IEP 2 Special Factors and Participation in State/District Wide Assessments
Name
Date
Does student require assistive technology devices and/or services or low incidence services, equipment and materials to meet educational goals and objectives? (If yes, specify)
Yes
No
Yes
No
Is student blind or visually impaired?
Yes
No
Yes
No
Instruction in Braille and/or the use of Braille will be provided
Yes
No
Yes
No
Instruction in Braille and/or the use of Braille is not appropriate because
Is student deaf or hard of hearing?
Yes
No
Yes
No
If yes, address the following areas based on student needs.
Specialized communications strategies, opportunities for direct instruction, communication with peers and adults in the student's language, and mode of communication
Does student's behavior impede learning of self or others? (if yes describe)
Yes
No
Yes
No
Yes
No (describe)
Yes
No (describe)
Specify positive behavior interventions, strategies, and supports
Yes
No
Yes
No
Behavior Support Plan (BSP) attached
Yes
No
Yes
No
Behavior Intervention Plan (BIP) attached
Is the child an English Learner?
Yes
No
Yes
No
If yes, consider the language needs of the child as those needs relate to the IEP:
Program Transition
Yes
No
Yes
No
Activities to support transition (e.g. preschool to kindergarten, special education and/or NPS to general education class) (If yes, describe:)
PARTICIPATION IN STATE/DISTRICT WIDE ASSESSMENTS (STAR)
CAT-6/California Standards Test
Yes
No
Yes
No
California Alternative Performance Assessment (CAPA) — Level
(CASEMIS)
Yes
No
Yes
No
Grade Exempt (before grade 2 and after grade 11)
CAHSEE (California High School Exit Exam)
Yes
No
Yes
No
Beginning no later than grade 9 parent(s)/guardian, student has been informed that as of the 2005-2006 school year student must pass the California High School Exit Exam to earn a diploma.
True
False
True
False
Student NOT working towards diploma
True
False
True
False
Student NOT high school age
Promotion/Graduation Standards
Other State-Wide Assessments/Accommodations/Modifications
Other District-Wide Assessments/Accommodations/Modifications