general physical education program

available to non-disabled students.

No, state the exceptions and describe the reasoning for these exceptions:

x Yes, Student will be educated in the school he or she would attend if not
disabled.

No, state the exceptions and describe the reasoning for these exceptions:

Page 21 of 27
x Yes, the length of the instructional day will be the same as the instructional
day for non-disabled peers.

No, state the exceptions and describe the reasoning for these exceptions:
 Program Information

Corporation of Legal Settlement:

School of Legal Settlement:

Educating District and Code:

Educating School and Code:

Educating School is non-public and accredited.

Educating School in non-public and non-accredited.
If Educating School is non-public and non-accredited circle
the facility type.
01: nonpublic school, not contracted for preschool (PK) students
with disabilities 02: Community based preschool or Head Start
03: Neglected or Delinquent
Institutions 04: Court ordered
Facility
05: Nonpublic school, not
accredited 06: Health
Institution
07: Nonpublic school contracted for preschool students with
Next Educating District and Code:

Next Educating School and Code:

Next Educating School is non-public and accredited.

Next Educating School in non-public and non-accredited.
If Next Educating School is non-public and non-accredited
circle the facility type.
01: nonpublic school, not contracted for preschool (PK) students
with disabilities 02: Community based preschool or Head Start
03: Neglected or Delinquent
Institutions 04: Court ordered
Facility
05: Nonpublic school, not
accredited 06: Health
Institution
07: Nonpublic school contracted for preschool students with

Additional information:
 Participants:

The following individuals participated in the case conference committee meeting. Those
individuals identified as Teacher of Record, General Education Teacher, Public Agency
Rep and Instructional Strategist attended the entire meeting unless parental excusal
was obtained before the meeting.

Position Name Additional Title

Parent Mike Moore
Parent Pam Moore
School Counselor Tim Jones
School Psychologist Lisa Jaynes
Principal Lou Reed

_
Written Notes and Other Relevant Factors:
 Notice of Initial Proposed IEP

I have been presented with a copy of the Individualized Education Program (IEP) which
contains:

1) A description of the action proposed by the public agency;

2) An explanation of why the public agency proposed to take the action;
3) A description of each evaluation, procedure, assessment, record, or report the
agency used as a basis for the proposed action;
4) A description of other options that the case conference committee considered
and the reasons why those options were rejected; and
A description of other factors relevant to the agencys proposal.

I understand that as parent of a student with a disability I have protection under the
procedural safeguards. I can request a copy of the procedural safeguards at any time.
The procedural safeguards document includes a list of resources to contact for
assistance in understanding the provisions of Indiana special education rules.

I consent to the provision of special education services for my child. I understand that
this (IEP) will be implemented no later than ten instructional days after my consent is
received or by the initiation date stated on the IEP.

I refuse to consent to the provision of special education services described in this

written notice. I understand that as the parent, I have the right to contest the public
agencys decision and challenge the proposed action by:

Requesting and participating in a meeting with an official of the public agency who
has the authority to facilitate the disagreement between the parent and the public
agency regarding the action proposed or refused by the public agency.
Securing an agreement for mediation under 511 IAC 7-45-2.
Requesting a due process hearing under 511 IAC 7-45-3.

Sign Date
 Notice of Implementation

I have been presented with a copy of the Individualized Education Program (IEP) which
contains:

1) A description of the action proposed by the public agency;

2) An explanation of why the public agency proposed to take the action;
3) A description of each evaluation, procedure, assessment, record, or report the
agency used as a basis for the proposed action;
4) A description of other options that the case conference committee considered
and the reasons why those options were rejected; and
5) A description of other factors relevant to the agencys proposal.

I understand that the public agency is not required to obtain a written parental consent
and can implement this IEP ten (10) instructional days after the provision of this notice
unless I challenge the proposed action by:

Requesting and participating in a meeting with an official of the public agency who
has the authority to facilitate the disagreement between the parent and the public
agency regarding the action proposed or refused by the public agency.
Securing an agreement for mediation under 511 IAC 7-45-2.
Requesting a due process hearing under 511 IAC 7-45-3.

I understand that if a parent challenges the proposed IEP prior to its implementation,
the public agency must continue to implement the current IEP under 511 IAC 7-42-7 (b)
(5).

PROCEDURAL SAFEGUARDS

I understand that as parent of a student with a disability has protection under the
procedural safeguards, I can request a copy of the procedural safeguards at any time.
The procedural safeguards document includes a list of resources to contact for
assistance in understanding the provisions of Indiana special education rules.

Sign Date

CONSENT TO IMPLEMENT IEP

I have been provided with the Notice of Implementation and a copy of the proposed IEP. I
give my consent for the School to implement the IEP in accordance with the initiation
date that is prior to the expiration of ten (10) instructional days from the date the Notice
of Implementation and proposed IEP were provided to me.
Sign Date