Special Factors

Name   IEP Date
 

 
  Does student require assistive technology devices and/or services? Does student require assistive technology devices and/or services?
      If yes, specify:
 
 
  Does student require low incidence services, equipment and/or materials to meet educational goals? Does student require low incidence services, equipment and/or materials to meet educational goals?
    If yes, specify:
 
 

 
  Considerations if the student is blind or visually impaired
 
 
  Considerations if the student is deaf or hard of hearing
 
 
  If the child is an English Learner, consider the language needs of the child as those needs relate to the IEP
 
 
  Does student's behavior impede learning of self or others? Does student's behavior impede learning of self or others?   (If yes, describe)
 
 
  If yes, specify positive behavior interventions, strategies, and supports If yes, specify positive behavior interventions, strategies, and supports
 
  Behavior Support Plan (BSP) attached Behavior Intervention Plan (BIP) attached
 

 
  Areas of need to be addressed in goals for student to receive educational benefit
 
 

 
PARTICIPATION IN STATE/DISTRICT WIDE ASSESSMENTS (STAR)
 
Grade Exempt (before grade 2 and after grade 11)
 
CAT-6/California Standards Test CAT-6/California Standards Test   
 
California Alternative Performance Assessment (CAPA) – California Alternative Performance Assessment (CAPA) –
 
The student will not participate in the CAT-6/CST because
 
Participation in the CAPA is appropriate because
 

 
For Preschoolers (Ages 3, 4 and 5 years) (Desired Results Developmental Profile (DRDP))
 
DRDP-R DRDP-Access
 
Adaptations  
 

 
  Other Statewide/District-Wide Assessments (Accommodations/Modifications)
 
 
Other Statewide/District-Wide Assessment(s) Alternate
 
Alternate Assessment(s) appropriate because