LOW INCIDENCE SEVERE IMPACT STATEMENT EXAMPLES
ELA – Sam Severe
IMPACT STATEMENT: SS has significant cognitive deficits that cause him/her to have difficulty
functionally acquiring, retaining, and applying grade-level concepts within text and English Language
Arts content in the general curriculum without environmental/instructional support and adult
assistance with prompting. This adversely affects his/her success and performance in larger
instructional settings. He/She benefits from provisions and conditions such as scaffolding the content
of the material to focus on the essential elements of the concept, functional environmental/high
frequency vocabulary focus, picture/object word lists, adult assistance in direct specialized
instruction, visual cues and supports that include assistive technology devices, scaffolding/chunking
amounts of information to focus on basic key ideas/details, the practical use of technology and/or
devices, simplifying basic directions, positive practice/preview/review of previously learned material,
errorless learning strategies, etc.
TARGETED NxG EE OBJECTIVES (Kindergarten-Grade 5-Severe):
READING:
Literature
Informational Text
E.EE.RL.2.1 (Ask Who/Where
EE.RI.K.3
questions)
EE.RI.1.3
E.EE.RL.1.3 (Who & What)
EE.RI.2.3
E.EE.RL.2.3 (Who & What)
EE.RI.3.3 (Order 2 events)
E.EE.RL.3.1 (Who & What)
EE.RI.4.1
E.EE.RL.4.3 (Characters)
EE.RI.5.3
E.EE.RL.5.3 (Characters)
WRITING:
EE.W.K.8 (Identify personal info)
Foundational Skills
EE.RF.K.1 (Read Text)
EE.RF.K.2 (Understanding of
Spoken word)
SPEAKSPEAKING and LISTENING:
Discussions/Communication/Conversations:
EE.SL.K.1
EE.SL.1.1
EE.SL.2.1 (Participate in conversations)
EE.SL.3.3 (Use language to make requests)
EE.SL.4.1
EE.SL.5.1
LANGU LANGUAGE:
Letter & Word Use/Grammar & Usage:
EE.L.K.1
EE.L.1.1
EE.L.2.1
EE.L.3.1
EE.L.4.1
EE.L.5.1
TARGETED NxG EE OBJECTIVES (Grade 6-8-Severe):
READING:
Literature
Informational Text
E.EE.RL.6.3 (Identify how people
EE.RI.6.3 (Identify details)
respond)
EE.RI.7.10
E.EE.RL.7.10
EE.RI.8.10
E.EE.RL.8.10
Foundational Skills
WRITING:
EE.W.6.10 (Write routinely for purpose)
EE.W.7.10
EE.W.8.10 (Personal Information)
SPEAKSPEAKING and LISTENING:
EE.SL.6.5 (Select & give information)
EE.SL.7.1
EE.SL.8.6
LANGU LANGUAGE:
EE.L.6.3 (Use language to achieve outcome)
EE.L.7.3
EE.L.8.3
TARGETED NxG EE OBJECTIVES (Grade 9-12-Severe):
READING:
Literature
Informational Text
E.EE.RL.9-10.2 (Recount events) EE.RI.9-10.3 (Determine logical connections)
E.EE.RL.11-12.10
EE.RI.11-12.10
Foundational Skills
WRITING:
SPEAKSPEAKING and LISTENING:
EE.W.9-10.2 (Write to share information)
EE.SL.9-10.1 (Engage in discussions)
EE.W.11. -12.10
EE.SL.11. -12.1
LANGU LANGUAGE:
EE.L.9-10.3 (Use language for outcome)
EE.L.11. -12.3
MATHEMATICS – Sam Severe
IMPACT STATEMENT: SS has significant cognitive deficits that cause him/her to have difficulty
functionally acquiring, retaining, and applying grade-level mathematical concepts without adult
environmental supports and assistive technology. This adversely affects his/her performance in larger
instructional settings. He/She gains benefits from provisions and conditions such as: small groups, use
of manipulatives and object representation, practical practice of skills within environmental
simulations and use of the skill in daily living examples, content focus on essential learning concepts
and skills necessary for daily living and practical use of the skill, positive preview/review of previously
learned material, errorless learning strategies, functional use of technology, structured curriculum
focus, adult assistance and prompting, etc.
TARGETED NxG OBJECTIVES (Kindergarten-Grade 5-Severe):
Math:
Counting &
Cardinality (K)
K.CC.1 (Count to
10)
K.CC.4 (1-1
Correspondence)
K.CC.1 (Counting to
10)
Operations &
Algebraic Thinking
(1-5)
K.OA.1 (Preaddition/subtraction)
1.OA.1a (Preaddition/subtraction)
Numbers &
Operations in Base
Ten (K-2)
NBT.1.a. (Count by
1’s to 30)
1.NBT.1.b (Count to
10 and represent with
numeral)
Numbers &
OperationsFractions (3-5)
Measurement
& Data (K-5)
Geometry
(K-5)
EE.3.NF.1-3
K.MD.1-3
G.1-4 (Sort
(Differentiate
fraction from a
whole)
(Classify
objects to
attributes)
MD.1.a (Tell
time)
items)
EE.5.NF.1
(Identify
models of
halves)
TARGETED NxG OBJECTIVES (Grades 6-8-Severe):
Math:
Ratios &
Proportional
Relationships (6-7)
The Number System (6-8)
Expressions &
Equations (6-8)
Geometry (6-8)
Statistics &
Probability (6-8)
EE.6.RP.2
EE.7.RP.1-3
EE.7.NS.1 (Continuing
EE.6.1-2 (Identify
EE.6.G.1 (Solve
EE.6.SP.1-2
Addition & Subtraction)
equivalent number
sentences)
real world
problems)
(Display data)
(Understanding
Ratio)
TARGETED NxG OBJECTIVES (Grades 9-12-Severe):
Math:
The Real
Number
System
The
Complex
Number
System
N-RN.1
(Determin
e value
and
quantity)
Seeing
Structure
in
Expressions
Creating
Expressions
Interpretin
g
Functions
Congruence
Geometric
Measurement
& Dimension &
Modeling
Interpreting
Data
N-CN.2b A-SSE.3
A-CED.1
F-IF.4-6
S-ID.1-2
(Create real
world
equation)
(Graph with
change)
G.CO.1
G-CO.6-8
G-GMD.1-3
(Add/Sub
tract
decimals)
(Predictions of
value)
(Make/Inter
pret graph)
(Solve
simple
expressions
(Identify
similar parts
of shape)
G-MG.1-3
(Describe real
life objects)