1. Staten Island Integrated Service Center 1 VERIFY - NEVER LEAVE BLANK VERIFY Prior to writing on this line, contact your school’s Special Education Liaison for “Specialized Transportation” Procedures IEP meeting recommendations are written here at the end of meeting e.g. Special Class with Related Services (if applicable) Checking this box indicates “Special Education” Transportation Don’t forget to check this box if applicable Indicate the student’s current grade. Note: for all CTT classes K-12 the staffing ratio is 12:1 (See SOPM Page 13) We urge schools to combine the 3-year-review (Tri) (if applicable) and the annual review, by moving the IEP Meeting up to the earlier compliance date, when possible. Medical/physical VERIFY (ISP-See SOPM Page 92, 119-121) (See SOPM: Pages 92, 120- Alternate placement statements- if applicable:) (The type of vehicle (e.g. mini wagon) is not to be indicated on the IEP-See SOPM page 94) (See SOPM page 55: Bilingual Cascade) Parental Revocation (See SOPM Pages 41, 140-141, 193 & 194) An IEP may be amended only after an annual review meeting. (See SOPM Pages 13, 72-73) IEP Meeting Agenda (See SOPM Page 77) Definition of a Parent (See SOPM Pages 35-38)

2. Staten Island Integrated Service Center 2 Mandated & designated by the Principal All changes must be written here & check appropriate box NOTE: All mandated members MUST sign this page only if they attend the IEP meeting Mandated to invite at age 14 and older Mandated Member Check appropriate box below See Sample Student IEP Meeting Invitation Handout not to exceed one year Mandated Member These dates must be indicated (See SOPM Pages 66-67, 71, 76, 103, 109 & 153) (See SOPM Page 65) (See SOPM Page 66) (See SOPM Pages 64, 67, 69, 70 & 74)) (See SOPM Pages 67, 69, 71 & 72) (See SOPM Page 76) Member Excusal (See SOPM Pages 70 – 72 & 179) NOTE: IEP TEAM MANDATED MEMBERS CANNOT BE EXCUSED FROM INITIAL MEETINGS SC/CTT Preference Form (See SOPM Pages 109) (See SOPM Pages 64, 65, 67, 70, 75, 104 & 153) (See SOPM Page 76) (See SOPM Page 64 & 67) Additional Members (See SOPM Page 68) Chapter 408 (See SOPM Page 112)

3. Staten Island Integrated Service Center 3 IMPORTANT: All student’s academic needs described in this section should be addressed on IEP page 6-annual goals. Include present levels of performance from related service providers (if applicable). Student’s STRENGTHS & needs should be described in this section. Describe the instructional implications of the testing results listed below (What does the testing results listed below look like in classroom instruction?). Results of the assessments in this section should be described above (Scores recorded should be current – within 1 year) Indicate the instructional modifications and resources to enable the student to succeed (e.g. learning styles, visual aids, books on tape, manipulatives, etc.). What will the student need immediately for access to grade- level curriculum (what modifications, if any) while remediation related to Annual Goals is taking place? Transition statements in the resent levels of performance on this page must be used to develop transition plan goals on IEP pages 6 & 10 JARGON- FREE _____ Results of the assessments in this section should be described above (Scores recorded should be current – within 1 year) Present Levels of Performance Samples (See SOPM Pages 105-107) Mandated Three-Year Review (See SOPM Pages 31, 73 & 175) (See SOPM Pages 81, 105 & 107)

4. Staten Island Integrated Service Center 4 A BIP should be developed and implemented collaboratively by the teachers, paraprofessional (if applicable), related service providers (if applicable) and staff working with the student. If either of these last 2 boxes are checked then FBA & BIP Required ____ (See statement above for details) Present Levels of Performance Samples (See SOPM Pages 105-107) FBA/BIP (See SOPM Pages 48, 51, 105, 149, 151, & 153) (See SOPM Pages 81 & 107) FYI: All students with an IEP recommendation for a behavior management/crisis paraprofessional must have an FBA & BIP

5. Staten Island Integrated Service Center 5 All Special Alerts from IEP Page 1 should be reflected here Include present levels of performance from related service providers (if applicable, e.g. OT, PT, Health, etc.) e.g. F.M. Unit Do not write specific name of any medication This should be reflective of page 1 (See SOPM Pages 52, 70, 96, 105 & 256) (See SOPM Pages 81, 105 & 107) (See SOPM Pages 105-107)

6. Staten Island Integrated Service Center 6 See Progress key below # of Report cards PROGRESS KEY Annual Goals are statements developed to address the needs from the PRESENT LEVELS OF PERFORMANCE and are written in measurable terms, describe a skill, knowledge or behavior that the student can be reasonably expected to accomplish within one year. All Related Service Providers must collaborate & contribute functional goals Short term objectives (required for Pre-K & alternate assessment students only) are intermediate steps moving towards the achievement of the student’s annual goals Goals relating to transition should address the educational instruction that will be provided to the student to achieve post-secondary goals & interests as indicated on IEP pages 3 &10 Progress reports are to be completed and sent home every marking period for every annual goal (See SOPM Pages 108) (See SOPM Pages 107-108) (See SOPM Pages 107-108)

7. Staten Island Integrated Service Center 7 For students who receive related services as a supplementary aid & service simply indicate “Related Service(s).” It is not necessary to list each related service here since they are specified on IEP page 9. For students who receive related services as a supplementary aid & service simply indicate Related Service(s). It is not necessary to list each related service here since they are specified on IEP page 9.. CTT: Do not write “core subjects” or “content area subjects” You must indicate the name of each subject which will be co- taught (e.g. Math) Collaborative Team Teaching (CTT) - Integrated Co-Teaching - 12:1 (See SOPM Page 13)

8. Staten Island Integrated Service Center 8 > General Education with Supplementary Aids & Services should be your first consideration. > Provide an explanation of all programs/services considered and the reason for rejection. The programs listed should be written in the language consistent with the Continuum of Services (e.g. Special Education Teacher Support Services, etc.) Students who demonstrate severe language & communication difficulties which significantly interfere with their school performance may be considered for exemption. These deficits must be clearly indicated in the Present Levels of Performance & the team must provide an explanation for the exemption. NOTE: All services/program options discussed at the IEP meeting should be listed _________________________ Least Restrictive Environment (See SOPM Page 81) (See SOPM Pages 11, 66, 81, 98 & 103)

9. Staten Island Integrated Service Center 9 General Education Classroom OR Separate Location Specify time Indicate the mandated group size “Conference Result” I-INITIATION C-CONTINUATION M-MODIFICATION T-TERMINATION “Conference Result” I-INITIATION C-CONTINUATION M-MODIFICATION T-TERMINATION e.g. Speech and Language Therapy (Must be consistent with page 2) Testing accommodations MUST reflect the individual student’s needs High school students (grades 9-12) with disabilities must attain the necessary number of credits in order to be promoted to the next grade. They do not have modified promotion criteria. Students in 8th grade should not have modified promotion criteria written on their IEP for the following school year if their IEP is developed after January 31st. (See SOPM: Page 92- if applicable:) “Interim Monolingual Speech pending availability of a bilingual provider” Declassification test accommodations (See SOPM Page 88) (See SOPM: Page 128)

10. Staten Island Integrated Service Center 10 The school year that the student turns 14 The school year that the student turns 15 Measurable post secondary goals NOTE: Transition MUST be reflected throughout the IEP - e.g. pages 3, 6 & 10 The school year that the student turns 14 Level 1 Vocational Assessment (See SOPM Pages 48, 50, 105 & 220-222) EXIT SUMMARY (See SOPM Pages 13, 90 & 224 - 229) (See SOPM pages 77, 81, 89, 90, 99 & 230) (See SOPM Pages 66, 77, 81, 87 & 108)