AEA 10 Service Level Matrix
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TimestampStudent Name:Birthdate:Person Completing Form:Curriculum ModificationsSpecially Designed Instruction related to all goal areas regardless of settingSupport for School Personnel and LRE EffortsSupplementary Aids & Services/Specialized Transportation CMSDISSPSASSCORELEVEL
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1/14/2012 23:30:48TEST1/13/2012BROEGStudent has academic or behavioral goals in 1 or 2 goal areas.Specially designed instruction regardless of setting that is designed by and/or delivered by special education personnel for 86% to 100% of the school day. Could include teaching, coteaching, and collaborative instructionSpecial education teachers engage in joint planning for 1 to 2 hours per month with general education teachers and/or para-educators to support involvement and progress in the general education curriculumTransportation: Transportation needs require attendant services, or the purchase of special equipment for safe transportation on a vehicle. 1322103
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8/31/2013 4:27:13b8/20/1973bStudent requires limited modifications to the general curriculum that allow for social skills instructionSpecially designed instruction regardless of setting that is designed by and/or delivered by special education personnel for 86% to 100% of the school day. Could include teaching, coteaching, and collaborative instructionSpecial education teachers conduct joint planning with more then 3 general education teachers and/or para-educators over the course of each month.Assistive Technology: Requires extensive individualization and/or training for the student
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