FORM
3A
– SPECIAL FACTORS
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 studentÕs
language and communication needs, opportunities for direct communications with peers and professional
personnel in the studentÕs language and communication mode,
academic level, and full range of needs including opportunities for direct instruction in
the
studentÕs language and communication mode.
If
the student is not deaf or hard of hearing, indicate ÒN/AÓ.
5. English Learner: The IEP Team needs
to decide which of the three program options the student
needs Structured English Immersion (SEI), English Language Mainstream
(ELM) or an alternative program (native language instruction).
If
the
student is an
English Learner
complete the sections listed below:
a. Will
the
student need primary language instruction (preview/review or
directions given)
If yes, indicate the title of the staff member(s)
who
will provide this support.
b. Indicate what
the
language of instruction will be. It must
be English unless the
IEP team
has designated otherwise.
c. Indicate who by title (such as general education teacher, special
education teacher, etc.) will
provide the studentÕs ELD services.
All EL students MUST
receive ELD services unless a parental exception waiver has been submitted.
d. EL students get either
English language Mainstream
(ELM) or Structured
English Immersion (SEI)
services depending on their CELDT scores or
proficiency
in English. It is recommended that
a student get SEI
if
they score at the beginning or early intermediate level on CELDT or have Òless than
reasonable fluencyÓ in English.
6. Behavior: Does the studentÕs 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. If there is a behavior
goal check the box to indicate a goal is in the IEP.
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 be a goal.
[Excerpted from the State SELPA IEP Manual, July 2013]