VI.
SPECIAL EDUCATION / RELATED SERVICES / SUPPLEMENTARY AIDS AND SERVICES / PROGRAM MODIFICATIONS – Include, as appropriate, for nonacademic
and extracurricular services and activities.
A. PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION (SDI)
SDI may be listed with each goal or as part of the table below.
Include supplementary aids and services as appropriate.
For a student who has a disability and is gifted, SDI also should include adaptations, accommodations, or modifications to the general
education curriculum, as appropriate for a student with a disability.
Modifications and SDI Location Frequency Projected Beginning Date Anticipated Duration
Lisa will be given a study When testing situations
School environment 9/1/2020 8/31/2021
guide prior to a test. occur
Lisa will be provided with
simplified test wording and When testing situations
School environment 9/1/2020 8/31/2021
rephrased test questions or occur
directions.
Lisa will be allowed to have
alternative books or
School environment During in-class assignments 9/1/2020 8/31/2021
materials on the topic
being studied.
Lisa will be given audio
books and videos when
School environment During in class lessons 9/1/2020 8/31/2021
working and learning a
topic.
Lisa problems will be
When testing situations
arranged from easiest to
School environment occur or in-class 9/1/2020 8/31/2021
hardest on a worksheet or a
assignments
test.
Lisa will be given 60
When testing situations
minutes, additional time on School environment 9/1/2020 8/31/2021
occur
a test.
B. RELATED SERVICES – List the services that the student needs in order to benefit from his/her special education program.
Service Location Frequency Projected Beginning Date Anticipated Duration
N/A 9/1/2020 8/31/2021
N/A 9/1/2020 8/31/2021
N/A 9/1/2020 8/31/2021
C. SUPPORTS FOR SCHOOL PERSONNEL – List the staff to receive the supports and the supports needed to implement the student’s IEP.
School Personnel to Support Location Frequency Projected Beginning Anticipated Duration
Receive Support Date
Communicate with
Parent School environment Biweekly 9/1/2020 8/31/2021
IEP team
Communicate with
General Ed. Teacher School environment Once a week 9/1/2020 8/31/2021
case manager
D. GIFTED SUPPORT SERVICES FOR A STUDENT IDENTIFIED AS GIFTED WHO ALSO IS IDENTIFIED AS A STUDENT WITH A DISABILITY – Support
services are required to assist a gifted student to benefit from gifted education (e.g., psychological services, parent counseling and education,
counseling services, transportation to and from gifted programs to classrooms in buildings operated by the school district).
Support Service N/A
Support Service N/A
Support Service N/A
E. EXTENDED SCHOOL YEAR (ESY) – The IEP team has considered and discussed ESY services, and determined that:
Student IS eligible for ESY based on the following information or data reviewed by the IEP team:
OR
As of the date of this IEP, student is NOT eligible for ESY based on the following information or data reviewed by the IEP team:
The IEP team reviewed the criteria in Chapter 14.132.2 and agree that at this time Lisa does not
qualify for ESY.
The Annual Goals and, when appropriate, Short Term Objectives from this IEP that are to be addressed in the student’s ESY Program
are:
If the IEP team has determined ESY is appropriate, complete the following:
ESY Service to be Provided Location Frequency Projected Beginning Date Anticipated Duration
