Support for Accommodation Request
To be used in consideration of post-secondary academic accommodation requests.
Student:
1.
_
ELIGIBILITY/DIAGNOSTIC STATEMENT:
• Date of original eligibility: 3/12/2005
• Most recent reevaluation date: 3/12/2014
• Current goal area(s) of concern: Reading-oral reading fluency
Writing-correct word sequences
2.
FORMAL DIAGNOSIS and DATE (when available):
Eligible individual in the area of reading fluency and written language - March, 2005.
Eligible individual for speech and language services – March, 2003.
.
3.
What is the BASIS OF DETERMINATION for current services? (Provide available formal/informal diagnostic
assessment information and recent evaluation results; include performance levels with/without
accommodations.)
Academic Assessments:
Iowa Assessments:
Accommodations: Given in a quiet setting. Test read aloud when appropriate. Extended time given, if
necessary. Breaks are given for 5-10 minutes due to anxiety attacks.
Reading: 257 NSS/Peer proficiency range 246 - 312 NSS
Written Expression: 237 NSS/Peer proficiency range 242 – 316 NSS
Mathematics Total: 287 NSS/Peer proficiency range 249-310 NSS
Jamestown Reader Probe
Accommodations: 1:1 with teacher
___________reads at a median rate of 89 correct words per minute (CWPM). Typical grade peers read
between 126-156 CWPM, using GWAEA winter norms.
Writing Probe
Accommodations: None
__________ writes a median rate of 56 total words (TWW) with 57 correct word sequences (CWS).
Typical grade peers write between 62-72 TWW with 63-74 CWS, using GWAEA winter norms.
AAIMS Math Probe
Accommodations: None
_____________ scored 13 correct problems. Typical peers score 17-38 correct problems.
The IEP team discussed adding a math goal at her last IEP meeting, but decided against it due to her
scores on the Iowa Assessment as well as her grade in her current math class.
4.
Describe the CURRENT FUNCTIONAL IMPACT of the disability:
___________ is able to progress through the general education curriculum at same pace as peers in
the all areas with the exception of language arts, reading and written language. __________ needs
content material read to her or through other auditory methods (text to speech on iPad, total class
reading, read to her by other students, resource teacher or classroom para educator)._________ also
needs assistance with organizing lengthy writing assignment, generating ideas, and checking grammar.
5.
RESPONSE TO specially designed INSTRUCTIONAL INTERVENTION:
_________ is more responsive to the specially designed instruction in reading with a demonstrated ability to
implement strategies learned to content materials than the specially designed instruction in writing.
In the area of reading, __________ has been instructed in research based decoding strategies using current,
popular, adolescent literature. Direct instruction is provided in the strategy, followed by teacher modeling, group and
individual practice with word lists supporting the strategy, immediate feedback given, and then application in the
chosen literature book. Fiction and non-fiction books are used. _________ is attentive to the direct instruction,
maintains eye- contact, and often volunteers to demonstrate the strategy to peers during whole group practice. She
responds well to feedback from teachers as well as peers. When attempting to implement the strategy using the
selected resource class literature text, as well as when she is reading general education course textbooks, she
always asks if she can try to decode the word for herself rather than have someone tell her the word. She remains
positive about her performance on her reading progress monitoring probes no matter what her correct words per
minute was for the day.
In the area of writing, ____________ is less receptive to instruction as evident by her lack of participation orally or in
written form. She begins instructional time sitting up straight in the chair with all her materials (paper, writing utensils,
graphic organizers) and eyes towards instruction, but by the end of the direct instructional time, she is slouched
down in the chair, no eye-contact or responses to questions asked by the teacher and materials are scattered
around her work space. She seldom generates a topic for writing. This is similar to the behavior that is seen in the
general education classroom when writing is assigned. She says that she does feel that graphic organizers help her
with writing tasks, but observation does not support this as an independent skill in either the resource class or
general education setting. She can assist a teacher or para educator in completing a graphic organizer when given a
topic and then writing a rough draft from it. She does share her rough draft with an adult when it is completed to get
feedback and corrections which she cannot identify on her own. She does respond and incorporate suggestions
about her writing when given to her.
6.
Expected PROGRESSION or STABILITY of the disability:
If direct instruction in reading using similar methodology and strategy as is currently being utilized were to
be continued, continued improvement in reading skills could occur. It is hoped that _________’s current
reading skills and abilities would not regress, given her active participation in instruction, practice and
application, but this is not a certainty.
In the area of written language, ___________’s passive response to direct instruction in writing skills as
well as her minimal progress, as evident by progress monitoring data, in the number of total words written
and correct word sequence during since her eligibility, it can be concluded that her disability in this area is
stable.
7.
HISTORY of ACCOMMODATIONS:
• 9th Grade:
Vocabulary and spelling word banks provided for writing assignments.
No point or grade deduction for spelling or grammatical errors on writing assignments.
Testing should be in a quiet setting, free from distractions
Breaks in all classes when needed.
Preferential seating away from windows, distracting peers, and close to instruction.
• 10th Grade:
Vocabulary word banks provided for any writing assignments.
Extended time on vocabulary and spelling assessments and written assignments.
A suitable testing environment in a quiet setting, free from distractions with frequent breaks.
One, 10 minute break from general education class, when needed.
Preferential seating away from windows, distracting peers, and close to instruction
• 11th Grade:
Vocabulary word bank provided for writing assignments in content areas with content specific terminology.
Extended time on vocabulary and spelling assessments and written assignments. This extension will not
exceed 2 days past the original administration date.
A suitable testing environment will be provided, as needed.
One, 5-10 minute break from general education class, when needed.
Preferential seating away from windows, distracting peers, and close to instruction.
• 12th Grade:
Extended time on written assignments. This extension will be negotiated between ________ and the teacher.
A suitable testing environment will be provided, when________ requests it.
One, 5 minute break from general education class, when requested.
Preferential seating away from windows, distracting peers, and close to instruction.
8.
9.
SUGGESTED ACCOMMODATIONS for post-secondary experiences:
When reading is required, _________would benefit from audio books or in some form oral form so that she
can get the information at a pace similar to that of her peers. She should be allowed to highlight key terms, ideas,
and concepts in the textbooks or to use a sticky note system (write questions or links to learning in her own words on
sticky notes and place them in the text.) Peer tutoring or learning would also be helpful to ensure that she is gaining
key points from the reading.
Graphic organizers should continue to be used for lengthy writing assignments. Though these have not been
observed as a ‘successful’ or ‘useful’ tool, __________ says that it is and it is a tool that she has had instruction and
knowledge. If there is a class with specific vocabulary that is needed to be mastered and used in assessment, it
would be helpful to have these specific words on word cards and to allow ________to have access to them when
taking the assessment. _______ might benefit from assistive technology in this area. ________ has had limited
opportunity to use assistive technology in high school so it is unclear as to how successful this might be. If there is an
assistive technology class or study group, ________should be encouraged to participate to see if this is a viable
alternative.
RECOMMENDATIONS for (include accommodations, linkages to adult services, other support):
• Living:
___________ has a driver's license and knows how to get around her community successfully.
She knows how to cook and prepare food for herself. She can perform everyday household
tasks such as cleaning, cooking, and laundry. ________ knows how to take care of her own
money and knows how to create a budget. She has good hygiene skills and knows how to take
over the counter medications when necessary. She independently goes to the nurse when she
is feeling ill. She might need assistance when reading rental agreements, contracts, credit card
applications or other legal documents. Her parents, other trusted adult, Vocational Rehabilitation
counselor, or local Legal Aid might be beneficial support to her in this area.
• Working:
______ will need assistance in reading contracts, as mentioned above, as well as any other
material that might be required once in a job for skills maintenance or advancement. A Vocational
Rehabilitation Counselor should be considered as a primary source for assistance in this area until
a trusted co-worker or other support person can be identified and established. She will need
assistance in writing a resume, vita and in completion of any documents that are needed in
applying for a job. Once again, a Vocational Rehabilitation Counselor, university/college Support
Services office personnel and/or parents could be identified and considered as support with these
tasks.
10. ADULT/COMMUNITY Contacts:
Name/Position: Susan Goodfellow
---------------------------------------
Agency: Vocational Rehabilitation
Status: Active
Phone:(319) 123-4567
11. SIGNATURE of Credentialed Professional:
Faith Inu
Special Education Consultant
Name of person completing this form (print)
Title/Role
(319)987-6543
Signature
Phone
Area Education Agency
Agency/Organization
6/1/2014
Date
12. AUTHORIZATION for RELEASE OF INFORMATION:I hereby authorize the release of information summarized
in this Support for Accommodation Request for the purpose of evaluating eligibility and accommodation
requests.
Name of student {printed)
Student's signature
Date
13. STUDENT WRITTEN RESPONSE-Statement of Goals (please write your statement of at least 3-5 sentences
describing what you hope to accomplish in the next year.)