Transcript Document

Transition in the IEP
Diane Sobolewski
2004 PA Transition
Communities of Practice Conference
Pennsylvania Training and Technical Assistance Network
Pennsylvania Department of Education
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INDIVIDUALIZED EDUCATION PROGRAM (IEP) Format
**************************************************************** School Age
IEP Meeting Date ____________________
IEP Implementation Date (Projected Date when Services and Programs Will Begin): ____/____/____
Mo Day Yr
Anticipated Duration of Services and Programs of this IEP: ____/____/____
Mo Day Yr
Student Name: _____________________________________ DOB: ________________
Grade: ______________
Age:
Anticipated Year of Graduation: ___________________
School District: _____________________________________
Parent Name: _____________________________________________________
Address:
________________________________________
________________________________________
________________________________________
County of Residence: _______________________
Phone:
(H) ________________________________
(W_________________________________
Other Information:
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IEP TEAM/SIGNATURES*
The Individualized Education Program (IEP) Team makes the decisions about the student’s program and placement. The student’s parent(s), the
student’s regular teacher and a representative from the local education agency are required members of this team. A regular education teacher
must also be included if the student participates, or may be participating in regular education. Signature on this IEP documents attendance, not
agreement.
NAME (typed or printed)
POSITION (typed or printed)
Parent
Parent
SIGNATURE
Student*
Regular Education Teacher
Special Education Teacher
Local Ed. Agency Rep. (Chair)
Community Agency Rep.**
Vocational Teacher (if appropriate)
*The IEP team must invite the student if transition services are being planned or if the
parents choose to have the student participate.
**As determined by the LEA as needed for transition services.
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I. SPECIAL CONSIDERATIONS THE IEP TEAM MUST CONSIDER BEFORE DEVELOPING THE IEP. ANY FACTORS
CHECKED MUST BE ADDRESSED IN THE IEP.
Is the Student Blind or Visually Impaired?
_____No
Yes - Team must provide for instruction in Braille and the use of Braille unless the IEP Team determines, after an
evaluation of the child’s reading and writing skills, needs and appropriate reading and writing media (including an evaluation of the child’s
future needs for instruction in Braille or the use of Braille), that instruction in Braille or the use of Braille is not appropriate.
Is the Student Deaf or Hearing Impaired?
_____No
Yes - Team must consider the child’s language and communication needs, opportunities for direct communications with
peers and professional personnel in the child’s language and communication mode, academic level, and full range of needs, including
opportunities for direct instruction in the child’s language and communication mode in the development of the IEP.
_____ COMMUNICATION NEEDS.
_____ ASSISTIVE TECHNOLOGY, Devices and /or Services
_____ LIMITED ENGLISH PROFICENCY
_____ BEHAVIORS THAT IMPEDE HIS/HER LEARNING or that of OTHERS
_____ TRANSITION SERVICES
_____ OTHER (Specify)________________________________________________________
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II. PRESENT LEVELS OF EDUCATIONAL PERFORMANCE
STUDENT'S PRESENT LEVELS OF EDUCATIONAL PERFORMANCE:
Written in relation to the post-school outcomes !
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IV. SPECIAL EDUCATION / RELATED SERVICES:
A. PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION: (Specially designed instruction may be listed with
each goal/objectives.)
Modifications and SDI
Location
Frequency
Projected
Beginning Date
Anticipated
Duration
B. RELATED SERVICES: List the services that the student needs in order to benefit from or access his/her special education program:
Service
Location
Frequency
Projected
Beginning
Date
Anticipated
Duration
*Include only if differs from IEP beginning and/or duration dates.
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VII. TRANSITION PLANNING
1. Will the student be 14 years of age or older during the term of this IEP?
_____ No - (Not necessary to complete this section)
_____ Yes - Team must address the student's courses of study and how the course of
study applies to components of the IEP
Student's courses of study:
Student will graduate according to district outcomes/standards -- see
attached plan
Student will graduate based on completion of IEP goals -- see attached plan
Student will graduate based on a combination of district standards and IEP
goals -- see attached plan
Student will enroll in a vocational-technical program: CIP code ________
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SERVICE
LOCATION
FREQUENCY
PROJECTED
BEGINNING
DATE
ANTICIPATED
DURATION
Post-secondary Education / Training
Outcome:
How Service will be provided:
Person Responsible
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Post-secondary Education/Training
Sample Statements
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
None – student expresses no interest or desire
Student is undecided at this time
Two- or four-year college/university – w/o support
Two- or four-year college/university – with support
Technical/trade school – w/o support
Technical/trade school – with support
Military training
Adult education classes
Special adult classes
Other ________________________________
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Post-secondary Education/Training
Specific area of study ___________________________
School of interest ______________________________
_____ ASVAB ____PSAT/SAT ____ accommodations
_____ College fairs _____ College/facility tour
_____ Application _____ Financial Aid
_____ Note taking _____ Organizational skills
_____ Time management _____ Self-disclosure
_____ Documentation
_____ Recent
_____ Licensed psychologist
_____ Rationale for accommodations
_____ Request accommodations
_____ Hiram Andrews information
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SERVICE
LOCATION
FREQUENCY
PROJECTED
BEGINNING
DATE
ANTICIPATED
DURATION
Employment
Outcome:
How Service will be provided:
Person Responsible
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Employment Sample Statements
1.
Competitive employment – w/o support
2.
Competitive employment – with support (long / short term)
3.
Sheltered employment
4.
Adult training facility (formerly Therapeutic Activity Center)
5.
Adult day care
6.
Other ____________________________________
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Employment
Specific career interest __________________________
_____ Career exploration
_____ Choices software
_____ Guest speakers
_____ Graduation project
_____ In-school work experience
_____ Community service
_____ Job shadowing
_____ Job tryouts
_____ Work experience
_____ Vocational-technical school
_____ Tour
_____ Shadow vocational programs
_____ Co-op job placement (vo-tech)
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Employment
_____ Community-based instruction
_____ Pre-employment skills
_____ Travel training
_____ Social skills
_____ Career TRACK
_____ CareerLink
_____ DPW Employment Program referral
_____ OVR referral
_____ Determination of eligibility
_____ Employment services
_____ Job training
_____ MH/MR referral
_____ Sheltered employment
_____ Adult Training Facility program
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SERVICE
LOCATION
FREQUENCY
PROJECTED
BEGINNING
DATE
ANTICIPATED
DURATION
Residential
Outcome:
How Service will be provided:
Person Responsible
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Residential Sample Statements
1.
2.
3.
4.
5.
6.
7.
8.
9.
Live at home with parents or relatives
Independent living with no supports
Independent living w/ occasional supports
Independent living w/ daily supports
Supported apartment or community living arrangement
Group home – 24-hour supervision and training
Group home – skilled nursing care
Facility-based – personal care home, nursing home, etc.
Other _________________________________
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Residential
_____ Home responsibilities
_____ Participate in apartment program
_____ Summer camps
_____ Open case with MH/MR Base Service Unit
_____ Supports Coordination
_____ Community Living Arrangements
_____ Respite care
_____ Companionship / social groups
_____ Community-based instruction
_____ Shopping/money skills
_____ Pedestrian safety
_____ Social skills/communication
_____ Section 8 housing
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SERVICE
LOCATION
FREQUENCY
PROJECTED
BEGINNING
DATE
ANTICIPATED
DURATION
Participation
Outcome:
How Service will be provided:
Person Responsible
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Participation Sample Statements
1. Independent -- will access community resources
w/o support
2. Family support -- will access community resources
w/family supports
3. Agency support -- will access community resources
w/agency supports
4. Other _____________________________________
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Participation
_____ Transportation
_____ Driver’s license _____ Photo ID
_____ Public transportation
_____ Family transportation
_____ Special transportation
_____ Car pool
_____ Voter registration
_____ Selective service
_____ Jury duty information
_____ Court system / obeying the laws
_____ Community-based instruction
_____ Travel training
_____ Social skills
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SERVICE
LOCATION
FREQUENCY
PROJECTED
BEGINNING
DATE
ANTICIPATED
DURATION
Recreation / Leisure
Outcome:
How Service will be provided:
Person Responsible
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Recreation/Leisure Sample Statements
1.
Independent – will participate in community programs
w/o support
2.
Family support – will participate in community programs
w/ family supports
3.
Special support – will participate in community programs
w/ agency or outside supports
4.
Special programs – will participate in special program
with people with disabilities
5.
Other ____________________________________
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Recreation / Leisure
Current hobbies ________________________________
_____________________________________________
Current clubs __________________________________
_____________________________________________
Current social activities __________________________
_____________________________________________
_____ Community-based instruction
_____ Recreation facilities (YMCA, etc.)
_____ Social skills
_____ Sports
_____ Local clubs, teen centers
_____ Service organizations (AkTion Club, Kiwanis,etc)
_____ Church groups
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STATEMENT OF COORDINATED TRANSITIONAL SERVICES AND ACTIVITIES NEEDED TO
SUPPORT DESIRED POST-SCHOOL OUTCOMES:
The instructional areas should support the desired post-school outcomes. The following instructional areas should appear in the IEP
as annual goals, short-term instructional objectives or benchmarks, and/or specially designed instruction. For example (if appropriate):
Instruction and Related Services
Community Experiences
Acquisition of Daily Living Skills
Functional Vocational Evaluation
Adult Living
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
__________________________________________________________
Think “BIG PICTURE”
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LINKAGES
List the agencies, which may provide services/support (before the student leaves the
school setting):
Agency Name _________________
Phone Number _________________
Responsibilities/Linkages ________________________________________
Agency Name _________________
Phone Number _________________
Responsibilities/Linkages ________________________________________
Agency Name _________________
Phone Number _________________
Responsibilities/Linkages ________________________________________
Agency Name _________________
Phone Number _________________
Responsibilities/Linkages ________________________________________
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Agencies
_____ Office of Vocational Rehabilitation
_____ Mental Health
_____ Mental Retardation
_____ Blind and Visual Services
_____ Department of Public Welfare
_____ Children and Youth Services
_____ Juvenile Justice System
_____ Social Security Administration
_____ Career TRACK
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Other Agencies Supporting Youth
and Adults with Disabilities
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Centers for Independent Living
Office of Medical Assistance
Office for the Deaf & Hearing Impaired (L&I/DPW)
Children Youth and Families
Drug and Alcohol programs
United Cerebral Palsy Association
Association for Retarded Citizens
Mental Health Association
Epilepsy Foundation
Special Olympics
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