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]