STUDENT NAME: _______________________________________________________________________ DATE OF MEETING: ____________________________________
EDUCATIONAL ACCOMMODATIONS AND SUPPORTS
Complete for initial IEPs and annual reviews. (Anyone responsible for implementing the educational accommodations must be
notied of her/his specic responsibilities).
CONSIDERATION OF SPECIAL FACTORS
Check the boxes to indicate if the student requires any supplementary aids and/or services due to the following factors. For any box checked
“yes,” specify the special factors in the “Supplementary Aids, Accommodations and Modications” section and/or the Linguistic
and Cultural Accommodations section listed below.
assistive technology devices and/or services. If yes, please specify needed AT. If no, specify why AT is not needed to access FAPE.
communication needs including students who are deaf/hard of hearing. If yes, complete linguistic and cultural accommodations
English learner status– language needs
blind/visually impaired – provision of Braille instruction
behavior impedes student’s learning or that of others. If yes, the team must consider strategies, including positive behavioral
interventions and supports to address behavior. This may include a Functional Behavioral Assessment and/or a
Behavioral Intervention Plan. If so, attach any completed forms.
LINGUISTIC AND CULTURAL ACCOMMODATIONS
The student requires accommodations for the IEP to meet her/his linguistic and cultural needs. This includes students who are
deaf/hard of hearing. If yes, specify any needed accommodations:
Special education and related services will be provided in a language or mode of communication other than or in addition to English.
This includes services provided to students who are deaf/hard of hearing. If yes, specify any needed accommodations:
For students who are deaf/hard of hearing and others, as applicable:
• Identify the language and communication need(s): ASL Auditory/Oral Cued Speech Speech Generated Device Tactile
Signed English Other (please describe) ________________________
• List the opportunities for direct communication/interaction with peers and professional personnel in the child’s language and communication mode:
• List the identied mode of communication accessible in academic instruction, school services, and extracurricular activities that the student will receive:
SUPPLEMENTARY AIDS, ACCOMMODATIONS, AND MODIFICATIONS
Specify what aids, accommodations, and modications are needed for the child to make progress toward annual goals, to progress in the general education
curriculum, participate in extracurricular and other non-academic activities, and to be educated and participate with other children with disabilities and/
or nondisabled children (e.g., accommodations for daily work, environmental accommodations, moving from class to class, etc.). Supplementary aids,
accommodations, and modications must be based upon peer-review research to the extent practicable.
SUPPORTS FOR SCHOOL PERSONNEL
Program trainings and/or supports for school personnel are needed for the student to advance appropriately
toward attaining the annual goals, participate in the general curriculum, and be educated and participate with
other students in educational activities. If yes, specify what trainings and/or supports are needed, including
when appropriate, the information that clarifies when the trainings and/or supports will be provided, by
whom, in what location, etc.
ISBE 34-54N (2/19) Illinois State Board of Education, Special Education Services, 100 North First Street, Springfield, Illinois 62777-0001