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.
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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.
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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)
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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.
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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.)
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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]