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Case Study: Lauren

Section 1:
Introduction: Lauren is a 10 year old caucasian girl who attends a public school in
Idaho. In second grade, Laurens teachers noticed she was not achieving at the same rate as
her peers in reading and language skills. Although she is very social and makes friends easily,
she was not meeting grade level benchmarks. As a Tier 1 intervention, a school wide
assessment of The Idaho Reading Indicator (IRI) and the Idaho Standards Achievement (ISAT)
were given. Upon reviewing her scores, Lauren qualified for Tier 2 intervention. In addition to the
60 minutes of daily reading instruction in a general education classroom, Lauren received small
group instruction of an additional 60 minutes daily. In this small group the teacher used Phonics
for Reading, Read Naturally and Making Words. Laurens progress was monitored using
Dynamic Indicators of Basic Early Literacy (DIBELS) scores, and weekly first grade reading
probes. A 12 week goal was set for Lauren to read 86 words per minute, but her teachers noted
that she fell below the aim line on three occasions so they placed her in Tier 3 instruction. In Tier
3 instruction, Lauren was grouped with two other students and received thirty additional minutes
of direct instruction, using the same interventions as in Tier 2. During this time she improved her
reading to 72 words per minute, but was still short of the typical third grade level of 120 words
per minute.

Disabilities: The educational team at this Idaho Public School are suspecting that
Lauren has a Specific Learning Disability.

REFERRAL FORM
SPECIAL EDUCATION AND RELATED SERVICES
Form R-1 (Rev. 7/06)

Idaho SCHOOL DISTRICT

X Initial

Reevaluation

Name of child(Last, first,


middle)

Date of birth

Grade

School

Lauren

1996-

4th grade

Idaho Public Schools

Name of parent or legal


guardian
Bob and Kathy

Telephone
area/no.
n/a

Address (Street, city, state, zip)


n/a

Person making referral/title


General Education Teacher

Date parent notified of intent to refer


November 2004

Method of notifying parent of intent to refer

Conference

Phone call

Is an interpreter needed?

Yes

No

Written
Parents or adult students native language or other primary mode of communication if other than
English (specify): n/a
Childs native language or other primary mode of communication if other than English (specify): n/a

Date of receipt of referral by school district/LEA 11/20/2004


(month, day, year)
(Note: the date the district receives the referral begins the 15 business day timeline in which to
complete the review of existing information and notify the parents of whether additional
assessments are needed.)

State reason you believe this child has a disability (impairment and a need for special education) such as academic and non-academic performance and medical information; any special programs,
services, interventions used to address this students needs and the results of those interventions,
etc.

We believe Lauren is eligible to receive special education services based on her inability to reach
grade level reading skills, even after intense interventions. Lauren qualified for Tier 3
intervention and was given an extra 30 minutes of instruction in addition to her 60 minutes in a
general education classroom. After twelve weeks of interventions she was only able to reach an
average of 76.3 words per minute, where her grade level peers are expected to read 120 words
per minute.This is further evident based on her test scores. On the WIATT- II, she scored below
grade level in the areas of mathematical reasoning, phonological awareness, word reading, and
reading comprehension. Based on the data collected, and Laurens test scores we are
recommending a special education placement.

If the child is transitioning from a Birth to 3 Early Intervention Program, and the district was
invited by the designated lead agency to participate in the transition planning meeting, document
the date of the meeting and who attended for the LEA or explain why the LEA did not attend:

N/A

EVALUATION REPORT
Form ER-1 (Rev. 10/06)

Idaho SCHOOL DISTRICT

Name of Student: Lauren

TYPE OF EVALUATION:

Initial

Reevaluation

DATE ON WHICH ELIGIBILITY DETERMINATION WAS MADE _______Oct. 2004______


(month/day/year)
THIS EVALUATION REPORT AND DETERMINATION OF ELIGIBILITY INCLUDES THE
FOLLOWING (check all that apply)

Information from review of existing data

Additional documentation required when child is evaluated for a specific learning disability

Information from assessments and other sources

Documentation for determining Braille needs for a child with a visual impairment

Determination of eligibility for special education

INFORMATION FROM REVIEW OF EXISTING DATA


A. Summary of previous evaluations
As a Tier 1 intervention, a school wide assessment of The Idaho Reading Indicator (IRI) and the
Idaho Standards Achievement (ISAT) were given. Upon reviewing her scores, Lauren qualified for Tier 2
intervention. In addition to the 60 minutes of daily reading instruction in a general education classroom,
Lauren received small group instruction of an additional 60 minutes daily. In this small group the teacher
used Phonics for Reading, Read Naturally and Making Words. Laurens progress was monitored using
Dynamic Indicators of Basic Early Literacy (DIBELS) scores, and weekly first grade reading probes. A
12 week goal was set for Lauren to read 86 words per minute, but her teachers noted that she fell below
the aim line on three occasions so they placed her in Tier 3 instruction. In Tier 3 instruction, Lauren was
grouped with two other students and received thirty additional minutes of direct instruction, using the
same interventions as in Tier 2. During this time she improved her reading to 72 words per minute, but
was still short of the typical third grade level of 120 words per minute.
B. Information provided by parents
Laurens parents are aware of the interventions that are in place for Lauren at this time and are actively
helping Lauren at home as well. They are involved in meetings and have given permission to evaluate
Lauren for special education services.
C. Previous interventions and the effects of those interventions
Lauren received tier one intervention as a school-wide benchmark. she scored below grade level in many
areas including the Idaho Reading Indicator, the first time she took this she was near grade level in Sept.
04 then in Jan. 05 and May 05 she fell below grade level, not able to retain the basic reading level she
needed. She also took the Idaho Standards Achievement Test and all three times in Sept.04, April 05,
Sept. 05 she scored below basic proficiency. This caused Lauren to receive tier 2 interventions in a small
group setting that focused on Phonics for Reading, Read Naturally, and Making Words. Laurens goal was
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not met to read 86 words per minute correctly. She then moved into a group of two students to minimize
environmental issues that could be affecting her rate of progress for tier 3 intervention. Here she was
given 30 minutes of extra time for Phonics for Reading, Read Naturally, and Making words. Her progress
was monitored, (see figure 1 above). Lauren continues to come shy of her goals and fall below grade
level.
D. Current classroom-based, local or state assessments
Idaho Reading Indicator (IRI)-9/21/04, 1/21/05, 5/11/05
A Score of 1 indicates achievement below grade level. A score of 2 indicates near, but below grade level.

Date

Laurens Scores

Cut Scores to Designate Risk

9/21/04

2 (88/154) - near grade level

118

1/21/05

1 (115/188)- below grade level

156

5/11/05

1 (148/255)- below grade level

196

Idaho Standards Achievement Test (ISAT)-Sept/Oct. 2004, April/May 2005, Sept./Oct. 2005
Dates

Laurens Scores

Sept/ Oct 2004

166 Rash Unit points- below


basic proficiency

April/ May 2005

184 Rash Unit points- below


basic proficiency

Sept/ Oct 2005

184 Rash Unit points- below


basic proficiency

Cut Scores to Designate Risk

ISAT proficiency score is 193

DIBELS Oral Reading Fluency Assessment-[Weekly] Oct. 2004-April.2005 (Started as Tier 2 Progress
Monitoring) Progress is documented in Figure 1
E. Current classroom-based observations
Lauren is an enjoyable student, she fits in with her peers and there are no concerns with her social
development. She is falling below grade level and receiving tier 3 interventions for reading and language
arts.
F. Observations by teachers and related service providers

Laurens teacher are aware of her goals and intervention plan. Lauren is receiving tier 3 interventions with
one other students to make sure her needs are being met and she is getting the small group interactions
that she needs to be successful.
INFORMATION FROM ASSESSMENTS AND OTHER SOURCES
In determining whether the student has a disability (impairment and need for special education)
document consideration of other information including individual assessments, aptitude and achievement
tests, independent and outside evaluations, teacher recommendations and information about the students
physical condition, social or cultural background and adaptive behavior.
Lauren was evaluated with the Idaho Reading Indicator (IRI) on 9/21/04, 1/21/05 and 5/11/05.
She showed some improvement but still remained below grade level. This test was given with validity.
Lauren was evaluated using the Idaho Standards Achievement Test (ISAT) on Sept/ Oct 2004, April/May
2005 and Sept/ Oct 2005. The ISAT proficiency score is 193, Laurens scores ranged from 166-184
putting her below basic proficiency. This test was given with validity. Lauren qualified for Tier 2
intervention during her third grade school year (2004-2005). She was with her classroom reading teacher
60 minutes a day each week working with Making Words, Phonics for Reading, and Read Naturally.
Instruction was provided in a small group setting. Laurens progress was monitored using DIBELS for
oral reading. Laurens goal was to read 86 words per minute, but because Lauren had three data points
below the aimline, she qualified for Tier 3 intervention. Lauren qualified for Tier 3 intervention when she
had three data points fall below the aimline. Tier 3 intervention included 30 additional minutes a day with
an instructional assistant working with Making Words, Phonics for Reading, and Read Naturally.
If assessments or other evaluation materials were not administered in accordance with the
instructions provided by the publisher or producer of the assessments describe the extent to which there
were variations in administration from standard conditions such as qualifications of the evaluator or
methods of assessment administration including the language or other mode of communication that was
used in assessing the student.

ER-2
DETERMINATION OF ELIGIBILITY FOR SPECIAL EDUCATION
A. This student meets the criteria for one or more of the following impairments:
Check all that apply:

Autism
Cognitive Disability
Emotional Behavioral Disability
Hearing Impairment
X Specific Learning Disability
(complete ER-2, Additional
documentation required for
specific learning disabilities)
None found (complete C. below)

Orthopedically Impaired
Other Health Impairment
Speech or Language Impairment
Traumatic Brain Injury
Visual Impairment (complete ER-3,
Determining Braille Needs)

Significant Developmental Delay (first


consider other areas as the primary disability)

B. For each impairment identified, document how the student meets the criteria:
Lauren has made inadequate classroom achievement from second grade on. As a Tier 1
intervention, a school wide assessment of The Idaho Reading Indicator (IRI) and the Idaho Standards
Achievement (ISAT) were given. Upon reviewing her scores, Lauren qualified for Tier 2 intervention. In
addition to the 60 minutes of daily reading instruction in a general education classroom, Lauren received
small group instruction of an additional 60 minutes daily. In this small group the teacher used Phonics for
Reading, Read Naturally and Making Words. Laurens progress was monitored using Dynamic Indicators
of Basic Early Literacy (DIBELS) scores, and weekly first grade reading probes. A 12 week goal was set
for Lauren to read 86 words per minute, but her teachers noted that she fell below the aim line on three
occasions so they placed her in Tier 3 instruction. In Tier 3 instruction, Lauren was grouped with two
other students and received thirty additional minutes of direct instruction, using the same interventions as
in Tier 2. During this time she improved her reading to 72 words per minute, but was still short of the
typical third grade level of 120 words per minute.

C. Were impairments considered and rejected? x Yes

No

(If yes, document which one(s) and how the student did not meet the criteria)
Lauren has no documented medical conditions, or pre- diagnosed disabilities. She has never been
referred for speech therapy.

D. By reason of the impairment(s) identified, does this student need or continue to need special education?

X Yes

Yes

No

No (In order for the IEP team to determine that the student needs special
education, the IEP team must answer yes to question 1 AND list needs under
2b and/or 3 below)
1.
Does the student have needs that cannot be met in regular education as
structured?
(If yes, list the needs below. Use reverse side or attach additional pages if
needed)

(If no, there is no need for special education).

Yes

No

2. Are there modifications that can be made in the regular education program to
allow the student access to general education curriculum and to meet the educational
standards that apply to all students? (Consider adaptation of content, methodology and/or
delivery of instruction.)
If yes,
a) List modifications that do not require special education. (Use reverse side of
page or attach additional pages if needed)
preview new material
help recognize patterns and how information compares to prior knowledge

b) List modifications that require special education. (Use reverse side of page or attach
additional pages if needed)
1:1 reading instruction
Assessments read out loud
Extra time for assessments and projects
Scribe

(If no, go to question 3).

Yes

No

3.
Are there additions or modification that the child needs which are not
provided through the general education curriculum? (Consider replacement content,
expanded core curriculum, and/or other supports.)
(If yes, list below. Use reverse side of page or attach additional pages if needed)

REQUIRED DOCUMENTATION FOR


SPECIFIC LEARNING DISABILITY (SLD) INITIAL EVALUATION
Form ER-2A (New. 9/13)

Student Name: Lauren

Date of Eligibility Determination: Jan. 24, 2005


If #1, #2, and #3 are marked YES", the student meets the eligibility criteria for the impairment of
Specific Learning Disability (SLD). If any item is marked "No, the student does not meet eligibility
criteria for the impairment of SLD. Prompts for additional information must be completed as appropriate.
If such information is addressed elsewhere in the IEP team evaluation report, please reference where the
information can be found.

DOCUMENTATION OF ELIGBILITY
Yes No 1. Inadequate Classroom Achievement. The student does not achieve adequately for
his/her age/grade-level after intensive intervention.
If Yes, achievement is inadequate in the following area(s): (check all that apply)
XOral Expression
X Basic Reading Skill
Mathematics Calculation
Listening Comprehension
Reading Comprehension
X Mathematics Problem Solving
Written Expression
X Reading Fluency Skills
Data Used to Support Determination: Lauren was given the WIAT-11 on 4/05/05. To qualify for
learning disabilities a student needs a standard score of 83 or lower. Lauren scored below a 83 in
Pseudoword Decoding, Math Reasoning, and spelling.

If the 1.25 standard deviation (SD) requirement was not used to make this determination, provide the
reason why valid and reliable standard scores could not be attained and document inadequate
achievement using other empirical evidence:

Additional Notes (if any):

Yes No 2. Insufficient Progress. The student does not make sufficient progress to meet age or gradelevel standards following at least two intensive, scientific research-based or evidence-based interventions

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implemented with adequate fidelity and closely aligned to individual student needs. To meet initial SLD
eligibility criteria, the student must demonstrate insufficient progress in one or more areas.
If Yes, the response is insufficient in one or more of the following area(s) (check all that apply below
and complete the chart for each area checked):

FIGURE 1 Laurens Tier 3


DIBELs 12 week progress
monitoring- Oral Reading Fluency

Date

Correct
Words per
Minute

9/16/2005

86

9/23/2005

76

9/30/2005

74

10/14/2005

93

10/21/2005

86

11/4/2005

111

11/18/2005

96

12/2/2005

95

12/9/2005

112

12/16/2005

105

1/6/2006

75

1/13/2006

85

1/20/2006

89

1/27/2006

75

**Trend line shows where Lauren should be at 120 words per minute. Laurens performance level
is 83 words per minute. Laurens rate of growth is -1. **
Data Used to Support Insufficient Progress Determination
Area
The student did not
demonstrate sufficient progress
in:

Decision Rule
The students rate of progress was:

Progress Monitoring Data


Briefly summarize data collected. Attach
supporting data as appropriate.

11

Basic Reading Skill

X - the same or less than same age peers.


- greater than same age peers, but will not result
in the student reaching the average range of same
age peers achievement in a reasonable period of
time.
-greater than same age peers but the intensity of
resources necessary to obtain this rate of progress
cannot be maintained in general education.

- Lauren received two years of


direct reading instruction and her
discrepancy ratio was still 3.13.
She read 32 words per minute,
while her same aged peers were
reading 100.
Interventions included Read
Naturally, Lindamood Bell,
Edmark, and Open Court. All
interventions were done with
fidelity according to the
instructional manuals.
Laurens scores on DIBELs oral
fluency measures using firstgrade reading probes (through
February).

Reading
Comprehension

X- the same or less than same age peers.


greater than same age peers, but will not result
in the student reaching the average range of same
age peers achievement in a reasonable period of
time.
greater than same age peers but the intensity of
resources necessary to obtain this rate of progress
cannot be maintained in general education.

In May 2005, Lauren was


evaluated using the Idaho
Reading Indicator (IRI). She
scored a 2 which indicates near
(but below) grade level. Her
comprehension score was a 100
percent.

Reading Fluency Skills

X- the same or less than same age peers.


greater than same age peers, but will not result
in the student reaching the average range of same
age peers achievement in a reasonable period of
time.
greater than same age peers but the intensity of
resources necessary to obtain this rate of progress
cannot be maintained in general education.

Laurens fluency on second


grade reading probes is 72
words per minute. This is a 1.5
times discrepant from the
expected benchmark on third
grade DIBELS probes.

Mathematics
Calculation

X the same or less than same age peers.


greater than same age peers, but will not result
in the student reaching the average range of same
age peers achievement in a reasonable period of
time.
greater than same age peers but the intensity of
resources necessary to obtain this rate of progress
cannot be maintained in general education.

No information was given on


progress monitoring, but based
on Laurens score on WIAT- II
(given 4/05//05) her math
reasoning was just about
average.

12

Mathematics Problem
Solving

X-the same or less than same age peers.


greater than same age peers, but will not result
in the student reaching the average range of same
age peers achievement in a reasonable period of
time.
greater than same age peers but the intensity of
resources necessary to obtain this rate of progress
cannot be maintained in general education.

No information was given on


progress monitoring, but based
on Laurens score on the WIATII (given 4/05/05) her math
reasoning was below average,
and numerical operations was
just above average.

Written Expression

X- the same or less than same age peers.


greater than same age peers, but will not result
in the student reaching the average range of same
age peers achievement in a reasonable period of
time.
greater than same age peers but the intensity of
resources necessary to obtain this rate of progress
cannot be maintained in general education.

No information was given on


progress monitoring, but based
on Laurens score on the WIATII (given 4/05/05) written
expression was average

Oral Expression

X- the same or less than same age peers.


greater than same age peers, but will not result
in the student reaching the average range of same
age peers achievement in a reasonable period of
time.
greater than same age peers but the intensity of
resources necessary to obtain this rate of progress
cannot be maintained in general education.

Lauren was given a curriculumbased intervention on 1/31/05


using the Comprehensive Test of
Phonological Processing
(CTOPP). Lauren showed below
average ability in phonological
awareness. She was put in the
average range for fluency and
short term memory.

Listening
Comprehension

X -the same or less than same age peers.


greater than same age peers, but will not result
in the student reaching the average range of same
age peers achievement in a reasonable period of
time.
greater than same age peers but the intensity of
resources necessary to obtain this rate of progress
cannot be maintained in general education.

Lauren was given a curriculumbased intervention on 1/31/05


using the Comprehensive Test of
Phonological Processing
(CTOPP). Lauren showed
average ability in rote
memorization and recall.

x The instructional strategies used with the student, including intensive intervention, were applied in a
manner highly consistent with the design, closely aligned to pupil need, and culturally appropriate.
Evaluations: Lauren was evaluated with the Idaho Reading Indicator (IRI) on 9/21/04, 1/21/05
and 5/11/05. She showed some improvement but still remained below grade level. This test was given
with validity.

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Lauren was evaluated using the Idaho Standards Achievement Test (ISAT) on Sept/ Oct 2004,
April/May 2005 and Sept/ Oct 2005. The ISAT proficiency score is 193, Laurens scores ranged from
166-184 putting her below basic proficiency. This test was given with validity.
Tier 2 Interventions: Lauren qualified for Tier 2 intervention during her third grade school year
(2004-2005). She was with her classroom reading teacher 60 minutes a day each week working with
Making Words, Phonics for Reading, and Read Naturally. The program used in Tier 2 interventions were
delivered in accordance with the design and instructions of the testing instrument. Instruction was
provided in a small group setting. Laurens progress was monitored using DIBELS for oral reading.
Laurens goal was to read 86 words per minute, but because Lauren had three data points below the
aimline, she qualified for Tier 3 intervention.
Tier 3 Interventions: Lauren qualified for Tier 3 intervention when she had three data points fall
below the aimline. Tier 3 intervention included 30 additional minutes a day with an instructional assistant
working with Making Words, Phonics for Reading, and Read Naturally. The program used in Tier 3
interventions were delivered in accordance with the design and instructions of the testing instrument.

x The students parents were informed about the amount and nature of their childs performance data that
would be collected and the general education services that would be provided, progress-monitoring data
collected, the strategies for increasing their childs rate of learning, including the intensive interventions
used, and their right to request an evaluation.
Additional Notes (if any): Laurens parents were notified after each evaluation period with complete
documentation of her scores. Laurens parents were involved in a parent meeting to discuss Laurens Tier
2 interventions. Laurens parents were given a summary of Laurens progress at the end of each week.
When Lauren qualified for Tier 3 intervention, her parents were promptly notified and a parent meeting
was held. Similar weekly feedback was given during Laurens Tier 3 intervention.

Yes No 3. Exclusionary Factors DO NOT apply. Mark "Yes" if none of the exclusionary factors are
the primary reason for the students inadequate achievement or insufficient progress. Mark "NO" if the
students inadequate achievement or insufficient progress are primarily due to one or more exclusionary
factor, and check the factor(s) below. If the students inadequate achievement or insufficient progress is
primarily due to one or more exclusionary factor, the student is not a student with a specific learning
disability.
The student does not meet general education expectations primarily because of (check all that apply):
Environmental, cultural, or economic factors
Limited English proficiency
Lack of appropriate instruction in the identified area(s) of concern: oral expression, listening
comprehension, written expression, basic reading skill, reading fluency skills, reading
comprehension, mathematics calculation, or mathematics problem solving
Other impairment (specify):

14

Additional Considerations (complete whether or not an exclusionary factor applies)The IEP team
considered:
X Data demonstrating, prior to or as part of the evaluation, the student was or was not provided
appropriate instruction.
X Evidence

the student received repeated assessments of achievement reflecting student progress.

X The students parents were informed of such assessments.


Additional Notes (if any): Lauren received reading instruction from her general education teacher
60 minutes daily.

ADDITIONAL DOCUMENTATION REQUIRED WHEN STUDENT IS EVALUATED FOR SLD


Relevant behavior noted during observation of the student in his or her learning environment, including
the regular classroom, and during intensive intervention, and the relationship of that behavior to the
students academic functioning.
Educationally relevant medical findings
Yes, relevant medical findings, (specify):
X No relevant medical findings.
The IEP team assures that the decision of whether the child has a specific learning disability was based on
information from a variety of sources and not on any single measure or assessment as the sole criterion.
Each IEP team participant must sign below and indicate whether he/she agrees with the conclusions
regarding whether or not the child is a child with a specific learning disability. If this does not reflect
his/her conclusions, then that IEP team participant must also attach a statement with his/her conclusions.

Name and title:


Rachel Mixtacki
Maddy Smith

Signature:
Rachel Mixtacki
Madalynn Smith

Agree or disagree:
Agree
Agree

Additional Notes (if any):

15

REQUIRED DOCUMENTATION FOR


SPECIFIC LEARNING DISABILITY (SLD) INITIAL EVALUATION USING
SIGNIFICANT DISCREPANCY
Form ER-2C (New. 9/13)

Student Name: Lauren

Date of Eligibility Determination: _______________________


This checklist may be used, but is not required, for initial evaluations of parentally placed private
school students and students enrolled in home-based private education (homeschool). Districts are
permitted to use progress data from a students response to intensive scientific research-based or
evidence-based intervention (see form ER-2A).
If #1, #2, and #3 are marked YES", the student meets the eligibility criteria for the impairment of
Specific Learning Disability (SLD). If any item is marked "No, the child does not meet the eligibility
criteria for an impairment of SLD. Prompts for additional information must be completed as appropriate.
If such information is addressed elsewhere in the IEP team evaluation report, please reference where the
information can be found.

DOCUMENTATION OF ELIGBILITY

Yes No 1. Inadequate Classroom Achievement. The student does not achieve adequately for
his/her age/grade-level after intensive intervention.
If Yes, achievement is inadequate in the following area(s): (check all that apply)
XOral Expression
X Basic Reading Skill
Mathematics Calculation
Listening Comprehension
Reading Comprehension
X Mathematics Problem Solving
Written Expression
X Reading Fluency Skills
Data Used to Support Determination: Lauren was given the WIAT-11 on 4/05/05. To qualify for
learning disabilities a student needs a standard score of 83 or lower. Lauren scored below a 83 in
Pseudoword Decoding, Math Reasoning, and spelling.
If the 1.25 standard deviation (SD) requirement was not used to make this determination, provide the
reason why valid and reliable standard scores could not be attained and document inadequate
achievement using other empirical evidence:
Additional Notes (if any):
Yes No 2. Insufficient Progress. The student has made insufficient progress based on Significant

16

Discrepancy.
If Yes, the student has a significant discrepancy between ability and achievement in one or more of the
following areas (check all that apply).

x Oral Expression
x Basic Reading Skill
Mathematics Calculation
Listening Comprehension
Reading Comprehension
x Mathematics Problem Solving
Written Expression
xReading Fluency Skills
Data Used to Support Determination:
If the regression formula was not used to make this determination, the reasons why it was not appropriate
to use the regression procedure and documentation that a significant discrepancy exists, including
documentation of a variable pattern of achievement or ability, in at least one of the eight areas of potential
specific learning disabilities using other empirical evidence.
Additional Notes (if any):
Date

Correct Words
per Minute

9/16/2005

86

9/23/2005

76

9/30/2005

74

10/14/2005

93

10/21/2005

86

11/4/2005

111

11/18/2005

96

12/2/2005

95

12/9/2005

112

12/16/2005

105

1/6/2006

75

1/13/2006

85

1/20/2006

89

1/27/2006

75

Yes No 3. Exclusionary Factors DO NOT apply.


Mark "Yes" if none of the exclusionary factors are the primary reason for the students inadequate
achievement or insufficient progress. Mark "NO" if the students inadequate achievement or insufficient
progress are primarily due to one or more exclusionary factor, and check the factor(s) below. If the

17

students inadequate achievement or insufficient progress is primarily due to one or more exclusionary
factor, the student is not a student with a specific learning disability.
The student does not meet general education expectations primarily because of (check all that apply):
Environmental, cultural, or economic factors
Limited English proficiency
Lack of appropriate instruction in the identified area(s) of concern: oral expression, listening
comprehension, written expression, basic reading skill, reading fluency skills, reading comprehension,
mathematics calculation, or mathematics problem solving
Other impairment (specify):

Additional Considerations (complete whether or not an exclusionary factor applies)The IEP team
considered:
Data demonstrating, prior to or as part of the evaluation, the student was or was not provided
appropriate instruction.
x

x Evidence

the student received repeated assessments of achievement reflecting student progress.

x The students parents were informed of such assessments.

Additional Notes (if any): Lauren received reading instruction from her general education teacher 60
minutes daily.
ADDITIONAL DOCUMENTATION REQUIRED WHEN STUDENT IS EVALUATED FOR SLD
Relevant behavior noted during observation of the student, in his or her learning environment, and the
relationship of that behavior to the students academic functioning.

Educationally relevant medical findings


Yes, relevant medical findings, (specify):
x No relevant medical findings.
The IEP team assures that the decision of whether the child has a specific learning disability was
based on information from a variety of sources and not on any single measure or assessment as the
sole criterion. Each IEP team participant must sign below and indicate whether he/she agrees with
the conclusions regarding whether or not the child is a child with a specific learning disability. If
this does not reflect his/her conclusions, then that IEP team participant must also attach a statement
with his/her conclusions.

Name and title

Signature

Agree or disagree

18

Rachel Mixtacki
Madalynn Smith

Rachel Mixtacki
Madalynn Smith

Agree
Agree

Additional Notes (if any):

EVALUATION REPORT AND IEP COVER SHEET


Form I-3 (Rev. 10/06)

Name: Lauren

DOB:

Sex: Female

Grade: 4th

Parent or Legal Guardian


XXXXX
Telephone (area/number)
(XXX)XXX-XXXX

District of Residence

Current District of Placement

Race/Ethnic (if parent chooses to


identify)

Address

For students transferring between public agencies:


IEP reviewed and adopted by
________________________________________________
On _____________________________________________

For students transferring between public agencies:


Evaluation report reviewed and adopted by
_____________________________________
On _____________________________________________

PURPOSE OF MEETING (Check all that apply):

Evaluation including determination of eligibility

Initial or annual IEP development

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IEP review/revision
Develop a statement of transition goals and
services (required for students age 14 and older, or younger if appropriate)

Placement

Manifestation determination

Alternate assessment
disciplinary change in placement

Determine setting for services during

Other: _____________________________

Other: _____________________________

If a purpose of this meeting is IEP development, review, and/or revision related to the academic,
developmental and functional needs of the child, the IEP team considered the results of:
Initial or most recent evaluation Yes
Statewide assessments

Yes

District-wide assessments

Not applicable
Not applicable

Yes

Not applicable

Date of Meeting: 2/15/2006


(month/day/year)
IEP Team Participants Attending or Participating by Alternate Means in the Meeting:
Parent/Guardian

Regular education
teacher/title: 4th grade
teacher

Regular education
teacher/title:

Student (if appropriate):

Special education
teacher/title: School
Special Education
Teacher

Special education
teacher/title:

LEA Representative/Title:

Other: Principal

Other: Case
Manager

Other:

Other:

Other:

If the parent did not attend or participate in the meeting by other means and did not agree to the time and
place of the IEP team meeting, document 3 efforts to involve the parents:
INDIVIDUALIZED EDUCATION PROGRAM: PRESENT LEVEL
OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
Form I-4 (Rev. 9/13)

Name of Student Lauren

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Describe the students strengths and the concerns of the parents about the students education.
Lauren is an extremely enjoyable student in the classroom and she gets along with her peers well.
She has strengths in comprehension, route memorization and recall.
Laurens parents are concerned about Laurens reading fluency and decoding of certain words.
Parents are also concerned about Laurens math reasoning at at this time Lauren is not receiving
any interventions for this.
Describe the students present level of academic achievement and functional performance including how
the students disability affects his or her involvement and progress in the general education curriculum.
For preschool children, describe how the disability affects involvement in age-appropriate activities.
(Note: Present level of performance must include information that corresponds with each annual goal)
Lauren is a social, friendly fourth grader at Idaho Public Schools. Lauren attends all of her general
education classes, and works very hard at her school work. Lauren is very creative, shows high levels of
comprehension for her academics, and with rote memorization. Lauren benefits from small group work as
well as direct instruction. She is most successful when she can compare new information to prior
knowledge. Lauren has received two years of direct and intensive interventions, but still shows a severe
gap in reading from her age grouped peers. Even with direct instruction and small group work, Laurens
progress has been inconsistent and slow.

Will the student be involved full-time in the general education curriculum or, for preschoolers, in ageappropriate activities? X Yes
No
(If no, describe the extent to which the student will not be involved full-time in the general
curriculum or, for preschoolers, in age-appropriate activities)

SPECIAL FACTORS After consideration for special factors (behavior, limited English proficiency,
Braille needs, communication needs including deaf/hard of hearing, and assistive technology), is there a
need in any of the areas?

Yes X No

(If yes or student has a visual impairment, attach I-5, Special Factors page)
INDIVIDUALIZED EDUCATION PROGRAM:
SPECIAL FACTORS
Form I-5 (Rev. 7/06)

Note: For any need(s) identified below, there must be a statement of the service(s) to meet that need
(including amount/frequency, location, and duration) on the Program Summary page (I-9).

Name of Student: Lauren


A. Does the students behavior impede his/her learning or that of others?

Yes

No

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(If yes, include the positive behavioral interventions, strategies, and supports to address that
behavior)

B. Is the student an English Language Learner? Yes X No


(If yes, include the language needs that relate to this IEP)

C.

If visually impaired, does the student need instruction in Braille or the use of Braille?

Yes
X No
Cannot be determined at this time
(If yes, include Braille needs; if no or cannot be determined, attach ER-3, Determining Braille
Needs from the latest evaluation/reevaluation)

D.Does the student have communication needs that could impede his/her learning? Yes
(If yes, include communication needs)

X No

{If yes and the student is deaf or hard of hearing, identify the communication needs including (a) the
students language; (b) opportunities for direct communication with peers and professional personnel in
the students language and communication mode; and, (c) academic level and full range of needs
including opportunities for direct instruction in the students language and communicative mode}:

E. Does the student need assistive technology services or devices?


{If yes, specify particular device(s) and service(s)}
INDIVIDUALIZED EDUCATION PROGRAM:
ANNUAL GOAL

Yes

No

Form I-6 (Rev. 10/06)

Name of Student: Lauren


Measurable annual academic or functional goal to enable the student to be involved in and progress in the
general education curriculum, and to meet other educational needs that result from the students disability.
(Note: present levels of academic achievement and functional performance must include information that
corresponds with each annual goal)

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Upon review:

Goal met

X Goal not met

1. Given familiar 4th grade reading material, Lauren will read with fewer than 3 errors per 100 words at a
rate of 120 wpm.
2. While reading a passage, Lauren will use knowledge of consonants, consonant blends, and common
vowel patterns to decode unfamiliar words with 90% accuracy in three trials.
3. When given a topic, Lauren will use appropriate vocabulary and sentence structure with 80% accuracy
3/4 trials.

Procedures for measuring the students progress toward meeting the annual goal.
DIBELS progress monitoring, progress reports to parents

Will the student participate in an alternate assessment aligned with alternate achievement standards for
students with disabilities in any subject area?
Yes
(If yes, include benchmarks or short-term objectives for the student)

No

When will reports about the students progress toward meeting the annual goal be provided to parents?
Reports will be provided to parents quarterly

Justifying Our Decisions:


Laurens progress has been very inconsistent over the last couple of years in reading. She has
received tier 1, tier 2 and tier 3 support and has not seen the results to bring her up to grade level or on
track for getting on grade level. The decisions that were made about Lauren needing special education
support are brought on by her struggles to meet grade level in reading. We have continued to observe that
Lauren could also use support and intervention in mathematical reasoning. The environmental factors in
the classroom are affecting her progress.
When compared with her peers, Lauren is falling further and further behind even with all the
intervention time that she is given. By giving her the support that she needs; separate environment, one on

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one support, extra time for assessments and project and a scribe, we can closely monitor Lauren to make
sure she is meeting her goals.
Laurens goals need to be aggressive to make sure that she is being challenged and pushed up to
grade level. By aiming high and giving Lauren more pull out time we will get Lauren up to grade level
and make sure that she is succeeding. We want Lauren to spend as much time in the classroom as possible
but we know that some of her support will need to take place in a place with fewer distractions.
Laurens parents are aware of her struggles and will continue to support Lauren at home. There
will be contact with Laurens parents to ensure that we are always on the same page. More extensive
intervention will need to be in place to ensure that Lauren is up to par in reading and math. More time
will be added to ensure she is receiving all the help she can get.

Section 2
Learning that your son or daughter might have a learning disability can be very stressful,
especially after you have been informed that previous interventions have helped, but just not enough.
The first thing for teachers to do is to validate parents feelings of anxiety and confusion, but to encourage
them that this diagnosis will help their child by giving them the services and attention they need to be
successful.
Laurens parents have been very involved in their daughters education. They noted in a parent
interview that they always read to Lauren when she was a baby, and encouraged their daughter to read.
Laurens mother noted that Lauren always understood what her parents would read to her, but when asked
to read out loud she would get so focused on what they words actually read and loose the purpose of the
reading.
As Laurens special education teachers, we would set up a daily communication log. This could
be a spiral notebook, or binder with loose leaf paper. This way we could keep a running log of daily
occurrences in Laurens school day. We could give anecdotal pieces of what Lauren did in her various
classes, as well as certain things we would want parents to know.
We would also write weekly dispositions about how Lauren is doing specifically in reading. We
would keep data on her words per minute, decoding and fluency. This is beneficial for the parents to see
Laurens progress, and to be kept as a running log for annual IEP meetings.
An annual IEP meeting will be held with Laurens parents to discuss Laurens progress over the
year in detail. We will send home a draft of the IEP a few days early so Laurens parents have time to look

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it over, and present any questions or concerns. As a team we will discuss what will be the next step for
Lauren to ensure success.
We will also hold parent meetings, or phone conferences when needed, and when appropriate will
email back and forth.

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