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Stud
ent N
ame:
D
ate
of P
lan:
Team
sig
natu
res:
Po
siti
on:
Ann
otat
ion:
For a
stud
ent w
ith a
n In
divi
dual
ized
Edu
catio
n Pr
ogra
m (I
EP),
the
posi
tive
beha
vior
supp
ort p
lan
is in
tegr
ated
with
in th
e IE
P do
cum
ent.
How
ever
, w
hile
focu
sing
on
beha
vior
al in
terv
entio
ns, t
he te
am m
ay fi
nd it
hel
pful
to d
evel
op a
ll co
mpo
nent
s of
the
plan
at o
ne ti
me.
For
this
reas
on,
the
anno
tate
d po
sitiv
e be
havi
or s
uppo
rt p
lan
incl
udes
rele
vant
com
pone
nts
of S
ectio
n VI
of t
he IE
P do
cum
ent:
prog
ram
mod
ifica
tion
s an
d sp
ecifi
cally
des
igne
d in
stru
ctio
n, re
late
d se
rvic
es, a
nd s
uppo
rts
for s
choo
l per
sonn
el p
rovi
ded
for t
he c
hild
. The
se m
ay se
rve
as re
min
ders
fo
r the
IEP
team
to c
onsi
der i
n de
sign
ing
the
posi
tive
beha
vior
supp
ort p
lan.
(Spe
cial
ly-d
esig
ned
inst
ruct
ion
may
be
liste
d w
ith e
ach
goal
/obj
ectiv
e an
d/or
list
ed in
Sec
tion
VI).
All
appl
icab
le se
ctio
ns sh
ould
be
com
plet
ed b
y th
e IE
P te
am, e
ven
thou
gh th
ese
sect
ions
may
be
loca
ted
in o
ther
par
ts
of th
e IE
P fo
rm.
Ann
otAt
ed P
osi
tive
Beh
Avio
r su
PPo
rt P
lAn
Stud
ent N
ame:
2
ASS
ESSM
ENT
SUM
MA
RY
Stre
ng
ths
of t
he
stu
den
t:
Ant
eced
ents
to
the
B
ehav
ior o
f Con
cern
Beh
avio
r of C
once
rnCo
nseq
uenc
es
Mai
ntai
ning
the
B
ehav
ior o
f Con
cern
Perc
eive
d Fu
ncti
on
of th
e
Beh
avio
r of C
once
rn*
Iden
tify w
hat h
appe
ns be
fore
the b
ehav
ior o
f co
ncer
n:
(Con
sider
med
ical f
acto
rs, so
cial v
ariab
les, a
ctivi
ty
dem
ands
, env
ironm
enta
l stim
uli, e
tc.)
Desc
ribe t
he be
havio
r usin
g mea
sura
ble,
obse
rvab
le te
rms:
Iden
tify w
hat h
appe
ns af
ter t
he be
havio
r of
conc
ern:
(Wha
t are
actio
ns ta
ken
by ad
ults/
peer
s? W
hat
activ
ities
does
the s
tude
nt en
gage
in or
stop
en
gagi
ng in
? Wha
t doe
s the
stud
ent g
ain, o
r wha
t do
es th
e stu
dent
avoi
d, es
cape
, or p
ostp
one?
)
To ga
in:
To av
oid,
esca
pe, o
r pos
tpon
e:
*Not
e: Th
e per
ceive
d fun
ctio
n of
the b
ehav
ior o
f co
ncer
n is
the t
eam
’s hyp
othe
sis. O
ngoi
ng da
ta
colle
ctio
n an
d ana
lysis
are r
equi
red t
o sup
port
or
refu
te th
is hy
poth
esis.
Hyp
oth
esis
sta
tem
ent:
Whe
n (a
ntec
eden
ts to
the b
ehav
ior o
f con
cern
)
the
stud
ent (
beha
vior o
f con
cern
)
in o
rder
to (p
erce
ived f
unct
ion
of th
e beh
avio
r of c
once
rn)
Iden
tify
edu
cati
onal
(ski
ll) d
efici
t(s)
rela
ted
to th
e be
havi
or o
f con
cern
: (Ac
adem
ic sk
ill de
ficits
, com
mun
icatio
n and
/or s
ocia
l skil
l defi
cits,
sens
ory p
roce
ssin
g skil
l defi
cits)
☐
Refe
r for
furt
her a
sses
smen
t: (C
heck
here
and d
escri
be pl
an fo
r ass
essm
ent i
f skil
l defi
cits h
ave n
ot pr
eviou
sly be
en as
sess
ed an
d ide
ntifi
ed)
D
escr
ibe: A
sses
smen
t Pla
n
Stud
ent N
ame:
3
AN
NO
TATI
ON
: W
hen
beha
vior
is c
heck
ed a
s a sp
ecia
l con
side
ratio
n on
the
IEP,
asse
ssm
ent d
ata
shou
ld b
e ad
ded
to th
e Pr
esen
t Lev
els s
ectio
n of
the
IEP
(Sec
tion
2). A
sses
smen
t dat
a sh
ould
incl
ude
iden
tifica
tion
of a
ntec
eden
ts, m
easu
rabl
e de
scrip
tion
of b
ehav
ior o
f con
cern
, con
sequ
ence
s, fu
nctio
n,
and
hypo
thes
is.
Base
line
data
from
func
tiona
l beh
avio
r ass
essm
ent o
r inf
orm
al b
ehav
ior a
sses
smen
t sho
uld
be in
clud
ed in
this
sect
ion
of th
e IE
P.
All
com
pone
nts
of th
e Pr
esen
t Lev
els
sect
ion
shou
ld a
lso
incl
ude
info
rmat
ion
rele
vant
to th
e st
uden
t’s b
ehav
ior o
f con
cern
.
☐
Educ
atio
nal d
efici
ts a
ddre
ssed
in o
ther
are
as o
f IEP
: (Ch
eck h
ere i
f defi
cits h
ave p
revio
usly
been
asse
ssed
and i
dent
ified
and d
escri
be ho
w th
ey ar
e bein
g add
ress
ed in
the I
EP.)
D
escr
ibe: A
reas
of IE
P tha
t add
ress
the i
dent
ified
skill
defic
it(s)
V. G
OA
LS A
ND
OBJ
ECTI
VES
– In
clud
e, a
s app
ropr
iate
, aca
dem
ic a
nd fu
nctio
nal g
oals
. Use
as m
any
copi
es o
f thi
s pag
e as
nee
ded
to p
lan
appr
opria
tely
. Sp
ecia
lly d
esig
ned
inst
ruct
ion
may
be
liste
d w
ith e
ach
goal
/obj
ectiv
e or
list
ed in
Sec
tion
VI.
Shor
t ter
m le
arni
ng o
utco
mes
are
requ
ired
for s
tude
nts w
ho a
re g
ifted
. The
shor
t ter
m le
arni
ng o
utco
mes
rela
ted
to th
e st
uden
t’s g
ifted
pro
gram
may
be
liste
d un
der G
oals
or S
hort
Term
Obj
ectiv
es.
MEA
SURA
BLE
AN
NU
AL
GO
AL
Incl
ude:
Con
diti
on, N
ame,
Beh
avio
r, an
d Cr
iter
ia(R
efer
to A
nnot
ated
IEP
for
desc
ript
ion
of th
ese
com
pone
nts)
Des
crib
e H
OW
th
e st
uden
t’s p
rogr
ess
tow
ard
mee
ting
this
goa
l will
be
mea
sure
d
Des
crib
e W
HEN
pe
riod
ic re
port
s on
pro
gres
s
will
be
prov
ided
to p
aren
tsRe
port
of P
rogr
ess
Stud
ent N
ame:
4
AN
NO
TATI
ON
:
Annu
al g
oals
are
des
igne
d to
mee
t the
stud
ent’s
nee
ds th
at re
sult
from
his
/her
dis
abili
ty to
ena
ble
him
/her
to b
e in
volv
ed in
and
mak
e pr
ogre
ss in
the
gene
ral e
duca
tion
curr
icul
um. A
nnua
l goa
ls a
re d
esig
ned
to m
eet e
ach
of th
e st
uden
t’s o
ther
edu
catio
nal n
eeds
that
resu
lt fr
om h
is/h
er d
isab
ility
.
Mea
sura
ble
Ann
ual G
oal:
Annu
al g
oals
, inc
ludi
ng a
cade
mic
and
func
tiona
l goa
ls, a
re st
atem
ents
in m
easu
rabl
e te
rms t
hat d
escr
ibe
wha
t rea
sona
ble
expe
ctat
ions
can
be
acco
mpl
ishe
d w
ithin
a tw
elve
-mon
th p
erio
d. A
mea
sura
ble
goal
mus
t con
tain
the
cond
ition
(situ
atio
n, se
ttin
g, o
r giv
en m
ater
ial)
unde
r whi
ch th
e be
havi
or is
to b
e pe
rfor
med
.
• T
he s
tude
nt’s
nam
e.
• C
lear
ly d
efine
d b
ehav
ior:
The
spec
ific
actio
n th
e st
uden
t will
be
exp
ecte
d to
per
form
.
• T
he p
erfo
rman
ce c
riter
ia d
esire
d: T
he le
vel t
he s
tude
nt m
ust d
emon
stra
te fo
r mas
tery
, the
num
ber
of t
imes
the
stud
ent m
ust
dem
onst
rate
the
skill
for m
aste
ry, a
nd h
ow fr
eque
ntly
the
teac
her a
sses
ses
the
stud
ent’s
mas
tery
of t
he s
kill.
Ther
e m
ust b
e a
dire
ct re
latio
nshi
p be
twee
n th
e an
nual
goa
ls a
nd th
e pr
esen
t lev
els o
f aca
dem
ic a
chie
vem
ent a
nd fu
nctio
nal p
erfo
rman
ce. A
nnua
l goa
ls
are
requ
ired
for a
reas
that
are
dire
ctly
affe
cted
by
the
stud
ent’s
dis
abili
ty.
Des
crib
e ho
w th
e st
uden
t’s p
rogr
ess t
owar
d m
eetin
g th
is g
oal w
ill b
e m
easu
red:
The
IEP
team
mus
t dec
ide
how
the
annu
al g
oals
will
be
mea
sure
d.
Beha
vior
goa
ls c
an b
e m
easu
red
thro
ugh
form
al o
r inf
orm
al a
sses
smen
t too
ls su
ch a
s: ru
bric
s, ch
eckl
ists
, and
scat
ter p
lots
.
How
pro
gres
s will
be
mea
sure
d is
det
erm
ined
by
the
IEP
team
. Pro
gres
s mon
itorin
g is
link
ed to
the
day-
to-d
ay in
stru
ctio
nal a
nd a
sses
smen
t pro
cess
.
Des
crib
e W
HEN
per
iodi
c re
port
s on
prog
ress
will
be
prov
ided
to p
aren
ts: T
he IE
P te
am m
ust d
ecid
e w
hen
the
prog
ress
on
thos
e an
nual
goa
ls w
ill b
e re
port
ed to
par
ents
. Thi
s rep
ortin
g m
ust b
e do
ne a
t lea
st c
oncu
rren
t with
the
issu
ance
of r
epor
t car
ds th
roug
h qu
arte
rly a
nd o
ther
per
iodi
c re
port
s, su
ch a
s:
• A
dden
da to
rep
ort c
ards
• Sp
ecia
l pro
gres
s re
por
ting
inst
rum
ents
• D
uplic
ated
cop
ies
of th
e go
als
and
obje
ctiv
es p
age
of th
e IE
P
• D
ocum
ente
d p
hone
con
fere
nces
with
par
ents
, OR
• O
ther
mea
ns d
ecid
ed b
y th
e IE
P te
am
Repo
rt o
f Pro
gres
s:
This
last
col
umn
is to
doc
umen
t the
stud
ent’s
pro
gres
s tow
ard
each
goa
l to
the
pare
nt. I
t is n
ot to
be
com
plet
ed w
hen
the
IEP
is b
eing
dev
elop
ed. I
t may
be
hel
pful
to w
rite
the
date
whe
n pr
ogre
ss w
ill b
e re
port
ed. T
his p
age
can
be d
uplic
ated
and
sent
hom
e as
the
prog
ress
repo
rtin
g in
stru
men
t.
Stud
ent N
ame:
5
AN
NO
TATI
ON
:
Shor
t ter
m o
bjec
tives
/ben
chm
arks
are
onl
y re
quire
d fo
r stu
dent
s who
are
elig
ible
for s
peci
al e
duca
tion
who
take
alte
rnat
ive
asse
ssm
ents
alig
ned
to
alte
rnat
e st
anda
rds (
i.e.,
stud
ents
seve
rely
cog
nitiv
ely
disa
bled
and
ass
esse
d by
the
Penn
sylv
ania
Alte
rnat
e Sy
stem
of A
sses
smen
t (PA
SA)).
Onc
e th
e IE
P te
am h
as d
evel
oped
mea
sura
ble
annu
al g
oals
, the
team
mus
t det
erm
ine
shor
t-te
rm o
bjec
tives
/ben
chm
arks
that
serv
e as
a p
lan
for r
each
ing
annu
al
goal
s and
a m
eans
for m
easu
ring
prog
ress
tow
ard
mee
ting
the
annu
al g
oals
.
Shor
t ter
m o
bjec
tives
/ben
chm
arks
pro
vide
a m
echa
nism
for d
eter
min
ing
whe
ther
the
stud
ent i
s pro
gres
sing
dur
ing
the
year
to e
nsur
e th
at th
e IE
P is
co
nsis
tent
with
the
stud
ent’s
inst
ruct
iona
l nee
ds, a
nd if
app
ropr
iate
, to
revi
se th
e IE
P. Th
e te
am m
ay in
dica
te th
e ex
pect
ed le
vel o
f ach
ieve
men
t, us
ing
for e
xam
ple,
a p
erce
ntag
e sc
ore,
num
ber o
f cor
rect
resp
onse
s, et
c. T
he m
etho
d of
eva
luat
ion
may
als
o be
indi
cate
d on
the
IEP
by li
stin
g sp
ecifi
c w
ays
achi
evem
ent w
ill b
e m
easu
red.
The
IEP
team
may
dec
ide
to in
clud
e sh
ort t
erm
obj
ectiv
es o
n an
y st
uden
t’s IE
P, no
t jus
t for
thos
e w
ho a
re ta
king
alte
rnat
e as
sess
men
ts a
ligne
d to
al
tern
ate
stan
dard
s. Sh
ort t
erm
obj
ectiv
es/b
ench
mar
ks sh
ould
incl
ude
the
sam
e co
mpo
nent
s as a
n an
nual
goa
l:
• C
ondi
tion
•
Cle
arly
defi
ned
beh
avio
r
• St
uden
t’s n
ame
•
Perf
orm
ance
crit
eria
Gif
ted:
The
IEP
of a
stud
ent w
ith a
dis
abili
ty w
ho is
gift
ed m
ust i
nclu
de:
• A
sta
tem
ent o
f ann
ual g
oals
and
sho
rt te
rm le
arni
ng o
utco
mes
whi
ch a
re re
spon
sive
to th
e le
arni
ng n
eeds
iden
tified
in th
e
Eval
uatio
n Re
por
t, an
d
• A
pp
rop
riate
ob
ject
ive
crite
ria, a
sses
smen
t pro
cedu
res
and
timel
ines
for d
eter
min
ing,
on
at le
ast a
n an
nual
bas
is, w
heth
er th
e
goal
s an
d le
arni
ng o
utco
mes
are
bei
ng a
chie
ved.
• Ea
ch s
hort
term
lear
ning
out
com
e m
ust r
elat
e to
onl
y on
e A
nnua
l Goa
l.
SHO
RT T
ERM
OBJ
ECTI
VES
– R
equi
red
for s
tude
nts w
ith d
isab
ilitie
s who
take
alte
rnat
e as
sess
men
ts a
ligne
d to
alte
rnat
e ac
hiev
emen
t sta
ndar
ds (i
.e.,
PASA
).
Shor
t ter
m o
bjec
tive
s / B
ench
mar
ks
Stud
ent N
ame:
6
VI.
PRO
GRA
M M
OD
IFIC
ATIO
NS
AN
D S
PECI
ALL
Y D
ESIG
NED
INST
RUCT
ION
FO
R TH
E PO
SITI
VE
BEH
AVIO
R SU
PPO
RT P
LAN
:
A
Ant
eced
ent (
prev
enti
on) S
trat
egie
s:
Out
line
stra
tegi
es to
ass
ist in
pre
vent
ing
the
beha
vior
of c
once
rn fr
om o
ccur
ring
and
to in
crea
se th
e oc
curr
ence
of t
he re
plac
emen
t beh
avio
r. Th
is m
ay in
clud
e a
desc
riptio
n of
env
ironm
enta
l adj
ustm
ents
, or a
djus
tmen
ts to
type
of c
onte
nt o
r ins
truc
tion
pres
ente
d to
the
stud
ent.
B
Repl
acem
ent B
ehav
ior:
Id
entif
y th
e be
havi
or th
at w
ill b
e ta
ught
to th
e st
uden
t as a
repl
acem
ent t
o th
e be
havi
or o
f con
cern
. The
repl
acem
ent b
ehav
ior s
houl
d effi
cien
tly a
chie
ve th
e sa
me
func
tion
as th
e be
havi
or o
f con
cern
. Inc
lude
the
plan
for i
nstr
uctio
n in
clud
ing
prom
pts,
and
syst
emat
ic a
djus
tmen
t of b
ehav
ior r
equi
rem
ents
ove
r tim
e (b
ased
on
data
).
C
Cons
eque
nces
(rei
nfor
cem
ent)
for w
hen
the
stud
ent p
erfo
rms
the
repl
acem
ent b
ehav
ior:
D
escr
ibe
spec
ific p
roce
dure
s for
pro
vidi
ng re
info
rcem
ent w
hen
the
stud
ent p
erfo
rms t
he re
plac
emen
t beh
avio
r, so
that
the
repl
acem
ent b
ehav
ior w
ill b
e eff
ectiv
e
and
effici
ent f
or th
e st
uden
t in
achi
evin
g th
e sa
me
func
tion.
Rei
nfor
cem
ent s
houl
d in
crea
se th
e lik
elih
ood
that
the
stud
ent w
ill co
ntin
ue o
r inc
reas
e th
e re
plac
emen
t be
havi
or. A
lso, i
nclu
de a
pla
n fo
r sys
tem
atic
ally
thin
ning
the
rein
forc
emen
t sch
edul
e ov
er ti
me
(bas
ed o
n da
ta).
→
Stud
ent N
ame:
C
Cons
eque
nces
(inc
ludi
ng p
roce
dure
s to
follo
w) w
hen
the
stud
ent p
erfo
rms
the
beha
vior
of c
once
rn:
Des
crib
e sp
ecifi
c pro
cedu
res t
o fo
llow
whe
n th
e st
uden
t per
form
s the
beh
avio
r of c
once
rn. P
roce
dure
s sho
uld
ensu
re th
at th
e be
havi
or o
f con
cern
will
no
long
er b
e eff
ectiv
e an
d effi
cien
t in
achi
evin
g th
e fu
nctio
n, th
us w
eake
ning
the
beha
vior
of c
once
rn. I
nclu
de th
e or
der o
f pro
gres
sion
of sp
ecifi
c pro
cedu
res t
o fo
llow
, and
crisi
s pl
an, i
f app
ropr
iate
.
7
→
VI.
SPEC
IAL
EDU
CATI
ON
/ RE
LATE
D S
ERV
ICES
/ SU
PPLE
MEN
TARY
AID
S A
ND
SER
VIC
ES /
PRO
GRA
M M
OD
IFIC
ATIO
NS
– In
clud
e, a
s app
ropr
iate
, for
no
naca
dem
ic a
nd e
xtra
curr
icul
ar se
rvic
es a
nd a
ctiv
ities
.
A.
PRO
GRA
M M
OD
IFIC
ATIO
NS
AND
SPE
CIAL
LY-D
ESIG
NED
INST
RUCT
ION
(SD
I)
• SD
I may
be
liste
d w
ith e
ach
goal
or a
s par
t of t
he ta
ble
belo
w.
• In
clud
e su
pple
men
tary
aid
s and
serv
ices
as a
ppro
pria
te.
• Fo
r a st
uden
t who
has
a d
isab
ility
and
is g
ifted
, SD
I als
o sh
ould
incl
ude
adap
tatio
ns, a
ccom
mod
atio
ns, o
r mod
ifica
tions
to th
e ge
nera
l edu
catio
n cu
rric
ulum
, as a
ppro
pria
te fo
r a st
uden
t with
a d
isab
ility
.
Mod
ifica
tion
s an
d SD
ILo
cati
onFr
eque
ncy
Proj
ecte
d B
egin
ning
Dat
eA
ntic
ipat
ed D
urat
ion
Stud
ent N
ame:
8
AN
NO
TATI
ON
:
NO
TE: D
o no
t be
over
ly c
once
rned
abo
ut th
e ca
tego
ry o
f the
item
s you
writ
e in
to th
is se
ctio
n (e
.g.,
does
this
serv
ice/
activ
ity fa
ll un
der t
he c
ateg
ory
of S
DI,
mod
ifica
tions
, or s
uppl
emen
tary
aid
s and
serv
ices
?). I
nste
ad, i
nclu
de w
hat t
he st
uden
t nee
ds a
nd w
rite
it in
whe
re y
ou b
elie
ve is
the
mos
t app
ropr
iate
loca
tion.
Mod
ifica
tion
/SD
I: Sp
ecia
l edu
catio
n m
eans
spec
ially
-des
igne
d in
stru
ctio
n (S
DI),
at n
o co
st to
the
pare
nts,
to m
eet t
he u
niqu
e ne
eds o
f a st
uden
t with
a d
isabi
lity.
Spe
cial
ly-
desig
ned
inst
ruct
ion
mea
ns a
dapt
ing,
as a
ppro
pria
te, t
he c
onte
nt, m
etho
dolo
gy, o
r del
iver
y of
inst
ruct
ion
to a
ddre
ss th
e un
ique
nee
ds o
f the
stud
ent t
hat
resu
lt fro
m th
e st
uden
t’s d
isabi
lity
and
to e
nsur
e ac
cess
of t
he st
uden
t to
the
gene
ral e
duca
tion
curr
icul
um so
that
he
or sh
e ca
n m
eet t
he e
duca
tiona
l sta
ndar
ds.
Acce
ss m
ay in
clud
e pr
ovid
ing
inst
ruct
iona
l mat
eria
ls in
alte
rnat
e ac
cess
ible
form
ats o
r spe
cial
ized
form
ats (
e.g.
, Bra
ille,
aud
io, d
igita
l, la
rge-
prin
t) in
a ti
mel
y m
anne
r. “T
imel
y m
anne
r” m
eans
that
an
LEA
has t
aken
reas
onab
le st
eps t
o en
sure
that
stud
ents
who
are
blin
d or
oth
er p
erso
ns w
ith p
rint d
isabi
litie
s hav
e ac
cess
to th
eir a
cces
sible
form
at in
stru
ctio
nal m
ater
ials
at th
e sa
me
time
that
stud
ents
with
out d
isabi
litie
s hav
e ac
cess
to in
stru
ctio
nal m
ater
ials.
Penn
sylv
ania
has
ado
pted
the
Nat
iona
l Ins
truc
tiona
l Mat
eria
ls Ac
cess
ibili
ty S
tand
ard
(NIM
AS).
This
refe
rs to
a st
anda
rd fo
r sou
rce
files
of p
rint i
nstr
uctio
nal
mat
eria
ls cr
eate
d by
pub
lishe
rs th
at m
ay b
e co
nver
ted
into
acc
essib
le in
stru
ctio
nal m
ater
ials.
NIM
AS in
sure
s the
tim
ely
prov
ision
of h
igh
qual
ity, a
cces
sible
in
stru
ctio
nal m
ater
ials
to ch
ildre
n w
ho a
re b
lind
or o
ther
per
sons
with
prin
t disa
bilit
ies.
Supp
lem
enta
ry A
ids a
nd S
ervi
ces:
Su
pple
men
tary
aid
s and
serv
ices
mea
ns a
ids,
serv
ices
, and
oth
er su
ppor
ts th
at a
re p
rovi
ded
in g
ener
al e
duca
tion
clas
ses,
othe
r edu
catio
n-re
late
d se
ttin
gs, a
nd in
ex
trac
urric
ular
and
non
acad
emic
sett
ings
, to
enab
le st
uden
ts w
ith d
isabi
litie
s to
be e
duca
ted
with
non
disa
bled
stud
ents
to th
e m
axim
um e
xten
t app
ropr
iate
.
The
purp
ose
of p
rovi
ding
supp
lem
enta
ry a
ids a
nd se
rvic
es is
to su
ppor
t stu
dent
s with
disa
bilit
ies a
s act
ive
part
icip
ants
with
non
disa
bled
pee
rs a
s wel
l as t
o en
able
th
eir a
cces
s to
the
gene
ral c
urric
ulum
. Sup
plem
enta
ry a
ids a
nd se
rvic
es in
clud
e m
odifi
catio
n to
the
gene
ral c
urric
ulum
. A st
uden
t with
a d
isabi
lity
is no
t to
be
rem
oved
from
gen
eral
edu
catio
n cl
assr
oom
s sol
ely
beca
use
of n
eede
d m
odifi
catio
n in
the
gene
ral c
urric
ulum
.
Fede
ral l
aw m
anda
tes t
hat,
“Spe
cial
clas
ses,
sepa
rate
scho
olin
g, o
r oth
er re
mov
al o
f chi
ldre
n w
ith d
isabi
litie
s fro
m th
e re
gula
r edu
catio
nal e
nviro
nmen
t occ
urs
ON
LY if
the
natu
re o
r sev
erity
of t
he d
isabi
lity
is su
ch th
at e
duca
tion
in re
gula
r cla
sses
with
the
use
of su
pple
men
tary
aid
s and
serv
ices
cann
ot b
e ac
hiev
ed
satis
fact
orily
.”
• Su
pple
men
tary
aid
s and
serv
ices
are
to b
e ba
sed
on p
eer-r
evie
wed
rese
arch
to th
e ex
tent
pra
ctic
able
.
• “P
eer-r
evie
wed
rese
arch
” gen
eral
ly re
fers
to re
sear
ch th
at is
revi
ewed
by
qual
ified
and
inde
pend
ent r
evie
wer
s to
ensu
re th
at th
e qu
ality
of t
he
info
rmat
ion
mee
ts th
e st
anda
rds o
f the
fiel
d be
fore
the
rese
arch
is p
ublis
hed.
• “T
o th
e ex
tent
pra
ctic
able
” mea
ns th
at se
rvic
es a
nd su
ppor
ts sh
ould
be
base
d on
pee
r-rev
iew
ed re
sear
ch to
the
exte
nt th
at it
is p
ossib
le, g
iven
the
ava
ilabi
lity
of p
eer-r
evie
wed
rese
arch
. Thi
s doe
s NOT
mea
n th
at th
e se
rvic
e w
ith th
e gr
eate
st b
ody
of re
sear
ch is
the
serv
ice
nece
ssar
ily re
quire
d fo
r a
child
to re
ceiv
e a
Free
App
ropr
iate
Pub
lic E
duca
tion
(FAP
E).
• Th
e fa
ilure
of a
pub
lic a
genc
y to
pro
vide
serv
ices
bas
ed o
n pe
er-re
view
ed re
sear
ch w
ould
not
aut
omat
ical
ly re
sult
in a
den
ial o
f FAP
E. Th
ere
is no
thin
g
in th
e la
w re
quiri
ng th
at a
ll el
emen
ts o
f a p
rogr
am p
rovi
ded
to a
stud
ent b
e in
clud
ed in
an
IEP.
It is
an IE
P te
am d
ecisi
on re
gard
ing
whi
ch in
stru
ctio
nal
met
hodo
logi
es a
re re
quire
d ba
sed
on a
n in
divi
dual
stud
ent’s
nee
ds. T
here
fore
, if a
n IE
P te
am d
eter
min
es th
at sp
ecifi
c ins
truc
tiona
l met
hods
are
nec
essa
ry
for t
he st
uden
t to
rece
ive
FAPE
, tho
se in
stru
ctio
nal m
etho
ds m
ay b
e ad
dres
sed
in th
e IE
P.
Stud
ent N
ame:
9
Supp
lem
enta
ry A
ids a
nd S
ervi
ces c
ontin
ued
Supp
lem
enta
ry a
ids a
nd se
rvic
es sh
ould
be:
• Av
aila
ble
to a
ll st
uden
ts w
ho n
eed
them
• D
esig
ned
to p
rovi
de m
eani
ngfu
l edu
catio
nal b
enefi
t
• Pr
ovid
ed in
a m
anne
r tha
t avo
ids s
tigm
atiz
ing
stud
ents
Dur
atio
n of
the
serv
ice
mus
t be
liste
d. D
urat
ion
refe
rs to
the
antic
ipat
ed e
ndin
g da
te fo
r ser
vice
. IEP
team
s sho
uld
be c
aref
ul to
not
offe
r too
few
or t
oo m
any
mod
ifica
tions
or a
ccom
mod
atio
ns a
s pro
vide
d. F
or e
ach
serv
ice,
the
team
mus
t list
the
loca
tion
and
the
frequ
ency
of t
he se
rvic
e to
be
prov
ided
. A fr
amew
ork
for
cons
ider
ing
the
full
rang
e of
supp
lem
enta
ry a
ids a
nd se
rvic
es c
an b
e fo
und
on a
pub
licat
ion
title
d, “S
uppl
emen
tary
Aid
s and
Ser
vice
s” a
vaila
ble
on th
e Pa
TTAN
w
ebsit
e (w
ww
.pat
tan.
net)
unde
r “Pu
blic
atio
ns.”
This
fram
ewor
k in
clud
es fo
ur c
ateg
orie
s of s
uppl
emen
tary
aid
s and
serv
ices
(col
labo
rativ
e, in
stru
ctio
nal,
phys
ical
, an
d so
cial
-beh
avio
ral)
as w
ell a
s man
y ex
ampl
es.
It is
impo
rtan
t tha
t the
IEP
team
dev
elop
spec
ially
-des
igne
d in
stru
ctio
n fr
om th
e as
sess
men
t inf
orm
atio
n fo
r a p
artic
ular
stud
ent i
n co
nsid
erat
ion
of
the
stud
ent’s
spec
ific
need
s and
the
Penn
sylv
ania
aca
dem
ic st
anda
rds.
IEP
team
s sho
uld
be c
aref
ul to
not
offe
r too
few
or t
oo m
any
mod
ifica
tions
or
acco
mm
odat
ions
as e
ither
ext
rem
e ca
n ha
ve a
neg
ativ
e im
pact
on
the
stud
ent’s
edu
catio
n.
Dire
ctio
ns fo
r com
plet
ing
the
grid
:
If th
e IE
P te
am d
eter
min
es th
at a
stud
ent h
as a
n ed
ucat
iona
l nee
d fo
r a se
rvic
e in
ord
er to
ben
efit f
rom
a fr
ee a
ppro
pria
te p
ublic
edu
catio
n, th
en it
mus
t be
pro
vide
d. F
or e
ach
serv
ice,
the
team
mus
t lis
t the
loca
tion
and
the
freq
uenc
y of
the
serv
ice
to b
e pr
ovid
ed.
Loca
tion
refe
rs to
whe
re th
e st
uden
t will
be
rece
ivin
g th
e m
odifi
catio
n/SD
I/Sup
plem
enta
ry A
ids a
nd S
ervi
ces.
Freq
uenc
y re
fers
to h
ow o
ften
the
stud
ent
will
be
rece
ivin
g th
e m
odifi
catio
n/SD
I/Sup
plem
enta
ry A
ids a
nd S
ervi
ces.
Doc
umen
tatio
n of
freq
uenc
y us
ing
vagu
e te
rms s
uch
as “A
s nee
ded”
is n
ot
appr
opria
te. T
he p
roje
cted
beg
inni
ng d
ate
and
the
antic
ipat
ed d
urat
ion
of th
e m
odifi
catio
n/SD
I/Sup
plem
enta
ry A
ids a
nd S
ervi
ces m
ust b
e lis
ted.
D
urat
ion
refe
rs to
the
antic
ipat
ed e
ndin
g da
te fo
r ser
vice
.
Stud
ent N
ame:
10
B.
RELA
TED
SER
VICE
S –
List
the
serv
ices
that
the
stud
ent n
eeds
in o
rder
to b
enefi
t fro
m h
is/h
er sp
ecia
l edu
catio
n pr
ogra
m.
Serv
ice
Loca
tion
Freq
uenc
yPr
ojec
ted
Beg
inni
ng D
ate
Ant
icip
ated
Dur
atio
n
AN
NO
TATI
ON
:
Not
e: R
elat
ed se
rvic
es re
fer t
o tr
ansp
orta
tion
and
any
deve
lopm
enta
l, co
rrec
tive
or o
ther
supp
ortiv
e se
rvic
e ne
eded
to a
ssist
a st
uden
t with
a d
isabi
lity
to
bene
fit fr
om sp
ecia
l edu
catio
n. T
he fo
llow
ing
exam
ples
are
not
a c
ompl
ete
list o
f pos
sible
rela
ted
serv
ices
as r
elat
ed se
rvic
es a
re id
entifi
ed b
ased
on
the
indi
vidu
al n
eeds
of t
he st
uden
t. Co
unse
ling
serv
ices
incl
udin
g re
habi
litat
ion
coun
selin
g se
rvic
es.
Exam
ples
of r
elat
ed s
ervi
ces
incl
ude:
• Tr
ansp
orta
tion
Pare
nt C
ouns
elin
g, Tr
aini
ng
• Co
unse
ling
Serv
ices
Reh
abili
tatio
n Co
unse
ling
• Au
diol
ogic
al S
ervi
ces S
peec
h an
d La
ngua
ge P
atho
logy
/The
rapy
•
Scho
ol H
ealth
Ser
vice
s Int
erpr
eter
• Ps
ycho
logi
cal S
ervi
ces A
dapt
ive
Phys
ical
Edu
catio
n •
Soci
al W
ork
Serv
ices
Orie
ntat
ion
and
Mob
ility
• Ph
ysic
al Th
erap
y Be
havi
or In
terv
entio
n Pr
ogra
m
• M
enta
l Hea
lth S
ervi
ces p
rovi
ded
by o
ther
than
IU/S
D
• O
ccup
atio
nal T
hera
py A
ssist
ive
Tech
nolo
gy D
evic
es a
nd S
ervi
ces
• O
ther
Dire
ctio
ns fo
r com
plet
ing
the
grid
:
If th
e IE
P te
am d
eter
min
es th
at a
stud
ent h
as a
n ed
ucat
iona
l nee
d fo
r a se
rvic
e in
ord
er to
ben
efit f
rom
a fr
ee a
ppro
pria
te p
ublic
edu
catio
n, th
en it
mus
t be
prov
ided
. For
eac
h se
rvic
e, th
e te
am m
ust l
ist th
e lo
catio
n an
d th
e fre
quen
cy o
f the
serv
ice
to b
e pr
ovid
ed.
Loca
tion
refe
rs to
whe
re th
e st
uden
t will
be
rece
ivin
g th
e re
late
d se
rvic
e. F
requ
ency
refe
rs to
how
ofte
n th
e st
uden
t will
be
rece
ivin
g th
e re
late
d se
rvic
e.
Doc
umen
tatio
n of
freq
uenc
y us
ing
vagu
e te
rms s
uch
as “A
s nee
ded”
is n
ot a
ppro
pria
te. T
he p
roje
cted
beg
inni
ng d
ate
and
the
antic
ipat
ed d
urat
ion
of th
e re
late
d se
rvic
e m
ust b
e lis
ted.
Dur
atio
n re
fers
to th
e an
ticip
ated
end
ing
date
for s
ervi
ce. A
ntic
ipat
ed D
urat
ion:
5-1
2-20
Stud
ent N
ame:
11
C.
SUPP
ORT
S FO
R SC
HO
OL
PERS
ON
NEL
– L
ist t
he st
aff to
rece
ive
the
supp
orts
and
the
supp
orts
nee
ded
to im
plem
ent t
he st
uden
t’s IE
P.
Scho
ol P
erso
nnel
to
Rece
ive
Supp
ort
Supp
ort
Loca
tion
Freq
uenc
yPr
ojec
ted
Beg
inni
ng
Dat
eA
ntic
ipat
ed D
urat
ion
AN
NO
TATI
ON
:
Scho
ol p
erso
nnel
who
pro
vide
supp
ort t
o a
stud
ent w
ith a
disa
bilit
y m
ay n
eed
assis
tanc
e in
impl
emen
ting
the
IEP.
This
sect
ion
prov
ides
an
oppo
rtun
ity fo
r th
e te
am to
disc
uss a
nd a
rtic
ulat
e th
ose
spec
ific
supp
orts
or t
rain
ing
nece
ssar
y fo
r sch
ool p
erso
nnel
to p
rovi
de FA
PE.
This
coul
d in
clud
e:
• Ai
ds
• Re
sour
ce m
ater
ials
• Tr
aini
ng o
r
• Eq
uipm
ent
Dire
ctio
ns fo
r com
plet
ing
the
grid
:
For e
ach
supp
ort,
the
team
mus
t list
the
scho
ol p
erso
nnel
to re
ceiv
e th
e su
ppor
t, th
e su
ppor
t, lo
catio
n an
d th
e fre
quen
cy o
f the
supp
ort t
o be
pro
vide
d.
Loca
tion
refe
rs to
whe
re sc
hool
per
sonn
el w
ill b
e re
ceiv
ing
the
supp
ort.
Freq
uenc
y re
fers
to h
ow o
ften
scho
ol p
erso
nnel
will
be
rece
ivin
g th
e su
ppor
t. Th
e pr
ojec
ted
begi
nnin
g da
te a
nd th
e an
ticip
ated
dur
atio
n of
the
supp
ort m
ust b
e lis
ted.
Dur
atio
n re
fers
to th
e an
ticip
ated
end
ing
date
for s
uppo
rt.
Proj
ecte
d Be
ginn
ing
Dat
e: O
ctob
er 2
019
Anti
cipa
ted
Dur
atio
n: A
pril
2020
revised 8/19
Co
mm
on
we
alth
of P
en
nsy
lva
nia
Tom W
olf, Governor