IEP Teaching Assistant Request, Justification (PDF) - Capital Region ...

Capital Region BOCES
1:1 Teaching Assistant Request
Student: DOB: School: Grade:
Contact Person Regarding Request:
Date:
Team members involved in completion of this request:
Teacher’s Name Principal’s Name CSE Chairperson Name
Teacher’s Signature Principal’s Signature CSE Chairperson’s Signature
The intent of aide support for a student is to promote independence. The role of the aide is based on:
• The specific support needs of the student,
• Methods to be employed to promote independence,
• Natural supports available to the student, and
• Methods to be employed to increase social skills and social inclusion of the student.
Step 1: Identify the needs of the student using the following checklist.
1. Is there a safety concern for self or others? Please describe, including
frequency and duration of behaviors causing concern. Yes No
2. Does the student require assistance with basic functional skills?
• Toileting
Yes No
• Mobility
Yes No
• Eating
Yes No
• Dressing
Yes No
• Following basic safety rules
Yes No
3. Does the student require continual teacher prompts:
• During instruction
Yes No
• After instruction, during independent work
Yes No
5. Do peers include the student in classroom activities?
Yes
Is the student receptive to peer tutoring and support?
Yes
6. Is the student currently receiving specialized, small or individualized
group instruction in specific academic areas? Yes No
Please describe:
7. Please note what interventions or program changes you have tried and
describe their rate of success (e.g., cooperative learning, behavior
management plan, re-grouping within the classroom, pairing with other
students).
If no alternatives have been tried, explain why.
No
No
4. Is the student’s performance consistent with his or her ability/aptitude?
Yes No

Student Name: Grade: Class(es) with Aide Support:
Step 2: Identify specifically what the role and duties of the aide will be in each period or activity for which you are recommending aide
assistance.
Specify
Period/Activity
Indicate Number
of period and
name of class or
activity
Identify the Duties and
Responsibilities of the
Aide during this period.
What will the aide do to
assist the student?
Identify strategies to increase social
skills and social inclusion
What will the aide and teacher do to
increase social integration of the
student?
Identify strategies for
increasing student
independence
What will the aide and
teacher do to increase
independence of the
student?
Total time
needed for aide
assistance in this
period/activity
Total anticipated
time reduction in
aide assistance
for this
period/activity by
annual review