Special Factors
Name   IEP Date

 
Did the IEP team determine that the student requires assistive technology devices and/or services? Did the IEP team determine that the student requires assistive technology devices and/or services?
    If yes, specify:
 
Does the student have a low incidence disability and require low incidence services, equipment, and/or materials to meet educational goals? Does the student have a low incidence disability and require low incidence services, equipment, and/or materials to meet educational goals?
    If yes, specify:
 
Considerations if the student is blind or visually impaired Student not visually impaired
 
 
Considerations if the student is deaf or hard of hearing Student not hearing impaired
 
 
If the child is an English Language Learner, consider the language
needs of the child as those needs relate to the IEP:
Student not ELL
 
 
 
  EL services setting   (this item does not print)
 
Does student's behavior impede learning of self or others? Does student's behavior impede learning of self or others?
    (If yes, describe)
 
If yes, specify positive behavior interventions, strategies, and supports
 
 
 
Behavior Goals Behavior Support Plan (BSP) attached Behavior Intervention Plan (BIP) attached
 

 
Participation in State/Districtwide Assessments (STAR)
(California Standards Test, California Modified Achievement Test, California Alternate Performance Assessment)
 
Grade Exempt (before grade 2 and after grade 11)
 
(CASEMIS)   
 
  Participation status Accommodations/modifications
ELA
   
 
MATH
   
 
SCIENCE
   
 
History
   
 
Writing
   
 
California Alternative Performance Assessment (CAPA) - Level   
 
The student will not participate in the CST because
(Other:) 
 
Participation in the CAPA is appropriate because
(Other:) 
 

 
For Preschoolers (Ages 3, 4 and 5 years) (Desired Results Developmental Profile (DRDP)) DRDP Access
 
  Adaptations
   
 

 
Other State-Wide/ District-Wide Assessments (Accommodations/Modifications)
 
 
Physical fitness test
(Grades 5, 7, 9 only) Accommodations / Modifications  
 

 
CELDT
 
  Listening
 
 
  Speaking
 
 
  Reading
 
 
  Writing
 
 
 

 
Promotion Criteria
 
 
Parents will be informed of progress
 
How?
 
 

 
Other Agency Services
 
California Children's Services (CCS) Regional Center
Probation Department of Rehabilitation
Department of Social Services (DSS)
  Other (specify):
County Mental Health (CMH)