INDIVIDUALIZED EDUCATION PLAN
INDIVIDUALIZED EDUCATION PROGRAM
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Any County Schools
School Anywhere Date 3/15/11
PART I: STUDENT INFORMATION
|Student’s Full Name Jay Doe |DOB 2/18/01 |
|Parent(s)/Guardian(s)/ Surrogate Parent John and Mary Doe |Age 10 |
|Address P.O. Box 12345 |Grade 5 |
|(Address continued) Anytown, WV 25123 |WVEIS# 110001234 |
|Telephone Home: 555-1234 Work: Cell: |
| | | | |
|Reevaluation Due Date: 11/25/2011 | |
| | |
Initial Annual Review Reevaluation Review Amendment (Incorporated)
Parent Requested Teacher Requested
|Transfer: (from) |Date |
PART II: Documentation of Attendance
|Signature | |Position |
| | | |
|______________________________________________ | |Parent |
|_____________________________________________ | |Parent |
|______________________________________________ | |Student |
|_____________________________________________ | |General Education Teacher |
|_______________________________________________ | |Special Education Teacher |
|______________________________________________ | |Birth to Three Representative |
|______________________________________________ | |Chairperson |
|______________________________________________ | | |
|______________________________________________ | | |
|_____________________________________________ | | |
|_____________________________________________ | | |
|_____________________________________________ | | |
|_______________________________________________ | | |
The following people participated in the IEP team meeting via an alternate method:
|Name |Position |Alternate Method |
| | | |
| | | |
| | | |
INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jay Doe |Date 3/15/11 |
PART III: EXTENDED SCHOOL YEAR (ESY) DETERMINATION
Will ESY be considered while developing this IEP?
____ Yes _X__ N/A (Student is gifted)
The IEP Team in making its determination of a student’s need for ESY shall review documentation that the student exhibits, or may exhibit:
• Significant regression during an interruption in educational programming;
• A limited ability to recoup, or relearn skills once programming has resumed;
• Regression/recoupment problem(s) that interfere with the maintenance of identified critical skills as described in the current IEP; and
• Others factors that interfere with the maintenance of identified critical skills as described in the current IEP, such as predictive data; degree of progress; emerging skills and breakthrough opportunities; interfering behaviors; nature and/or severity of the disability; and special circumstances
The lack of clear evidence of such factors may not be used to deny a student ESY services, if the IEP Team determines the need for such services and includes ESY in the IEP.
Does the student need ESY services?
____ Yes ____ No Defer until: _____________________________
(ESY shall be determined annually)
PART III B: EXTENDED SCHOOL YEAR (ESY) DETERMINATION
| ESY Services |Direct/ |Location of Services |Extent/Frequency |Initiation Date |Duration m/y |
| |Indirect (D or|* General Education |per |m/d/y | |
| |I) |Environment = GEE | | | |
| | |* Special Education | | | |
| | |Environment = SEE | | | |
| | |* Other = | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
The parent(s)/guardian(s) / adult student accept(s) reject(s) extended school services
INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jay Doe |Date 3/15/11 |
PART IV: CONSIDERATION OF FACTORS FOR IEP DEVELOPMENT/ANNUAL REVIEWS
The IEP Team considers for all students:
• The strengths of the student
• The concerns of the parent
• Results of the initial or most recent evaluation of the student. Are additional evaluations needed? (specify) ______________________________________________________________________
• Academic, developmental and functional needs of the student
• Revisions needed to address lack of progress
|Additional Considerations (must be documented in Part IV Present Levels Narrative) |Yes |No |
|1. |Is the student identified as gifted? |X | |
| |If yes, consider whether acceleration will be provided and document its effect on graduation. | | |
|2. |Does the student need assistive technology devices or services? | |X |
| |If yes, document the type of device and provision for home use, if any, and/or the nature and amount of | | |
| |services. | | |
|3. |Does the student have communication needs? | |X |
| |If yes, address in the IEP. | | |
|4. |Does the student’s behavior impede his or her learning or that of others? | |X |
| |If yes, consider the use of positive behavior interventions and supports and other strategies to address the | | |
| |behavior. | | |
|5. |Does the student have blindness or low vision? | |X |
| |If yes, document provision of instruction in Braille and the use of braille, OR after an evaluation of the | | |
| |student’s reading and writing skills, needs and appropriate reading and writing media, including an evaluation| | |
| |of the student’s future needs for instruction in braille or the use of braille, document in the Present Levels| | |
| |a justification that instruction in braille or the use of braille is not appropriate for the student.. | | |
|6. |Is the student deaf or hard-of-hearing? | |X |
| |If yes, consider the language and communication needs of the student, opportunities for direct communication | | |
| |with peers and professional | | |
| |personnel in the student’s language and communication mode, the student’s | | |
| |academic level and full range of needs, including opportunities for | | |
| |direct instruction in the student’s language and communication mode. | | |
|7. |Does the student have limited English proficiency? | |X |
| |If yes, consider the language needs of the student. | | |
|8. |Will the student’s next IEP address transition services? | |X |
| |If yes, permission must be obtained to invite other agency representatives to the next meeting. (See | | |
| |Activities/Linkages section under Transition Planning) | | |
INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jay Doe |Date 3/15/11 |
PART V: ASSESSMENT DATA
Student Summative Assessment Data (WESTEST)
|TEST YEAR |Reading/Language Arts |Math |Science |Social Studies |Other |
| |SS |PL |LX |SS |PL |
| |PL |PL |PL |PL |PL |
|2007 | | | | | |
|2008 | | | | | |
|2009 | | | | | |
|2010 | | | | | |
|2011 | | | | | |
|2012 | | | | | |
(PL = performance level)
Benchmark, Formative and Additional Assessment Data
|Using current, annual data, list benchmark and formative assessments that have been used with the student and describe the results and |
|implications for specially designed instruction. Also the data may describe information relevant to student behavior, setting demands, work |
|habits/learning skills, technology skills, workplace skills, independent living skills, performance based assessments and describe the results|
|and implications for specially designed instruction. |
|Assessment |Description |
|Lexile Analyzer |Demonstrated reading level at the 880 L |
|Acuity Benchmark Assessment – |(5th grade) Overall 75% |
|Reading/Language Arts | |
|Acuity Benchmark Assessment - |(5th grade) Overall 70% |
|Mathematics | |
|Learning Skills Rubric |Scored at the Proficient Level of a 5-Level Rubric |
|Interest Inventory |Greatest interest in animals and history |
INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jay Doe |Date 3/15/11 |
PART VI: TRANSITION PLANNING (for students beginning no later than the first IEP to be in effect when the student is 16, or younger if appropriate) (Refer to Policy 2510 and IEP instructions)
Age of Majority (for students reaching age 17 within the next 12 months)
The student and parent have been informed of the transfer of educational rights that will occur on reaching age 18.
| Yes | No |Date |_____________ |Student Initials |_____ |Parent Initials |_____ |
Transition Planning Considerations:
How were the student’s preferences and interests considered? (Check all that apply):
Student interview/survey Interest inventory (specify)
Parent interview/survey Other (specify)
Functional vocational evaluation
Transition Assessments Reviewed (specify):
The student’s educational program will lead to a: standard diploma modified diploma
Post-Secondary Goals
Anticipated post-secondary education goals:
Anticipated post-secondary employment goals:
Anticipated post-secondary adult living goals:
Career Pathway/Cluster/Concentration the student selected on the Individualized Student Transition Plan (ISTP) is:
| | | |
|Pathway (8th grade) |Cluster (8th grade) |Concentration (10th grade) |
|Entry(for 9th graders 04-05 through 07-08 only) | Arts and Humanities | |
|Skilled |Business/Marketing | |
| |Engineering/Technical | |
| Professional | Health Sciences | |
| |Human Services | |
| |Science/Natural Resources | |
Transition Services: Indicate areas identified through IEP goals.
Instruction Employment and other adult living objectives
Related Services Daily living skills (if appropriate)
Community experiences Functional vocational evaluation (if appropriate)
| |Lead Party/Agency | |
|Activities/Linkages |Parent / |School |Agency |Description of Service |
| |Student | |(Specify) | |
|Instruction/education | | | | |
|Vocational aptitude/interest | | | | |
|assessment | | | | |
|Career awareness/work-based learning | | | | |
|Employment | | | | |
|Independent living/mobility | | | | |
|Agency referral/application | | | | |
Activities/Linkages: Identify activities needed for attaining post-secondary outcomes and the lead party/agency responsible for those services.
*Should the identified agency fail to deliver transition activities outlined in the IEP, the IEP team must reconvene to identify alternative strategies to meet the transition needs of the child.
INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jay Doe |Date 3/15/11 |
PART VII: PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
Narrative Descriptions of Present Levels of Academic Achievement and Functional Performance (refer to IEP Instructions) Add pages as needed.
General Information
Jay is a fifth grade student. He scored above average and distinguished in Reading/Language Arts, Math, Science, and Social Studies last year on the 4th grade 2010 WESTEST2. Using the Lexile Analyzer, Jay is found to read at the 880 Lexile which corresponds with high 5th grade or low 6th grade reading level. According to his fifth grade teacher, his work is above and beyond what is required at least 90% of the time in the classroom. According to Interest Inventories given on January 14, 2011, Jay indicated higher interests in animals and history. At school, he likes music, art and social studies, and he participates in band. He would like to learn French and Spanish if these languages were offered. In math class, he likes fractions and algebra. In social studies class, he likes the study of the 1900s time period, and he enjoys learning about United States geography. In science, he likes the study of genes. In his spare time at home, he enjoys watching television and playing or watching basketball. Jay also indicates that he likes to read realistic fiction. He dabbles in writing poetry, enjoys free drawing, crossword puzzles and word searches. Jay’s chosen career interest at this time is Law. The topic he has chosen for his independent study in project based learning is relevant to his stated career interest.
Jay’s exceptional performance on a test of general intellectual ability and above-grade level achievement indicates that he may be under-challenged by the content instruction normally provided in the general education classroom.
Functional Skills
The Learning Skills/Behavior Rubric was completed on January 17, 2011. The outcome was an overall score of 51. This is considered proficient with regard to Jay’s overall behavior typically addressed in gifted education. Of the 20 elements addressed on the rubric, Jay is proficient in persistence, managing impulsivity, responding with wonderment and awe, finding humor, thinking interdependently, learning continuously, and ethical behavior. He was found to be distinguished in listening to others and in the work ethic. The elements where Jay is developing are thinking flexibly, metacognition (thinking about thinking), striving for accuracy and precision, questioning and posing problems, applying past knowledge to new situations, thinking and communicating with clarity and precision, gathering data through all senses, creating, imagining and innovating, taking responsible risks, reasoning, and civic responsibility.
Specifically, Jay can think flexibly when new data is provided, but he needs guidance in using different strategies when original plan is not working. He is aware of learning processes and can use them with visual aids and teacher guidance. He is learning to develop a product that matches criteria. He requires prompting to generate appropriate questions. He can articulate his thoughts and ideas with some assistance via oral, written or multimedia communication. He can, with assistance, solve problems using all available sensory pathways and can generate more than one original idea with assistance.
Teacher observation, during the process of research learning and gathering for the project based learning experience in the past year, corroborates the areas on the Learning Skills/Behavior Rubric where Jay is developing in these skills. For example, Jay is learning, with assistance, how to reason at greater depths of knowledge. Although Jay is not familiar with the research process, he is learning that understanding and implementing the process are more important than the final product. He is learning to use technology to organize his ideas and thoughts, but he still needs more instruction in this area. Another area that Jay finds extremely challenging is developing ideas and questions at different depths of knowledge. Interpreting information as presented on charts and graphs and applying the information to what he already knows is also a challenge for him.
Although Jay is performing above grade level according to his classroom benchmark assessments throughout the year, he will benefit from learning skills that will provide enrichment and depth to the fifth grade curriculum. He is still developing in a number of elemental learning and thinking skills, and he needs to participate in activities that will enhance the overall achievement of these skills at least to the proficient level. Independent study via project based learning can provide some of these learning activities.
INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jay Doe |Date 3/15/11 |
PART VIII: ANNUAL GOALS, Part A (For students who are taught the WV CSOs)
* Denotes critical skill(s) to consider for extended school year.
|Progress: |
| |
|How and when will the student’s progress toward the IEP goals be reported to the parent(s)? Specify. |
| |
|How? ___Progress Reports_________ When? ____End of each grading period__ |
|Goal 1: Functional Skills |
| |
|By the end of the 2011-2012 school year, given instruction in project based learning and the research process, Jay will accomplish each stage of |
|the research process including making a topic web, a KWL Chart, developing essential questions, finding and using a variety of primary and |
|secondary sources, and developing a product that informs or helps with 100% mastery as observed and measured during each class session by a |
|portfolio assessment of work. |
|Goal 2: Functional Skills |
| |
|By the end of the 2011-2012 school year, given instruction and guidance in Bloom’s Taxonomy and types/level of questioning, Jay will develop a |
|chart of essential questions that probe deeper into the topic he has chosen for his independent study of his project based learning experience |
|with 100% mastery as observed and measured during each class session by a portfolio assessment of work. |
|Goal 3: Functional Skills |
| |
|By the end of the 2011-2012 school year, through discussion, visual aids, relevant examples and essential questions, Jay will read, interpret and|
|use a variety of tables, charts, maps, and graphs to identify patterns, note trends, and draw conclusions for his project topic with 100% mastery|
|on all research activities as observed and measured during each class session on a portfolio assessment of work. |
|Goal 4: Functional Skills |
| |
|By the end of the 2011-2012 school year, through direct instruction and modeling of relevant examples, Jay will learn and use technology skills |
|to articulate thoughts and ideas and gather data for his project with 100% mastery on all research activities as observed and measured during |
|each class session via portfolio assessment. |
INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jay Doe |Date 3/15/11 |
PART IX: SERVICES
|A. Supplementary Aids, |Location of Services | |Initiation |Duration |
|Services/Program | |Extent/Frequency |Date |m/y |
|Modifications | |per |m/d/y | |
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|B. Special Education Services |Direct / |Location of Services | |Initiation |Duration |
| |Indirect |* General Education | |Date |m/y |
| |(D or I) |Environment = GEE |Extent/Frequency |m/d/y | |
| | |* Special Education |per | | |
| | |Environment = SEE | | | |
| | |* Other = | | | |
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|C. Related Services | | | | | |
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INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jay Doe |Date 3/15/11 |
PART X: PLACEMENT
Explain the extent, if any, to which the student WILL NOT participate in the general education classroom and/or extracurricular and other non-academic activities. Present levels of academic achievement and functional performance must explain why full participation is not possible.
The student will not participate in the general education classroom 100% of the time in order to participate in the gifted education setting for appropriate peer interaction and instruction in advanced concepts and content which is not ordinarily provided in the general classroom.
Percentage of time in: 97% General Education Environment 3% Special Education Environment
|Ages 6 – 21 |WVEIS LRE Code |
| General Education: Full-Time (FT) 80% or more |0 |
| General Education: Part-Time (PT) 40% to 79% |1 |
| Special Education: Separate Class (SC) (general education less than 40%) |2 |
| Special Education: Special School (SS) Public or Private |3 |
| Special Education: Out-of-School Environment (OSE) |5 |
| Special Education: Residential Facility (RF) Public or Private |6 |
| Parentally placed in private school (Service Plan only) |8 |
| Correctional facility |9 |
|Ages 3 – 5 |WVEIS LRE Code |
|For students in early childhood programs - Minutes per week in: | |
| a. Early childhood program with typical peers (including private community programs) | |
| b. Special education or related services (individual or with students with disabilities only) | |
| a divided by (a + b) x 100 = percentage | |
| | |
| In the early childhood program at least 80% of time |J |
| In the early childhood program 40% to 79% of time |K |
| In the early childhood program less than 40% of time |L |
| | |
|For students not in regular early childhood programs: |WVEIS LRE Code |
| Separate special education class |M |
| Separate school |N |
| Residential facility |P |
| Home |R |
| Service provider location |S |
Least Restrictive Environment Considerations
The school the student would normally attend, if not exceptional, was considered.
Only schools and classroom settings that are appropriate to the student’s chronological age were considered.
Education in a general classroom with the use of supplementary aids and services was considered.
The potentially harmful effects on the exceptional student and the quality of the student’s services which might result from particular educational environments/placement were considered.
Integration with age-appropriate non-exceptional peers was considered.
INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jay Doe |Date 3/15/11 |
PART XI: Statewide Testing: (Please check all appropriate boxes)
1) Indicate the appropriate WV Measures of Academic Progress Assessment and 2) check standard conditions or standard conditions w/accommodations.
WESTEST 2 Grades 3-11 Alternate Assessment (APTA) Grades 3-8 & 11 (MA & RLA)
WESTEST 2 Online Writing Grades 3-11 Alternate Assessment (APTA) Grades 4, 6 & 11 (Science)
A) Standard Conditions A) Standard Conditions
B) Standard Conditions w/Accommodations B) Standard Conditions w/Accommodations
NOTE: For APTA eligibility, the student must exhibit significant cognitive disabilities, be instructed through Alternate Academic Achievement Standards and be pursuing a modified diploma (age 14+). APTA is large print formatted. APTA is large print formatted. Justification:
|WVEIS |Standard Conditions with Accommodations |Specify the test or |
|Code |Check all that apply |the part of the test |
| | | |
| |WVEIS Codes: P – Performance R – Response T – Timing | |
| P02 |Have test read aloud verbatim (except WESTEST R/LA) | |
| P03 |Use braille or other tactile form of print | |
| P06 |Have test presented through sign language (except WESTEST R/LA) | |
| P13 |Have test presented through text-talk converter (VI) | |
| P15 |Have directions only read aloud (acceptable for WESTEST R/LA) | |
| P16 |Have directions presented through sign language (acceptable for WESTEST R/LA) | |
| P17 |Use secure electronic braille note-taker (for directions & test stimulus materials) | |
| P18 |Have directions rephrased by trained examiner | |
| P19 |Use large print edition (when it is typical access) | |
| P20 |Use tactile graphics | |
| P21 |Use screen enlarging or screen reading software to access the computer | |
| P22 |Adjust screen resolution to enlarge text (VI; online only) | |
| P23 |Use a magnifying screen cover (when it is the typical access; online only) | |
| P24 |Use electronic translator or sign-dictionary to present test (except WESTEST R/LA) | |
| P25 |Use electronic translator or sign-dictionary to present directions only (acceptable for WESTEST R/LA) | |
| P26 |Have directions, passage and prompt read aloud (WESTEST 2 Online Writing) | |
| R02 |Indicate responses to a scribe (selected-response items) | |
| R03 |Use braille or other tactile form of print (when it is typical response mode) | |
| R04 |Indicate responses to a scribe, specify all elements to be scored (constructed-response items) | |
| R05 |Use an abacus (acceptable for the blind on all parts of WESTEST math) | |
| R11 |Use computer, typewriter or other assistive technology device to respond | |
| R13 |Provide physical support (if routine) by teacher/aide who is trained examiner | |
| R16 |Mark responses on large-print test booklet | |
| R17 |Use an electronic translator or sign-dictionary to respond | |
| T03 |Take more breaks (no studying) | |
| T04 |Use extra time for any timed test (WESTEST not timed) | |
| T07 |Flexible scheduling, extra time within the same day (no studying) | |
INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jay Doe |Date 3/15/11 |
PART IX: CONSENT
Complete only for initial placement.
I give my consent to my child’s initial special education placement:
|Parent Signature _________________________________________________ |Date __________________ |
| | |
|Parent Signature _________________________________________________ |Date __________________ |
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