APPLICATION FOR SUPPORT UNDER CRITERIA "E"

SEVERE EMOTIONAL/BEHAVIOR DISORDER

    Eligibility Criteria Reviewed

Description of Alternate Course

Students Name_____________________________           School________________________

Date of Birth_______________________          Grade_________________________________

INDIVIDUAL SUPPORT SERVICES PLANNING TEAM CONFIRMATION

We, the undersigned have been involved in the assessment and individual support services planning

process for ___________________________________ (Child's Name)  and verify the accuracy

of the information provided in this documentation for support under Teacher Staffing Regulation 10.1

E Severe Emotional/Behavior Disorder. We have concluded that existing resources are not sufficient

to meet this student's needs. We understand that this service will not remain in effect throughout

the students school career, and that it is provided to supplement the services of the non categorical

special education teacher.

______________________          _________________________
Date                                                           Guidance Counselor

____________________________          ________________________________
Parent                                                         Principal

____________________________         ________________________________
Student                                                       Teacher

____________________________          ________________________________
Psychologist                                                Other

____________________________          ________________________________
Other                                                           Other

This letter must accompany all applications for categorical teaching units

As principal of this school I acknowledge, as I sign my initials before each statement, that the following conditions exist in this school and the utilization of Student Support Services personnel will be monitored by the Division of Student Support Services:

_____1. Special education teachers are providing services on a prioritized basis in Pathways 5, 4,3               and 2 respectively.

_____2. Special education teachers are not teaching prescribed courses (high school) or programs               (K-9) except under the following circumstances:

            _____the course/curriculum is being offered only to students with identified 
           exceptionalities, as articulated in Appendix A of the Transitional Student
           Support Services Policy.

            _____the group size is kept to a maximum of ten (10) students.

_____3. Special education teachers are not used as remedial teachers, other than for students with               diagnosed exceptionalities.

_____4. There is not sufficient time in the schedules of the Special Education teachers
            (non categorical) to meet the needs of children/youth with the above mentioned 
            exceptionalities.

_____5. Any categorical units allocated for students with severe mental handicaps and severe                     physical disabilities are utilized solely for the students designated.

_____6.It is fully understood that any teacher allocated is provided as a support to the
            non categorical special education teacher and is not seen as a separate and related
           allocation.

_____7. The student will be in school on a full time basis.

Signature of Principal____________________________     Date:_______________________

Comments:__________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Documentation of Educational/Other Supports

Verify that curriculum modification/direct instruction has not diminished the intensity of the emotional/behavior disorder.

         
          Provide:

• Sufficient information to clarify the nature and intensity of interventions/supports provided up to this point. For each of the Programming Pathways that have been implemented, specify the following:

• Program Area

• Nature of Supports/modifications/interventions

• Person(s) responsible for interventions

• Intensity of support provided, e.g. 2 hours per day in Special Education resource room

• Duration of Support, e.g. September-December, 1997; 6 weeks, Spring, 1998, etc.

• Include supports and interventions provided by all Student Support Services Personnel (e.g., itinerant teacher, guidance counselor, SLP, psychologist, student assistant, etc.)

• Include supports provided by other agencies (e.g. child management specialist, occupational therapist, private tutor, etc.)
  
  
  Provide:
  

• Current ISSP (IPP) as per item 9 of the criteria
  

The educational/behavior component of the ISSP as signed by the team includes:

• goals and objectives/outcomes for modified course(s)

• required alternate courses

• supports required by the child/youth to enable learning:
  

( I )     the needed structures and routines

( II )    transitional supports

( III )   environmental adaptations(s)

( IV )   counseling

• response protocols for all persons interacting with the student

• how and where (includes child's/youth's schedule) intensive interventions will be provided

• specific strategies which the student must learn to accommodate his/her Emotional Behavior Disorder

• Ensure that Alternate Course/Program descriptors are included (a sample form is provided for use if desired)

• Ensure that there is evidence of direct instruction to transfer skills learned in alternate courses to other environments

DISTRICT OFFICE CONFIRMATION OF PROCEDURES

The documentation, including a report of the comprehensive assessment and the ISSP, has been reviewed. Services that have been provided through existing resources have been deemed insufficient to meet this student's needs and therefore we concur with the request of the ISSP team for this categorical teacher allocation.

_______________________________________
Program Specialist for Student Support Services

_______________________________________
Director or Assistant Director (Programs)

_______________________________________
Date

Individual Alternate Program/Course Plan

General Information

Student's Name __________________School_______________________________________

Date of Birth_____________________Grade_______________________________________

Parent(s)/Guardians____________________________________________________________

Home Address _______________________________________________________________

Telephone Number___________________________________________

Classroom/Home room Teacher _________________________________

Note

Alternate program/course descriptions will be kept on file at the school as components of the student's Individual Support Services Plan.