INDIVIDUALIZED EDUCATION PLAN .us
INDIVIDUALIZED EDUCATION PROGRAM
Page of
Any County Schools
School Anywhere Date 5/15/14
PART I: STUDENT INFORMATION
|Student’s Full Name Jane Doe |DOB 2/18/04 |
|Parent(s)/Guardian(s)/ Surrogate Parent John and Mary Doe |Age 10 |
|Address P.O. Box 12345 |Grade 6 |
|(Address continued) Anytown, WV 25123 |WVEIS# 110001234 |
|Telephone Home: 555-1234 Work: Cell: |
| | | | |
|Reevaluation Due Date: 11/25/2013 | |
| | |
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 Jane Doe |Date 5/15/14 |
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 __X_ 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 = | | | |
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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 Jane Doe |Date 5/15/14 |
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 Jane Doe |Date 5/15/14 |
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 |
|2008 | | | | | |
|2009 | | | | | |
|2010 | | | | | |
|2011 | | | | | |
|2012 | | | | | |
|2013 | | | | | |
(PL = performance level)
Formative 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 assessment and describe the results |
|and implications for specially designed instruction. |
|Assessment |Description |
|Acuity custom-made math 7th test and |Demonstrated above mastery skills in 7th Math CSOs (one grade-level above). |
|quiz questions | |
|Writing rubric – Reading/LA and social |Demonstrated distinguished level in 6th grade CSO in writing standard and social studies standard. |
|studies informational essay |Five performance levels from Novice to Distinguished. |
|Teacher made checklist – Portfolio of |Demonstrated mastery of 6th grade CSOs in English/Language Arts writing standard |
|writing | |
|Scoring guide – debate |Demonstrated mastery of 5-8 grades CSOs in Learning Skills in reasoning, critical thinking and |
| |decision making skills |
|Problem solving rubric |Demonstrated 3rd level skills in science problem solving. (5-level rubric) |
|Learning Skills Rubric |5-Level Rubric of Learning Skills – Scored at the Developing Level (2) |
INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jane Doe |Date 5/15/14 |
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
__________________ COUNTY
|Student’s Full Name: Jane Doe | Page ____ |
| |of ____ |
| |Date: May 15, 2014 |
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.
Mathematics:
Grade- Level General Education Curriculum Expectations:
Seventh grade students 1) develop understanding of and applying proportional relationships; 2) develop understanding of operations with rational numbers and working with expressions and linear equations; 3) solve problems involving scale drawings and informal geometric constructions and work with two-three dimensional shapes to solve problems involving area, surface area and volume; and 4) draw inferences about populations based on samples.
21 Century Learning Skills and Technology Tools:
Fifth through eighth grade students are flexible in approach to solving problems and completing tasks, consider alternative methods, solutions and perspectives, abandon strategies that do not work, and reallocate time and resources as priorities change.
Present Level:
Jane scored at the Distinguished Level in English/Language Arts, Math, Science and Social Studies on the 6th grade WESTEST 2. Using the Acuity assessment tool, she demonstrated proficiency in 7th grade Mathematics using above-grade level custom-made tests. However, general education teachers report that she does not always complete assignments. During a grading period, she turns in an average of eight out of ten assignments.
Given the Learning Skills/Behavior Rubric, Jane scored in the Developing range overall. Her weakest area was in “Persisting” – sustaining the problem solving process over time.
Given a learning styles inventory, Jane is a logical/mathematic learner who learns best by using logic and patterns to solve problems. She may benefit from the provision of logic problems and from activities that develop problem-solving skills.
Given an interest inventory, Jane shows an interest in math and computers and wishes to pursue a career that involves math.
Impact Statement:
Jane’s exceptional intellectual ability and classroom achievement indicates she may be under-challenged in the grade-level content instruction normally provided in the general education classroom. This impacts her educational progress in that she may need grade-level curriculum enriched to include more depth and complexity and acceleration to above-grade level content in mathematics.
Targeted NxG Objective:
21C.O.5-8.3.LS2 (Learning Skills) is flexible in approach to solving problems and completing tasks, considers alternative methods, solutions and perspectives, abandons strategies that do not work, and reallocates time and resources as priorities change.
INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jane Doe |Date 5/15/14 |
PART VIII A: ANNUAL GOALS, Part A (for students who are taught the WV CSOs)
GOALS (Continued)
* Denotes critical skill(s) to consider for extended school year.
| |Timeframe |Condition |Behavior |Evaluation Procedure|Mastery/Progress |
|Critical | | | |with Criteria |Codes (optional) |
|Skill | | | | |(per Grade Period) |
| |By the end of the |using Paul’s reasoning|Jane will apply the steps of a |at the highest level|Mastery (ESY) |
| |2014-2015 school |model and presented |problem-solving model to complete a|of proficiency on a | |
| |year |with real-life |project |4-level problem | |
| | |projects | |solving rubric in 4 | |
| | | | |of 5 work samples. | |
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| |By the end of the |given a variety of |Jane will plan, develop, organize, |demonstrating a |Mastery (ESY) |
| |2014-2015 school |resource materials, |and deliver a research project with|highest level of | |
| |year |(electronic and |documented sources, in-text |proficiency on a | |
| | |non-electronic,) and a|citations to avoid plagiarism, and |4-level research | |
| | |research model |computer-generated graphic aids. |rubric for 3 out of | |
| | | | |4 trials. | |
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| |By the end of the |given extension |Jane will communicate her research |at the distinguished|Mastery (ESY) |
| |2014-2015 school |activities within the |effectively using spoken, written, |level on a | |
| |year, |7th grade social |and visual language for a variety |teacher-made rating | |
| | |studies curriculum, |of audiences and for different |scale for 4 out of 5| |
| | | |purposes |trials. | |
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|Progress |
|How and when will the student’s progress toward the IEP goals be reported to the parent(s)? Specify. |
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|How? Progress Report mailed |
|When? End of 9 week period |
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|Record dates on which Progress Reports have been provided to parents. |
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• Mastery Code: 0 = Regression 1 = Maintained 2 = Recouped
• Student Progress Code: P = Progress Sufficient A = Achieved
IP = Insufficient Progress NA = Not Applicable
INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jane Doe |Date 5/15/14 |
PART IX: SERVICES
|A. Supplementary Aids, |Location of Services | |Initiation |Duration |
|Services/Program | |Extent/Frequency |Date |m/y |
|Modifications | |per |m/d/y | |
|Acceleration to above-grade- |During Math classes |Daily class work |9/01/14 |3/15 |
|level math curriculum | | | | |
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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 = | | | |
|Enrichment in all content areas. |D |SEE |45 min./week |9/01/14 |3/15 |
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|C. Related Services | | | | | |
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INDIVIDUALIZED EDUCATION PROGRAM
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|Student’s Full Name Jane Doe |Date 5/15/14 |
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 environment for the entire time in school in order to participate in a gifted education setting for appropriate peer interaction and specialized instruction in advanced concepts and content that she would not ordinarily receive in the general education environment.
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 | |
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| 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 |
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|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 Jane Doe |Date 5/15/14 |
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 Jane Doe |Date 5/15/14 |
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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