Distance Learning Form

Distance Learning Goals: include IEP goals that will be addressed via distance learning. For each empty goal area, choose 'NONE'. For the empty goal, enter 0.

	Goal Area	Goal
Goal 1:
Goal 2:
Goal 3:
Goal 4:
Goal 5:
Goal 6:
Goal 7:
Goal 8:

Prior Written Notice for the provision of FAPE:

I have elected for my child to participate in the distance learning/virtual option and declined the traditional option. I understand and acknowledge that my child's IEP offers FAPE, and in light of the current circumstances, this Distance Learning Plan will act as an extension of the IEP and FAPE. I understand and acknowledge that the services and supports agreed upon in this Distance Learning Plan are in place to support at-home learning and were discussed with the IEP team.

Student Name:*

First NameLast Name

Date of DLP Meeting:*

MonthDayYear

Secondary Disability:

School: *

Grade Level:*

Case Manager:*

Primary Disability:*

Parent Name:*

First NameLast Name

Date of Last Annual Review:*

MonthDayYear

Date of Last Evaluation:*

MonthDayYear

Student Virtual Interaction: Servicees are conducted with interactive video connection in real time to create an in-person experience similiar to that achieved in a traditional in-person special education or therapy session.

Capture and Share: Images, videos, therapy sessions, and special education activities are captured and shared between the student and therapist or special education teacher.

Interactive Followup: Interactive audio or video sessions to follow up capture and share.

Phone Conference: Audio connection in real time.

Printed Materials: Materials that act as the primary way to deliver services.

Special Education Services and Supports: (Delivery Methods: Student Virtual Interaction, Capture & Share, Interactive Follow-Up, Phone Conference, Printed Materials - enter all that apply). If service is 'NO' and provider is 'NONE', enter 0 for frequency and delivery method.*

	Service	Provider	Frequency	Delivery Method
Instruction
Speech/Language
Occupational Therapy
Physical Therapy
Vision Therapy
Behavioral Counseling

Access and Opportunity:

Student has access to internetStudent has access to computerStudent has been assigned a system issued device

Progress Monitoring: How will progress on IEP Goals and/or objectives be assessed and measured? (Include programs and frequency targets.)*

Irwin County Schools