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CheckBox297@ CheckBox251A CheckBox252B CheckBox253C CheckBox254D116 Bothers other studentE117 Responds inappropriatF118 Will not share possesG119 Will not allow othersH120 Does not resolve confI121 Does not make approprJ122 Cannot work appropriaK123 Does not share schoolL124 Writes and passes notM 125 TattlesN CheckBox255O CheckBox256P CheckBox257Q CheckBox258R CheckBox259S CheckBox260T CheckBox261U CheckBox262V CheckBox263W CheckBox264X CheckBox265Y CheckBox266Z CheckBox267[ CheckBox268\126 Has unexcused absence]127 Has unexcused tardine^128 Blames other persons_129 Does not participate`130 Blames self for situaa131 Is preoccupied with pb132 Is not motivated by rc133 Is easily upset by ad134 Avoids situations asse135 Demonstrates selfdestf136 Threatens to hurt selg137 Feels no one likes orh138 Ignores consequencesi139 Does not smile laughj 140 Cheatsk141 Throws temper tantruml142 Is tired listless apam143 Does not care about an144 Is overly critical ofo145 Frowns scowls looks up146 Needs immediate rewarq147 Does not care for perr148 Is pessimistics149 Runs away to avoid prt150 Whines or criesu151 Behaves inappropriatev152 Behaves inappropriatew153 Behaves impulsively wx154 Exhibits extreme moody155 Is unpredictablez156 Inappropriate sexuall{157 Moves about unnecessa|158 Is easily overexcited}159 Lies denies exaggerat~160 Speaks in an unnatura161 Speaks incoherently162 Engages in nervous ha163 Destroys school or ot164 Has difficulty accept165 Reacts physically whe166 Engages in inappropri167 Becomes pale may thro168 Demonstrates phobic t169 Does not change behav170 Cannot fasten article171 Will not change cloth172 Does not demonstrate179 Demonstrates inapprop180 Does not follow the c173 Steals or forcibly ta174 Inappropriate seat be175 Does not follow direc1 7 6 Brings inappropriat1 77 Responds adversely t1 7 8 Does not follow sch184 Does not demonstrate185 Does not raise hand w186 Behaves inappropriate187 Does not take notes w188 Is under the influenc189 Has difficultyy movin190 Behaves more appropri191 Behaves inappropriate192 Behaves inappropriate193 Behaves inappropriate181 Does not wait appropr182 Does not wait appropr183 Does not use schoolre FillText164 FillText165 FillText166 FillText167 FillText168 FillText169 FillText170 \KhC" }* ````  Assessment TermsCriterion Referenced Test (CRT) Criterion referenced tests assess an individual's performance on a specific set of standards or criteria. These criteria are based on specific skills or objectives the individual has been taught. The CRT measures the level to which the criteLynette StoddardHillary Stoddard1217June 27, 1985Monty and Lynette Currently Hillary's standardized assessment scores are not in line with her classroom grades. I would like Hillary to be given an opportunity and time to achieve standardized assessments scores that are more in line with her classroom grades.Experience less test anxiety.Continue to explore and focused on positive realistic potentials.Good sense of Humor and helpful to teachers.Resourceful and knowledgeable about sports scienceStrongly committed to goals. Life is never dull around Hillary.She can make even the most routine, mundane event seem exciting. 103831 Road 17436-23930104/01/031000Last semester Hillary earned a 3.7 GPA on a 4.33 Scale (A-). On standardized achievement scores, according to the CAT/5 Anticipated National Percentile score (AAMP) , Hillary should be scoring at the 41st percentile however she scores 26%ile on the total Battery. Note that her classroom grades are more in line with what is expected.April 1, 2003 (-Continue to allow Hillary extra time to complete assignments and classroom assessments test items.that Hillary be tested for learning disabilities.Hillary StoddardKari Gifford Ed Newland Nick Hodge Carol NewlandHillary Stoddard000Hillary Stoddard000000Hillary StoddardHillary Stoddard00Hillary Stoddard}|{p-3,#1"q!O~u A? 2 , B Karin JonesCurtis Hanan510 years, 7 months 13 days02/03/1994Amy Hauck00632-99810109/16/0401Karin Jones10Curtis Hanan Curtis Hanan 000Curtis Hanan000000Curtis HananCurtis Hanan00Curtis Hanan    }|{rq p g, ~u     (%(?-Barb CooperSavannah Jordan16 years 7 months 28 days01/17/1998Hope and Gregg WurdemanStudent is presently substituting 'F' for 'th' Sound. We world like her not to do this.103253 Rd 67783-100309/14/040109/14/0400Barb Cooper00The classroom teacher has modeled the correct speech patterns.08-30-04: Our speech teacher, Doy Hergert visited with Savannah and recommended the SAT meet with the classroom teacher. SAT members were made aware of Savannah's speech problems. The classroom teacher also supports the need for intervention. The SAT would like to allow at least two weeks of classroom instruction and intervention to take place before reviewing this case. Further recommendations of take place at that time. Currently the teacher might model correct speech patterns.Review and two weeks, or after parent teacher conferences.Savannah JordanTwila Griffiths, Madalyn Soule, Ed Newland, Carol Newland, and Karin JonesDuring parent teacher conferences classroom teacher, Barb Cooper and Savannah's mother, Hope (0Mrs. JemenezAlexandria JordanK5Oct 30, 1998Kelly and Heather SchmidtThere is a possible speech deficit. She says "F" instead of "th".Alex does great academicallyAlex is a little shy.She is a friendly girl103253 CR 36 Harrisburg, NE783-57550009/01/0401Hellen Jemenez00The problem is newly identified so I have not yet addressed it.The speech teacher met with her briefly on Tuesday, Aug. 31st. Continue to model correct speech patterns. Increase child's awareness.Reconvene after 10 days and consider formal assessments.Alexandria JordanTwila Griffiths Ed Newland Karin Jones Helen JemenezMrs. Eberspecher and I have emphasized the "th" sound in kid writing so all kids are more aware of it. Alex only seems to notice the problem when it is pointed out to her. --Hellen Jemenezcontinue current strategies modeling etc.The Team Recommends speech and language testing take place as soon as possible. The team recommends continued instructional emphasis on the aforementioned speech patterns.Alexandria JordanK(2Wardeman agreed Savannah should be further evaluated. Mrs. Wurdeman contacted me, Ed Newland, to request that the SAT follow through with the recommendation for further testing of Savannah.Continue modeling correct speech patterns.The SAT would like to recommend speech testing. Counselor will advise Doy Hergert on this date.Savannah JordanCarol Newland Ed Newland Madalyn Soule Karin JonesTwila GriffithsSeptember 28 2004010Savannah Jordan000000Savannah JordanSavannah Jordan00Savannah Jordan}|{srq5pg`f*e-J,#:"! >~u  W     #O3 )  +     (}D("9(0arin Jones Carol Newland Ed Newland Twila Griffiths Madalyn Soule Hellen JemenezSeptember 28 2004010Alexandria Jordan000000Alexandria JordanAlexandria Jordan00Alexandria Jordan}|{srq9pgf)e-7,#8"I!> ?~u   A  }|{spgfe,#"& ;~u  &&$       ~u#O3 )  +      Alexan(.(2Ed NewlandKacey Fleenor1016 years, 7 Months02/29/1988Lansen FleenorOur school district would like Kacey to succeed in school by passing his subjects.We would like Kacey to know where to get help with his class room studies and take it upon himself to ask for assistanceI would like to reserve this space to add comments from his teachers.Good sense of humor101517 Avenue J635-0450 (Kim 635-1902)10/11/040110/07/0400Ed Newland01Kacey FleenorKacey Fleenor000Kacey Fleenor000000Kacey FleenorKacey Fleenor00Kacey Fleenor    }|{p , ~u    ExR   ((Peggy EberspecherAnnel Sandoval811/27/90Yucundo SandovalParticipate in physical educational program designed to meet specific functional needs of Annel such as appropriate range of motion (flexibility) , strength, and endurance.NOTES: This document will not be processed. I attended a SPED meeting on 10/28/04 regarding Annel Sandoval. The SAT was not asked to convene. Therefore this matter will remain under the control and supervision of the Physical Education Teacher.10HC 85 Box 83308-262-66510010/29/0410Read Notes00Annel SandovalAnnel Sandoval000Annel Sandoval000000Annel SandovalAnnel Sandoval00Annel Sandoval}|{p,~u   (A$Juneil Schamp00000000Juneil SchampMrs. Griffiths advises that one-on-one instruction is helpful. However, she is concerned about Juneil becoming to dependent and not taking responsibility for her own education. The student assistance team plans to look into this at the meeting in January. No action or intervention taken at this time.Continue current interventions and encourage make Juneil aware of her need to initiate action when it comes to study skills.Testing: learning and behavior. Counselors to initiate consent for evaluation. SAT plans to meet in January for follow-up.Juneil SchampCarol Newland Karin Jones Ed Newland Twila GriffithsDecember 9, 20041001Banner CountyJanuary 3, 2005Sharlene SchampJuneil SchampBanner County School District001011It is our intent to not only provide Juneil with the opportunity to meet or exceed learning standards but to make certain all necessary resources become accessible. While some classroom interventions have some positive effect on Juneil's ability to (2 learn, she sometimes demonstrates anger, avoidance, feigning illness, and can become obstinate.I. Math Intervention: (1) Involve classroom aid (provide one-on-one instruction) (2) Expand Curriculum to include appropriate math level content (3) Provide aid with resource materials from Title I and 3rd grade classroom. II. Address her desire to learn. III. Address study skills (desire to learn).The students assistance team decided to focus on an area that could be managed at this time (Math Skills). Interventions related to her desire to learn and avoidance behaviors could not be supported due to a lack of information. (1) Student Assistance Team evaluations (2) Iowa Test of Basic Skills (3) CTBS Terra Nova (4) NWEA RIT Scores (5) Student Progress Reports (6) Teacher Recommendations (7) Attendance Records (8) Disipline NoticeDocumentation reveals a sequence of events and/or circumstances, when factored together, help explain academic deficiencies. However, a common thread that falls outside the rea(2 lm of these events includes teacher recommendations that Juneil receive extra academic assistance and improve her study habits.Juneil SchampBanner County602/06/1992Juneil SchampBanner County602/06/199200Juneil SchampBanner County602/06/1992         /,Y  }|{sq7p g{f|e., ~u (2 Kari GiffordMatthew Hawk91405/08/1991Loretta Hawkcomplete and turned in assignments on timelistened and participate in class discussion, oral reading, etc.Matthew is polite in friendlysleeps in classlikes to talk about sportsdraws and his notebook instead of taking notes and participated in class discussiondoes not turn assignment even if he is givenMatthew enjoys drawingtime to complete them in class101401 19th Avenue No. 40, Scottsbluff NE 69361635-245709/20/050109/14/0510Kari Gifford00I have moved Matthew so that he is sitting in the front of the classroom. I asked them to read aloud and asked him discussion questions to involved in the classroom discussion. I remind him to sit up and listen, get started on his work, etc.This StAT meeting generated many questions based on Matthew's behavior. There are many peripheral concerns that fall outside the realm of this report. A simple interpretation of Matthew's weakness is his preference not to work. Documentation on an 8th grade permanent record s(F tates: "Grandmother related Matt had been diagnosed as ADD and was on medication". This statement was made during the 3rd quarter of his 8th grade year. Current statements from the classroom teacher and shared chronological documentation support a reoccurring theme throughout Matthew's educational career. Various descriptors are used to pinpoint his behaviors which include the following: (SEE ATTACHMENT)1. Counseling sessions (n=2): Discuss his behavior patterns and their relationship to positive regard, indifference, and negative regard. Make certain Matthew is aware of skills and conditions necessary to promote positive regard. 2. Allow Matthew to work in a quiet place. Mr. Cooper has agreed to allow Matthew to use his room if necessary. Mr. Cooper's calculus class has 1 student as opposed to 23 students in Mrs. Gifford's Business class. REVIEW October 10 @ 3:30 PM in Cafeteria Matthew HawkCarol Newland Rebecca Favinger Kari Gifford Twila GriffithsMadalyn Soule Ed NewlandMatthew will se(F t in Mr. Cooper's room and still not attend to his workThe student assistance team recommends after school academic detention to start in January if supported by our school board. The SAT team also recommends that Matthew be evaluated in intellectual, academic, social and emotional domains.Re-evaluate after Four Weeks.Matthew HawkMattie Soule -SAT member Becky Favinger -Science Teacher Karen Jonas -SAT member Carol Newland -SAT memberKari Gifford-SAT Gerald Wallace-principalDecember 7 2005001Banner County SchoolTuesday, Dec. 13, 2005Loretta HawkMatthew HawkBanner County School District001011It is our intent to not only provide Matthew with the opportunity to meet or exceed learning standards but to make certain all necessary resources become accessible. Matthew is failing english, social studies, physical science, spanish, shop and business class. scores below the 20% on achievement test (MAP Fall 2005). Classroom interventions have had little effect on Matthews ability to learn. Despite num(F erous interventions, Matthew demonstrates reoccurring behaviors that include, but are not limited to, a preference not to work, indifference, avoidance, insubordination, and unusual attention seeking behaviors..Counseling: create awareness of skills and conditions necessary to promote positive regard. Provide a quiet working environment for Matthew during school and after school. Continued awareness and implementation of the principles of remediation for: (1) Low Self-Esteem (2) failure to complete assignments (3) Excessive Activity (4) failure to give attention to Routine Tasks and Activities (5) Noncompliance and Failure to Complete Tasks, and (6) Difficulty at the Beginning of Tasks.Interventions related to Matthews inability to learn and unconventional behaviors could not be supported due to a lack of specific academic, social and emotional information.(1) Classroom grades and transcripts. (2) student assistance team documentation (3) discipline records (4) behavior reports from former scho(F ols. (5) MAP CRT (Fall 2005 Assessment) (6) no information by way of standardized achievement tests.Documentation on an eighth-grade permanent record states "Grandmother related Matthew had been diagnosed as having ADD and was on medication". We have no official written documentation to support the aforementioned.60 DaysMatthew HawkBanner County SchoolMatthew HawkBanner County School00Matthew HawkBanner County School   m  }|{sr*qmp gfeF.->, #,"! ~u -, S   @*    (HFKari GiffordJessica Bolton915 years 5 Months 18 days06-27-1990Jody Eaton (Foster Parent)perform at a higher level when completing work that requires reading. For example, when taking tests and completing worksheets.conscientious about her workdoes not seem to comprehend what she reads.she is friendlystumbles over words when reading out loudJessica does poorly on written exams and worksheetswhen Jessica asked questions, she wants a "quick" fix or just wants the answer.10245 D Street, Gering Nebraska 69341436-334012/07/050112/06/0510Mrs. Kari Gifford00Ms. SchadeggMr. CooperMs. FavingerMr. VanPeltMs.DvorakMrs. WoundedArrowMrs.GiffordMrs. ParsonsWe read out loud in class, with each student taking a turn. This gives Jessica an opportunity to listen to the required reading. I have asked Jessica to be sure to ask about any questions that she doesn't understand when taking a test or completing an assignment. Math teacher, Mr. Cooper, advises "innate to our Mathematics curriculum. written passages are br(DJerry RevelleTyler Darnell7136-20-1992Robin and Lane DarnellI want him to be ready when class starts, have his paper and pencil out and be ready to participate and take notesI would like him to turn his work and on-time. Study for tests.Bring his assignment book, notebook to class, book, and assignment to class with himHe is politeHe does not focus on the task, it doesn't matter if it is lecture notes an assignment or readinghe is friendly and has lots of friendshe doesn't like seat working so finds other things to keep him occupiedhe is always messing with other objects instead he is happyof paying attention in classhe likes sewing so is doing well in that areaHe is immature for his age103020 Road 67 Harrisburg, NE 69345308-783-227711/30/050111/22/051000Mr.RussellMrs. SouleMr. Van PeltMrs. RevelleMr. MalcolmMrs. ParsonsMrs. Wounded ArrowI tried to get him to bring items with him to class by checking them periodically and giving extra points for having them. I reminded him to fill out his assign(9ment book and put his paper in his notebook but he doesn't get it done. I have also visited with his mother about the problem. She asked if I would start this process.Poor grades, visiting with other teachers I have gotten the same response from them about his behavior in class. Wrestling coach indicated that he is easily distracted and will wander to another place in the gym when they are talking to the wrestlers or practicing.Mrs. Revelle advises Tyler will have a schedule change that will allow for a study skills class instead of extra time in music class. Mr. Wallace to look into this schedule change.Tyler DarnellTyler Darnell000Tyler Darnell000000Tyler DarnellTyler Darnell00Tyler Darnell    }|{p , "!  J      ~u !- 0 G & `  T@r(9ief and concise".Jessica entered our school system, September 26, 2005 as a 9th grade student. Based on the spring norms of 2005 Jessica scores around the 16th percentile in reading (MAP). She scores around the third percentile on the sub-test category called "main idea". She scores lower on the vocabulary. Seventh grade transcripts show Jessica earning a 61 percent in reading. The eighth grade norm reference scores (Terra Nova) show Jessica working at a grade equivalent of 5.0, local percentile is 9th, and a national percentile of 24 in reading. Jessica's work ethic is perceived, by teachers, as strong and consistent.Addressing a need to provide all students that will benefit from extra time, an opportunity to focus on academics, the student assistance team recommends after school academic detention to start in January. A discussion will take place with all of Jessica's teachers regarding this SAT meeting with the goal of creating an awareness of aforementioned concerns. The SAT also reco(Dmmends that Jessica be reevaluated in the areas of academic and intellectual domains. UPDATE NOTICE (December 15, 2005): This recommendation has been amended, by Administration, to address students who are noncompliant. Jessica does not fall into a noncompliant category.the assumption is that no follow-up until testing takes place. (Follow-up was not addressed)Jessica BoltonMattie Soule -SAT member Becky Favinger -Science Teacher Karin Jones -SAT member Carol Newland -SAT memberKari Gifford-SAT Gerald Wallace-principalJessica Bolton000Banner CountyJan. 2, 2006Jody Eaton (Foster Parent)Jessica BoltonBanner County School District000011While achievement documentation is on file, our district does not have student ability scores. It is believed a discrepancy exists between Jessica's ability to learn and poor academic success. Low or Failing grades in Social Studies, English, Physical Science and Business as opposed to high grades in Math, Music Theory, Art and Physical Education. A performanc(De correlation between courses that require considerable reading may be real. Reevaluation would not only clarify this but allow for accommodations that will promote learning. Provide additional time via detention after school to address academic needs.Recommendation was rejected on the basis of this student's effort. Jessica demonstrates responsible behavior with classroom tasks. She is demonstrating efforts to succeed in the classroom.Jessica's sincere efforts to learn that produced poor grade reports inspired this referral. Tara Nova and MAP achievement test results sustain classroom grades. However a student ability index is missing.Jessica BoltonBanner CountyJessica BoltonBanner County00Jessica BoltonBanner County   M  }|{p.*-m,#\"!e {       ~u(DRoger RussellJeremy Greenman71308/27/1992Jackie GreenmanBasic Math Facts (examples Attached)organize and compete daily assignmentsseems to be behind in basic math facts101814 Avenue C632-69590009/14/1510Roger Russell00I have encourage Jeremy to ask questions when he needs helpthe StAT team has recommended Jeremy receive math tutoring from senior student aims. More specifically, Jeremy will be pulled from one (1) junior high band class (course No. 069) scheduled to meet fifth hour, two days a week (Mon.-Tuesday). At 12:05 PM each Monday Mattie Lapaseotes (student aid) will tutor Germany for 15 minutes on math facts in the elementary library. A worksheet will be provided to Germany by Mr. Russell. Every Thursday Ryan Parker Jake Knaub may be available to Germany eighth (8) hour. Mr. Russell supervise this processintention of this intervention is to help Jeremy fill educational gaps, as it relates to mathematics, and improve his confidence. The team will follow up on Jeremy's progress October (.10th at 3:30 PM in the cafeteria.Jeremy GreenmanNOTE: WHILE I (MR. NOON) AND RESPONSIBLE FOR DOCUMENTATION OF StAT MEETINGS I WAS NOT AVAILABLE TO RECORD FOR CHAIR THIS MEETING.Jeremy needs extra help with after school study hall Jeremy should continue working with high school student beginning to second semester sharing has been withdrawn from band class input into a study skills class seven-hour each day. Jeremy is still provided an opportunity to take band class three days a week. The decision to withdraw Jeremy from band class and add him to a study skills class was based upon his need to bring up his grades in all this core curriculum courses.investigate a formal 504 plan. While Jeremy does not qualify for special education services a 504 plan may need to be considered. Mr. will be looking at processing this investigation.Jeremy Greenmanunknown0101Jeremy Greenman000000Jeremy GreenmanJeremy Greenman00Jeremy Greenman(.\KhC  Y5 !SSSS ! GUIDELINES FOR TEAM MEMBERSj!Y\2  m 0,i SSSS Team members carry the responsibility for preparing for each team meeting by being familiarwith the case and bringing recommendations for action to the meeting. There are eightguidelines for fulfilling this responsibility.!F2+D [!BU U!XS!f . ;sJ? !SSSS I.<ktlI  F\sVR !SSSS Become familiar with the case. ]uQć  [;&lb !SSSS A. D]j>  }Q SSSS Read the referral.Identify the student's areas of strengths and weaknesses.Study the interrelationships of problem areas.Consider recommendations W~   F\{l@ !SSSS B.]l(k  kP 9 \&l !SSSS C.]j  ~b . \{l !SSSS D.]ӿ(k  }vB-  C3J !SSSS II.4lI  \9 !SSSS Be on time for the meeting.]:58  *QKx !SSSS III.Q,IT  \OQv !SSSS ==Be supportive of the referring teacher's need for assistance.]PR = !3!hK68 !SSSS IV. 4b"J5  #F\!#I SSSS Attempt to overcome your own need for more information (unless absolutely necessary) and try to respond to the referring teacher's need."$] #5 T"#]3F 3 &3;RK&j !SSSS V.%<RTIg  (\S($k !SSSS 88Keep your comments limited to the point being discussed.']PU'h 8 *2ishK !SSSS VI.)3tJl  ,\t !SSSS 00Be succinct in your responses and contributions.+B^v 0 .U*'KN !SSSS VII.-+zI*  0\%L !SSSS Q[ Help other team members explore their point thoroughly before raising new points./]x^( Q 2!K !SSSS   VIII.1#I  44] C SSSS RX Respond appropriately to the leader's responsibilities and the needs of other team3^l R 6a"Sz !SSSS GUIDELINES FOR TEAM LEADERS5#OV  8<f4 !SSSS YYThe team leader carries the responsibility for insuring that the team achieves the stated7->1 Y :1</bG !SSSS SSobjectives for each meeting. There are seven guidelines which may help team leaders9=@1C S <J/9PVP !SSSS .; L:N2M  >/=v@c!W !SSSS fulfill this responsibility.=>A yT  @=aLy !SSSS I.?>0cJu  B]2bYy !SSSS --Help team members prepare for the meeting by:A@_c`5v - D~Wz SSSS Alerting team members to the time and place of the meeting.Asking each team member to read the referral, identify problem areas, studytheir interrelationships and consider recommendations prior to the meeting.Assign a team member to talk with the teacher and possibly the child in class.CG{aZ ; F]{$m' !SSSS A.E^S|k CJDU 8 K I]ދxm !SSSS B.H@_1&l CKGf$ KCJUDG N MD]E  !SSSS __C.Call the meeting to order at the appropriate time.Appoint a team member to serve as recorder.LO_&lH  P4XK !SSSS II.LSM@_[ 2N=6jJ[  RQ,kK !SSSS III.Q-jJn LO^n + U4K' !SSSS IV.T5%jJ$  W]'!N( !SSSS Begin the discussion by:V^z*%  YW~)˿@ !SSSS FFReviewing the reasons why the referring teacher requested the meeting.X*x= F [D]I*$mpA !SSSS A.Z^+kL>  ^]:$mQ !SSSS B. _~:Q !SSSS &&Summarizing the child's problem areas.\^&<kN ]&<;N & a\Kb !SSSS CCInsuring that everyone has a common understanding of the situation.`SLV__ C c]K$mb !SSSS C.b@_Mk_  eD]ol t SSSS uuAsk the referring teacher to state her expectations and help the group negotiatea specific objective for the meeting.df^mr Pde^~P % i3 K2 !SSSS   VI. j] 2 !SSSS ,,Lead the group's problem solving efforts by:g4^jJ h^^ , lW~ !SSSS ##Stating each topic to be discussed.kո› # n\׷l !SSSS A.mB^*}k  qD] $m2 !SSSS B. rW~ J2 !SSSS Establishing time limits.o^^k p^hI  t}@\g !SSSS ))Helping group members speak to the point.s C ) v]l !SSSS C.u@_}k  yD]lE !SSSS D. zW~E !SSSS ##Summarizing relevant contributions.w^q}k! xq›! # |~Sz !SSSS MMBeing alert to group and individual needs and helping each member contribute.{UV  M ~]l !SSSS E.}^|k   , M" !SSSS VII.@. YL  _]6( !SSSS Schedule the follow-up meeting.`b5\%  @?1@ X/| ```` members[Zl ria have been met.Norm Referenced Test (NRT)Norm referenced tests compare an individual's performance on a test to other people who took the test. The results are reported in comparison to other people rather than how much of a specific criteria has been met.National PercentilesNational Percentile ranks indicate relative standing of a student in comparison with other students in the same grade in the norm group who took that test at a comparable time of year. Percentile ranks range from a low of 1 to a high of 99, with 50 denoting average performance for the grade. The percentile rank is a way of comparing the relative ranking of a student who took the test at that grade level. A percentile of 74 indicates that the students did better than 73 of every 100 students who took the test.StaninesStanine scores indicate a students relative standing in the national norm group. They range from a low of 1 to a high of 9. Stanine Scores of 1, 2, or 3 indicate functioning below average. Stanines of 4, 5, and 6 are considered average, and stanines of 7, 8 or 9 are considered above average.Normal Curve Equivalents (NCE)NCE's were developed to avoid problems that often occur with other types of scores. School personnel frequently try to aggregate percentile scores, but percentile scores should never be added, subtracted or averaged because the distance between points is not equal. At the upper and lower ends of the scale, the percentile points are farther apart than in the middle. Because of its equal-interval nature, any difference, such as 5 NCE's, has the same meaning, regardless of the part of the normal curve being referenced.  ^ #)u3 ^ u3)CC ^ CC)S ^ S)b y^ b)r s^ r){  ^ {)I  ^ I)  ^ ) s ^ ) d ^ )  ^ )O  ^ O) ^ ) ^ ) v^ )  w^ )U0 w^ U0)#@ y^ #@)O %^ O)_ ^ _)o ^ o)[ y^ [)) x^ )) 3^ )Ů ^ Ů) ^ )a t^ a)/ p^ /) x ^ ) q!^ )  = ^ )g Y  g g Arial"Courier New1Times New RomanpBookman Old StylehC\Kj ƚ;!SSSS a\  F&8F :6U6 2 EET zW SSSS !' Percent of casesunder portions of N- N'  T6,  !SSSS 34.13% &4u  lb.  !SSSS 14% Ү  !SSSS 13.59% p^  !SSSS 34.13% c  %p _a  ?R8  !SSSS 14 % ʰ  !SSSS 13.59% .S}  !SSSS 0.13%P6 Ph TP|  B| !SSSS the normal curve 0.13%inA  T @F@U v( %!SSSS StandardDx{ Y"  FwZ6!SSSS Deviations  -4qx3  TӪT ",F3 !SSSS  -3q!- E0  %!1 !SSSS  -2q &!5 !SSSS  +2q#ԃ 0 $P#2  (#-y7 !SSSS  +4q' $ڦ4  , o!/ !SSSS   -10q -X@#J2 !SSSS  o .&(5 !SSSS   +1q)^"02 *A EI0 +g$93  0\<&}V}5 !SSSS  +3q/=[$)U*4  767  4_>SR !SSSS 1 5>R !SSSS 12@O 3@QO  9h:?@R !SSSS 1 :RC?HR !SSSS 1 ;I?OR !SSSS 16;g@]?5P 7Dg@G5P 8>Kg@8N5P  >i?AS !SSSS 1 ?i?AS !SSSS 1<@CP =D@>P  A@ S !SSSS 1@eA3Q  CsMM:Q%a !SSSS Cumulative Percentages 0.1%BƌNOn^  E&KN)#b !SSSS 1 5.9%DxOl_  I҄Nxb !SSSS 23% J!1Nt\xb !SSSS 50.0% KNxb !SSSS 84.1%F$O5_ Gt2O"[_ HmOƲ_  NNi b !SSSS 9 7.7% Ob9N eb !SSSS 99.9%LGP ` M:GPc`  Q\\p !SSSS RoundedP]m  UƊ`t !SSSS  2% V`t !SSSS 16% W6`*Wt !SSSS 50%R#bAq S#bq Tj7#bUq  Yc w !SSSS 98%X?Meu  [za#Ru !SSSS 84%ZbЭr  ]_Ñ!SSSS 1\dӉ %  _:Ո]?!SSSS 1^<( >z  avFA !SSSS  Percentile`wmf cv  !SSSS  Equivalents 1bwG@ eDv:a !SSSS 1dwg  y rzۦ j:: ?a !SSSS  1 k]:Ua !SSSS  1h<= i  mg !SSSS  10 20 30 40 50 60 70 80 90l8  qy !SSSS  5 rq!SSSS 95 sg q!SSSS 99n9j޺ o3 p 3  u4  !SSSS 1tDV  xIMa !SSSS 1 ya !SSSS 1vJܯL w;ܯ7  {BI6O !SSSS 1zJ[M*  ]5 !SSSS 1 ]5 !SSSS 1 o]t5 !SSSS 1 M]A5 !SSSS 1 H]5 !SSSS 1 ]5 !SSSS 1|O }K ~Jqs   ?  `hm !SSSS 1 TBH !SSSS 1iXl CIG  :ZA !SSSS 1 _ !SSSS 1f;Y@( Y(  u !SSSS  z- scoresFwS j !SSSS 1W`&  l !SSSS   ,1,"n4   Jf !SSSS  4.0 xf !SSSS -1.0 >  1+HJ !SSSS -3.0  !SSSS -2.0 VAK !SSSS o,5H ԃ5 B5CJ  m7ڨ !SSSS +1.0Y  h6Ud !SSSS +3.07T  h} !SSSS +2.03*  5Ӫ  !SSSS +4.0W  uA!SSSS T - scoresFwA BI6OD !SSSS 1 >uzD !SSSS 1 1D !SSSS eJpMh vp6yh pޤh  r !SSSS  1 BrH !SSSS 1 rA !SSSS 1 r !SSSS 1 Hr !SSSS 1 r# !SSSS 1O CG K F  "  <2!SSSS 1 ?;1B!SSSS 1 5jn!SSSS 1 (!SSSS 1 !SSSS 1P <@P kmP ݕՙP -~P  b =@ !SSSS 40p  q !SSSS 30ɟ"  5$H !SSSS  20 <gO !SSSS 506<Fv 5><Nv  2> !SSSS 60e  -`o !SSSS 7 0    %DV !SSSS 80wE: WUt  &-!SSSS Sub testEy*  g&4 !SSSS  e AguH4 !SSSS 1 Þg^4 !SSSS e11 B#G1  1  xj4 !SSSS e qHN4 !SSSS 12 IgM2  A:e3A5 !SSSS 1;?2  ;/ FillText164l9 l9  ; 1/ FillText165l9 l9  1 B/ FillText166l9 l9  B / FillText167l9 l9   I/ FillText168l9 l9  I / FillText1694l9 l9  ;/ !SSS >; 1/ !SSS >1 B/ !C SSS >B / !SSS > I/ !SSS >I / !ESSS > 56 !SSSS 1?a 7Y3 fA:. D. tA. Kx. rH.  Re. ͟%w?!SSSS  Scale U&ow<  <4kMiF !SSSS  10 04iF !SSSS 13 4iF !SSSS 7 {C4SiF !SSSS 195>5LD 5gD 5zD D5]RD  +4F !SSSS 16~56boD  <75(G !SSSS 46֙D  954@gG !SSSS 1:6>E  C9^!SSSS CompositeE9[ YN%h!SSSS 1 &YNàh!SSSS 1 YNhh!SSSS 1 IYNaPh!SSSS 1 Oe  yOqe  Oe  KOOe  BNsI#i!SSSS 1CP!H#f  :OAxi!SSSS 1 O*xi!SSSS 1 mO_xi!SSSS l;VP5@xf ߔVPטxf VP xf  _KU6o!SSSS Scale ~Vl  /cc/c g{ !SSSS  85 !8g R{ !SSSS 100 "g{ !SSSS 115=$ix =:$iPx ݓ$ix  %D%h˞{ !SSSS 70 &3%h{ !SSSS 130#xiyFy $xiFy  )4zhFR| !SSSS 55 *@zhOYR| !SSSS 145'5iEy ()BiWy W W . .Z Z   ?    5(   FillText170l9 l9 46(   !SSSS >5[) 84>  !SSSS  47_  >5!k !SSSS 3 ?>Hk !SSSS 5 @-luk !SSSS 6 A(ik !SSSS 7 Bik !SSSS 89 :1@xG ;mrt <{ =%  Dy !SSSS 2C5:'  Gd<k !SSSS 1 H < & !SSSS 9Ee6j] Fs$]  K7 \ !SSSS  7% L  !SSSS  12% 17% 20% 17% 12%I]+ JC]+  N_7 !SSSS  7%Mk  QO]v !SSSS  4% R4* !SSSS  4%O^tԱ P[)Ա  T  !SSSS Percent in stanineSӜJ г  W#!SSSS 1 X@D#!SSSS 1U3 VA3C  \959>x!SSSS 1 ]5x!SSSS 1 ^5̜x!SSSS 1Y?;<ڼ Z4ڼ [љxڼ  a̾!SSSS 1 b%r̾!SSSS 1_ܶ>. `xܶ.  &m2&m ?s?  H UUD tt/ \ \#\#8 IOIO+\KhC_Q x[H```` Page 5\M4  =# 2!SSSS DEPRESSION/MOTIVATION>7%_ 1  =2zI!SSSS 126. Has unexcused absences>4&@  (g14M>126 Has unexcused absence \l9 l9 (g14M>10 =@X!SSSS 127. Has unexcused tardiness >2BN  (@4gM127 Has unexcused tardine]l9 l9  (@4gM10 =P>g!SSSS &&128. Blames other persons or materials >QQ=^ & (P4r]128 Blames other persons ^l9 l9 (P4r]10 =u^u!SSSS 129. Does not participate>_]nl  (_4l129 Does not participate_l9 l9 (_4l10 =lKj(!SSSS ..130. Blames self for situations beyond his/her>Tmhy . (wn4]{130 Blames self for situa`l9 l9 (wn4]{10 =zj#!SSSS control>O|Qi  =k?p!SSSS ..131. Is preoccupied with problems unrelated to>nd . (ƈ4131 Is preoccupied with p#al9 l9 (ƈ410 =f!SSSS school>d  "=)!SSSS 132. Is not motivated by rewards!>UJ $(4m132 Is not motivated by r'bl9 l9 #(4m10 &=+Z8R!SSSS ''133. Is easily upset by a suggestion or%>~7$ ' ((4133 Is easily upset by a-#cl9 l9 '(410 *=!SSSS constructive criticism)>E  ,=&(:!SSSS $*134. Avoids situations, assignments,+>f& $ .(4134 Avoids situations ass3'dl9 l9 -(410 0>!SSSS responsibilities/?*3  2=YA !SSSS ++135. Demonstrates self-destructive behavior1>mW + 4(4135 Demonstrates selfdest7-el9 l9 3(410 6=Qg!SSSS --136. Threatens to hurt self or commit suicide5>?e - 8(F4,136 Threatens to hurt sel;3fl9 l9 7(F4,10 :=p,(!SSSS ..137. Feels no one likes or cares about him/her9>Xo . <(4!137 Feels no one likes or?7gl9 l9 ;(4!10 >=W"i~9!SSSS --138. Ignores consequences of his/her behavior=>#hP0 - @(#4{0138 Ignores consequencesC;hl9 l9 ?(#4{010 B?2 bI!SSSS ++139. Does not smile, laugh, or appear happyAPA3`@ + D(.4 4A139 Does not smile laughG?il9 l9 C(.4 4A10 F?D[!SSSS 140. CheatsEPAF]R H(E 4R 140 CheatsKCjl9 l9 G(E 4R10 J?bVm!SSSS %141. Throws temper tantrumsIPAWo[d  L(W 4d141 Throws temper tantrumOGkl9 l9 K(W 4d10 N?h|!SSSS 44142. Is tired, listless, apathetic, unmotivated, notMOAj{v 4 P(8j 4w142 Is tired listless apaUKll9 l9 O(8j 4w10 R?;yb!SSSS interested in schoolQOAzU4  T?mw!SSSS --143. Does not care about academic performanceSPAvf - V( 4143 Does not care about aYOml9 l9 U( 410 X?j!SSSS 144. Is overly critical of selfWPA4c  Z( 4ը144 Is overly critical of]Unl9 l9 Y( 4ը10 \BS.z!SSSS ""145. Frowns, scowls, looks unhappy["DL-L " ^( 4145 Frowns scowls looks uaYol9 l9 ]( 410 `Bxl!SSSS **146. Needs immediate rewards/reinforcement_"D-%k * b( 4146 Needs immediate reware]pl9 l9 a( 410 dB*]Q!SSSS **147. Does not care for personal appearancec#D}D\# * f( 4l147 Does not care for periaql9 l9 e( 4l10 hB/!SSSS 148. Is pessimisticg"D!ۻ  j(* 4148 Is pessimisticmerl9 l9 i(* 410 lB[&!SSSS 149. Runs away to avoid problemsk#D%  n( 4149 Runs away to avoid prqisl9 l9 m( 410 pBc(!SSSS 150. Whines or crieso#D0  r( 4s150 Whines or criesxmtl9 l9 q( 4s10 tE _2@SSSS 00INAPPROPRIATE BEHAVIOR UNDERNORMAL CIRCUMSTANCESsuFa!]. stk1d9>  wE0>{WU!SSSS 00151. Behaves inappropriately when others do wellvF?()L 0 y[+<6I151 Behaves inappropriate~qul9 l9 x[+<6I10 {GWJbY!SSSS or receive praise or attentionzHKPX  }E \Hq0s!SSSS .4152. Behaves inappropriately for the situation|F\]oj . [+Z6f152 Behaves inappropriatexvl9 l9 ~[+Z6f10 EenJpH}!SSSS ..153. Behaves impulsively, without self-controlFon^| . [+l6x153 Behaves impulsively w~wl9 l9 [+l6x10 Eg7?!SSSS ""154. Exhibits extreme mood changesFk6 " [+t~6Z154 Exhibits extreme moodxl9 l9 [+t~6Z10 EԪ!SSSS 155. Is unpredictableF7  [+ 6155 Is unpredictableyl9 l9 [+ 610 ECdj!SSSS ,,156. Inappropriate sexually related behaviorFcc< , [+6156 Inappropriate sexuallzl9 l9 [+610 Ev!SSSS 157. Moves about unnecessarilyFɼo  [+ҹ6157 Moves about unnecessa{l9 l9 [+ҹ610 E8_!SSSS 158. Is easily overexcitedF1  [+6158 Is easily overexcited|l9 l9 [+610 E,!SSSS 22159. Lies, denies, exaggerates, distorts the truthF} 2 [+6159 Lies denies exaggerat}l9 l9 [+610 E&!SSSS !!160. Speaks in an unnatural voiceF% ! [+6z160 Speaks in an unnatura~l9 l9 [+6z10 E!SSSS 161. Speaks incoherentlyF   [+)6161 Speaks incoherentlyl9 l9 [+)610 E-!SSSS 162. Engages in nervous habitsF([$  [+16"162 Engages in nervous hal9 l9 [+16"10 ]F(?!SSSS //163. Destroys school or other students propertyG)6 / t,(75163 Destroys school or otl9 l9 t,(7510 ]F 914P!SSSS $$164. Has difficulty accepting changeG`:0G $ t,97E164 Has difficulty acceptl9 l9 t,97E10 ]FJua!SSSS 00165. Reacts physically when excited (e.g., flapsGLtX 0 t,nJ7TW165 Reacts physically whel9 l9 t,nJ7TW10 ]F[( r!SSSS hands, stutters, trembles, etc.)G\i |+ B!SSSS //166. Engages in inappropriate behaviors related,u9 / )6166 Engages in inappropril9 l9 )610 <E\,S!SSSS to bodily functionsX=ZI  Je  b!SSSS ..167. Becomes pale, may throw up, or passes out6LX . IV167 Becomes pale may throl9 l9 IV10 [ϖr!SSSS when anxious or frightened]}i  !SSSS 4>171. Will not change clothing for Physical Education ^ 4 jP171 Will not change clothl9 l9 jP10  !SSSS ..172. Does not demonstrate appropriate mealtimeg . 172 Does not demonstratel9 l9 10 "!SSSS behaviors*  ! !SSSS //179. Demonstrates inappropriate behavior on the8 ޢ / ͕179 Demonstrates inappropl9 l9 ͕10 fE@!SSSS school groundslD  180 Does not follow the cl9 l9 10 z!SSSS RULES AND EXPECTATIONSOɽ   h9'!SSSS 00173. Steals or forcibly takes things from otherse  0  173 Steals or forcibly tal9 l9  10 + &R7!SSSS 174. Inappropriate seat behavior~!Ӹ$. 2+174 Inappropriate seat bel9 l9 2+10 12\XI!SSSS 00175. Does not follow directives from teachers or3 *@ 0 /<175 Does not follow direcl9 l9 /<10 BYvY!SSSS other school personnelDuP  P g!SSSS 17176. Brings inappropriate or illegal materials toR^ 1 O[1 7 6 Brings inappropriatl9 l9 O[10 a  y!SSSS school9c o  o!SSSS &&177. Responds adversely to redirectionq1} & !o|1 77 Responds adversely tl9 l9 !o|10 Ǿʛ!SSSS !!178. Does not follow school rulesu ! 1 7 8 Does not follow schl9 l9 10 S%"<!SSSS ..184. Does not demonstrate appropriate care and'!3 .  :' 4184 Does not demonstrate l9 l9  :' 410 S5L!SSSS handling of others' property6<C  SDj\!SSSS ))185. Does not raise hand when appropriate JFR ) _C~EP185 Does not raise hand wl9 l9  _C~EP10 SFWmn!SSSS ..186. Behaves inappropriately going to and fromX?e . T~a186 Behaves inappropriate l9 l9 T~a10 Szg~!SSSS schoolhsu  Sxs!SSSS ''187. Does not take notes when necessarytq ' p~}187 Does not take notes wl9 l9 p~}10 Sԝ!SSSS //188. Is under the influence of drugs or alcohol / ƒ~188 Is under the influenc"l9 l9 ƒ~10 S6J!SSSS while at school4Hڤ  S){z!SSSS GROUP BEHAVIOR @y  !S!SSSS (2189. Has difficultly moving with a group  ( #~189 Has difficultyy movin&l9 l9 "~10 %S !SSSS ++190. Behaves more appropriately alone or in$F  + ' ~190 Behaves more appropri."l9 l9 & ~10 )S!SSSS **small groups than with the whole class or (&R * +S݄!SSSS in large group activities*  -S!6H!SSSS ..191. Behaves inappropriately in small academic,t . /~191 Behaves inappropriate4&l9 l9 .~10 1S ( !SSSS groups0T   3S2 !2!SSSS //192. Behaves inappropriately in the presence of2M( / 5d~J%192 Behaves inappropriate:.l9 l9 4d~J%10 7S/+MiVB!SSSS a substitute teacher6,g(9  9S <GS!SSSS ..193. Behaves inappropriately in large academic8s==J . ;:~G193 Behaves inappropriateB4l9 l9 ::~G10 =SMN#e!SSSS groups<OO[  ?!SSSS ((180. Does not follow the classroom rules>Pڹ: ( A~#!SSSS 22181. Does not wait appropriately for an instructor@P+" 2 CQ7181 Does not wait approprH:l9 l9 BQ710 E5!SSSS to arriveDP G~#!SSSS 22182. Does not wait appropriately for assistance orFP+" 2 I182 Does not wait approprNBl9 l9 H10 K@5g !SSSS attention from an instructorJP9  MLs!SSSS **183. Does not use school-related materialsLQ|E * O^D183 Does not use schoolreHl9 l9 N^D10 Q;-!SSSS appropriatelyPP'S:$       !"#$%&'()*+,-./0123456789:;<=>?@ABCFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~\KhC^a  9N'J6!SSSS ''59. Does not compose complete sentences]:(:IG5 '  98< I!SSSS !!or express complete thoughts when]:9zF !  9Ii]X!SSSS writing]:KUhW   9Xk1Wf!SSSS ''60. Fails to correctly organize writing]:Y0f ' 9iAr{x!SSSS activities ]:$kpw 9{sWX!SSSS **61. Omits, adds, or substitutes words when ]:,} V҉ *  9 i!SSSS writing ]:_Uh  9u!SSSS 1162. Fails to form letters correctly when printingN;מt} 1 9b |!SSSS or writingN;z[  9Sg!SSSS ++63. Fails to use verb tenses correctly when]:<}R +  9i!SSSS writing]:oUh  :\}p!SSSS //64. Uses inappropriate letter size when writing@<*oU / AC!SSSS SPELLINGB<<  9< !SSSS 65. Fails to use spelling rulesN; q5  ;||j0!SSSS ..66. Has difficulty with phonetic approaches to1= )iu- . ;Z0xn?!SSSS spelling1=1%mS>  "9@"y_Q!SSSS 2267. Omits, substitutes, adds, or rearranges letter!N;%BwN 2 $9P0?a!SSSS ""or sound units when spelling words#N;R.^ " & 9 e\v!SSSS --68. Has difficulty spelling words that do not%]:^fk[s - (<tv!SSSS follow the spelling rules'#>Kv  * 96Oiѓ!SSSS ,,69. Does not use word-endings correctly when)]:g/ , ,9)!SSSS spelling or omits them+O;J  .9Ux!SSSS 1170. Spells words correctly in one content but not-N;{wN 1 09޴ex!SSSS in another/N;1~ 28V!SSSS ,,71. Requires continued drill and practice in1l9RU , 482H!SSSS order to learn spelling words3l9+  698.!SSSS MATHEMATICAL CALCULATIONS5;^7  8;mX- !SSSS $$72. Has difficulty solving math word7<,f $ :;K w!SSSS problems9< uD  <;E!'!SSSS !!73. Fails to change from one math;<r >& ! >;%3!SSSS operation to another=<M'3  @ `"x```` Page 4?las$  B (B,5 CheckBox237Cl9 l9 A (B,510 D YB,e CheckBox238EAl9 l9 C YB,e10 F B|B, CheckBox239GCl9 l9 E B|B,10 H B,i CheckBox240IEl9 l9 G B,i10 J ؾB, CheckBox241KGl9 l9 I ؾB,10 L B, CheckBox242MIl9 l9 K B,10 N B, CheckBox243OKl9 l9 M B,10 P B,+ CheckBox244QM l9 l9 O B,+10 R 2AB, N CheckBox245SO!l9 l9 Q 2AB, N10 T }bB,Xo CheckBox246UQ"l9 l9 S }bB,Xo10 V ɃB, CheckBox247WS#l9 l9 U ɃB,10 X B, CheckBox248YU$l9 l9 W B,10 Z QB,, CheckBox249[W%l9 l9 Y QB,,10 \ B,\ CheckBox250]Y&l9 l9 [ B,\10 ^ B,# CheckBox269['l9 l9 ] B,#10 `:44;8K!SSSS %+74. Does not understand abstract math_6<d59 B % b:FDlm[!SSSS ""concepts without concrete examplesa5<E?R " d={Q8Ph!SSSS **75. Fails to correctly solve math problemsc ?RNt_ * f=[a2)5SSSS ++requiring regrouping (borrowing andcarding)eg ?b'To #ef ?ru  i;*~/7Q!SSSS %%76. Works math problems left to righth&=}5# % k; ۥ!SSSS instead of right to leftj'=  m:0RW!SSSS ++77. Fails to follow necessary steps in mathl6<P) + o:ev!SSSS problemsn5<lu^  q8:K!SSSS **78. Fails to correctly solve math problemspb9DI * s8&M!SSSS involving fractions or decimalsrb9y  u83;!SSSS %%79. Fails to demonstrate knowledge oftb9g1  % w8(!SSSS place valueva9G~ y8r-'!SSSS ##80. Confuses operational signs whenxa9%k  # {8 "!SSSS working math problemsza9   }8[%3!SSSS %%81. Fails to correctly solve problems|b9$T* % 8;,bC!SSSS involving money~a9-4:  8>6MU!SSSS ++82. Fails to correctly solve problems usingb9%@KL + 8\Of!SSSS measurementa9PU] 8]Ku!SSSS **83. Fails to correctly solve math problemsb9,_  $!!SSSS 92. Does not turn in homeworkw3Ϫ  $ ܱ\!SSSS 93. Cannot work independentlyw1   $.Jk,!SSSS 94. Fails tests or quizwi'+  $q/sY ?!SSSS 95. Is not preparedw0 Xj=  $CCS!SSSS 96. Does not remain on taskwDMl9 l9 [F6S10 qZLg CheckBox297?l9 l9 qZLg10 kx CheckBox251@l9 l9 kx10 |߈ CheckBox252Al9 l9 |߈10 ¼͋B CheckBox253Bl9 l9 ¼͋B10 F! CheckBox254Cl9 l9 F!10 dq!SSSS INTERPERSONAL RELATIONSHIPS,F  e@!SSSS &&102. Makes unnecessary comments/noisesl9 & e!SSSS 103. Fights with other students!  eKr!SSSS 0:104. Becomes physically aggressive with teachers:D 0 e  !SSSS ,,105. Makes unnecessary physical contact with\ , e f2!SSSS others^  e)!SSSS --106. Makes inappropriate comments to teachersB  - ew#:!SSSS 00107. Responds adversely to praise or recognition$p1 0 e2I!SSSS ))108. Is easily angered, annoyed, or upset3G@ ) eA>AX!SSSS *4109. Agitates or provokes peers to a levelmBO * eOf!SSSS of verbal or physical assaultQ]  e!` Hw!SSSS //110. Has little or no interaction with teacherstaZ n / er|7!SSSS ,,111. Has little or no interaction with peers cs)  , e!SSSS **112. Makes inappropriate comments to peers h * e1٫!SSSS ((113. Responds adversely to being bumped, ( ep+!SSSS "touched, brushed against W~  ed!SSSS 11114. Responds inappropriately to friendly teasing] 1 e!SSSS &&115. Is not accepted by other students & eJ!SSSS 116. Bothers other students%  ˼M116 Bothers other studentDl9 l9 ˼M10 e!SSSS 11117. Responds inappropriately to others' attempts? 1 ˼M{117 Responds inappropriat$El9 l9 ˼M{10 e!SSSS ++to be friendly, complimentary, sympathetic,; + !ee7!SSSS etc. ^  #ez(!SSSS ,,118. Will not share possessions or materials"T& , % 118 Will not share posses(Fl9 l9 $ 10 'e)!SSSS 00119. Will not allow others to take their turn or&O  0 )˼M119 Will not allow others.$Gl9 l9 (˼M10 +ey"9!SSSS participate*#r0 -e3J!SSSS ,,120. Does not resolve conflict appropriately,52A , /˼1M>120 Does not resolve conf2(Hl9 l9 .˼1M>10 1eC@Z!SSSS //121. Does not make appropriate use of free time0DzQ / 3˼!CMP121 Does not make appropr6.Il9 l9 2˼!CMP10 5e}TJk!SSSS ..122. Cannot work appropriately with peers in a4Uvb . 7˼fUMLb122 Cannot work appropria<2Jl9 l9 6˼fUMLb10 9eAa,Lhx!SSSS tutoring situation8bJ:o  ;eio!SSSS $$123. Does not share school materials:pb} $ =˼}mMcz123 Does not share school@6Kl9 l9 <˼}mMcz10 ?e|:!SSSS 124. Writes and passes notes>I~  A˼|M124 Writes and passes notD<Ll9 l9 @˼|M10 Ce, !SSSS 125. TattlesB7*ݗ E˼M 125 TattlesF@Ml9 l9 D˼M10 G q CheckBox255HDNl9 l9 F q10 I˼QK, CheckBox256JFOl9 l9 H˼QK,10 K˼K CheckBox257LHPl9 l9 J˼K10 M˼K CheckBox258NJQl9 l9 L˼K10 O˼Ky  CheckBox259PLRl9 l9 N˼Ky 10 Q˼#K~0 CheckBox260RNSl9 l9 P˼#K~010 S˼1K> CheckBox261TPTl9 l9 R˼1K>10 U˼YAK4N CheckBox262VRUl9 l9 T˼YAK4N10 W˼_Kk CheckBox263XTVl9 l9 V˼_Kk10 Y˼oKv| CheckBox264ZVWl9 l9 X˼oKv|10 [˼Kc CheckBox265\XXl9 l9 Z˼Kc10 ]˼KK& CheckBox266^ZYl9 l9 \˼KK&10 _ L' CheckBox267`\Zl9 l9 ^ L'10 a˼K CheckBox268^[l9 l9 `˼K10\KhC]< \OGT^ !SSSS .PIS\ >VP +QTO TEACHER Checleachbehavl9 l9 +Q !SSSS >f@٤YP 4 ,F SSSS ^^TO TEACHER Check each behavior you have observed the studentdemonstrate during the last month. b!څ4 <r<1 D " c@Mit ݠ5SSSS 44MEMORY, ABSTRACTIONS,GENERALIZATION,AND ORGANIZATION Aj" Fw   %_z{  c@_NSSSS PP20. Requires slow, sequential, substantiallybroken down presentation of concepts A?MX , 7V L  A?M6 $ c@^!SSSS LISTENINGAG  c@Wʶ!SSSS 1. Is disorganizedAwP  ,/81 Is disorganizedl9 l9 ,/810 c@&2o!SSSS %%21. Does not follow verbal directionsAS0 % c@fE!SSSS 2. Limited memory skillsA  c@21!SSSS %%22. Does not hear all of what is saidA}1 % c@E !SSSS ((3. Has difficulty understanding abstractAWD ( c@w!SSSS conceptsA>Lv  "c@VYC}!SSSS ))23. Does not direct attention or fails to!ABO ) $c@n?&SSSS BBmaintain attention to important soundsin the immediate environment#']Cc>g & &c@<U!SSSS ++4. Unable to find locations in the building%AT5 +#$A,E$  )c@2o!SSSS $$5. Does not respond appropriately to(A&}1 $ +c@~%B8!SSSS ))24. Has difficulty differentiating speech*A&]Aw3 ) -c@ke#!!SSSS environmental cues,Ad!  /c@m5^E!SSSS sounds heard.A6 fC 1c@Y%s4!SSSS 246. Does, not stay in assigned areas, for specified0A&rR3 2 3c@C @S!SSSS ((25. Unsuccessful in activities requiring2AVD>P ( 5c@2%_A!SSSS time4Ap3]@  7c@SFymd!SSSS listening6A3Uwa 9c@Fx{V!SSSS 117. Needs oral questions and directions frequently8A3HEwT 1 ;q?cOMs!SSSS ((26. Attends more successfully when close:@eONq ( =c@1Uwc!SSSS repeated<AVv*c  ?c@r=+!SSSS to the source of sound>At  Ac@kp-z!SSSS --8. Demonstrates difficulty with visual memory@AlUo|y - Cc@73V^!SSSS ++27. Requires eye contact in order to listenBAT0 + Ec@n!SSSS successfully DA Gc@{x!SSSS //9. Demonstrates difficulty with auditory memoryFA6}w܉ / Ic@&qМ!SSSS ,,10. Does not demonstrate an understanding ofHAyp , K\s!SSSS SPEAKINGJc]j  Mc@#ͪ!SSSS directionalityLAvf  Omτ!SSSS **28. Has difficulty imitating speech soundsNcn{ * Qc@d!SSSS 11. Has difficulty concentratingPAn] Sh~9!SSSS 1129. Omits, adds, substitutes or rearranges soundsRca 1 Uc@TpB!SSSS -312. Perseverates-does the same thing over andTAo - W%U!SSSS or words when speakingVbS  Yc@1]!SSSS overXA\*  [ڨ!SSSS --30. Distorts or mispronounces words or soundsZc-LӶ - ]c@6Y<!SSSS ))13. Fails to demonstrate logical thinking\AW ) _6!SSSS ++when speaking (not attributed to dialect or^cb5 + a !SSSS accent)`b@  cc@UE| !SSSS .bA[D  ec@ R!SSSS (.14. Has difficulty retrieving, or namingdA`P ( gc@Bt!SSSS objects, persons, places, etc.fA!;  ig!SSSS ))31. Does not use appropriate subject-verbhc` ) k_!SSSS agreement when speakingjb]  mc@hje*!SSSS ++15. Demonstrates visual perception problemslAda( + o"I!SSSS %%32. Has a limited speaking vocabularynbu % qc@*;!SSSS 16. Has difficulty classifyingpA+C8  s7 +!SSSS ,,33. Fails, to use verb tenses correctly whenrc 0 , uc@=YlK!SSSS **17. Fails to generalize knowledge from onetA?XK * wc@>N\!SSSS situation to anothervAO7\  ys2!SSSS %34. Does not speak fluentlyxc.r)  {c@cGr!SSSS 18. Demonstrates confusionzAdIq  }-}D!SSSS ##35. Does not complete statements or|c.*}; # c@ y:}!SSSS ..19. Remembers information one time but not the~A]z{ . >'TU!SSSS thoughts when speakingc @RL  c@|^!SSSS nextA׋)]}  JZlM ```` Page 3[Q  ,/8' CheckBox180l9 l9 ,/8'10 ,v/8Q CheckBox181l9 l9 ,v/8Q10 ,'/8i4 CheckBox182l9 l9 ,'/8i410 ,/8_ CheckBox183l9 l9 ,/8_10 ,/8 CheckBox184l9 l9 ,/810 ,#/8 CheckBox185l9 l9 ,#/810 ,/8 CheckBox186l9 l9 ,/810 ,c/8p CheckBox187l9 l9 ,c/8p10 ,w/8R CheckBox188l9 l9 ,w/8R10 ,gI/8BV CheckBox189l9 l9 ,gI/8BV10 ,+/88 CheckBox190l9 l9 ,+/8810 ,l/8fy CheckBox191l9 l9 ,l/8fy10 ,N|/8) CheckBox192l9 l9 ,N|/8)10 ,/8y CheckBox193l9 l9 ,/8y10 ,=/8J CheckBox194l9 l9 ,=/8J10 ,/8߽ CheckBox195l9 l9 ,/8߽10 ,/8y CheckBox196l9 l9 ,/8y10 ,x/8h CheckBox197l9 l9 ,x/8h10 ,/8[ CheckBox198l9 l9 ,/8[10 ,/8c CheckBox199l9 l9 ,/8c10 ,/8 CheckBox200l9 l9 ,/810 ,g$/8B1 CheckBox212l9 l9 ,g$/8B110 ,A/8N CheckBox213l9 l9 ,A/8N10 ,/8 CheckBox214l9 l9 ,/810 ,c/8ip CheckBox215l9 l9 ,c/8ip10 ,N}/8) CheckBox216l9 l9 ,N}/8)10 n`{ CheckBox217l9 l9 n`{10 ~`܊ CheckBox218l9 l9 ~`܊10 ` CheckBox219l9 l9 `10 ` CheckBox220l9 l9 `10 `r CheckBox221l9 l9 `r10  ` CheckBox222l9 l9  `10 `) CheckBox223l9 l9 `)10 0`< CheckBox224l9 l9 0`<10 P'`!SSSS  READINGcVQ]  bk z!SSSS ))36. Does not comprehend what he/she readsc6dp ) u;!SSSS 2237. Fails to finish assignments because of readingcw 2 Ls!SSSS difficultiesb7E 7.!SSSS ,2 38. Fails to demonstrate word attack skillsce0 , ~!SSSS ++39. Fails to recognize words on grade levelcѫw + Nyu!SSSS 40. Loses place when readingcxG  s;!SSSS 2241. Has difficulty with sound-symbol relationshipsbl 2 7^!SSSS 2242. Has difficulty with phonic skills when readingb=0 2 G!SSSS 2243. Omits, adds, substitutes, or reverses letters,c= 2 )!SSSS words, or sounds when readingb̀   ( ?!SSSS ++44. Fails to demonstrate word comprehensionb)6 + ;R!SSSS 0045. Reads words correctly in one context but notb==I 0 Kc!SSSS in anothercGM2Y (_^Ov!SSSS 46. Does not read independentlyc{` !m  ҘcR^p CheckBox225l9 l9 ҘcR^p10 ҘvR CheckBox226l9 l9 ҘvR10 Ҙ;bRo CheckBox227l9 l9 Ҙ;bRo10 Ҙ:R CheckBox228l9 l9 Ҙ:R10 ҘR CheckBox229l9 l9 ҘR10 ҘR CheckBox230l9 l9 ҘR10 ҘR CheckBox231l9 l9 ҘR10 Ҙ7R CheckBox232 l9 l9 Ҙ7R10 ҘRy CheckBox233 l9 l9 ҘRy10 Ҙ)R6 CheckBox234 l9 l9 Ҙ)R610 ҘP<R+I CheckBox201 l9 l9 ҘP<R+I10 r !SSSS 1147. Does not discriminate between similar letterscLt> 1 !SSSS and wordscՄ4{ 5!SSSS 1148. Does not know all the letters of the alphabetca 1 %9!SSSS 0049. Understands what is read to him/her, but notcx 0 Yb!SSSS what he/she reads silentlycaaR  Ҙ>sR CheckBox235  l9 l9 Ҙ>sR10 Ҙ#R CheckBox236 l9 l9  Ҙ#R10 ҘR CheckBox202+ l9 l9  ҘR10  ;!SSSS --57. Fails to punctuate correctly when writingc - 5!SSSS ))58. Does not use appropriate subject-verbc  ) yUt!SSSS agreement when writingc;&T  s+!SSSS WRITINGcl  ݢ!SSSS ##50. Performs assignments carelesslyc # U!!SSSS 0051. Is unable to copy letters, words, sentences,c 0 !SSSS ,,and numbers from a model at a close distancecV  , 9 U-5SSSS V\52. Is unable to copy letters, words, sentences,and numbers from a model at a distancec 2 0g) & (8!SSSS ..53. Fails to use capitalization correctly whencM*o6 . "8gI!SSSS writing!c-:F  $-EU!SSSS /554. Uses inappropriate spacing between words or#cF&S / &bU1Of!SSSS sentences when writing%cVM[c  (a"y!SSSS --55. Reverses letters and numbers when writing'cNco - *=t!SSSS ''56. Fails to write within a given space)cuh6 ' ,Ҙ4R CheckBox203- l9 l9 +Ҙ4R10 .ҘR CheckBox204/+l9 l9 -ҘR10 0Ҙ R] CheckBox2051-l9 l9 /Ҙ R]10 2Ҙ)R6 CheckBox2063/l9 l9 1Ҙ)R610 4ҘFRlS CheckBox20751l9 l9 3ҘFRlS10 6Ҙ2bR o CheckBox20873l9 l9 5Ҙ2bR o10 8ҘtsRO CheckBox20995l9 l9 7ҘtsRO10 :ҘăR CheckBox210;7l9 l9 9ҘăR10 <ҘRţ CheckBox2119l9 l9 ;ҘRţ10\KhC\ %7 ```` %Request for S.A.T. Intervention 'v&D6  7Q^```` UNDERSTANDING A STUDENT NEEDSwS=!\  %kE ```` Student Name'o/~ 2KoT ```` Age3qS  twl8 ```` Grade  p  #d ```` Date Completed +%tB  g ```` As perceived by:  9  %g1 ```` This worksheet should be used as a tool or a guide to reflect on the needs that students may have. Read each statement and check the box of the most appropriate response.'5 m' = %JG ```` ,,From your experience estimate the following: 'RE , KGcV CheckBox124zl9 l9 KGcV10 KGcV CheckBox125{l9 l9 KGcV10 KG^cVY/ CheckBox126|l9 l9 KG^cVY/10 KG,7cV'H CheckBox127}l9 l9 KG,7cV'H10 KGOcV` CheckBox128~l9 l9 KGOcV`10 KGhcVy CheckBox130 l9 l9 KGhcVy10 !KGcV CheckBox131"l9 l9  KGcV10 #KGdcV_ CheckBox132$ l9 l9 "KGdcV_10 %KG2cV- CheckBox133&"l9 l9 $KG2cV-10 'KGcV CheckBox134($l9 l9 &KGcV10 )KGcV CheckBox160*&l9 l9 (KGcV10 +KGcV CheckBox175D(l9 l9 *KGcV10 -lfyf ```` Below average,g8 /lfG 4 ```` Below average.g  1lf#5 ```` Below average0g#3 3lf;M ```` Below average2g<pL 5lfTf ```` Below average4gpU>e 7lfml ```` Below average6g>n ~ 9lfM: ```` Below average8g ږ ;lf ```` Below average:gڟ =lf ```` Below average<gv ?lf ```` Below average>gvD Alfr ```` Below average@gD ClfS@ ```` Below averageBg Ej CheckBox176F*l9 l9 Dj10 Gj CheckBox177HDl9 l9 Fj10 Ijz!u2 CheckBox178JFl9 l9 Hjz!u210 KjH:CK CheckBox179LHl9 l9 JjH:CK10 MjSd CheckBox85NJl9 l9 LjSd10 Ojk| CheckBox86PLl9 l9 Njk|10 Qj CheckBox87RNl9 l9 Pj10 Sj{ CheckBox88TPl9 l9 Rj{10 UjNI CheckBox89VRl9 l9 TjNI10 Wj CheckBox90XTl9 l9 Vj10 Yj CheckBox91ZVl9 l9 Xj10 [j CheckBox92Xl9 l9 Zj10 ]/7 ```` Low average\n5q  _ 9m ```` Low average^n? 7  aN$;;6 ```` Low average`n %:4 c=; O ```` Low averagebn=:M eU 8g ```` Low averagednV6wf gn 8 ```` Low averagefnwo6E i:s ```` Low averagehnE8 kT9A ```` Low averagejn7 m"!8 ```` Low averageln6 o: ```` Low averagenn9} q: ```` Low averagepn}9K s:y ```` Low averagernK8 u]Z%; ```` Averaget[۝  w]ZW ```` Averagev[   y]Z!3 ```` Averagex["#N2  {]Z:|L ```` Averagez[N;NK  }]Z]SڔJe ```` Average|[Tzc  ]Z+l~ ```` Average~[l|  ]Z ```` Average[  ]ZǝI ```` Average[T  ]Z˕ ```` Average[Tk"  ]ZcP ```` Average["@  ]Z1ڔ ```` Average[z  ]Z ```` Average[#  AP CheckBox93Zl9 l9 AP10 A P CheckBox94l9 l9 A P10 A]#PX4 CheckBox95l9 l9 A]#PX410 A+<P&M CheckBox96l9 l9 A+<P&M10 ATPe CheckBox97l9 l9 ATPe10 AmP~ CheckBox98l9 l9 AmP~10 AP CheckBox99l9 l9 AP10 AcP^ CheckBox100l9 l9 AcP^10 A1P, CheckBox101l9 l9 A1P,10 AP CheckBox102l9 l9 AP10 AP CheckBox103l9 l9 AP10 AP CheckBox104l9 l9 AP10 3"&  ```` High Average$ "& ```` High Average$  "&2 ```` High Average!$\1 9"&K ```` High Average\:$*J kR"&Xd ```` High Average*S$b 9k"&&} ```` High Averagek${ "& ```` High AverageƄ$ ՜"&® ```` High Average$b "& ```` High Averageb$0 q"&^ ```` High Average0$ ?"&, ```` High Average$ "& ```` High Average$} נ CheckBox105l9 l9 נ10 נ CheckBox106l9 l9 נ10 נy!t2 CheckBox107l9 l9 נy!t210 נG:BK CheckBox108l9 l9 נG:BK10 נSd CheckBox109l9 l9 נSd10 נk| CheckBox110l9 l9 נk|10 נ CheckBox111l9 l9 נ10 נz CheckBox112l9 l9 נz10 נMH CheckBox113l9 l9 נMH10 נ CheckBox114l9 l9 נ10 נ CheckBox115l9 l9 נ10 נ CheckBox116l9 l9 נ10 &y8 ```` IntelligenceG(7y &y8 ```` Reading AbilityG(y7G  & y8u2 ```` Math AbilityG(G!71 &V9y8CK ```` Writing AbilityG(:7I  &$Ry8d ```` Communication AbilityG(R7b  &jy8| ```` Problem Solving AbilityG(k7{  &y8 ```` Ability to Trust OthersG(7M  &y8{ ```` Ability to be LikedG(M7  &\y8I ```` Ability to Ask For HelpG(7  &*y8 ```` Ability to Follow RulesG(7  &y8 ```` Physical HealthG(7  ' ```` Self-Confidence(p  =&Z7G. ```` **Need for Attention/Affirmation/Recognition'o6, * =&(57G ```` Need for Power and Control'5o6E  =&M7_ ```` Need for Nourish/Food'No6^  =&f7x ```` Need for Safety'go6Qw  =&7 ```` Need for Belonging'Qo6  Z$o\ ```` Need for Structure%.7  HW- CheckBox117l9 l9 HW-10 H_5WZF CheckBox118l9 l9 H_5WZF10 H-NW(_ CheckBox119l9 l9 H-NW(_10 HfWw CheckBox120l9 l9 HfWw10 HWĐ CheckBox121l9 l9 HWĐ10 HW CheckBox122l9 l9 HW10 yjH!53 ```` More than Averagek"1  B"Z|3 CheckBox123 l9 l9 B"Z|310 E ```` AverageFZ=D(  eo!3 ```` Less than Average p"Cd2  Y"h|3 CheckBox129l9 l9  Y"h|310 yj:L ```` More than Averagek:J  BO;ZJL CheckBox135 l9 l9 BO;ZJL10 -[IH ```` AverageJH  eo:L ```` Less than Averagepd;C2K  Y2=h-N CheckBox136l9 l9 Y2=h-N10 yjR&d ```` More than AveragekSqc  BTZe CheckBox137 l9 l9 BTZe10 <lI~ ```` AveragebmKH0}  eosS`e ```` Less than Averagep2TCd  !YThe CheckBox138$l9 l9  YThe10 #yjk&} ```` More than Average"kql?|  %BlZ} CheckBox139* l9 l9 $BlZ}10 'K dTJQf ```` Average&#U4l9 l9 8BZ10 ;g#O5 ```` Average:$Nr4  =eoݝʯ ```` Less than Average<pCj  ?Y0h+ CheckBox144B8l9 l9 >Y0h+10 A#RU> ```` &Cognative Style (Learning Style)@+% C CheckBox145F>l9 l9 B10 EfƶD] ```` VisualD[S  Gŋݚ  CheckBox146LBl9 l9 Fŋݚ 10 Ii ```` AuditoryHɣ[o  KUB ```` Touch/MovementJa  M  CheckBox147PFl9 l9 L 10 Oc"P ```` High AverageN"C! QǦ*ߵ% CheckBox148TLl9 l9 PǦ*ߵ%10 S%I^x ```` Affect:R'J\  U924 CheckBox149XPl9 l9 T92410 W M ```` IntrovertV Ybcq^ CheckBox150\Tl9 l9 Xbcq^10 [x ```` ExtrovertZGz4 ] CheckBox151bXl9 l9 \10 _C#q ```` Sequential / Left Brained^$CK  a ```` Simultaneous /Right Brained`~CL  c CheckBox152r\l9 l9 b10 e"P4 ```` #-Has this child experienced divorce ?d$Q2 # g"`P4M1 ```` &0Has this child experienced Alcoholism ?f$ 2/ & i".8^J ```` 4> Has this child experienced a significant death/loss?h$8d]H 4 k"Pldb ```` -7 Has this child experienced abuse of any kind?j$Q ca - m"ik{ ```` )3 Has this child used chemical substances ?l$jjWz ) o"!m<Z ```` This student usually appears:n",  q) ```` 77How long has this child been experiencing difficulties?pF+q? 7 sNf CheckBox153xbl9 l9 rNf10 u<}# ```` Near Tearst~R  wfs ```` Sad / Withdrawnv Ee  yQfiu CheckBox154|rl9 l9 xQfiu10 {e8 ```` Mad / AngryzԈ7 }܆ח CheckBox155~xl9 l9 |܆ח10 3B CheckBox156|l9 l9 ~3B10 /C0 ```` Emotionless / Flat г  Foח ```` Near Explosion5Hw  Do\j CheckBox157~l9 l9 Do\j10 }ա³ ```` Mixed Mad / Sad~Gb  euz CheckBox158l9 l9 euz10 N8f3 CheckBox159l9 l9 N8f310 7od$ ```` Happy / Relaxed}cIJ  &5 CheckBox161l9 l9 &510 ]= ```` Six months to one year>9a  (= ```` Less than six months>Jc  r&5 CheckBox162l9 l9 r&510 ?N ```` Greater than Two Years@  r&5 CheckBox163l9 l9 r&510 &5 CheckBox164l9 l9 &510 :t ```` One or Two years;Ff  p CheckBox165l9 l9 p10  ````  nonoM  u CheckBox166l9 l9 u10 pm h1 CheckBox167l9 l9 pm h110 tj ```` yesԄ s  um h1 CheckBox168l9 l9 um h110 p;96J CheckBox169l9 l9 p;96J10 uX7SH CheckBox170l9 l9 uX7SH10 p Rc CheckBox171l9 l9 p Rc10 uQb CheckBox172l9 l9 uQb10 uo CheckBox173l9 l9 uo10 pn CheckBox174l9 l9 pn10Ms  tj0 ```` yesԄ ^/  t5jG ```` yesԄ{6 IF  tmPjZb ```` yesԄ,Q `  tlj} ```` yesԄl |  / ````  nonoM Mm.  }7I ````  nono(?^8 ^8?,H  nnP[b ````  nono_A0-Q -Q0`  m~ ````  nono]Mm mM}  im)U FillText178l9 l9 im)U ```` >rn'~ SW.q) FillText179l9 l9 SW.q) ```` >Xr]  .q) FillText180l9 l9  .q) ```` > rK] r FillText181l9 l9 r ```` >Ҏ 6v FillText185l9 l9 6v ```` >= cq( ```` Newland, 1998rc \]nq5? \KhC/ Q?5οhK63 Does not change behavi0l9 l9 Q?5οhK10  4tK !SSSS %+ 63. Does not change behavior from one^5"H % 67MN41 Inappropriate seat beh 1l9 l9 67dMN10 Y7.<N !SSSS 41. Inappropriate seat behaviorZ8:K  sF_vD] !SSSS situation to another pG uiZ  6H[dMqq42 Behaves inappropriatel2l9 l9  6H[dMqq10 YZVq !SSSS ##42. Behaves inappropriately for the Z[Un # 3 h !SSSS UNHAPPINESS/DEPRESSION*j#}  {{l !SSSS situation[|mǀ 64 Does not participate3l9 l9 !10 ^9|` !SSSS 64. Does not participateU{  6ޏM43 Avoids situations assi 4l9 l9 6ޏdM10 Y5V\ !SSSS ##43. Avoids situations, assignments,ZPU # |e6 !SSSS responsibilitiesY}  65 Blames self for situat#5l9 l9 !10 Gn !SSSS %%65. Blames self for situations beyond % "zR !SSSS his/her control!mQ  $6M44 Behaves impulsively wi)6l9 l9 #6M10 &LYtpE !SSSS 44. Behaves impulsively, without%ZD ({" !SSSS self-control'[|NG ,!66 Is easily upset by a s/#7l9 l9  + !SSSS ++66. Is easily upset by a suggestion or con-*N +)!10 .eh  !SSSS #structive criticism-}g   0=6L45 Exhibits extreme mood7)8l9 l9 /=6L10 2LY_\ !SSSS !!45. Exhibits extreme mood changes1ZD[  ! 4q067 Threatens to hurt selfA=9l9 l9 3q!010 6D1 !SSSS $$67. Threatens to hurt self or commit5pTi. $ 86M@346 Is unpredictable=/:l9 l9 76M@310 :LYm$3 !SSSS 46. Is unpredictable9Z0  <qO+ vB !SSSS suicide;,c?  >=6z@LV47 Does not follow direct37;l9 l9 ==6z@LV10 @X?RTV !SSSS ##47. Does not follow directives from?JZ$ART # B\O!e68 Feels no one likes orI3<l9 l9 A\O!e10 D^Ne !SSSS %%68. Feels no one likes or cares aboutCPb % FzQo*h !SSSS ""teachers or other school personnelE|VRsnOe " H_% w !SSSS him/herG8a#1t  J=6uL48 Ignores consequences oMA=l9 l9 I=6uL910 LXgt:` !SSSS ##48. Ignores consequences of his/herKJZu^ # NG!p69 Does not smile laugh oUI>l9 l9 MG!p10 P^Ip !SSSS $$69. Does not smile, laugh, or appearOH $ R{Cj !SSSS behaviorQ[|  TД !SSSS happySm#p  V5Lx49 Inappropriate sexually]M?l9 l9 U5fL$10 XX$ !SSSS ++49. Inappropriate sexually related behaviorWYPI + Zݸ!70 Is apatheticas@l9 l9 Yݸ!10 \߷tA !SSSS 70. Is apathetic[2!@+  ^=6^L50 Is easily overexcitedeUAl9 l9 ]=6^L10 `X  !SSSS 50. Is easily overexcited_Y  bO!71 Is overly critical ofiYBl9 l9 aO10 dB؎i !SSSS 71. Is overly critical of selfc  f5fL51 Lies denies exaggerates]Cl9 l9 e5fL10 hX@ !SSSS ++51. Lies, denies, exaggerates, distorts thegJZ + jvw72 Frowns scowls looks unoaDl9 l9 i!#10 l^Q^x !SSSS !!72. Frowns, scowls, looks unhappyk  ! n zKqr !SSSS truthm]{  pO]"!873 Is pessimistic}iEl9 l9 oO]"810 r!O8 !SSSS 73. Is pessimisticq#M6  t5W%fL;52 Brings inappropriate oYeFl9 l9 s5W%fL;10 vX$J; !SSSS ##52. Brings inappropriate or illegaluY&hI8 # xz5RM !SSSS materials to schoolw|47-J  zAD[ !SSSS PHYSICAL SYMPTOMS/FEARSyFvY  |XWxkn !SSSS &&53. Destroys school or other students'{JZX&jk & ~5BZfLkp53 Destroys school or othoGl9 l9 }5BZfLkp10 hvL74 Is preoccupied with pr}Hl9 l9 h!~10 {hv !SSSS 74. Is preoccupied with problemsi#| _z kG !SSSS property{sl?l  oYyw !SSSS unrelated to schoolzu  =6-LV 54 CheatsIl9 l9 =6-LV10 X !SSSS 54. CheatsJZ֏Ϣ v775 Demonstrates selfdestrJl9 l9 !10 8 !SSSS **75. Demonstrates self-destructive behaviordJ] * =6L55 Has difficulty movingKl9 l9 =6L10 X$k !SSSS &&55. Has difficulty moving with a groupJZi & O!76 Moves about unnecessarLl9 l9 OF10 t !SSSS 76. Moves about unnecessarilyC  6M56 Responds adversely toMl9 l9 6M10 LYi !SSSS %%56. Responds adversely to redirectionZHhA % v77 Speaks in an unnaturalNl9 l9 !10 ^,#S !SSSS 77. Speaks in an unnatural voiceѼx 6L*57 Has difficulty acceptiOl9 l9 6M10 XYW !SSSS ##57. Has difficulty accepting changeJZNV  # O! 78 Speaks incoherentlyPl9 l9 O10 ~  !SSSS 78. Speaks incoherently9}2  6M:258 Does not follow schoolQl9 l9 6M:210 X!B2 !SSSS 58. Does not follow school rulesJZ@0 O*!pA79 Engages in nervous habRl9 l9 O*A10 I*pA !SSSS # 79. Engages in nervous habits+>  6t?LU59 Does not care about acSl9 l9 6t?MU10 LY>RU !SSSS 59. Does not care about academicZ@XQS OVN!d80 Throws temper tantrumsTl9 l9 OVNd10 N(e !SSSS 80. Throws temper tantrums\TOMb  zOV$g !SSSS performance|PQId Oq!81 Reacts physically whenUl9 l9 Oq10 q7 !SSSS ))81. Reacts physically when excited (e.g.,\cre\ ) 6 tM360 Needs immediateVl9 l9 6 tM310 LYse܊ !SSSS 60. Needs immediateZu  q !SSSS &&flaps hands, stutters, trembles, etc.) & z" !SSSS rewards/reinforcement|;4  O!!82 Becomes pale may throwWl9 l9 Oͼ10 H  !SSSS ""82. Becomes pale, may throw up, or\LE " 6L61 Does not care for persXl9 l9 6M10 LY77ǿ !SSSS 61. Does not care for personalZ5  H !SSSS %%passes out when anxious or frightenedո % _z'bN !SSSS appearance{zs O83 Demonstrates phobic tyYl9 l9 O10 ^Ls !SSSS &&83. Demonstrates phobic type reactionss & 5fL62 Engages in inappropriaZl9 l9 5fL10 X~ft !SSSS &&62. Engages in inappropriate behaviorsJZs & (+  SSSS 99(e.g., fear of school, speaking in frontof a group, etc.)m{Yt ( z0- !SSSS related to bodily functions|Y/R W`P  = !SSSS Page 10Mib \KhC5` )6` SSSS _e TO TEACHER: Check each behavior you have observed thestudent demonstrate during the last month.|77J 57JO~] * rq}C !SSSS  LEARNINGor+h  ewӽ22 Is easily angered anno l9 l9  dv9 !SSSS ((22. Is easily angered, annoyed, or upsetew^ (ewӽ10 _ !SSSS &&1. Does not work on assignments during `ҕP˨ & 3'I1 Does not work on assignl9 l9  3'IP10 du !SSSS ))23. Agitates/provokes peers to a level ofȚ ) ӽ23 Agitatesprovokes peers l9 l9 (F10 ew[վ !SSSS class timex wb$ !SSSS verbal or physical assaultPI  ]j5 !SSSS 2. Does not turn in homework@_4  2I2 Does not turn in homewo! l9 l9 2I:10 ӽ24 Has little or no inter%n l9 l9  `l !SSSS %%24. Has little or no interaction withb %ӽ10 "( !SSSS teachersu:T'3  "2lI3 Is disorganized) l9 l9 !2I10 $B^$K !SSSS 3. Is disorganized#_w<p  (~q25 Has little or no inter- l9 l9  'Kr !SSSS ++25. Has little or no interaction with peers&b +%ӽ10 *2I&4 Performs assignments ca1!l9 l9 )2H&10 ,]\& !SSSS ""4. Performs assignments carelessly+^1[*# " 0'ӽ=26 Makes inappropriate co;%l9 l9  /Y&= !SSSS ##26. Makes inappropriate comments to. ': #-'ӽ=10 424HfJ5 Cannot work independent7)l9 l9  3D]?396fJ !SSSS 5. Cannot work independently2^44G 124HJ10 6w7|O !SSSS peers549(-L  :E2WnHm6 Fails tests or quizzesA1l9 l9  9D]V; m !SSSS 6. Fails tests or quizzes8^W j 7E2WnHn10 <U\)kr27 Responds adversely toE-l9 l9 ;U\~r10 >f[Ur !SSSS ''27. Responds adversely to being bumped,=\o ' @w m G !SSSS touched, brushed against?snl  BE2{nH-7 Is not motivated by rewI7l9 l9 AE2{nH-10 D]z9- !SSSS 7. Is not motivated by rewardsC^Y{58R  F*28 Responds inappropriateS;l9 l9 E*10 Hf  !SSSS ((28. Responds inappropriately to friendlyG֑Ϥ ( JE2gnH8 Is not preparedOAl9 l9 IE2gnH10 L\i !SSSS 8. Is not preparedKB^  N e2 !SSSS teasingM ^W  P1vnH9 Does not remain on taskWIl9 l9 O1vH10 R\]$ !SSSS 9. Does not remain on taskQB^  #  Tlռ29 Is not accepted by oth[El9 l9 Slռ10 Vfl !SSSS %%29. Is not accepted by other studentsU % ZE2.HW10 Performs below ability_Ol9 l9  YU6 !SSSS 10. Performs below ability levelXV.5' WE2.nHW10 \ռL30 Bothers other studentseSl9 l9 [ռ10 ^{2 !SSSS 30. Bothers other students]d  `E2=Hf11 Does not follow writteiWl9 l9 _E2=nHf10 bU?_f !SSSS &&11. Does not follow written directionsaV>^ & df ! !SSSS ++31. Responds inappropriately to others' at-c Q + fW "31 Responds inappropriater[l9 l9 eW #10 hyiF 3SSSS 68tempts to be friendly, complimentary,sympathetic, etc.gm2 % l2+IA12 Does not follow verbaln_l9 l9  kUM*[tA !SSSS %+ 12. Does not follow verbal directionsjPW+Z> %i2+IA10ghB04a;C  o2NlId13 Is reluctant to attempil9 l9 n2NId10 qRVM?3d !SSSS 13. Is reluctant to attempt newpWO1a  sWPSyi32 Will not share possesszel9 l9 rWPSyi10 uR~i !SSSS !!32. Will not share possessions ortS+f ! wew8_ _v !SSSS assignments or tasksvx`< s  y.d+U{ !SSSS materialsx eM*zx {3EIn14 Limited memory skillsrl9 l9 z3EIn10 }VG2n !SSSS 14. Limited memory skills|NX   W;d33 Will not allow others l9 l9 ~W;d10   !SSSS ,,33. Will not allow others to take their turnݛ , $G@ !SSSS or participatewljFe  3SI|15 Has difficulty underst~z!l9 l9 3SI|10 VUaw| !SSSS ))15. Has difficulty understanding abstractWv ) wݶ !SSSS concepts y0)  |S SSSS 00INAPPROPRIATE BEHAVIOR UNDERNORMAL CIRCUMSTANCESsϽ 3 B  3>J16 Does not comprehend wh~"l9 l9  V"l !SSSS ##16. Does not comprehend what he/sheNX>j7 #3>Jg10 xs !SSSS readsayl  ,34 Makes unnecessary comm#l9 l9 ,10 g_ !SSSS %%34. Makes unnecessary comments/noises  % 3J%17 Requires repeated dril$l9 l9 3J%10 Wkr% !SSSS ((17. Requires repeated drill and practiceX)q"# ( WH+35 Has unexcused absences%l9 l9 WH+10 u + !SSSS 35. Has unexcused absences(  ܐ92n`I !SSSS  INTERPERSONAL RELATIONS/3umF  8,VN36 Has unexcused tardines&l9 l9 8,N10 7N !SSSS 36. Has unexcused tardiness8K  2UHk18 Fights with other stud'l9 l9 2UHk10 VUN,l !SSSS 18. Fights with other studentsWV*i  [,eq37 Makes unnecessary phys(l9 l9 [,q10 <[cr !SSSS &&37. Makes unnecessary physical contact\o & $l18A !SSSS with otherswmm6f 2yI)19 Becomes physically agg)l9 l9 2yI)10 Vxpҏ !SSSS &&19. Becomes physically aggressive withWyn & vމA !SSSS teachersx1*  {,38 Blames other persons o*l9 l9 {,10 ':N !SSSS %%38. Blames other persons or materialszs % 3?Jh20 Makes inappropriate co+l9 l9 3?Jh10 RVd !SSSS ##20. Makes inappropriate comments toWc # ߳׻39 Steals or forcibly tak,l9 l9 ߳,10 5\ !SSSS ((39. Steals or forcibly takes things from ( wD !SSSS teachers ypAi  $u !SSSS othersw#   C3I21 Responds adversely to-l9 l9 C3lI10 UY !SSSS ##21. Responds adversely to praise orV(X! # W+G40 Behaves inappropriatel.l9 l9 WG10  !SSSS ''40. Behaves inappropriately when others ' wt  !SSSS recognition y! yQox !SSSS &&do well or receive praise or attention & q !SSSS   Page 9MsN  ı|5ı`hC\K F \'!SSSS  .@C%  Y;cq!SSSS )Instructional Intervention PlanZ=_  FZ`q` XktڏEStudent1l9 l9 XktڏE !SSSS > tG Coordinator l9 l9 tG !SSSS > (u# Goal_Areal9 l9  s !SSSS  Student: o8uZ0  (u# !SSSS > t0= !SSSS  Goal Area: ti= !SSSS  Coordinator:ku hu #v  wvF  {vѼ >-2d2d-mm-DC-DE--5 "ؒS|?'!SSSS Physical$7{  '!SSSS Motivational ]D\'uSSSS ",Instructional ContentAnd Procedure(@_ޕtCS kޕS "ӻa%'!SSSS Time!%  %cv<'!SSSS Materials &'!SSSS  Who#w $ P  [#G{GS! +X'!SSSS Arrangement ,'!X'!SSSS Strategies)=PȖ *(PΑ Ѽվ վ>2d~2dm-mD-CD-E- 55 5G^^q!SSSS  1)4I]  7E}@_Yq!SSSS  2)6rF~]O >~2d- - ;vD)<Qq!SSSS 6@Data-Collection Plan: (frequency, summarization, etc.):E++M 6>-k > 94D !SSSS  ...=7//B  @!Ds]̾q!SSSS Decision-Making Plan:?tEB\º >k>k D`Pq!SSSS  .C~VF  FtE!@q!SSSS *:(at what point does the team re-evaluate?)EF> *hC\Kr A A @ B\>0gq!SSSS )Instructional Intervention Plan]^@k&c  /rtA !SSSS  Student: Aliceshs  )t; !SSSS  Coordinator: Mr. B ~tiq !SSSS # Goal Area: Reading Goal I|6v~:. Ѿ6vp. B^-$k$k-11---- B &!SSSS PhysicalpCUԐ  ~]J!!SSSS Instructional ContentUhI  WwSSSS  MotivationalStrategies! l CB!SSSS TimeP  ލX!SSSS Materials1޵{* =!SSSS  Who۵  'I' B) ƛ-!SSSS And ProcedureN,g ")!SSSS ArrangementC-2d  *e bbB^$kpo$k11B^$kpo ,2fV !SSSS (1) Daily time trials of letter+gU]   0q5!SSSS  15 1q{5!SSSS Mr. B 2q5!SSSS During small-T0  .(  /#  4k!SSSS 1. Verbal3i[  6is!SSSS 1. Alphabet5t Y  8c&!SSSS naming.7d4 #  :; W'!SSSS cards9 3)$  ? _'!SSSS min. @ '!SSSS Para Ay 2'!SSSS group time in B, c'!SSSS praise;2  ~$ <2 @~$ =2 ~$ >A.2 b~$  D= !SSSS  oC 4  FtCq!SSSS  xEj?  Imq"z@!SSSS 2. Sheets of J%"Wz@!SSSS readingGr$L= Hw$VL=  M #l@!SSSS 2. Games NZ #@!SSSS dailyKU$j= LU$W=  P9 tLW!SSSS 3. RewardOq:rT R;HY!SSSS randomQ<V  T;T"kr!SSSS lettersSUο=o  V-PUqs!SSSS choicesU.Voo B^qo$k Zn!SSSS 4. Pair withB^qo$kXqho~ \6dnvBSSSS &02) Additional practice onletter naming[]eho$A [\e:J _-?t!SSSS friends as a^?/ բ a]&ДS+!SSSS  I`'*I  c, lѾ!SSSS rewardbA.Wpk  ec G !SSSS 6@Data-Collection Plan: (frequency, summarization, etc.)d4ejE 6B^TB^T i6d>\$!SSSS :DData will be collected and charted at least once per week.he4Z! :B^Tպ lcSSSSS Decision-Making Plan: (at what point does the team re-evaluate?)If three consecutive data points fall below the goal line, the team will reconvene and an instructionalchange will be made.km4eT;n @knlemD  gkmeiן  p=.16>t?!SSSS - .1o/X7t==  r=> C!SSS  .q> D \KhCJ jL+3 $!SSSS .Do's and Don'ts When Selectingkޕ)S  j]H'!SSSS ACCOMMODATIONSk@\  # !SSSS   30sk  Og<5 dddd AE Do... make accommodation decisions based on individualized means h؛h -hh؛  f5 dddd ae Don't... make accommodations based on whatever's easiest to (for example, preferential seating). I"wG ' OgV6< dddd y} Do... selected combinations that reduce the effect of the disability and to access instruction and demonstrate learning. 0h7؛I - 4~ dddd  Don't... selected commendations unrelated to documented student learning needs or are intended to give students and unfair advantage>";6G - Og9|< dddd Zd Do... the certain to document instructional and assessment accommodations only IEP or 5042h}؛ 1 | dddd Rb Don't... use an accommodation that is not been documented on the IEP or 504 plans.@"}b / Og<A  dddd y} Do... be familiar with the type's of accommodations that can be used as both instructional and assessment accommodations3hR؛ & P  dddd Xb Don't... assume all instructional accommodations are appropriate for use on assessments.C" 1 Og<V dddd UY Do... be specific about the "where, when, who, and how) of providing accommodations.5h؛Z! 0 HW dddd ^h Don't... simply indicate an accommodation will be provided "as appropriate" or "as necessary."D"Y! / OgD<< dddd VZ Do... provide accommodations for assessments routinely used for classroom instruction;hMF؛W . KE dddd T^ Don't... providing assessment accommodation for the first time on the day of a test.G"FX 0 !Og< dddd UY Do... selected commendations based on specific individual needs in each content area <h!؛ 0 #r dddd u Don't... assume certain accommodations, such as extra time, are appropriate for every student and every content area."H" 0 %Og<? dddd  Do... get input about accommodations from teachers, parents, and students, and use it to make decisions at IEP team or 504 planning committee meetings$8h؛i + '> dddd Q[ Don't... make decisions about instructional and assessment accommodations alone.&A"h 1 )OgV< dddd X\ Do... Refer to state accommodations policies and understand implications of selections.(6hW؛Ti . +VB dddd PZ Don't... check every accommodation possible on a check with simply to be "safe."*E"SXi / -Og< dddd 37 Do... evaluate accommodations used by the student.,7h؛G + /5 dddd KU Don't... assume the same accommodations remain appropriate year after year..F"F ( 1 hI؛Z 3 0hZ؛k h؛c )4h؛ (3h؛{ +hZ!؛2 %()hTi؛z *,-hG؛ $9%hi؛  /$:8h ؛/ +$9h/؛0 hW؛i ( !h؛ %  e?"GY )>"Ydj ."bŠ #&'". "H"I "z '"!3 /*+"i{ !./"  #"Xui $"B#"I 2 J "G= 1 I"=G"       !"#$%&'()*+,-./012345789:;<=>?@ABCDEFGHJKLMNOPQRSTUVWXYZ[]^_`abcdefghilmnopqrstuvwxyz{|}~\KhC xCL!SSSS  .DyJ [{^  4ĘԔ  !SSSS @J STUDENT CHARACTERISTICS: EASILY DISTRACTED; SHORT ATTENTION SPANQr @ OƗ  SSSS )3 Accommodations toConsider for AssessmentsTt# [XX] X]  {j  SSSS )3 Accommodations toConsider for Instruction ^N  a߹t  !SSSS  CategorybB  4s  H(iW [XEXE] E "mE  !SSSS *4  Use books on tape or recorded books to .u * a  !SSSS  Presentationb$Y K0e#  !SSSS  help focus on textOc}  9A$=!SSSS  I';h ;  "+X87  5SSSS /9  Give short and simple directions withexamples u]$ '$64 [EXBXEBE] B %{dK<_  !SSSS ,6  Write in test booklet instead of on answer$L/ \ , '"K_  !SSSS ,6  Write in test booklet instead of on answer&uM\ , ) Sg  !SSSS   -(^`UX/e  +S'B\Fp  !SSSS  sheet*(]Dtm  -\ p  !SSSS  sheet,MN^n  /kq  !SSSS +5  monitor placement of student responses on.#0m| + 1wwlqO  !SSSS +5  Monitor placement of student responses on0m} + 3S'|p  !SSSS  answer sheet2(~moݍ 5}Jؐ  !SSSS  answer sheet4Mc~hI2 7 c  !SSSS +5  Use materials or devices used to solve or6#7  + 9w2  !SSSS ,6  Use materials or devices. used to solve or8C , ;i_!  SSSS )3 organize responses Use visual organizers:>(̞Ԑ  =wi]yv  5SSSS )3 organize responses Use visual organizers<?̞zj :;# { <= xо  Aӽ  !SSSS "  Use graphic organizers@#6R  C'  !SSSS "  Use graphic organizersBOY  F%  !SSSS #-  Highlight key words in directions G-  !SSSS #-  Highlight key words in directionsDw2 #E۹ # I%  !SSSS ,6  Have student repeat and explain directionsHwH{ , Kg  !SSSS ,6  Have student repeat and explain directionsJy , M&|  !SSSS $ to check for understandingLQ(&)  O#  !SSSS $ to check for understandingNM{ДJ  Qr{  !SSSS   Use templateP#p  SbL  !SSSS   Use templateR[K*  V%pY$  !SSSS +5  Use graph paper to keep numbers in proper WY$  !SSSS +5  Use graph paper to keep numbers in ProperTw! +Uo! + YS' !X4  !SSSS  columnsX(n"HW=2  [!25  !SSSS  columnsZ#12 [BXT{XBT{B] T{B] T{ ayIpm  SSSS >H  Sit in front of room Change location to reduce distractions`frJ#AZ  c Ipm  SSSS >H  Sit in front of room Change location to reduce distractionsbgsrJumAZ  ecdI<]  !SSSS  SettingddJ<Z `aZSj (bcsZj ([U{XygXU{ygU{] ygU{] yg nyʕ  !SSSS '1  Use short segment test booklets (when ouʕ  !SSSS '1  Use short segment test booklets (whenlU$ 'mU$ ' q8cG  !SSSS  Timing andpd`y sc} U  !SSSS  Schedulingr4e v'{`S  !SSSS  available) w{:S  !SSSS  available)tO)ޓ8_ uKޓ49 yy[3  !SSSS '1  Allow for multiple or frequent breaksx[ ' {uV  !SSSS '1  Allow for multiple or frequent breaksz ' }yf  !SSSS )  Schedule tests in the morning|^  u  !SSSS )  Schedule tests in the morning~F  y  !SSSS *4  cue student to begin working and stay on ~  !SSSS *4  Cue student to begin working and stay onz I *z,I * 'PD(  !SSSS  task(pC    !SSSS  taskX'  Y  !SSSS %/  Change testing schedule or order of Y  !SSSS %/  Change testing schedule or order of! % % Q( U  !SSSS  subtests)mT<  _/7   !SSSS  subtestsK.  u?9  5SSSS is  Limit reading periods Schedule activities requiring more seat timein the morning and more hands-on andzq & .K 'L6 $ 5I  !SSSS $. physical activities in the afternoon@7zG $ uhE@Y  !SSSS (  Divide long-term assignmentsFV  gIg  !SSSS   29  c Pc  !SSSS  response(eQHRa \KhCaay nD-A !SSSS 3=STUDENT CHARACTERISTICS: MATHEMATICS AND DISABILITYGC 3 sZA !SSSS  -b›h  k/C  !SSSS   ~.;Οܐ a\\\ g  SSSS )3 Accommodations toConsider for Assessments ʡs  P*ht  SSSS )5 Accommodations toConsider for InstructionL  ggټ  !SSSS  Category,id3  Oʕy Lf a\>\>> 0g  !SSSS  ResponsehZ  S  !SSSS  Use: P  !SSSS  Use:s q  r  !SSSS   Calculation devicesq4  !&vl  SSSS (2  Calculation devices Visual organizers $$$kX  #5  !SSSS   Visual organizers"i8   !$_   & y  !SSSS   Graphic organizers%G '  (9 |i   !SSSS   Graphic organizers'$ *hk  *0  !SSSS *  Math tables and formula sheets)$%- a>,g -xA5[!SSSS ,6Student Characteristics: Physical Disability,B94X ,a,g̖,g̖,g̖,g̖,g̖ 4.fq  SSSS )3 Accommodations toConsider for Assessments37Ogt`w  6.fh  SSSS )3 Accommodations toConsider for Instruction58gbL`w 34Ow 56Lqwg@ 'vE ?$vE & Ct  !SSSS *@ speech, pointing, or bY using an assistiveBQ8ο * E%  !SSSS ) through speech, pointing, or byD&TN#  H%'  !SSSS " using an assistive I'T}  !SSSS  communication deviceFU&<Y G|Y  K%^6  !SSSS  communication deviceJ&X  Mn  !SSSS $.  Type on or speak to word processorL$ $ O}>  !SSSS $  Type on or speak to wordN5p  Q&Ai  !SSSS $  Speak into tape recorderPy  S$]  !SSSS  processorR&>\N U&  !SSSS ,6  Write in test booklet instead of on answerTy}L , W}  !SSSS $  Speak into tape recorderV_C.  Y  !SSSS  sheetXQ[n*  [)]"  !SSSS ",  Write in test booklet instead ofZ{H " ]&#  !SSSS (8  Use augmentative devices for single or\y;N ! ( _}c\s  SSSS u on answer sheet Use augmentative devices forsingle or multiple messages(e.g., BIG Mack Jelly Beanswitch, or Dynovox)^b& M0  aUa 94  !SSSS (8 multiple messages (e.g., BIG Mack, Jelly`!~1 (^e_0 u@  d/C  !SSSS ( Bean switch, or Dynovox)cP1/A ^hbS'@ʿUP  g&!@S  !SSSS /9  Use written notes, outlines, and instructionsfyAoSQ /^ieS'fPp5` ^hS'F`Ęp N through speech, pointing or byusing an assistive communication0m<  m<  ! I  !SSSS  communication deviceA0M   M   "u=  3SSSS >H  Type on or speak to word processor Speak into tape recorder!'m) $ $/JV,  !SSSS  device#0-T)  &U(v-<  !SSSS $  Type on or speak to word%g)#9 !" +:  )C/8gL  !SSSS  processor(0B:fJ +:N  !SSSS !+  Use thick pencil or pencil grip*><O L ! -iIn  SSSS ;E  Speak into tape recorder Use thick pencil or pencil grip,0vJEZ  /Kc^  !SSSS /9  Use written notes, outlines, and instructions.mrLA\ /,-R\!l !{l|[ 3 ~X !SSSS .8 STUDENT CHARACTERISTIC: COMMUNICATION DISORDER2 IHW .:?| ;>8V 9<7{l[9;86[9:@7[6{l[Table3 84[   SS )3 Accommodations toConsider for Assessments 75[r  SS )3 Accommodations toConsider for Instruction 6=rz  !SSSS  Category<tSԼ ;5mq :4; n 9CA8{l9DB@9GA @Eor6  !SSSS  Presentation AFV  !SSSS   Screen readerCs DcU  BH=2 J  !SSSS  Screen readerG3n~= {l KJ  !SSSS @J STUDENT CHARACTERISTICS: READING DISABILITY; DIFFICULTY DECODINGJ9V @{l222 Pr3  SSSS )3 Accommodations toConsider for InstructionOU6;V !  R- 3  SSSS )3 Accommodations toConsider for AssessmentsQV|_!  Ts+  !SSSS  CategorySktO) OP!mq0 QR; p!?1 {l21212121 \9Y\M  !SSSS   Human reader[c:XJ  _k9JM  !SSSS   Human reader `r9M  !SSSS  Presentation]<;~ K ^t<; K ckbJ:^  !SSSS   Audiotape or CD dfbJi:^  !SSSS  Audiotape or CDaK-[ bK~h[  feDYLWm  !SSSS   Screen readereZUvj  hk@[P}o  !SSSS   Screen readerg\{rl  jelD  !SSSS   Videotapei*nB} {l1111 qms#  !SSSS  Setting r#  !SSSS .8  Change location so student does not distractotȚU pcYU . tkwظ  SSSS 4>  Change location so student doesnot distract othersswڕ2 ! v? ,  !SSSS  othersu +޵ st/c|2  y  !SSSS /9  Use written notes, outlines, and instructionsxcD /{l |™g  !SSSS DT STUDENT CHARACTERISTIC: WRITING DISABILITY; DIFFICULTY wiTH SPELLING{o D{l### 8s!  SSSS )3 Accommodations toConsider for InstructionV  _!  SSSS )3 Accommodations toConsider for Assessments[|*  s  !SSSS  CategoryktKT q` ; ;   {l### k)=  !SSSS (  Express response to a scribe or)=  !SSSS  ResponseX+'; sX+';  )WN  SSSS Q[  Express response to a scribe through speech Type on or speak to word processorcX+'; - .:N  !SSSS  through speechc6<L $/6<L  k^Jx6^  !SSSS $  Type on or speak to wordK%[  \Kؐ4_  !SSSS $  Speak into tape recordercL\  E.<[fo  !SSSS  processor/\enl :\p  !SSSS $4  Use spelling and grammar assistivec]\lm $ kj~  !SSSS $  Speak into tape recorder*l1{  l.  !SSSS *4 devices (e.g., electronic spelling device, &n} * Q{)  !SSSS $  Use spelling and grammar|  {yҏ  !SSSS " spell check on computer) ]}',  /  !SSSS /9  Use written notes, outlines, and instructions ./r  SSSS K[ assistive devices (e.g., electronicspelling device, spell check oncomputer)/a #ca /A0 A0zhw ;y  !SSSS   27  \KhC{    !SUSS   .[ f|] = Fy  !SSSS -7 STUDENT CHARACTERISTIC: DEAF; HARD OF HEARING lE0 - Ef  1SSSS )3 Accommodations toConsider for Assessmentsy f]]PQ] _n  SSSS )3 Accommodations toConsider for Instruction @¥R  $m|  !SSSS  Category wnֽ N  umq f[#P[#Q[# oU  !SSSS   Sign languagerRTA  qd|<  !SSSS   Sign languageU{  o  !SSSS '  Audio amplification devices q  !SSSS '  Audio amplification devicesPa P\  R  !SSSS   Screen reader z  !SSSS   Screen readerm.XQ o.x  !oUlG-  !SSSS   Visual cues F #o31  SSSS LV  Written notes, outlines, and instructions Videotape and descriptive video"$8e  +"#x/G/ ! &o0"rD  !SSSS *4  Provide advanced organizers and outlines%1A * (oxA0e  SSSS JT of lectures for student to follow Use gestures (e.g., point to materials)')EB>R !'(RTb ) +o6bv  !SSSS %/  Repeat questions and responses from*chs % -s!B  !SSSS  classmates,Ewt@F /w  !SSSS ,6  Allow student to copy notes from classmate.aѓ , 1)>  !SSSS )3  Use captioned versions of instructional0[ ) 3yn   SSSS S] films and include script when possible Give interpreter instructional materials in24 &23k& - 6G4  !SSSS  advance5~?3M  8  !SSSS &0  Learn manual signs and teach them to7^- & :G0o  !SSSS  hearing classmates9mb  <.  !SSSS (2  Allow student to use telecommunication;ksB ( >G+  !SSSS  device=Q*  f[#Ժ[#PԺQ[#Ժ C)   SSSS   Express response to scribe or interpreter Type on or speak to word processor Use spelling and grammar assistive devices Use visual organizers Use graphic organizersBHk+: + E)T=  !SSSS )  Express response to scribe orDm\++;  GI,-:$iN  !SSSS  interpreterF-;g_K BKCk;b_K $ JbJ|:^  !SSSS $  Type on or speak to wordImK)[ BNHkL[ , M+Zdon  !SSSS  processorLG-[ck BQKk\W|ql  Pj ~  !SSSS $  Use spelling and grammarOm.l̾{ BNk+m|  S,{7؎  !SSSS ! assistive devicesRE.c|2  Uc  !SSSS !  Use visual organizersTmW  WoiCA  !SSSS "  Use graphic organizersV̜ fպպPQպ ]n  !SSSS  Setting ^o!  !SSSS %  Change location to reduce[p* \*Ͻ  `mpH  !SSSS (2  Change location to reduce distractions_ ( b,o}  !SSSS  distractionsaE.m d\  !SSSS %/  Change location so student does notc\ + % fo0  SSSS 4>  Change location so studentdoes not distract otherseib  hfF  SSSS  distract othersChange location to increase physicalaccess (e.g., minimi e background noise,face student when speaking, speak tostudent and not to interpreter, and increasewait tune for interpreter to finish)gjCRT efE.qE@ gmh q@ $ lo  !SSSS '  Change location to increasekQh  gpjC ( oI,#@]u  SSSS  physical access (e.g., minimizebackground noise, face studentwhen speaking, speak tostudent and not to interpreter,and increase wait time forinterpreter to finish)nr-U$ gqmCV# $gtpC#2 ,nso-$3 nurE.3kC gqC2&lB $nvs.'CR nwuE.R%b nv.=b r  ymG  !SSSS  PresentationxnI {m.YB  !SSSS  Responsez=o/Q? \KhC ym''!SSSS #-EXAMPLES OF ACCOMMODATIONS BASED ONnԐe # mb'!SSSS !STUDENT CHARACTERISTICS or d*[ &l !SSSS 8B STUDENT CHARACTERISTICS: BLIND, LOW VISION, PARTIAL SITEouk 8dݺ0ݺs0s[0 g53  SSSS )3 Accommodations toConsider for Assessments ?&h!  VR3  SSSS )3 Accommodations toConsider for Instruction #?5!  j!+  !SSSS  Category&lcS)  !0  x!Q0 d0ݺ+ݺ0s+s0[+ j7dK  !SSSS  Presentationk8GH 7ZK  !SSSS   Large print 7(K  !SSSS   Large printD9YI PD9W'I jHqB\  !SSSS !  Magnification devicesIY  Hd\  !SSSS !  Magnification devicesP"JcY  !HYB m  !SSSS   Braille ZtAzj #Yum  !SSSS   Braille"P[j %&j,}  !SSSS %  Nemeth Braille code$kڍX{  '{j\/  SSSS (8  Nemeth Braille code Tactile graphics.&*k[{  ){`u܎  !SSSS   Tactile graphics(g|t6 &'P}rD  -ke  !SSSS   Human reader .39e  !SSSS   Human reader+wj ,P7  0  !SSSS *  Audiotape or compact disk (CD)/PzkI 2Ak{C  !SSSS  * Audiotape or CD1ΝVz  5h  !SSSS   Screen reader 677  !SSSS   Screen reader3X}g' 4PX5'  8Rӽ  !SSSS -7  Large print or Braille notes, outlines, and76b - :*  !SSSS  instructions9(j)9 <bL  SSSS &0  Descriptive video Talking materials;=JK ;<P(I d+ݺݺ+ss+[ Bq#f!SSSS  IAĜJ  Dj+  !SSSS  ResponseC&l+(  FRBM  SSSS cs  Express response to a scribe through speech Type on or speak to word processor Type on BraillerEJ+( - H|+  !SSSS &0  Express response to a scribe throughG*O) & KQ(B)<  !SSSS  speechENF)9 $Ii)tA9  M80\  SSSS 6F  Type on or speak to word processor Type on BraiflerLO9I $EJ=:E J LMrJwAZ  QR Jp]  !SSSS $  Speak into tape recorderPpKqo?[  S?DYZm  !SSSS $  Speak into tape recorderRZvj  URBZn  !SSSS (2  Use calculation devices (e.g., talkingT[>tk ( W"j  SSSS NX  Use calculation devices (e.g., talkingcalculator with enlarged keys, abacus)V[k(T{ ( Yjֻ~  !SSSS &0 calculator with enlarged keys, abacus)X(.l{ & \Rz"l  !SSSS #  Use personal note takerVWi|n݋ &Z|j݋ dݺsݺsss[sݺss d.  !SSSS %/  Change location so student does not eRB  !SSSS .8  Change location so student does not distract f(k+  !SSSS  Settinga %b .c{lؒ  h k  !SSSS  distract othersgiJi  j9   !SSSS  othersi( k  l?(  !SSSS &0  Change location to increase physicalk|K & nz  SSSS Zd  Change location to increase physical access Change location to access special equipmentmpP|K - qv@{  !SSSS  accessmnP> -oi#?  s8  SSSS ,6  Change location to access specialequipmentrt:N  #rsiJV dsݺ@Yݺss@Yss[@Y ygq?/  !SSSS   Extended Timexo,  |R'?/  !SSSS   Extended Time }jM/  !SSSS  Timing andzt=C- {&ltC- (k+Qt?  !SSSS  Scheduling~{l,< 7   !SSSS   25_.  \KhC> O+(4H1!SSSS  ,,,)?3~/  0g=aU !SSSS DN STUDENT IN PARENT RIGHTS IN IDENTIFICATION, EVALUATION AND PLACEMENThP?HR D 7p a  7SSSS )3 The following is a description of students and parents rights granted by Section 504 of the Civil Rights Rehabilitation Act of 1973. The intent ofthe law is to keep you fully formed concerning decisions about: your child mid to advise you of your rights if you disagree with any of thesedecisions.9*r 79ay0 :$mg 7׽ !SSSS   YOU HAVE THE RIGHT TO: 79NBF  <4 !SSSS ~ 1. Have your child take part and receive benefits from public education programs without discrimination based on a disability, ->f^ ~ ;]+ !SSSS KU 2. Have the school district advise you as to your rights under federal law. <ٺ K <;sO0 !SSSS Yc 3. Receive notice with respect to indemnification, evaluation or placement of your child. ;77 ^N !SSSS  4. Have your child receive a five appropriate public education. This includes the right to be educated with other students to the maximum<8 K OpEyk SSSS  extent appropriate. It also includes the right to have the school district make reasonable commendations to allow your child an equalopportunity to participate in school and school-related activities.QFBY QrVmji C ;isB !SSSS z 5- Have your child educated in facilities and receive services comparable to those provided students without disabilities./=t؇ z 3;+4 SSSS  6 Have your child receive special education and related services if she/he is found to be eligible under the Individuals with DisabilitiesEducation ACT (IDEA) (PL 10for1 -476), or to receive reasonable accommodations under Section 504 of the Rehabilitation Act.<Q ^P-% { :xW, SSSS  7. Have evaluation educational, placement decisions made based upon a variety of information sources, and by individuals; who knowthe student, the evaluation data and placement options.1< O|$kt 7 :qE| SSSS  8. Have transportation provided to a school placement set in at no greater cost to you than would be incurred if the student were placedm a program operating by the school district.; `Ou?3m - !:2 !SSSS  9. Give your chid an equal opportunity to participate nonacademic and extracurricular activities offered by the school district, ;7B/0 #98/9@VP !SSSS  10. Examined all relevant records related to decisions regarding your child's identification, evaluation, educational program and placement."9:M %7Wo !SSSS w 11 Obtain copies of educational records at reasonable cost if the fee would effectively deny you access to the records.$8hY`l w '7y  !SSSS  12. Receive a response from the school district to reasonable requests for explanations and interpretations of your child's records.&79xw );7Ȗ  !SSSS  13. Request amendment of your child's educational records if there is reasonable cause to believe 69 they are inac,ourate, misleading or(8Y +dM  SSSS  otherwise in violation of the privacy rights of your child. If the school district refuses this request, it shall notify you within areasonable time and advise you of the right to a hearing.*, Ozr *+N\oT 9 .;7 SSSS  14. Request mediation. or an impartial due process hearing related to decisions regarding your child's identification, evaluation. educationalprogram or placement. You and your child may take part in the hearing and have an attorney represent you.-/8rj -.N{ i 16Gw  !SSSS S] 15. Ask for payment of reasonable attorney fees if you are successful on your claim098$ S 3664 !SSSS ' 16. File a local grievance.27~~1  54ZLc !SSSS Zd The person in the school district who is responsible for Section 504 Part D Compliance is;45MG` Z 73RV˽ !SSSS  Name6?5T  9Uv  !SSSS  Telephone8к ;6.%<A !SSS   -:7 0:C <- Y 6U,wU M KM\KhC g!y;!SSSS *4INSTRUCTIONAL MODIFICATIONS/ACCOMMODATIONS"'8 * c#tEX}_!SSSS STUDENT PtE@_!SSSS DATE$F|\ RRF\  pG7JZSTUDENTOl9 l9  9pG/ JZ FillText70Pl9 l9  pG7JZ !SSSS > 9pG/ JZ !SSSS > O(I66X  (I X c#j" !SSSS mw Modifications needed to assure opportunity in regular, remedial, and supportive programs are specified below. $k~ m Cj !SSSS Assignments AB c#P !SSSS  Pacing$`O  U%pq FillText71Ql9 l9  2%O FillText72/Rl9 l9 U%pq !SSSS >2%O !SSSS >PWݘp ݘ wys SSSS ^h Extend time requirementsAllow breaks, vary activity oftenOmit assignments requiring copying in#y   C#D SSSS  Give directions in small, distinct stepsAllow copying from paper/bookUse written back-up for oral directionsLower difficulty level$= ( RVq FillText73%Sl9 l9   FillText74&Tl9 l9 !RVq !SSSS >" !SSSS >Wo  0 ) y}Hu !,|t  'U=p FillText953Ul9 l9  (2=O FillText106-Vl9 l9 %*U=p !SSSS >&+2=O !SSSS ># y q %'PWuo ( 2$^NV ' .2tON FillText1084&Wl9 l9 -/2tON !SSSS >., 1_z> !SSSS  timed situation0{@8 ,@8  5Uq FillText109?%Xl9 l9  6 FillText110=-Yl9 l9 37Uq !SSSS >48 !SSSS >5PWco2 60c2 <AT{ !SSSS  Shorten assignment ;wT. 7SSSS N\ School texts sent home for summer previewHome set of texts. for preview/review:Cay܎ )9<  >2Og FillText111F4Zl9 l9 =A2Og !SSSS > @RVqq FillText112H3[l9 l9 ?BRVqq !SSSS >>E @Wph :; y_ % EAXV( 7SSSS jt Reduce paper and pencil tasksRead directions to studentsGive oral cues or promptsRecord or type assignmentDP=  GN FillText113R=\l9 l9 FLN !SSSS > JRVq FillText114I?]l9 l9  KeOther1^H^l9 l9 HMRVq !SSSS >INe !SSSS >G0{J JWo K Qcxb  !SSSS  Other:DUE9/1 Oy80  S2O FillText115VF_l9 l9 RT2O !SSSS >S DZPph  W21O # FillText116\R`l9 l9 VX21O # !SSSS >W! 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Ed./relatedservices personnelBraille tests=+!]#4 $ +-Hr@ FillText87l9 l9 +-Hr@ !SSSS > z-{@ FillText88l9 l9 z-{@ !SSSS >K-P/F? |/)t? = 0U{C  K.xE !SSSS  Brailleq 0C bL 0awC  2<O FillText89l9 l9 2<O !SSSS >  z#=ҕO FillText90l9 l9  z#=ҕO !SSSS >>VN ]{>N =>UQ ̘=K*d 7SSSS 2B TDD (Telephone device for the deaf)Telescope (Far)D?94L4 ^ !SSSS > {ZLЖ4_ FillText92l9 l9 {ZLЖ4_ !SSSS >M] 5M] [|N~] M0*d !SSSS  Other:q{Nsa zN/ra  V<[qn FillText93l9 l9  <[nOther7l9 l9 V<[qn !SSSS ><[n !SSSS >W\ol \l  y[ s !SSSS  Other:_z\]Tp  _%< FillText94l9 l9 _%<@ [SSSS >&\  %} !SSSS  COMMENTS:]&Z| d#~;p ````   504@'p: \KhC ]Rx!SSSS School District5_U5u  JVSSSS ISSection 504 of the Rehabilitation Act (1973)INDIVIDUAL ACCOMMODATION PLAN҇T ,gMϯ    i Last_Name.l9 l9   i !SSSS > 38Birthday /l9 l9  j8Sex 0l9 l9 38 !SSSS > j8 !SSSS > G= '6 First_Name! 1l9 l9  '6 !SSSS > 75e  - )s 3z8 !SSSS Birthday4x   9 b !SSSS Last Name O8ap  jm0 !SSSS  Sex   'O6 !SSSS First NameY(  ewQ*State2 l9 l9  ewQ* !SSSS > ru*Zip43l9 l9 #ru* !SSSS > [z!fH*City!4l9 l9 $[z!fH* !SSSS >(g/( "(2d+ Home_Address 5 l9 l9 !%(2d+ !SSSS >#S) {G) "*b* )"j(yvB!SSSS State *( vB!SSSS City +t(vB!SSSS  Zip&uk8)'Y? 'M8)Y? (8)Y?  -['( C!SSSS Home Address,()Η@ 0C`M:`Phone1/46 l9 l9  1ݸ`M:` Fathers_Name2.7l9 l9 .6C`M:` !SSSS >/7ݸ`M:` !SSSS > 3%M*`Phone2H/8 l9 l9 28%M*` !SSSS > 5Y(N1a FillText96.9l9 l9 49Y(N1a !SSSS >0rDO^ 1/OC^ 3xmO <_ 5)kP0:` ;ٺ[H-v!SSSS Father's Name:+\+r =['[ibv!SSSS Mother's Name<($]Es ?G@][zw!SSSS Phone>Iw^yt  A|]^x!SSSS Phone@Ͻ _Au  D"!Ε Review_DateCH:l9 l9  E~<ΕBeginning_DateFB;l9 l9 BJ"!Ε !SSSS >CK~<Ε !SSSS > G^I# Ending_Date[C<l9 l9 FL^I# !SSSS > IOw Meeting_DateB2=l9 l9 HMOw !SSSS >D $Ε{ E۹,;{ G_Д I7U$ Pc!)D!SSSS Review Date Q)G-!SSSS Beginning DateN"` Oݸ`+  T;}!SSSS Meeting Date U[}'!SSSS Ending DateRhժ S<]պժ W(ғhKG!SSSS IAP:VW) J*  YY5g!SSSS #-Describe the nature of the concern:XZlf # \(6!SSSS  1. ]Zݸw FillText97dF>l9 l9 Z*@5 [^Zݸw@ SSSS >]F\ۻ% `LY sSSSS `jDescribe the handicap and nature of the handicap which substantially limits a major lifeactivity_cZUv X b(s>6!SSSS  2.aW)4 _`[5@V  eZ$x6 FillText98k[?l9 l9 dgZ$x6 !SSSS > JZW%wW%e[%$5 iYEe6`!SSSS FPDescribe how the handicap substantially affects a major life activity-hZF.d] F lY(F6`!SSSS  3. mZhG FillText99sd@l9 l9 j)LG?5m] knZhG@ SSSS >m[IyX pY1-!SSSS :DDescribe the reasonable accommodations that are necessary.oH[h, : rY(6!SSSS  4.q)?5ݤ  tZ-!\ FillText100~kAl9 l9 suZ-!\@ HSSSS >t[ؐ wJZX!SSSS U_Is the student going to receive all instruction in the regular education environment?v[ U y)6j!SSSS  5.xU*,5M  |LY(ew!SSSS  Yes }x(H!SSSS  NozZ_v {_  ]{$Yes1sBl9 l9  $3No1~Cl9 l9 ~]{$ !SSSS >$3 !SSSS >|   JZ Q$!SSSS YcIf no to item above, does appropriate documentation exist to justify removal from regular[   Y )5 6$!SSSS  6.U*l ?5!  *vB5!SSSS  NoM,J#Ak2  JZg5!SSSS education? Yes[2  F x/No2Dl9 l9 F x/ !SSSS > c=0 education_YesEl9 l9 c=0 !SSSS >lGv. ,y. Y>֏@Y!SSSS HRParents/student have been advised of Rights under Section 504 procedure?Z@#V H )?6Y!SSSS  7.U*V@?5wV  +Ppk!SSSS  No LYPwpk!SSSS  Yes~2RSh Z2RuSh  R eNo3Fl9 l9  {RKeYes2Gl9 l9 R e !SSSS >{RKe !SSSS >T> ~d [|T~d Y t|!SSSS 6@Persons serving on Individual Accommodation Plan Team:ZAu(b 6 (t=6(!SSSS  8.*u4  rDTable2rD4̼4̼ PU+ FillText101Hl9 l9  =3  FillText102Il9 l9 PU+ !SSSS >=3  !SSSS > ZiCC ChairpersonJl9 l9 ZiCC !SSSS >V͚N* #?͚  F\!A ZI2!SSSS Chairperson[޹ rDͼ44ͼ T+ FillText103Kl9 l9 T+ !SSSS > ZTB. FillText104Ll9 l9  =T . FillText105Ml9 l9 ZTB. !SSSS >=T . !SSSS >NV* F\ xA #? 4  (5F  !SSSS  8/97W) D  rF|_ FillText107Nl9 l9 rF|_ ```` >vK_{n^ eOpH```` Labe StAT 1P[M PM P5 P5/ P/  }$N=p ````   504(; \KhC1 ?ms  SSSS eo giving frequent short quizzes, not long examsallowing extra time for examreading test item to studentI8A]Q - w%BU  !SSSS " allowing open book exams yCWS  IQ`  wQe  !SSSS  giving exam orally ySFb  x_ms  !SSSS   giving take home tests`Γp ay`p  wspK  !SSSS $ using more objective items yq  w֓  !SSSS 7A allowing students to give test answers on tape recorder yak0 7 'kAdditional_aceommodation1?l9 l9 'k !SSSS >mI ew]  !SSSS $ Additional accommodations:x4  IK  !SSSS  ORGANIZATION:jJT# w|T  !SSSS 4> providing peer assistance with organizational skills y 4 ew(?  !SSSS ", assigning volunteer homework buddyxj=9 " ew<  !SSSS 6B allowing student to have an extra set of  books at homexn 6 w2d  !SSSS *4 sending daily/weekly progress reports home ybN * wS+  !SSSS FP developing a reward system for in-school work and home work completioncx? F !ew"  !SSSS 6@ providing student with a home work assignment notebook xAI  6 #wU2  !SSSS T^ teacher and parent initial home work assignment notebook (home-school communication)" y! T/ T %v.vB  !SSSS $ Additional accommodations;$x07 ?  <)< (HN+b  !SSSS  BEHAVIORS:'JPؒ_ *Z5 [z  ? SSSS ) allowing legitimate movement  )K[vk  ,v^=4*  SSSS ^h praising specific behaviorsusing self-monitoring strategiesgiving extra privileges and rewards+-xJ`p +1,cxo /Msnj  SSSS _i contracting with the studentincreasing the immediacy of rewardsimplementing time-out procedures.0ou .4/a0 #+-x`2/ # 3vU  !SSSS (2 keeping classroom rules simple and clear2xCT (.03 6vڜ  SSSS  making ''prudent use" of native consequencesallowing for short breaks between assignment&cueing students to stay on task (nonverbal signal)marking Student's correct answers, not his mistakesimplementing a classroom behavior management system57x=x  ,586xȭp -597=xS~" 25:8=x 359xi8 3 <vs,K  !SSSS 6@ allowing student time out of seat to run errands, etc.;xڏ 6 >vW\/  !SSSS IS ignoring inappropriate behaviors not drastically outside classroom limits=x   I @s=Additional_accomniodationFl9 l9 ?As= !SSSS >@ - Cu    !SSSS & Additional accommodations.BwE 9   EGY$B !SSSS  MEDICATION: DIW-E&= G8X`KName_of_PhysicianM?l9 l9 FH8X`K !SSSS >G>:W J Jc~<VP  !SSSS  Phone:Id=M  Lgv<P  !SSSS  Name of Physician:Kw6>@N  PHqZ Medications1QFl9 l9  O9FֹP!SSSS  ING8N MSHqZ !SSSS > RH[ Schedule1ZMl9 l9 QTH[ !SSSS >PIoY R3sJ. BZ `K`K Wv L_  !SSSS  Medication(s):VewlMx;]  YU{LB`  !SSSS  Schedule:X|N] [Wpj Medications2\Ql9 l9 Z^Wpj !SSSS > ]Xuk Schedule2dZl9 l9 \_Xuk !SSSS >[Yloxi ]ߵSZ "j av[vo  !SSSS  Medication(s):`ewL]$m  c{\p  !SSSS  Schedule:b|J^Cn fS)}g]WzMonitoring_of_Medicationse\l9 l9  g}gxWzdailyhdl9 l9 djS)}g]Wz !SSSS >ek}gxWz !SSSS > i&hC/{weeklyuel9 l9 hl&hC/{ !SSSS >f*5iB\y g܎5i%y ii-y n[j`w~  !SSSS  dailym@].lv{  pvl  !SSSS & Monitoring of Medication(s):oewm/P}  r%sl.K  !SSSS  weeklyqxm}  tE.mF  !SSSS  as needed basiss/nN~  vL]w7Administered_Byhl9 l9 uwL]w7 !SSSS >vy/  yuS|+  !SSSS  Administered By:xw}X  {GiA  !SSSS ! SPECIAL CONSIDERATIONS:znH̜k  }  5SSSS  altering bus driversuggesting agency involvementproviding group/ individual counseling providing social skills  group experiences|OXa'  iuhIV  SSSS GQ suggesting parenting program(s)monitoring student closely on field trip~wм ~vH (|}~L  v PU  !SSSS -7 in-servicing teacher(s) on child's disabilityewlS; -|Od &|O ) uJ  SSSS hr developing intervention strategies for transitional periods(e.g., cafeteria, physical education, recess)gvJ^ ;vY - pG/  FillText65ul9 l9 pG/ @ 7xCSSSS >H   rF  !SSSS  Comments:Ga0  Gq. K)This_form_indicates_the_wl9 l9 Gq. K) !SSSS >nH) ' rFO'-v> !SSSS  This form indicates the ways to adjust or modify instruction to best meet the needs  of  this student. I have read these accommodationsG( ; LD';N  !SSSS <F and will attempt to comply with this 504 Accommodation Plan.E<ĚYL < uB!SSSS  1vZg  K~!SSSS  1rą  NV!m1l9 l9 NV!m !SSSS > L. k6l9 l9  L. k !SSSS >WK \MI  F Na  !SSSS   5lGL  ;މD  !SSSS   6<AB  T  !SSSS  Teacher SignatureNVv=E  bJ  !SSSS  Teacher SignatureK  V3! 7l9 l9 V3!  !SSSS > Uwb4l9 l9 Uwb !SSSS >W L۵ 8l9 l9  L۵  !SSSS >LW@% \M3 b F~MV  !SSSS   8 E~bNV  !SSSS   7lGbL rFM  ;'pC  !SSSS   9<BY  T`<8  !SSSS  Teacher SignatureU  T   !SSSS  Teacher SignatureRVl?;  bJI  !SSSS  Teacher SignatureK  A   !SSSS  (Page 2 of 2)P 75">A !SSS  -+9.<A  Rfermn CheckBox39l9 l9 Rfermn10 Rftrh} CheckBox40l9 l9 Rftrh}10 Rfrk CheckBox41l9 l9 Rfrk10 Rfr CheckBox42l9 l9 Rfr10 Rfrj CheckBox43l9 l9 Rfrj10 Rfr CheckBox44l9 l9 Rfr10 Rfr CheckBox45l9 l9 Rfr10 Rfr CheckBox46l9 l9 Rfr10 Rfr CheckBox47 l9 l9 Rfr10 HF3űPEp ```` TEST TAKING:G3eC dhGtP CheckBox48 l9 l9 dhGtP10 dhVt_ CheckBox74 l9 l9 dhVt_10 dhfto CheckBox75 l9 l9 dhfto10 dh utW~ CheckBox76 l9 l9 dh utW~10 dhtގ CheckBox77l9 l9 dhtގ10 dht^ CheckBox78l9 l9 dht^10 cht CheckBox79l9 l9 cht10 cht CheckBox80l9 l9 cht10 cht CheckBox81l9 l9 cht10 chGt CheckBox82l9 l9 chGt10 cht CheckBox83l9 l9 cht10 chNt CheckBox84l9 l9 chNt10 chR$t- CheckBox49l9 l9 chR$t-10 chD2t; CheckBox50l9 l9 chD2t;10 *rDM CheckBox51l9 l9 *rDM10 *mS\ CheckBox52l9 l9 *mS\10 *pcl CheckBox53l9 l9 *pcl10 !_;i CheckBox54l9 l9 !_;i10 !rQ{ CheckBox55l9 l9 !rQ{10 !T CheckBox56l9 l9 !T10 !~̙ CheckBox57l9 l9 !~̙10 GUSf FillText66l9 l9 GUSf !SSSS >VUue EXMl  !SSSS   2eFGZKj  7JU h FillText67 l9 l9 7JU h !SSSS >KWg :ZAn  !SSSS   3U;S\@"l  TTg FillText68 !l9 l9  TTg !SSSS > IVVvxf DYLm  !SSSS   2 FJ[_Kk  Tg FillText69"l9 l9  Tg !SSSS >GVEt DL[  !SSSS   5F]K  S 6  !SSSS  Teacher SignatureTp?  UykGQ  !SSSS  Teacher SignatureWl|  TtkL  !SSSS  Teacher SignatureNVl=|  Kdj<~  !SSSS  Teacher SignatureQMk@{  Rf3r CheckBox58 #l9 l9 Rf3r10 Rf6r  CheckBox59$l9 l9 Rf6r 10 Rfr CheckBox60 %l9 l9 Rfr10 !JeqN CheckBox61"&l9 l9  JeqN10 #Jeq CheckBox62$ 'l9 l9 "Jeq10 %Jeq CheckBox63&"(l9 l9 $Jeq10 'Je qn CheckBox64($)l9 l9 &Je qn10 )p CheckBox65*&*l9 l9 (p10 +c CheckBox66,(+l9 l9 *c10 -f CheckBox67.*,l9 l9 ,f10 / CheckBox68,-l9 l9 .10 1)!:p ````   5040^%g8       "#$%&'()+,-./0123456789:;=>?@ABCDEFGHIJKLNOPQRSTUVWXYZ[]^_`abcdefghijklmnopqrstuvwxyz{|}\KhC P)P. !SSSS  Banner County School-Rg+  P2vD  !SSSS   504 ACCOMMODATION PLANR3F-B   OM*c  !SSSS  Date:/Q(`   PZRt2f  !SSSS  Name:\QSrc   oW  !SSSS  Date of  Birth: O o  !SSSS  Parent's Name:  pVR  Qp(R   k֏  !SSSS  Grade: slC  h%a  !SSSS  Teacher:iғ   Px_  !SSSS  School:\Qv  PEf !  !SSSS '1 1. Describe the nature of that concern:R ' 9a FillText20+l9 l9 9a@ 9pSSSS >bd N>  !SSSS EO 2- Describe the basis for the determination of a disability (if any): Pw E  O,L@  !SSSS <F 3. Describe how the disability affects a major life activity^PZ.)> <  Nj~  !SSSS  4. The Child Study Team has reviewed the files of the above named student and concludes that he!6he meets the classification as a`O2l| eyi  SSSS qualified individual with a disability under Section 504 of the Rehabilitation Act of 1973. In accordance with the Section 504 guidelines,the school has agreed to make reasonable accommodations and address the student's individual needs by: f{ f4Ú f "Mͨ4  !SSSS ' PHYSICAL ARRANGEMENT OF ROOM:!N0e3  $| "b  !SSSS * seating student near the teacher#Y}  &|w{   SSSS p seating  student near a positive role modelstanding near the student when giving directions or presenting lessons%'Y}"U *%&Y}$ F )]{*   7SSSS p| avoiding distracting stimuli (air conditioner, high traffic area, etc,)increasing the distance between the  desks(*|\ G()}3TS+ ) ,IC#Additional_commodationsDl9 l9 +-IC# !SSSS >,o /{C  !SSSS ' Additional  accommodations.[| e  1 NW%/9  !SSSS  LESSON PRESENTATION:0`O&6  3Y4hW  7SSSS FP providing written outline/Notesallowing student to tape record lessons26F6F  5{75!w  SSSS is pairing students to check workwriting key points on the boardproviding peer tutoringproviding visual aids47[|6iF 23}ELU '485[|%FU 4;7[|Ue  :U  SSSS l| having child review key points orallyteaching through malti-sensory modesusing computer-assisted instruction9<WXWӻ'g %48[|;e. u 9?:Wfv $ >zs  !SSSS # providing peer note taker=|u 9<Wnv@= # A zE  SSSS  making sure directions are understoodinclude a Variety of activities during each lessonbreaking longer presentations into shorter segments@B[|Aw %@CA[|3_x 2@B]{ 3 EEtAdditional_accommodationsU+l9 l9 DFEt !SSSS >EqR! H z5  !SSSS $ Additional accommodations:G]{. h  Jye =  !SSSS % simplify complex directionsI{   LcxE2v  SSSS  handing worksheets out one at a timereducing the reading level of the assignmentsrequiring fewer correct responses to achieve gradeallowing student to tape record assigaments/homeworkproviding a structured routine in written formproviding study skills  training/learning strategiesgiving frequent short quizzes and avoiding long testsshortening assignments; breaking Work  into smaller segmentsallowing typewritten or computer printed assignmentsKMz+=w $KNL{3d# -KOMz"2 2KPN zI2ДB 4KQO_zA*hQ .KRP zNua 3KSQy`p 5KTR zup߷D ;KSyϏ 4 VIaAdditional_aceommodations^Dl9 l9 UWIa !SSSS >V!? YwА8   !SSSS $ Additional accommodations,X y U  [Af  !SSSS  (Page 1 of 2)ZCs ]8;/!>A  !SSS   -\90<m@  _UvMr` FillText47aUl9 l9 ^`UvMr` ```` >_wO^_ bm+Kn@_ FillText48d^l9 l9 acm+Kn@_ ```` >b,N] e?kf FillText59gal9 l9 df?kf ```` >ecn2~ hw_k FillText60jdl9 l9 giw_k ```` >h`cnq2~ k@{9`Q FillText61mgl9 l9 jl@{9`Q ```` >k|čP nBTe FillText62pjl9 l9 moBTe ```` >n6R qW,  FillText63sml9 l9 prW,  ```` >q taz]!# FillText64vpl9 l9 suaz]!#@ 9D[SSSS >tb%  w^i*vb FillText58{sl9 l9 vx^i*vb@ 9D[SSSS >w`,#; z(y3  !SSSS #- giving extra time to complete tasksy{zY2 # |lx CheckBox28}vl9 l9 {lx10 ~lx CheckBox29{l9 l9 }lx10 lx CheckBox30}l9 l9 lx10 lx CheckBox31l9 l9 lx10 l#xq CheckBox32l9 l9 l#xq10 l xd CheckBox33l9 l9 l xd10 lJ;xD CheckBox34l9 l9 lJ;xD10 lEJxS CheckBox35l9 l9 lEJxS10 lHZxc CheckBox36l9 l9 lHZxc10 lhxr CheckBox37l9 l9 lhxr10 lGyx CheckBox38l9 l9 lGyx10 lLjx CheckBox12l9 l9 lLjx10 l˘x CheckBox13l9 l9 l˘x10 lx  CheckBox14l9 l9 lx 10 lx CheckBox15l9 l9 lx10 iWv] CheckBox16l9 l9 iWv]10 i WvX CheckBox17l9 l9 i WvX10 i Wv[ CheckBox18l9 l9 i Wv[10 iWv! CheckBox19l9 l9 iWv!10 i )WvZ2 CheckBox20l9 l9 i )WvZ210 i8WvA CheckBox21l9 l9 i8WvA10 iHWvQ CheckBox22l9 l9 iHWvQ10 iVWv_ CheckBox23l9 l9 iVWv_10 i~eWvn CheckBox24l9 l9 i~eWvn10 i vWv[ CheckBox25l9 l9 i vWv[10 iWvM CheckBox26l9 l9 iWvM10 iWvI CheckBox27l9 l9 iWvI10 M<]E CheckBox69l9 l9 M<]E10 HK]T CheckBox70l9 l9 HK]T10 K[]d CheckBox71l9 l9 K[]d10 i]s CheckBox72l9 l9 i]s10 Jz] CheckBox73l9 l9 Jz]10 M \ ````  ASSIGNMENTS/WORKSHEETScN  L!&9p ````   504$X8 \KhC; ,ґ N'!SSSS .8Notice and Consent for Reevaluation Evaluation.zJ . aUiu  !SSSS #- Give Consent for Initial EvaluationbTr # oJ  !SSSS hr I have received a copy of the Notice of this proposed reevaluation, understand the content of the Notice ّ h E)1I_have_received_a_copy_ofl9 l9 E)110 3  SSSS  and give consent for the multidisciplinary evaluation specified in this Notice. I understand this consent isvoluntary and may be revoked at any time. E^e l vpE ) 'I  !SSSS *4 Do Not Give Consent for Initial Evaluation EY * =  !SSSS ak I have received a copy of the Notice of this proposed reevaluation, understand the content of theJ a }I_have_received_a_copy_o1l9 l9 }10 s  5SSSS  Notice and do not give consent for the multidisciplinary evaluation specified in the Notice. The reason fornot giving consent to the evaluation is:L k FZ ( Q/*du FillText26l9 l9 Q/*du@ SSSS >31׽A Y{3Parent_Signaturel9 l9 Y{3 !SSSS > {$Date.l9 l9 {$ !SSSS >} e}м4 U}-  !SSSS  Parent Signature:E~2  !}֑  !SSSS  Date a<0  #Ԕp  !SSSS   -"ܐʿ  %=w  !SSSS  Student:$C  'IE0!  !SSSS  School:&? .{  *vk  !SSSS  Grade: +`  !SSSS  DOB:(awU$ )Uw$  -?  !SSSS   3,Fq  /7NE  FillText451l9 l9 [Childs_Name].07NE ```` >/?  2/w_ FillText534.l9 l9 [School_District]13/w_```` >2$1Yv  53 FillText5471l9 l9 [Grade Bottom]463```` >5x5I 8H_@T FillText554l9 l9 [DOB]79H_@T```` >8N>  ;5$=p ````   SPED:Z(s; \KhC4 /'5D!SSSS  .0Q(64A  C.VzL!SSSS .8Notice and Consent for Reevaluation EvaluationA0yI . {l>`֓  SSSS  Parents of children with disabilities have rights which are protected under the procedural safeguards of theIndividuals with Disabilities Act (IDEA). A copy of your parental rights is enclosed. If you have anyquestions regarding this notice or your rights you may contact:ma3pq l"nqaP ewnan0 ? t  !SSSS  Name: !"  2d׻  !SSSS  Phone Number: evE l   !SSSS  Additional Resources "nl;  lsb"  SSSS  You may contact any of the following resources to help you understand the federal and state for educatingchildren with disabilities and parental rights granted by those laws. An explanation of your rights will beprovided at no cost by any of the following organizations::"n5 ina0 k"nE ; lK-f#A  !SSSS =G Nebraska Parent Training Center: 800-281-8520 or 402-346-0525"n.}> = l=Q  !SSSS 8B Nebraska Advocacy Services: 800-422-6091 or 402-474-3183"n8?O 8 $mKq#  !SSSS  Student:wn}  uzw   !SSSS  School:&   \Hw   !SSSS  Grade:>^   =w   !SSSS  DOB:   tk  !SSSS   2۷"  "3" G %k`߲  FillText43'!l9 l9 $&k`߲  ```` >%aq (Mv  FillText44*$l9 l9 [Childs_Name]')Mv ```` >(p  +Zv  FillText50-'l9 l9 [School_District]*,Zv ```` >+p]Y  .Ń^v  FillText510*l9 l9 [Grade Bottom]-/Ń^v ```` >.%p  1W!v  FillText52-l9 l9 [DOB]02W!v ```` >1p  4)&P>p ````   SPED3)5= \KhCu -؎`O'!SSSS .8Notice and Consent for Reevaluation EvaluationjX/K . 18_rDate_of_Notice l9 l9 18_r !SSSS > 8>`CsSchool_Districtl9 l9 8>`Cs !SSSS >9aXpq aq M:bv  !SSSS  School District: :b5v  !SSSS  Date of Notice: c@ls  >c94ls  6Aؒ Parents_Namel9 l9  5ؒ Childs_Name l9 l9 [Chi Ids Name] 6Aؒ !SSSS >5ؒ !SSSS > 6 <  !SSSS  Parent's Name: 2  !SSSS  Child's Name:K ّ  ?1ّ igtC FillText15?l9 l9 igtC !SSSS >I!s v  !SSSS <F proposes to conduct a multidisciplinary reevaluation of yourawp < MEH  !SSSS >H child. The district proposes to reevaluate your child because:w >   !SSSS EO 1. Explanation of why the district proposes to reevaluate your child:xYG E ! V4  !SSSS '1 2. Any options the district considered: "U1 ' #o  !SSSS /9 3. Reasons why the above options were rejected:"Ip1N / %t  !SSSS cm 4. This proposal is based on the evaluation procedures, tests, records, or reports described below:$]ο c 'غ  !SSSS 9C 5. Any other factors which are relevant to this proposal:&  9 )K'=v`  SSSS w 6. The estimated amount of time for completing the multidisciplinary evaluation and making theverification decision is:(*>#YN ^()jND9^  ,|  SSSS y Following is a description of the components of the multidisciplinary reevaluation which the districtproposes to conduct:+-_~I. e+,IA_  /=r˿  !SSSS  Academic.V %  OIAҕ CheckBox11P3l9 l9  2e  !SSSS  Intellectual19L NIҕg CheckBox1006l9 l9  5 /a  !SSSS  Perceptual and Motor4 .  MI ҕ  CheckBox939l9 l9  8;):.N  !SSSS  Social and Emotional7;-[K  LIz<'RP CheckBox86<l9 l9  ;;ui0M}  !SSSS  Speech and Language:jG/z  KIqk'I CheckBox79?l9 l9  >;kC  !SSSS  Other=Ι  JI' CheckBox6<l9 l9  AG  !SSSS  Student:@Ey  C-  !SSSS  School:BSM,"  Fisq  !SSSS  Grade: Gxq  !SSSS  DOB:DtȘ Eb&  IX  !SSSS   1HIL ?I'333O10<Iqk'I333O109Iz<'RP333O106I ҕ 333O103Iҕg333O100IAҕ333O10 QV^8$ FillText32S0l9 l9 PRV^8$ o```` >Q Tc$'k FillText33VPl9 l9 SUc$'k p```` >Tb%5 Ws FillText34YSl9 l9 VXs ```` >WtL ZN FillText36\Vl9 l9 Y[N ```` >Z ] ? FillText37_Yl9 l9 \^ ? 3```` >]M~ `u\~ FillText38b\l9 l9 _au\~ ```` >`՘^m cf FillText41e_l9 l9 [Childs_Name]bdf```` >cs*l f0+q FillText46hbl9 l9 [School_District]eg0+q```` >f,[p i$[ Grade Bottomkel9 l9 hj$[```` >ia l/>DOBnhl9 l9 km/>```` >lv6A. ouL%[ FillText49qkl9 l9 npuL%[```` >ovzMź Z r_u FillText56nl9 l9 qs_u ```` >rի; u_z*Bp ````   SPEDt).A \KhCcz F)@Y!SSSS 1. _ !JJJJ OYThe aforementioned interventions or accommodations (see page 2 question 5) has:dG|W `PH O  X< !SSSS  Please enter new information and / or previous test data not discussed at the first meeting. For example: critique the current prescribed intervention strategies the SAT implemented to address these problems.2`YP0H ] <OK!SSSS 2.=)NJ  WP>U FillText16el9 l9  WP>U@ SSSS > -Y=L FoOO !SSSS % do not write below this line  ^ž  Y-Y !SSSS Wa Describe NEW intervention strategies the SAT plans implement to address these problems.P[@/28B W |G+ZFF!SSSS 3.H$-WYEC  7RE: FillText17 fl9 l9 7RE:@ SSSS >SYD1(T C-W`!SSSS 4.QE>U_  De>P FillText18gl9 l9 De>P@ SSSS >Eo  /K/ ' Lg ```` Page 3h  ړw^qo FillText27!pl9 l9 [Chi Ids Name] ړw^qo ```` >:B^n "%V[# FillText29&ql9 l9 !#%V[#@ SSSS >"xWi[Z8 %-'V !SSSS SAT members in attendance$(4  '+0! FillText30/!rl9 l9 &(+0!@ SSSS >'Bi *~Ib` o ```` Student:)J^n  ,k 6!R```` SAT Follow-up Review+ -T C  .~IZw  ```` Date:-Ju  0orR FillText31j&sl9 l9 /1orR ```` >0{pyrH 3`YH0@& Z2`Y@&089  5Tf( ```` JV Following the above described intervention techniques, the SAT recommends: 4V} J 79@RWK!SSSS Date:6J;U9  F ;BxVUp!SSSS 5. <̧!SSSS Signature9cCWATm :[ >o4]Ww!SSSS SAT MEMBERS=;q^7Vt @̧ѵ!SSSS Signature?$[ B̧!SSSS SignatureAJ[ ɎgWg ڐh @SS <` ;W I9]$```` DateHW;[  K8s\ݾ```` DateJװ}  M@Sd```` DateL]  |kW1W Zg- l2 R!SSSS SignatureQ-i Tʵ!SSSS SignatureS-i V!SSSS SignatureU-Di ZfZ ze g [:#^J```` DateZ_<D\  ]#*```` Date\_$ï  _k ```` ((had some positive effect on the behavior^=y ( aԮj ```` a.`N<B  ceV| ```` !!had little effect on the behaviorbz ! eV| ```` had no effect on the behaviordzX  gv  ```` b.fNB  i! ```` c.hNBW  kB_ CheckBox2l/{l9 l9 jB_10 mB CheckBox3nj|l9 l9 lB10 oB* CheckBox4rl}l9 l9 nB*10 q5//@```` No.p2).~?  sE9v19q*H FillText57nl9 l9 rtE9v19q*H ```` >s:T3oLF vV&z>pH```` Labe StATuw<1Yf uxv<fA uyw<Aе uzx<е* uy<*b= \KhCm Lg_9!SSSS 3. ~gx9!SSSS ::Describe what you have done to help the student cope with  Ni^8 Ui%8 : L{e!SSSS these problems  NC}Id   L FillText40 l9 l9  L@ !SSSS >]Mmf r!SSSS 3=Background information and / or previous test data  Tsm 3 KV_!SSSS 4. ?M]  Npo FillText171!l9 l9 Npo@ SSSS >jOe FoOO !SSSS % do not write below this line ^ž  x*GHE!SSSS ??Describe the intervention strategies the SAT plans to implementz&,GB ? |G+ZFF!SSSS 5.H$-WYEC  %H?Z!SSSS to address these problems.xI@BW  UAEY FillText172."l9 l9 UAEY@  SSSS >BxDOGT !C-W`!SSSS 6. 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