Special Education Department
Individualized Education Program (IEP)
DOB:
| Student Number:
| Student Name: | Birthdate: | Gender: | Grade: | ||||
| Student Address:
| Home Phone: | |||||||
| City, State, Zip:
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| Parent 1 Name:
| Parent 1 Relationship: | |||||||
| Parent 1 Address:
| Home Phone: | |||||||
| City, State, Zip:
| Work Phone: | |||||||
| Parent 1 Email:
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| Parent 2 Name:
| Parent 2 Relationship: | |||||||
| Parent 2 Address:
| Home Phone: | |||||||
| City, State, Zip:
| Work Phone: | |||||||
| Parent 2 Email:
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| Primary Language of Home:
| Primary Language Survey Date: Primary Language Survey Results: | Language of Instruction: | ||||||
| Home District: Attendance District: | Service Coordinator: | |||||||
| Home School: | Attending School: | |||||||
| Vision Screened On: | Results: | Hearing Screened On: | Results: | |||||
| Meeting Date: | Anticipated Duration of IEP: To | Re-evaluation Due: Current Evaluation: | ||||||
| Special Education Primary Category #1: | ||||||||
| Special Education Eligibility Category #2: | ||||||||
| Special Education Eligibility Category #3: | ||||||||
| For Students with SLD only, the following area(s) of eligibility was/were previously determined:
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| Level of Services: (A) | ||||||||
| Type: of Meeting:
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| Date Meeting Notice Sent to the Parent(s): | Date Procedural Safeguards given to the Parent(s): | |||||||
Special Education Department
Individualized Education Program (IEP)
The following persons participated in the conference and/or the development of the IEP. Additionally, parents have been given a copy of their rights regarding the student’s placement in special education and understand that they have the right to request a review of their child’s IEP at any time.
| Position/Relation to Student Participant Date (MM/DD/YY) |
*If during the IEP year the student turns 16, if the student is not present at the IEP meeting, the service coordinator must review the IEP with the student and obtain the student’s signature and the date of this review.
Special Education Department
Individualized Education Program (IEP)
PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
Section 1: Current IEP Information
Goal Number Written:
Summarize special education services the student is receiving:
Section 2: Evaluation Information
Areas of Eligibility
Special Education Primary Category:
Special Education Eligibility Category #2:
Special Education Eligibility Category #3:
For students with SLD only, the following area(s) of eligibility was previously determined:
Section 3: Present Level of Academic Achievement
READING
WRITING
MATH
Parent’s Input on Student’s Current Academic Achievement:
Current Classroom-Based Data:
State and District Assessments:
Section 4: Functional Performance
Social Emotional and Behavior:
Parent’s Input and Student’s Current Functional Achievement:
Summary of Work Habits:
Section 5: Summary of Educational Needs
Special Education Department
Individualized Education Program (IEP)
ADDITIONAL DOCUMENTATION/CONSIDERATION OF SPECIAL FACTORS
Considered Not Included
Needed
Individual Transition Plan
Statement of Transfer of Parental Rights at Age of Majority
For a student whose behavior impedes his/her learning, or that of
others, positive behavior interventions, strategies, and supports have
been considered.
Statement of Language Needs in the Case of a Child with Limited English
Proficiency
Statement of Provisions of Instruction in Braille & User of Braille for a
Visually Impaired Child
Statement of the Language of Needs, Opportunities for Direct Communication
with Peers in the Child’s Language and Communication Mode
Statement of Required Assistive Technology Devices and Services
Statement of Communication Needs for a Child with a Disability
Statement of Health Concerns
Special Education Department
Individualized Education Program (IEP)
Skill Area: Reading
Standard: Group settings
Annual Goal:
Improve her skills of reading-out loud in a group setting
Baseline Level of Mastery: Competency in group discussions
Service Provider(s) for this goal: Respective teachers and group leaders
Skill Area: Writing
Standard: Competency in writing
Annual Goal:
Raise her interest in writing in terms of answering questions in complete sentences and completing the amount (words or pages) for the written assignments.
Baseline Level of Mastery: Completeness, accuracy, adherence to word count (instructions), frequency of completion
Service Provider(s) for this goal: Subject teachers
Skill Area: Math’s Problem Solving
Standard: Geometry and required postulates
Annual Goal:
Improve her comprehension and solving of geometry related tasks
Baseline Level of Mastery: Accuracy, duration
Service Provider(s) for this goal: Math’s teacher
Skill Area:
Standard:
Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:
Special Education Department
Individualized Education Program (IEP)
ACCOMODATIONS
Date given to Genera Ed. Teacher: Service Coordinator:
Accommodations do not change now much of the curriculum the student is expected to learn. It only changes how students access and express knowledge on a daily basis. Accommodations are changes in how a student accesses information and demonstrates learning. Accommodations do not substantially change the instructional level, content, or performance criteria. The changes are made in order to provide a student with equal access to learning and equal opportunity to show what he or she knows and can do. Students with disabilities who qualify in one academic area are eligible for accommodations in other areas to the extent that their disability would affect performance in those areas.
| Accommodations | Type | Location |
| Receive extra time for completing written assignments/assessments. | 2 | B |
| Improve her writing in the areas of answering questions in complete sentences. | 2 | B |
| No accommodation or modification needed | 3 | E |
| No accommodation needed | 3 | H |
| Legend for Type and Location Fields |
| Type: 1 = Class work / assignments 2 = Assessments / tests 3 = Both class work / assignments / assessments. |
| Location: A = All Subjects B = Language Arts / English C = Reading D = Spelling E = Math F = Science G = Social Studies H = Health I = Electives J = Physical Ed. K = Lunch L = Transition / Vocation M = Library N = Title 1 Special / Exploratory |
Parental Communication
How will the parent be informed of their child’s academic progress and the extent to which that profess is sufficient to enable the child to achieve annual goals by the end of the year?
IEP Team Consideration for Extended School Year
Consideration for eligibility: IEP team considered ESY eligibility in the areas of regression and recoupment factors and essential skills at a critical stage of development.
Eligible for ESY:
Written explanation as to why ESY is or is not needed:
Special Education Department
Individualized Education Program (IEP)
ASSESSMENT
Rationale: Students with disabilities will participate in usual district assessments unless indicated by this form. Only those accommodations that are provided for instruction and are required by the IEP should be provided for assessment. All students will be assessed at grade level, other than the few who must be provided alternative assessments.
State Assessments
Standard Accommodation(s):
District Assessments
Standard Accommodation(s):
CURRENT STATE STANDARDIZED TEST (i.e., AIMS, PSSA) RESULTS
| Testing Area | Test Results | Grade | Semester | Year |
| Reading | ||||
| Writing | ||||
| Math | ||||
| Science |
Special Education Department
Individualized Education Program (IEP)
| SPECIAL EDUCATION SERVICES TO BE PROVIDED Special Education Program(s) Necessary to Meet Special Education Goals and Objectives during the school calendar year. | |||||
| **The child is in need of specially designed instruction in the following areas: | |||||
| Special Education Services | Instructional Setting / Location | Start Date | Frequency | Provider | Duration / End Date |
| Counseling | Hall | – | Often | Service Coordinator/ Principal | – |
| Math problem solving | Class | – | Often | Mathematics teacher | – |
| Written expression | Class | – | Often | English teacher | – |
| RELATED SERVICES Educationally Relevant Related Services Are Listed Below | |||||
| Special Education Services | Instructional Setting / Location | Start Date | Frequency | Provider | Duration / End Date |
| Study skills | Study skills class | – | Daily | Teacher | – |
| Clarification: | |||||
| SUPPLEMENTARY AIDS / ASSISTIVE TECHNOLOGY AND SERVICE FOR STUDENTS Educationally Relevant Supplementary Aides / Assistive Technology and Services Are Listed Below. | |||||
| Computer | Study skills class | – | Daily | Teacher | – |
| SUPPORTS FOR SCHOOL PERSONNEL Supports For School Personnel Are Listed Below | |||||
| Clarification: | |||||
LEAST RESTRICTIVE ENVIRONMENT
Provide an explanation of the extent, if any, to which the student will NOT participate with non-disabled students in the general curricular, extracurricular and nonacademic activities, and program options. §300.347(a)(4):
Lesley is asthmatic and this at times affects her physical activities, she is discouraged from frequent participation is physical activities as this may greatly affect her. If she has to participate, it should be limited or rather no often.
Consider any potential harmful effects of this placement for the child or on the quality of services that he or she needs §300.552 (a-b):
Reason for Different Services School: Service coordinator Service Coordinator Service Coordinator Service Coordinator Service coordinator
Rationale
The program, Individualized Education Program (IEP), can simply be defined as a written statement or records that are specifically for developing children who have special needs. The main reason for the IEP is to ensure that these special children’s outlined objectives are achieved and timely (Pretti-Frontczak, 2017). The IEP should be reviewed annually or even twice a year, and the parent is allowed to express and air their view concerning their contentment of their child’s progress. The IEP has two significant purposes; its first purpose is to measure the goal of a child on an annual basis. This means that a track of a child’s performance is easy since any information pertaining to the children is clearly defined and stated. This includes even their areas they portray to be healthy and those that may be facing challenges and need some help. To indicate the special education and related services and supplementary aids and services that the public agency will provide to or on behalf of the child (Lieber, 2015).
Based on the above, the IEP has accomplished the two general purposes that it was meant for; this is because, just as we have stated in the above paragraph, Lesley’s goals can be measurable on annual terms. For instance, there are some goals that Lesley is targeting to achieve by the end of the year. She intends to improve her reading skills, whereby she can read aloud when in a group setting. We learned that Lesley is an excellent student when it comes to reading. Her love for reading has made her adopt interpretation as a hobby by reading different texts during leisure. Although she needs to improve on one area in her reading, she can read aloud with others, making that to be one of her annual goals. Writing is another goal that Lesly intends to accomplish. She hates writing and only writes when it is so necessary. With this, there is a need for her to improve her writing skills and also improve her handwriting in general of ease in reading. Another goal is for lisle to improve her comprehension in solving math problems. Lesley has difficulty in solving and comprehending math problems and in particular geometry related tasks. The IEP will aid in recording her track and on performance and also determine whether the outlined goals will be achieved or not. The second purpose of stating the related services and supplementary aids and services is that Lesly has a special education, which is counseling. We see that in the past, she was unable to handle or somewhat control anxiety. She would take time to ‘cool down’ when angered by someone, and with this, she needed a counselor who would help her out. A supplementary aid that Lesley requires is anti-depressant drugs that are essential in suppressing her anxiety or depression (Vannest, 2015).
In the above IEP, several accommodations have been incorporated in favor of improving Lesly’s performance. We see that the English teacher, who, in this case, is the instructor, recommends that Lesley be accorded extra time to enable her to complete her assignments and assessments. This will be one of the ways that will significantly aid in improving her grades and performance in general. We also see that there are special services that are to be provided in the IEP, Lesly is allocated time to speak to her counselor or her principal when she is angered. When angered, she ‘blows,’ and all she needs is time to ‘cool down,’ and these two people greatly aid her in that. She is also given extra time with her study skills teacher who aids in her assignments and reading skills the teacher also helps her to learn using computer entirely, which she uses in preparing a schedule. Lesley is also scheduled to meet with her doctor frequently so that the doctor can monitor her health. The IEP also outlines that Lesley is restricted from intense physical exercise since she is asthmatic.
References
(n.d.).
Lieber, J. (2015). Supporting Young Children’s IEP Goals in Inclusive Settings Through Embedded Learning Opportunities. Topics on Early Childhood Special Education. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/027112140002000402
Pretti-Frontczak, K. (2017). Enhancing the Quality of Individualized Education Plan (IEP) Goals and Objectives. Journal of Early Intervention. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/105381510002300204
Vannest, K. J. (2015). Teaching exceptional children. Electronic Progress Monitoring of IEP Goals and Objectives. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/00400599110430050