SEIS – IEP Changes SEIS – IEP Changes & Compliance& Compliance

Prior Written Notice - Initial Only Prior Written Notice - Initial Only

This form is to be filled out when This form is to be filled out when presenting an evaluation plan for initial presenting an evaluation plan for initial evaluations only. evaluations only.

Prior Written Notice - SamplePrior Written Notice - Sample

Assessment PlanAssessment Plan

This form will be used when proposing an This form will be used when proposing an evaluation. evaluation.

Referred by – Needs to be signed by one of the Referred by – Needs to be signed by one of the four options of: Parent, Nurse, Teacher, or Sped four options of: Parent, Nurse, Teacher, or Sped Teacher (SLP can sign in place of SpEd Teacher (SLP can sign in place of SpEd Teacher). Teacher).

Check boxes in areas of suspected disability. Check boxes in areas of suspected disability. Put the title of the staff responsible, there’s no Put the title of the staff responsible, there’s no

need to list the name of the person performing need to list the name of the person performing the assessment. the assessment.

Assessment Plan – Sample #1Assessment Plan – Sample #1

Assessment Plan – Sample #2Assessment Plan – Sample #2

Notice of MeetingNotice of Meeting This form will be used to notify parents/guardians of the This form will be used to notify parents/guardians of the

IEP meeting. IEP meeting. Make sure to indicate a start and end time to the Make sure to indicate a start and end time to the

meetings. meetings. Try to come up with a mutually agreeable time and date Try to come up with a mutually agreeable time and date

prior to sending out the NOM. prior to sending out the NOM. There are now check boxes and additional boxes with There are now check boxes and additional boxes with

blank titles. There’s no need to put the names of staff blank titles. There’s no need to put the names of staff attending the meeting, write in the title. attending the meeting, write in the title.

The case manager indicated is the person to whom it The case manager indicated is the person to whom it should be returned. should be returned.

The case manager will always be the person to be The case manager will always be the person to be contacted with Procedural Safeguards questions. contacted with Procedural Safeguards questions.

Notice of Meeting – Sample #1Notice of Meeting – Sample #1

Notice of Meeting – Sample #2Notice of Meeting – Sample #2

IEP Team Member ExcusalIEP Team Member Excusal This form will be used to excuse IEP team This form will be used to excuse IEP team

members in full or with partial participation in an members in full or with partial participation in an IEP. IEP.

This form must be sent with the NOM prior to the This form must be sent with the NOM prior to the IEP meeting. IEP meeting.

You must receive a parent/guardian signature in You must receive a parent/guardian signature in order to proceed with the meeting. If it is not order to proceed with the meeting. If it is not agreed upon then another meeting needs to be agreed upon then another meeting needs to be calendared.calendared.

Signature of Designated District Representative: Signature of Designated District Representative: Must be signed by the person administrating the Must be signed by the person administrating the meeting. meeting.

Excusal – SampleExcusal – Sample

Individualized Education Individualized Education Program – Information PageProgram – Information Page

Complete information related to the student Complete information related to the student including the Purpose of the Meeting and including the Purpose of the Meeting and disability area/s. disability area/s.

Eligibility StatementEligibility Statement When completing the eligibility statement indicate how When completing the eligibility statement indicate how

the student’s disability impacts their performance in the student’s disability impacts their performance in the general education setting. the general education setting.

This is not the area to indicate services, including This is not the area to indicate services, including placement or location of the services taking place. placement or location of the services taking place.

For Initial Placements Only: Always check the For Initial Placements Only: Always check the NO box for the students receiving IDEA NO box for the students receiving IDEA Coordinated Early Intervention Services. Coordinated Early Intervention Services.

Info Page Sample #1Info Page Sample #1

Info Page Sample #2Info Page Sample #2

Present Levels of Academic Present Levels of Academic Achievement & Functional PerformanceAchievement & Functional Performance Strengths/Preferences, InterestsStrengths/Preferences, Interests Concerns of parents relevant to educational Concerns of parents relevant to educational

progressprogress Include all parent concerns before or during a Include all parent concerns before or during a

meeting. meeting. CST, CMA, CAPA, CELDT, PE, results from CST, CMA, CAPA, CELDT, PE, results from

previous yearsprevious years Other Assessment Data: Include any additional Other Assessment Data: Include any additional

classroom measures such as Dibels, Language classroom measures such as Dibels, Language progress indicators, etc…progress indicators, etc…

Hearing and Vision screening boxes must be Hearing and Vision screening boxes must be checked checked

Present Levels – Sample #1Present Levels – Sample #1

Present Levels of Academic Present Levels of Academic Achievement & Functional PerformanceAchievement & Functional Performance Preacademic/Academic/Functional Skills, Communication Preacademic/Academic/Functional Skills, Communication

Development, Gross/Fine Motor Development, Social Development, Gross/Fine Motor Development, Social Emotional/Behavioral, Vocational, Adaptive Living Skills, Emotional/Behavioral, Vocational, Adaptive Living Skills, HealthHealth::

Each field needs to be completed. If the field is not an area being Each field needs to be completed. If the field is not an area being addressed you can put a statement such as:addressed you can put a statement such as:

• ““Student is performing at an age/grade appropriate manner therefore this is Student is performing at an age/grade appropriate manner therefore this is not an area of concern.” Also, indicate what the student can do compared to not an area of concern.” Also, indicate what the student can do compared to peers of age or grade and that is why it is not an area of concern. peers of age or grade and that is why it is not an area of concern.

• Simply writing statements such as, “please see attached report” does not Simply writing statements such as, “please see attached report” does not provide adequate information. You may include an additional statement that provide adequate information. You may include an additional statement that says “see attached report for additional information” after providing a short says “see attached report for additional information” after providing a short annotation. annotation.

HealthHealth: There is not a Health Plan box to be checked as before. All : There is not a Health Plan box to be checked as before. All relevant information for health should be annotated in the box as well as relevant information for health should be annotated in the box as well as including a Health Plan attached to the IEP if necessary. including a Health Plan attached to the IEP if necessary.

Present Levels – Sample #2Present Levels – Sample #2

Special FactorsSpecial Factors Review with the IEP team any AT considerations. Describe generic AT Review with the IEP team any AT considerations. Describe generic AT

devices instead of identifying the items by name/brand. devices instead of identifying the items by name/brand. Review low incidence services, equipment and/or materials. Describe what Review low incidence services, equipment and/or materials. Describe what

is needed. is needed. Review Blind/Visually Impaired. Describe what is needed. Review Blind/Visually Impaired. Describe what is needed. Review Deaf or Hard of Hearing. Describe what is needed. Review Deaf or Hard of Hearing. Describe what is needed. English Learner: English Learner:

Need to complete all of the check boxes if they are marked as an EL student. Need to complete all of the check boxes if they are marked as an EL student. If yes, you will need to put who and how the services are being delivered. If yes, you will need to put who and how the services are being delivered. EL information here also needs to match with the info page of the IEP. EL information here also needs to match with the info page of the IEP. There is a comment box to address any other needs. There is a comment box to address any other needs.

Behavior:Behavior: We no longer need to mark the box “Behavior Support Plan”. Physically cross it We no longer need to mark the box “Behavior Support Plan”. Physically cross it

out on the IEP, until SEIS updates the form. out on the IEP, until SEIS updates the form. Need to complete the checked boxes as appropriate. If you check yes a Need to complete the checked boxes as appropriate. If you check yes a

description of the behavior and the positive behavior interventions/strategies are description of the behavior and the positive behavior interventions/strategies are required. Writing “See BIP” does not provide adequate information. required. Writing “See BIP” does not provide adequate information.

Input the specific goal areas to be addressed in the IEP. Input the specific goal areas to be addressed in the IEP.

Special Factors – SampleSpecial Factors – Sample

Statewide AssessmentStatewide Assessment Until we move to Smarter Balanced assessments fully, Until we move to Smarter Balanced assessments fully,

accommodations and modifications will still have to be entered on accommodations and modifications will still have to be entered on this page. this page.

Accommodations and Modifications are a blank box to write into. Accommodations and Modifications are a blank box to write into. Use the CST/CAPA Matrix for specific verbiage when listing Use the CST/CAPA Matrix for specific verbiage when listing accommodations and/or modifications. accommodations and/or modifications.

Please make sure to keep the SEIS information up to date with Please make sure to keep the SEIS information up to date with assessments. SEIS data is collected (prior to winter break) so that assessments. SEIS data is collected (prior to winter break) so that we know how many CST/CMA/CAPA books to order.we know how many CST/CMA/CAPA books to order.

Additionally, to make sure we are covered for any additional Additionally, to make sure we are covered for any additional assessments which could include Smarter Balanced Assessment, assessments which could include Smarter Balanced Assessment, copy and paste what you have for CST/CMA accommodations copy and paste what you have for CST/CMA accommodations and/or modifications into the “Other State-Wide/District-Wide and/or modifications into the “Other State-Wide/District-Wide Assessment Alternate Assessment” section.Assessment Alternate Assessment” section.

Statewide Assessments Statewide Assessments continued…continued…

CAPA criteriaCAPA criteria If the student is not taking the CST or CMA If the student is not taking the CST or CMA

and is taking CAPA you must check the box and is taking CAPA you must check the box that indicates the IEP team has reviewed the that indicates the IEP team has reviewed the criteria. criteria.

Additionally, you must now provide a Additionally, you must now provide a statement as to why they will not participate in statement as to why they will not participate in CST or CMA and why “CAPA is the most CST or CMA and why “CAPA is the most appropriate assessment because...”appropriate assessment because...”

Statewide Assessments Statewide Assessments continued…continued…

You must include the results and/or You must include the results and/or accommodations / modifications if accommodations / modifications if applicable for:applicable for: Physical Fitness Test Physical Fitness Test CAHSEE CAHSEE DRDP DRDP CELDT CELDT Alternate Assessment to CELDTAlternate Assessment to CELDT Standards based Test in Spanish Standards based Test in Spanish

Statewide Assessment – Sample #1Statewide Assessment – Sample #1

Statewide Assessment – Sample #2Statewide Assessment – Sample #2

Individual Transition PlanIndividual Transition Plan

ITPs must be completed on or before the student’s 16 ITPs must be completed on or before the student’s 16 birthday. birthday.

Check yes that the student was invited. Check yes that the student was invited. Check all boxes that apply indicating how the student Check all boxes that apply indicating how the student

participated in the process. participated in the process. Check yes that age appropriate assessments were used.Check yes that age appropriate assessments were used. Each ITP goal must be linked to an annual goal. Each ITP goal must be linked to an annual goal. You must attach the full official transcript. You must attach the full official transcript. Fill in Course of Study information, CAHSEE results, Age Fill in Course of Study information, CAHSEE results, Age

of Majority information. of Majority information. Make sure all boxes are checked yes on page 2 at the Make sure all boxes are checked yes on page 2 at the

bottom of the ITP. bottom of the ITP.

ITP Page 1 - SampleITP Page 1 - Sample

ITP Page 2 - SampleITP Page 2 - Sample

Annual Goals & ObjectivesAnnual Goals & Objectives Creating SMART goals: Creating SMART goals:

SpecificSpecific MeasurableMeasurable Action-OrientedAction-Oriented Realistic & RelevantRealistic & Relevant Time-BoundTime-Bound

Baselines must include specific data relevant to the Baselines must include specific data relevant to the annual goal addressing the need. annual goal addressing the need.

All special education students must have objectives for All special education students must have objectives for their annual goals. their annual goals.

Include the standard addressed, check any other boxes Include the standard addressed, check any other boxes that are appropriate, and indicate the person that are appropriate, and indicate the person responsible. responsible.

Annual Goals & Objectives – Sample #1Annual Goals & Objectives – Sample #1

Annual Goals & Objectives – Sample #2Annual Goals & Objectives – Sample #2

Offer of FAPE – ServicesOffer of FAPE – Services Make sure to consider and annotate all of the LRE service options Make sure to consider and annotate all of the LRE service options

that were considered by the IEP. that were considered by the IEP. Supplementary Aids, Services, & Other Supports require:Supplementary Aids, Services, & Other Supports require:

Who the service is being provided to (student vs. personnel)Who the service is being provided to (student vs. personnel) Start dateStart date End dateEnd date FrequencyFrequency DurationDuration Location: where the aids, services, or other supports will take placeLocation: where the aids, services, or other supports will take place Additionally consultation services can only be written here. Additionally consultation services can only be written here.

Transportation is a box to include an annotation of what the student Transportation is a box to include an annotation of what the student requires. Transportation offers need to be discussed and described. requires. Transportation offers need to be discussed and described.

Offer of FAPE – Services Offer of FAPE – Services continued…continued…

Special Education and Related Services and ESY are to be used when Special Education and Related Services and ESY are to be used when offering a direct service to the student (including collaboration). offering a direct service to the student (including collaboration).

Collaboration must be indicated by the service provider and can be described in Collaboration must be indicated by the service provider and can be described in the comments box for additional information. the comments box for additional information.

Consultation between staff members is input into the Supplementary Aids and Consultation between staff members is input into the Supplementary Aids and Services section. Services section.

Remember to mark the duplicate services as “Do Not Report” if applicable. Remember to mark the duplicate services as “Do Not Report” if applicable. ESY – Use the Regression and Recoupment worksheet for ESY service ESY – Use the Regression and Recoupment worksheet for ESY service

determination in the document library. determination in the document library. There’s no need to write in the comments box a statement about services There’s no need to write in the comments box a statement about services

being provided during the school calendar year. The statement is included being provided during the school calendar year. The statement is included at the bottom of the ESY section. at the bottom of the ESY section.

““Programs and services will be provided according to when student is in Programs and services will be provided according to when student is in attendance and consistent with the district of service calendar and scheduled attendance and consistent with the district of service calendar and scheduled services, excluding holidays, vacations, and non-instructional days unless services, excluding holidays, vacations, and non-instructional days unless otherwise specified.”otherwise specified.”

Offer of FAPE – Services – Sample #1Offer of FAPE – Services – Sample #1

Offer of FAPE – Services – Sample #2Offer of FAPE – Services – Sample #2

Offer of FAPE – Services – Sample #3Offer of FAPE – Services – Sample #3

Offer of FAPE – Educational Offer of FAPE – Educational SettingSetting

Make sure to fill in the type of Physical Education. Make sure to fill in the type of Physical Education. Indicate the District of Service, School of Attendance, School Type, Indicate the District of Service, School of Attendance, School Type,

Federal Setting, Federal Preschool Setting. Federal Setting, Federal Preschool Setting. Is the student being serviced at the student’s school of residence.Is the student being serviced at the student’s school of residence.

If no, include the rationaleIf no, include the rationale Percentages to be calculated, time in the general education setting Percentages to be calculated, time in the general education setting

and time out. We will provide a calculator worksheet. and time out. We will provide a calculator worksheet. Preschool day is 6 hoursPreschool day is 6 hours

A statement needs to be included as to what the student will not A statement needs to be included as to what the student will not participate in. participate in.

Include any other Agency ServicesInclude any other Agency Services Mark the Promotion Criteria, Parents informed of Progress (when Mark the Promotion Criteria, Parents informed of Progress (when

and how)and how) Check the Activities to Support Transition and Graduation Plan Check the Activities to Support Transition and Graduation Plan

Educational Setting – SampleEducational Setting – Sample

Signature & Parent ConsentSignature & Parent Consent

If there are multiple meetings use the If there are multiple meetings use the same signature page for each meeting, re-same signature page for each meeting, re-date and initial for each part. date and initial for each part.

Help parents understand that they can Help parents understand that they can sign for all or part of the services. sign for all or part of the services.

Advocates can note areas of concern on a Advocates can note areas of concern on a dissent that can be attached. dissent that can be attached.

You can note if someone participated You can note if someone participated telephonically. telephonically.

Signature & Parent ConsentSignature & Parent Consent

Medi-Cal signature and check box or Medi-Cal signature and check box or written notification: written notification:

Signature & Parent Consent – SampleSignature & Parent Consent – Sample #1#1

Signature & Parent Consent – Sample #2Signature & Parent Consent – Sample #2

IEP Team Meeting NotesIEP Team Meeting Notes

Put the date at the top of every notes Put the date at the top of every notes page. page.

Remember if you are typing or writing Remember if you are typing or writing notes they must be uploaded into SEIS. notes they must be uploaded into SEIS.

If parents make specific requests note the If parents make specific requests note the discussion about consideration of their discussion about consideration of their requests. requests.

Exit Summary of Student’s Academic Exit Summary of Student’s Academic Achievement & Functional Performance Achievement & Functional Performance

(Post Secondary Exit Pages 1 & 2)(Post Secondary Exit Pages 1 & 2)

Include as the last page of the IEP. Include as the last page of the IEP. Check the appropriate boxes that apply. Check the appropriate boxes that apply. Fill in any appropriate Agency/Service Fill in any appropriate Agency/Service

Linkages with the contact person and Linkages with the contact person and number. number.

Post Secondary Exit Page 1– Sample Post Secondary Exit Page 1– Sample

Post Secondary Exit Page 2– SamplePost Secondary Exit Page 2– Sample

IEP at a GlanceIEP at a Glance

This form can be used to be given to the This form can be used to be given to the general education teachers or any other general education teachers or any other necessary staff as an alternative to giving necessary staff as an alternative to giving the entire IEP. the entire IEP. Let them know the original will be kept with Let them know the original will be kept with

the case carrierthe case carrier Case carriers can input any additional Case carriers can input any additional

comments you would like the recipient to comments you would like the recipient to know about the student. know about the student.

IEP at a Glance – Sample #1IEP at a Glance – Sample #1

IEP at a Glance – Sample #2IEP at a Glance – Sample #2