Data Driven Decision Making Positive Behavior Supports Jean Ramirez Positive Behavior Support.
Annotated Positive Behavior Support Plan
12
Student Name: Date of Plan: Team signatures: Position: Annotation: For a student with an Individualized Education Program (IEP), the positive behavior support plan is integrated within the IEP document. However, while focusing on behavioral interventions, the team may find it helpful to develop all components of the plan at one time. For this reason, the annotated positive behavior support plan includes relevant components of Section VI of the IEP document: program modifications and specifically designed instruction, related services, and supports for school personnel provided for the child. These may serve as reminders for the IEP team to consider in designing the positive behavior support plan. (Specially-designed instruction may be listed with each goal/objective and/or listed in Section VI). All applicable sections should be completed by the IEP team, even though these sections may be located in other parts of the IEP form. A NNOTATED P OSITIVE B EHAVIOR S UPPORT P LAN
Transcript of Annotated Positive Behavior Support Plan
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
