IEP Form 3 – Special Factors

Participation in State/Districtwide Assessments

1.      Assistive Technology: Does the student require assistive technology devices and services or low incidence services, equipment and materials to meet educational goals and objectives? Check yes or no. If yes, specify the type of devices, services, equipment, and/or materials needed.

 

2.      Low Incidence: This applies only to the students with the following eligibility categories: DB, VI, OI, HH, and Deaf. Low incidence equipment is indicated only if it is required to meet specific educational needs. Check yes or no. If yes, specify.

Note: Best practice – assistive technology should be addressed in the Supplemental Aids and Services section and/or in a goal.

 

3.      Blindness or Visual Impairment: Is the student blind or visually impaired? If the student is visually impaired, indicate whether instruction in Braille will be provided, and if not, why? If the student will not be using Braille he/she may use large print text or other modified input.

 

4.      Deaf or Hard of Hearing: If the student is deaf or hard of hearing, consider the studentŐs language and communication needs, opportunities for direct communications with peers and professional personnel in the studentŐs language and communication mode, academic level, and full range of needs including opportunities for direct instruction in the studentŐs language and communication mode. If the student is not deaf or hard of hearing, indicate ŇN/AÓ.

 

5.      English Learner: Is the child an English Learner? Specify yes or no. If yes, specify how the studentŐs level of English proficiency, related to the IEP, will be addressed, including instructional strategies that will be used to support the studentŐs acquisition of English.

 

6.      Behavior: Does the studentŐs behavior impede learning? Check yes or no. If yes, describe how the behavior impedes learning. Specify positive behavior interventions, strategies, and supports to address the behaviors. Check if there is a Behavior Support Plan or Behavior Intervention Plan and attach a copy. Check which type of plan is attached.

 

7.      Areas of Need: Indicate areas of educational need that have been identified by the IEP Team based on assessments and present levels of academic achievement and functional performance and/or special factors. For every identified area of need there must a goal.

 

8.      Participation in State/Districtwide Assessments (STAR):  Indicate how the student will participate in each of the State/District Assessments:

 

 

 

The IEP Team may not waive state assessments.

The State Testing and Reporting (STAR) include the California Standards Test/CAT-6, California Modified Assessment (CMA), and the California Alternate Performance Based Assessment (CAPA). The IEP Team must determine which test will be the most appropriate for the student to take.

¤      Grade Exempt. Check the box to indicate that the student is below grade 2 or above grade 11 and therefore is exempt from the STAR.

¤      For the areas of Math, Science, and English Language Arts, determine if the student will be taking CST/CAT-6 or CMA and document any allowable accommodations or modifications. Check the appropriate boxes.

NOTE: A student may take a test in an area on the CST/CAT-6 and in another area on the CMA. If the student is taking CAPA he/she must take it in all areas. (Refer to http://www.cde.ca.gov/sp/se/fp/ for the Test Variation Matrix)

¤      California Alternate Performance Assessment (CAPA). If the student has a significant cognitive impairment, indicate the CAPA Level that is most appropriate to measure student progress. If the student is taking the CAPA, document why the student cannot participate in the CST/CAT-6. Also state why participation in the CAPA is appropriate.

¤      For 3, 4, & 5 preschoolers note if the child will take DRDP-R or DRDP access. If the child is at the developmental level of 3 years or below, the IEP Team should recommend the DRDP access. If the child needs adaptations in the preschool setting, then the IEP Team should document the adaptations. (Refer to http://www.draccess.org website for a list of adaptations.)

¤      Specify any accommodations or modifications the student may need to participate in other state/districtwide assessments, including writing proficiencies, physical fitness tests, etc. This would also be the place to note if the student is taking the Standards-based Test in Spanish (STS). This test is required for English learners who will have been enrolled in a school in the United States less than 12 months on the first day of testing or who are receiving instruction in Spanish regardless of the length of time he she has been enrolled in school in the United States.

NOTE: Do not put parent exemption on the IEP form as a reason that the student will not participate in statewide assessment. The IEP Team must address how the student would participate even if there is a parent exemption. The parent must file the exemption with the school site according to the district procedures for all students.

 

[Source: State SELPA IEP Manual, December, 2007]