IEP 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
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 student is 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. 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 a goal.
[Source: State SELPA IEP Manual (draft), July 2008]