Ed 1109.04(b)(3) Yes Yes Provide the written evidence of the IEP documenting implementation No No with regards to program modifications. NA— NA—no program Evidence may include the student’s schedule, progress reports, etc. no program modifications in IEP. modifications If N/A, Question 48(d) must also be N/A because there is no statement of in IEP. program modifications in the IEP. Ed 1109.04(b)(3) Yes Yes Provide the written evidence documenting implementation of the IEP No No with regards to supports for school personnel. NA— NA—no supports for Provide the evidence that supports for personnel have been implemented. no supports personnel in IEP Examples of evidence may include detailed notes specifically referencing the for personnel supports that have been provided for school personnel, logs that document in IEP the supports being provided, etc. If N/A, Question 48(e) must also be N/A because there is no statement of supports for personnel in the IEP. N. Definition of Individualized Education Program (Justification for Non-Participation) 34 CFR 300.320(a)(5); Ed 1109.01(a)(1) Yes Yes Provide the evidence of an explanation of the extent, if any, to which the No No child will not participate with nondisabled children in the regular class and in the activities described in the supports and services section of the IEP. Provide the page number of the currently agreed upon IEP where this explanation is located. Explanation must support why removal from regular class is critical to the students program. For preschool children, the regular class may include a Head Start classroom, childcare classroom, public or private preschool or kindergarten or other regular early childhood setting. It does not include preschool special education programs.
Ed 1109.04(b)(3) Provide the written evidence documenting implementation of the IEP with regards to program modifications. Evidence may include the student’s schedule, progress reports, etc. If N/A, Question 48(d) must also be N/A because there is no statement of program modifications in the IEP. Yes No NA— no program modifications in IEP. Yes No NA—no program modifications in IEP. Ed 1109.04(b)(3) Provide the written evidence documenting implementation of the IEP with regards to supports for school personnel. Provide the evidence that supports for personnel have been implemented. Examples of evidence may include detailed notes specifically referencing the supports that have been provided for school personnel, logs that document the supports being provided, etc. If N/A, Question 48(e) must also be N/A because there is no statement of supports for personnel in the IEP. Yes No NA— no supports for personnel in IEP Yes No NA—no supports for personnel in IEP N. Definition of Individualized Education Program (Justification for Non-Participation) 34 CFR 300.320(a)(5); Ed 1109.01(a)(1) Provide the evidence of an explanation of the extent, if any, to which the child will not participate with nondisabled children in the regular class and in the activities described in the supports and services section of the IEP. Provide the page number of the currently agreed upon IEP where this explanation is located. Explanation must support why removal from regular class is critical to the students program. For preschool children, the regular class may include a Head Start classroom, childcare classroom, public or private preschool or kindergarten or other regular early childhood setting. It does not include preschool special education programs. Yes No Yes No
2016_2017_self_assessment_form_fillable.docx