EdVantage
NOTICE OF CONFERENCE
IEP/TIEP
PST/CST
ESOL
D504
Name:
Student Number:
DOB:
Age:
Address:
Phone:
Dear Parent/Legal Guardian:
Parent Conference
Developing, amending, or updating your child's IEP
Q Reviewing the results of your child's evaluation/reevaluation
Discussing the possible discontinuation of one or more ESE programs or dismissal from all ESE programs
Identify Transitional Service needs of the student (14 and15)
Consideration of Post Secondary Goals and Transition Services (16 and older)
Date:_
O t h e r (Specify):
The meeting is scheduled on
at
Date
Location
The following participants have been invited to attend unless non-attendance (NA) and/or excusal (E) is requested:
NA E Position
NA E Position
Parent/Legal Guardian
Student -
Invited
Excused
Principal/Designee (LEA)
Interpreter of Instructional Implications of Evaluations
Teacher
ESE
n Regular Education Teacher
n
n
.n
.n
n
.n
n
The school district requests that the IEP team member(s) indicated above with "no need for participation" (NA) and/or with "request
excusal" (E) need not participate in this meeting because:
their area of the curriculum or related services is not being modified or discussed
and/or
t h e school district is requesting they be excused from the meeting and their written input provided prior to the meeting.D
Please check and sign:
I am in agreement with the school district with this/these IEP team member(s) not attending the meeting.
If there is an exception to your agreement, please indicate participants (by title) who should be required to attend:
Parent Signature
LEA Signature
I am unable to attend, but do give my permission for the meeting to proceed without me. (Please return Parent Planning Notes)
Comments:
Parent Signature
Date
As a parent(s)/Guardian(s) of a child with disability, you have certain protections under the Procedural Safeguards of the Individuals with Disabilities Education Act. A copy of
the Procedural Safeguards will be mailed with the annual IEP meeting notice, otherwise Procedural Safeguards will be provided at the meeting. You may also view and/or
download the entire document from the Manatee County Schools website at http://www.schools.manatee.k12.fl.us/3130ESE1/exceptional_student_education or from the
Florida Department of Education website at www.fldoe.org/ese/pdf/procedural.odf. Further explanation of rights and copies may be obtained from the ESE Department 7 5 1 6550 or contact
at
Name
Record of Attempts:
Position
1.
2.
3.
4.
Date:
Date:
Date:
Date
Page 1 of 2
Phone #
Tvoe:
Tvpe:
Tvoe:
Tvoe:
Result:
Result:
Result:
Result:
Notice of Conference
Distribution ( ) Student File ( ) Parent /Legal Guardi;in/Surrogate
Meeting Date
M a n a t e e County Schools
EdVantage
REPORT O F C O N F E R E N C E
IEP/TIEP
Revision
Reevaluation
Student:
Date of Birth:
| Aqe'
Case Status/Reason For Conference:
1 Grade:Pre-K
DPS/RTI
HCST
DESOL
D504
Student Number:
School:
QOther
1 Date:
"
Decision/Recommendations:
Report of C o n f e r e n c e
Date of M e e t i n g .
Revision Date.
Grade:_
School:
M A N A T E E C O U N T Y SCHOOLS
R E V I E W O F E L I G I B 1 L T Y AND C O N S E N T F O R P L A C E M E N T
Student:
Grade:
Parent/Legal Guardian:
Address:
" ~
Race:
Student U:
Sex:F
Date of Birth:
Language:
(Home)
Phone:
Date:
(Cell)
COMMITTEE MEMBERS
Principal/Designee:
ESE Administrator/Designee:
ESE Teacher:
Parent:
Other:
Guidance Counselor:
Evaluation Specialist:
Regular Education Teacher:
Speech/Language Pathologist:
Other:
ELIGIBILITY RECOMMENDATIONS
The Child Study Team/IEP committee, which reviewed educational information about this student met on
to consider
MOST R E C E N T EVALUATIONS:
Name
Description
Date
I I Is an in-state/out-of-state (circle one) transfer student and meets eligibility criteria for permanent placement in
Is recommended for dismissal from Exceptional Student Education based on the IEP/EP team meeting, which reviewed reevaluation
data indicating the student will be successful in the general curriculum without ESE support.
Plan Date
Revision Date
EdV^Ultage
f>>fi>ie iJui ^lulrnii;,- [ tarn. Di/an j * J .tihirir.
Student:
PARENT PLANNING NOTES FOR THE IEP/TIEP
Your participation in the development of the IEP/TIEP is very important for your child and your child's teachers. Please respond to the
areas below related to your child's need for special education services. Please return these notes to your child's teacher prior to the
IEP/TIEP meeting if possible, or bring them with you to the meeting.
I. Describe your child's:
Strengths:
Learning needs:
Communication skills:
II. List things that have helped your child be successful in learning (for example, repeating directions, providing extra time,
keeping you informed about academic and behavior progress, etc.):
III. If your child is 14 years old or older, describe your child's needs in the following areas:
Instruction/Training
Employment
Independent Living
Community Experiences
Information about your Procedural Safeguards and Parent Planning Notes are enclosed with your written meeting notice. A printed
copy of the full Procedural Safeguards document will be provided at your child's IEP meeting. You may also view and/or download
the entire document from the Manatee County Schools website at www.manateeschools.net,
http://www.schools.manatee.k12.fl.us/3130ESE1/exceptional_student_education or from the Florida Department of Education website
at www.fldoe.org/ese/pdf/procedural.pdf. If you would like additional information about your procedural safeguards contact one of the
school/district contacts listed above.
Parents of eligible students (Note: only students with disabilities) may choose to request a McKay Scholarship to (1) keep their child in
the same school; (2) enroll their child in another public school within the same district; (3) enroll their child in another public school in an
adjacent district; (4) enroll their child in a participating private school and receive a scholarship. Information is available on the
Department of Education's website at www.floridaschoolchoice.org or telephone the hotline at 1-800-447-1636.
Page 2 of 2
Notice of Conference
Distribution ( ) Student File ( ) Parent /Legal Guardian/Surrogate
Meeting Date
Current Grade
OR
Anticipated G r a d e _
For School Year
School A t t e n d i n g
M A N A T E E C O U N T Y SCHOOLS
EXCEPTIONAL STUDENT EDUCATION
INDIVIDUAL EDUCATIONAL PLAN
I E P Plan Date:
Student Name:
Student #:
Address:
T h r e e - y e a r Reevaluation T r a n s i t i o n IEP
Initial Placement Date:
3-Yr. Reevaluation Date:
Date o f B i r t h :
Phone:
EXCEPTIONALITIES:
Self-Determination (For a student whose IEP is developed or revised by age 16, specify how the student will be instructed and/or provided
information in self determination to assist the student to be able to actively and effectively participate in the IEP meetings and self advocate, i f
appropriate.)
I N S T R U C T I O N A L S T R U C T U R E : Place a check in those domains in which the student demonstrates a need and the IEP team will develop
present level of performance statements, measurable annual goals, and short term objectives or benchmarks (See attached IEP Goal Pages).
D O M A I N S : __Curriculum and Learning QSocial/Emotional [""[independent Functioning I iHealth Care I [Communication __Transition
G E N E R A L F A C T O R S : (Briefly describe each of the following general factors)
Strengths of the student:
Results of the initial or most recent evaluation:
MIS -41-00413
PAGE 1 o f 2
Plan Date
Revision Date
Initiation Date
Duration Date
Frequency
Location
INSTRUCTIONAL ACCOMMODATIONS/MODIFICATIONS
Initiation Date
Duration Date
Frequency
Location
SOCIAL/EMOTIONAL B E H A V I O R A L ACCOMMODATIONS/
MODIFICATIONS
Initiation Date
Duration Date
Frequency
Location
COMMUNICATION
Initiation Date
Duration Date
Frequency
Location
INDEPENDENT FUNCTIONING
Initiation Date
Duration Date
Frequency
Location
EVALUATION
Initiation Date
Duration Date
Frequency
Location
IMPLEMENTATON
__Yes - The IEP is accessible to each of the student's teachers who are responsible for implementation.
__Yes - Each teacher/therapist/service provider of the student will be informed by the student's case manager of the specific responsibilities related
to implementing the IEP.
Plan Date
Revision Date
Student Name:
Check Domain/
Transition Area:
Plan Date:
Domain:
C]A Curriculum & Learning
1 IB Social/Emotional
C. Independent Functioning
D . HealthCare
1 |E, Communication
Transition
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Activity Area:
No
I . Instruction (Academic)
No
2. Community Experience
No
3. Employment
No
4. Post School - Adult Living
5. Daily Living Skills
No
6. Functional/Vocational Evaluation
No
No
7. Related Services
Effects of Disability
For each domain, describe what unique educational needs, difficulties or challenges the student has accessing the general education
curriculum.:
For each domain, describe the impact of those needs, difficulties or challenges on the student's participation in the general curriculum as a
result of the disability:
For each domain/transition area, describe what the student is able to do:
M C S D ESE Form
Plan Date
Revision Date
SIGNATURE PAGE
Student:
Date o f Birth:
Student Number:
Age:
Grade:
Date:
School:
Parent/Guardian:
Parent/Guardian: Please read the attached "Parent Rights - Procedural Safeguards for Exceptional
Students." Parents o f a child with a disability have protection under the procedural safeguards. For
assistance and further understanding o f your rights, please call the Exceptional Student Education
Department 751-6550.
Procedural Safeguards (check all that apply): __ Received __ Reviewed __Waived I iMailed
Student:
Principal/Designee:
L E A Representative:
Counselor:
Psychologist:
Speech/Language Therapist:
ESE Teacher:
Evaluator:
Classroom Teacher:
Nurse:
Occupational Therapist:
Agency Representative:
Physical Therapist:
Other:
Vision Therapist:
Other:
Social Worker:
Other:
Please Check the following have been reviewed and received: __ Medicaid _ J McKay Letter
M C S D ESE Form
Signature Page
Plan Date:
Revision Date:
Student Name:
Plan Date:
Annual goals and short-term objectives must relate to meeting the student's needs resulting from the student's disability in ways that enable the
student to be involved in and progress in the general curriculum; and to meeting each of the student's other educational needs resulting from the
student's disability.
R E P O R T T O P A R E N T O N P R O G R E S S O F A N N U A L G O A L S : The IEP Committee has determined that the parent will be informed of the
student's progress toward meeting annual goals through the following methods: (Check all that apply)
__Annual Goal Progress Report __Report Card __Interim IEP Review [_Parent Conference [_Other (Specify):
Progress in regular education courses, as appropriate, is reported on the student's report card.
Domain:
C u r r i c u l u m and L e a r n i n g
Social/Emotional
independent Functioning
Health C a r e C J C o m m u n i c a t i o n
P e r s o n ( s ) R e s p o n s i b l e for G o a l :
Objectrve/Benchmark:
1.
2.
5.
Domain:
C u r r i c u l u m and L e a r n i n g S o c i a l / E m o t i o n a l i n d e p e n d e n t Functioning H e a l t h C a r e C o m m u n i c a t i o n
P e r s o n ( s ) R e s p o n s i b l e for G o a l :
Objective/Benchmark:
1.
2.
3.
P e r s o n ( s ) R e s p o n s i b l e for G o a l :
Objective/Benchmark:
1.
2.
3.
Plan Date
Revision Date
Student Name:
Student #
Birth Date:
Age:_
Other:
Other
Other
Students ages 16 and older require measurable post-secondary goals based on transition assessments. Annual goals, or short term objectives or
benchmarks must also be developed to reasonably enable the student to meet the measurable post-secondary goals.
Post-Secondary Education/Training goal & Employment goal (goals can be written individually or combined into one goal)
Position Responsible:
Position Responsible:
Post Secondary Independent living goal (When appropriate) (Can be written individually or combined with above Post Secondary goals)
Position Responsible:_
The Post Secondary Goals above arc based on the following age appropriate transition assessment (s):
Student is a client of
IEP team recommends a referral to the following agencies: I f so, Consent for Mutual Exchange of Information must be obtained each time invited
1 1 No Referral is being recommended at this time
1" 1 Division of Vocational Rehabilitation
| | Division of Blind Services
1 I Community College/Slate College, specify:
l~l Technical Institute, specify:
1 1 Division of Hearing Impaired
Other
1 1 Agency for Persons with Disabilities
Responsibilities and / or linkages for Transition Services: A person's signature below indicates willingness to provide for the support, services, or
skills that relate to this transition plan.
Agency Represented
Responsibilities
Other:
Responsibilities
Signature
If a participating agency responsible for transition services fails to provide the services stated above, then the IEP Team shall reconvene to discuss
alternative strategies.
M S C D ESE Form
Plan Date
Revision Date:
Date:
Dear:
(Name of Parent / Adult Student)
Your child's individual education plan (IEP) or program was revised to include a change in
placement or FAPE, and a copy of the IEP, with procedural safeguards is provided. Under federal
and state requirements, you must be informed of the following information.
Action proposed or refused:
Evaluation procedures, tests, records, or reports used as a basis for the proposal or refusal
included:
As parent(s) / guardian(s) of a child with a disability, you have certain protections under the
attached Procedural Safeguards of the Individuals with Disabilities Education Act. For a gifted
student, you have protections under the Procedural Safeguards under Rule 6A-6.03313, FAC.
Further explanation of rights and copies may be obtained from the ESE Department (751-6550)
or :
at
Name
Position
MCSD ESE Form Informed Notice of Change of Placement/FAPE Form Plan Date
Date:
Dear:
The federal regulations for the Individuals with Disabilities Education Act ( I D E A ) at CFR
8.3000.122(a)(3)(iii) state that, "Graduation from high schools with a regular diploma constitutes a change
o f placement requiring written prior notices in accordance with 8.300.503*.
has met the requirements o f the regular diploma and is
expected to graduate on
exceptional student services provided by the district will be terminated upon graduation with a regular
diploma. This proposal is based on a review that determined the criteria for a regular diploma as specified
in the district's Pupil Progression Plan which includes: required high school credits, grade point average
and passing the Florida Comprehensive Assessment Test (FCAT) has been met.
The option to provide a free appropriate public education (FAPE) was considered, however, this option was
rejected because the student has met all requirements for graduation with a regular high school diploma.
Other factors relevant to this proposal: _ ] N o n e OR _ _ Specify any
You have specific rights concerning this decision in the attachment, "Procedural safeguards". Should you
want additional information or to view the full document, please contact the ESE Department (751-6550)
or:
at
Name & Position
You may also view and / or download the entire document from the Manatee County Schools website at
http://www.schools.manatee.k 12.fl.us/3130ESE1 /exceptional student education or from the Florida
Department o f Education website at www.fldoe.org/ese/pdf/procedural.pdf.
Sincerely,
[_Principal
Revision Date