IEP Form – Services
Offer of FAPE
Special education and related services are determined at
the IEP meeting only after goals and if appropriate objectives / benchmarks
have been finalized. Placement decisions must be made in conformity with the
least restrictive environment (LRE) provisions. These provisions direct that to
the maximum extent appropriate, students with disabilities be education with
typically developing peers, and that special classes, separate schooling or
other removal of students from the general education environment occurs only if
the nature or severity of the disability is such that education in general
education classes with the use of supplementary aids and services cannot be
achieved satisfactorily. The placement must be made in the school that the
student would attend if the student did not have a disability unless unique circumstances
prevent this placement. Special education and related services and
supplementary aids and services, should be based on peer-reviewed research to
the extent practicable.
1.
Service Delivery Options Considered: Discuss
and document service delivery options considered. The team must first consider
placement in the general education classroom with supports prior to
recommending a more restrictive setting all or part of the day.
Note: In
determining the LRE, consideration must be given to any harmful effect on the
child or quality of services that the child needs.
Follow the continuum of services below as a guide to determining LRE:
·
General Education Class
·
General Education Class – Supplemental aids or services
·
General Education Class – Some direct instruction by special
education staff. Less than 21% of time out of the classroom for special
education services.
·
General Education Class – 21% to 60% of instructional day in
a separate classroom.
·
Some/or no instruction in General Education Class – 60% or
more of the instructional day in a separate classroom (intensive services).
·
Special day school – Separate facility (public or nonpublic)
with no general education students on campus.
·
Residential School.
·
Hospital Program.
·
Home Instruction.
2.
Supplementary Aids, Services and Other Supports
for School Personnel, or for the Student, or On Behalf of the Student: Note
supplementary aids and services and/or supports for the student, school personnel
(consultation to teachers, preferential seating, enlarged text, etc.). Indicate
if the supports are for the student or for school personnel by checking the
appropriate box in the grid.
Team must also document modifications and/or
accommodations that will be needed in order for the student to progress toward
annual goals while participating in the general curriculum. Accommodations do not fundamentally alter or
lower expectations or standards in instructional level, content, or performance
criteria (extended time on a timed task, enlarged text, etc.). Modifications
fundamentally alter or lower expectations or standards in instructional level,
content, or performance criteria (alternate math assignment, etc.). Indicate
who will be responsible for the supplementary aids and services, the start and
end date, duration, frequency, and location.
3.
Transportation: Document if the student will need
transportation. Check the appropriate
box. If the student requires special
education transportation, specify the type.
4.
Special Education and Related Services: The team needs to
determine the special education and related services that will provide
educational benefit and facilitate progress on the goals for the student (e.g.
specialized academic instruction, health and nursing, language and speech,
etc). Identify the type of service.
Indicate if the service will be individual or group. If the service is to
support secondary transition, check the secondary transition box. See CASEMIS codes below:
Specialized InstructioN
330 |
Specialized academic instruction |
Adapting, as appropriate to the needs of the child
with a disability the content, methodology, or delivery of instruction to
ensure access of the child to the general curriculum, so that he or she can
meet the educational standards within the jurisdiction of the public agency
that apply to all children. (RSP- school based, RSP, SDC inclusion services,
SDC-public integrated, SDC-public segregated, SDC-non-public school.) |
340 |
Intensive individual instruction |
IEP Team determination that student requires
additional support for all or part of the day to meet his or her IEP goals.
(1-1 instructional assistant) |
350 |
Individual & small group instruction |
Instruction delivered one-to-one or in a small group
as specified in an IEP enabling the individual(s) to participate effectively
in the total school program. (For
preschool only) |
Related Services
415 |
Language and Speech |
Includes receptive and expressive language,
articulation, voice, and fluency. |
425 |
Adapted physical education |
Direct physical education services provided by an APE. |
435 |
Health & nursing –specialized physical
health care services |
Specialized physical health care services means those
health services prescribed by the child’s licensed physician and surgeon
requiring medically related training of the individual who performs the
services and which are necessary during the school day to enable the child to
attend school. SPHCS include but are not limited to suctioning, oxygen
administration, catheterization, nebulizer treatments, insulin
administration, and glucose testing. |
436 |
Health & nursing – other services |
This includes services that are provided to students
by qualified personnel pursuant to an IEP when a student has health problems
which require nursing intervention beyond basic school health services. Services include managing the health
problem, consulting with staff, group & individual counseling, making
appropriate referrals and maintaining communication with agencies and health
care providers. |
445 |
Assistive technology services |
Any specialized training or technical support for the incorporation
of assistive devices, adapted computer technology or specialized media with
the educational programs to improve access for students. |
450 |
Occupational therapy |
OT includes services to improve student’s educational performance,
postural stability, self-help abilities, sensory processing and organization,
environmental adaptation and use of assistive devices, motor planning and
coordination, visual perception and integration, social play abilities and
fine motor. |
460 |
Physical therapy |
Services provided by a register PT pursuant to an IEP
when assessment shows discrepancy between gross motor performance and other
educational skills. |
Mental Health Services
510 |
Individual counseling |
One-to-one counseling, provided by a qualified
individual pursuant to an IEP. |
515 |
Counseling & guidance |
Counseling in a group setting, provided by a qualified
individual pursuant to an IEP. |
520 |
Parent counseling |
Individual or group counseling provided by a qualified
individual pursuant to an IEP to assist the parent(s) of special education
students in better understanding and meeting their child’s needs. |
525 |
Social work services |
Includes services provided pursuant to an IEP by a
qualified individual. |
530 |
Psychological services |
These services provided by a credentialed or licensed
psychologist pursuant to an IEP. |
535 |
Behavior intervention services |
A systematic implementation of procedures designed to
promote lasting, positive changes in the student’s behavior resulting in
greater access to a variety of community settings, social contacts, public
events, and placement in the LRE. |
540 |
Day treatment services |
Structured education, training and support services to
address the student’s mental health needs. |
545 |
Residential treatment services |
A 24 hour out-of-home placement that provides intensive
therapeutic services to support the educational program. |
Low Incidence Services
610 |
Specialized services for low incidence
disabilities |
Low
incidence services are defined as those provided to the student population of
orthopedic impairment (OI), visual impairment (VI), deaf, hard of hearing
(HH), or deaf-blind (DB). Typically, services are provided in education
settings by an itinerant teacher or the itinerant teacher/specialist.
Consultation is provided to the teacher, staff and parents as needed. |
710 |
Specialized
deaf and hard of hearing services |
These services
include speech therapy, speech reading, auditory training, and/or instruction
in the student's mode of communication. Rehabilitative and educational
services; adapting curricula, methods, and the learning environment; and
special consultation to students, parents, teachers, and other school
personnel may also be included. |
715 |
Interpreter
services |
Sign language
interpretation of spoken language to individuals, whose communication is
normally sign language, by a qualified sign language interpreter. |
720 |
Audiological services |
These services include measurements of acuity, monitoring
amplification, and Frequency Modulation system use. |
725 |
Specialized
vision services |
This
is a broad category of services provided to students with visual impairments.
It includes assessment of functional vision; curriculum modifications
necessary to meet the student's educational needs -- including Braille, large
type, aural media; instruction in areas of need; concept development and
academic skills; communication skills (including alternative modes of reading
and writing); social, emotional, career, vocational, and independent living
skills. It may include coordination of other personnel providing services to
the students (such as transcribers, readers, counselors, orientation &
mobility specialists, career/vocational staff, and others) and collaboration
with the student's classroom teacher. |
730 |
Orientation and
mobility |
Students with identified visual impairments are
trained in body awareness and to understand how to move. Students are trained
to develop skills to enable them to travel safely and independently around
the school and in the community. It may include consultation services to
parents regarding their children requiring such services according to an IEP. |
735 |
Braille
transcription |
Any transcription services to convert materials
from print to Braille. It may include textbooks, tests, worksheets, or
anything necessary for instruction. The transcriber should be qualified in English
Braille as well as Nemeth Code (mathematics) and be certified by appropriate
agency. |
740 |
Specialized
orthopedic services |
Specially designed instruction related to the unique
needs of students with orthopedic disabilities, including specialized
materials and equipment. |
745 |
Reading Services |
|
750 |
Note taking
services |
Any specialized assistance given to the student for
the purpose of taking notes when the student is unable to do so
independently. This may include, but is not limited to, copies of notes taken
by another student, transcription of tape-recorded information from a class,
or aide designated to take notes. |
755 |
Transcription
Services |
Any transcription service to convert materials
from print to a mode of communication suitable for the student. This may also
include dictation services as it may pertain to textbooks, tests, worksheets,
or anything necessary for instruction. |
760 |
Recreation
Services |
Therapeutic recreation and specialized
instructional programs designed to assist pupils to become as independent as
possible in leisure activities, and when possible and appropriate, facilitate
the pupil’s integration into general education programs. |
Transition Services
820 |
College
Awareness |
|
830 |
Vocational assessment,
counseling, guidance, and career assessment |
Organized educational programs that are directly
related to the preparation of individuals for paid or unpaid employment and
may include provision for work experience, job coaching, development and/or
placement, and situational assessment. This includes career counseling to
assist student in assessing his/her aptitudes, abilities, and interests in
order to make realistic career decisions. |
840 |
Career awareness |
Transition services include a provision for in
self-advocacy, career planning, and career guidance. |
850 |
Work experience
education |
Work experience education means organized
educational programs that are directly related to the preparation of
individuals for paid or unpaid employment, or for additional preparation for
a career requiring other than a baccalaureate or advanced degree. |
855 |
Job Coaching |
Job coaching is a service that provides assistance
and guidance to an employee who may be experiencing difficulty with one or
more aspects of the daily job tasks and functions. The service is provided by a job coach who
is highly successful, skilled and trained on the job who
can determine how the employee that is experiencing difficulty learns best
and formulate a training plan to improve job performance. |
860 |
Mentoring |
Mentoring is a sustained coaching relationship
between a student and teacher through on-going involvement and offers
support, guidance, encouragement and assistance as the learner encounters
challenges with respect to a particular area such as acquisition of job
skills. Mentoring can be either formal
as in planned, structured instruction of informal that occurs naturally
through friendship, counseling and collegiality in a casual, unplanned way. |
865 |
Agency linkages
(referral and placement) |
Service coordination and case management that
facilitates the linkage of individualized education programs. |
870 |
Travel Training (includes
mobility training) |
|
890 |
Other transition
services |
These services may include program coordination,
case management and meetings, and crafting linkages between schools and
between schools and post-secondary agencies. |
900 |
Other Special
Education/Related Services |
Any other specialized service required for a
student with a disability to receive educational benefit. |
3.
Start and End Date: This will often be the same
start/end dates for the primary service on the IEP.
4.
Provider: Note the title of the provider of the
service (do not put the person’s name).
5.
Frequency: Indicate the frequency of the service
being provided, such as daily, weekly, monthly, yearly, or any other frequency.
6.
Duration: Indicate number of times per frequency
(see CASEMIS for examples).
7.
Location:
Select the location of where the service is provided to the student from
the following:
210
Home instruction based on
IEP team determination (not medical)
220
Hospital
310
HeadStart center
320
Child
development or childcare facility
330
Public
preschool
340
Private
preschool
350
Extended
day care
360
Residential
facility
510 Regular classroom/public day school
Includes students who are fully included in general education classrooms.. Also includes students
who are seen under a “push in” model in the general education classroom and
students who receive DIS services in the general education classroom.
Additionally, students who receive services in a setting that includes other
students with special needs are included here if there are general education
students who are “reverse mainstream” students in that class for that portion
of the day.
520 Separate class in public integrated
facility
Includes students receiving special education “pull-out” services, including
RSP and DIS, or in a “special day class” model,” etc.
530
540 Separate school or special education
center or facility
550 Public residential school
560 Other public school or facility
570 Charter school operated by an LEA/district
580 Charter school operated as an LEA/district
610
Continuation
school
620
Alternative
work education center/work study facility
630
Juvenile
court school
640
Community
school
650
Correctional
institution or facility
710
Community
college
720
Adult
education facility
810
Nonpublic
day school
820
Nonpublic
residential school-in
830
Nonpublic
residential school-outside
840 Private day school
(not certified by CDE Special Education Division)
850 Private
residential school (not certified by CDE Special Education Division)
860
Parochial
school
890
Service
provider location
This would include CMH Outpatient Services provided at
a clinic or other outside medical/therapeutic setting.
900
Any
other location or setting
1.
Extended School Year (ESY): Discuss if the
student needs ESY to receive FAPE. Check yes or no. If yes, specify in the grid
the services the student will receive, the start and end date, provider,
frequency, duration, and location.
Note: ESY shall be provided to a student with a disability who the IEP deems
requires special education and related services in excess of the regular
academic year. Such students shall have disabilities which are likely to
continue indefinitely or for a prolonged period of time, and interruption of
the student’s educational programming may cause regression, when coupled with
limited recoupment capacity, rendering it impossible or unlikely that the
student will attain the level of self-sufficiency and independence that would
otherwise be expected in view of his or her disability. (5 CCR 3043)
Educational Benefit Reminder
o
Was the determination of the appropriate supplementary aids and services,
and special education and related services completed after the goals were finalized?
o
Are the appropriate
services identified to support progress toward all goals including: progress in
the general curriculum, participation in extracurricular activities, and other
nonacademic activities?
o
Are the special education,
related services, and supplementary aids and services based on peer-reviewed
research to the extent practicable?
o
Are the start/end
dates, provider, frequency, duration, and location specified for supplementary
aids and services as well as special education and related services?